Benefits from the long-term care insurance fund: care benefits in kind and care allowance Home help, personal care and support in everyday life

Are you worried because your parents are finding it increasingly difficult to cope with everyday life on their own? Every time you visit, you notice something new that doesn't work at all - neglected personal hygiene, dirt in every corner, an empty fridge or mountains of dirty laundry? You are always busy trying to get the place in some kind of shape? You wonder if it's because your mother is getting worse at bending over, or your father seems increasingly forgetful? You suspect that they are somehow muddling through, although they are actually already physically very limited? Even if some people don't like to admit it: If you can no longer manage your everyday life on your own, it helps to be classified in a care degree. This entitles them to so-called "care benefits in kind". These allow for professional support in everyday life, for example by an outpatient care service or the local neighbourhood assistance and other approved social services.

Depending on the degree of care the long-term care insurance fund then assumes the costs for the care benefits in kind up to a fixed maximum amount. However, this only applies to care services or individuals approved by the insurance fund. This is because the money that your relative is entitled to for care services in kind when he or she is classified in a care degree is not paid out. The service provider settles the account directly with the long-term care insurance fund. This is the difference to the care allowance, which is paid directly if a relative provides care at home him/herself.

The budget that your relative has available through the classification into a care degree may only be spent on very specific assistance services. In addition to so-called "body-related care measures" and so-called "basic care", these also include help with household management and so-called "care-related support measures". The costs are covered by the long-term care insurance fund up to a fixed amount, which is determined by the degree of care. Of course, this means that not everyone with a few minor deficits can simply be fully cared for at home. Everyone who applies for a care degree is first assessed and evaluated according to fixed criteria.

People in need of care can get help with things like 

• showering, combing and brushing teeth
• Shopping, cooking and eating
• changing positions in bed, moving from bed to their favourite armchair or climbing stairs if there are several floors at home;
• Going to the toilet
• Movement outside the home in the sense of going for a walk, accompanying to the cemetery or to events and friends
• Tidying up and cleaning or doing laundry .

Help can also be sought in dealing with financial matters or visits to the authorities. In addition, there is the possibility of simply getting supervision if, for example, your relative is increasingly frightened or confused or would even do dangerous things if no one were in the house. It can also simply be a matter of keeping the person's mental faculties alert - playing games, for example, or simply providing other entertainment and a bit of variety.

If you or someone in the neighbourhood takes over the care of your relative, care allowance is paid by the care insurance. Care allowance is only paid to people in need of care who are cared for at home. It is not paid to persons in need of long-term care who are accommodated in inpatient facilities, such as a retirement home or a senior citizens' home, which have concluded a framework agreement with the long-term care insurance funds. Exceptions are certain other inpatient forms of accommodation where the care allowance pays for the accommodation - for example in a special shared apartment.

The long-term care insurance fund does not pay this money to the carer, but directly to the person in need of care. He alone has this money at his disposal. It can be passed on as a kind of recognition to the person who cares for him or her. This is because it is intended to ensure care at home. The prerequisite is that he or she has been classified at least in care degree 2. When you are classified in a care degree, you can consider whether you or a neighbour want to take care of the care - or whether a professional service provider should do it.

The following amounts are paid out monthly, graded according to the degree of care:

• Care degree 2: 316 euros
• Care degree 3: 545 euros
• Nursing degree 4: 728 Euro
• Care level 5: 901 euros

This care allowance is lower than the monthly budget for the so-called "care benefits in kind" to which a person in need of care is entitled with a corresponding care degree. This is because the care benefits in kind are provided by professional service providers and are settled directly with the insurance fund.

If your relative receives care in kind, he or she does not receive care allowance - unless he or she does not fully use the amount due to him or her for this professional help from outpatient care services or other authorised providers. In that case, he or she can still receive care allowance on a pro rata basis. This is called a combination benefit. This must be applied for at the long-term care insurance fund.

For example, if your relative is classified in care level 3, he or she is entitled to care benefits in kind amounting to 1,298 euros. However, if he or she uses a maximum of 60 percent of this amount (778.80 euros), then he or she can have an additional 40 percent of the care allowance (218 euros in this example) paid out. By means of a cost estimate from the care service, it can be quickly determined whether the care benefits in kind are really being fully utilised. If not, your relative can apply for combined care.

Regular counselling visits are obligatory for care allowance recipients. As a rule, these home visits are carried out by accredited care services. They get a picture of the care situation on site and give you supportive advice if necessary, so that you as a caring relative can manage the situation optimally. If your relative has been classified in care level 2 or 3, a counselling visit every six months is obligatory. For care degrees 4 and 5, someone will check up on you every three months.  The costs for this counselling visit are covered by the care insurance fund.

Details on special regulations for civil servants and privately insured persons can be found here: [1], [2]

Every person in need of care who is cared for at home and has been classified in a care degree is entitled to a relief amount of 125 euros per month. If you, as a family caregiver, find that the budget for care benefits in kind is not enough, the relief amount can help. It allows for additional support in everyday life, but with a focus on help with care and household management. You have to pay the money for the household help in advance and later submit the bills to the health insurance fund.

What can be financed with the relief amount? Your relative may use the relief amount to co-finance certain services. These include costs for

• Part-time inpatient care
• Temporary inpatient short-term care, for example, in a retirement home or senior citizens' home.
• approved care services: You have to keep in mind: Only if your relative has only been classified in care level 1, the relief amount may also be used for body-related care measures by a care service. Otherwise (for care degrees 2 to 5), the relief amount may only be used for assistance with care and household management.
• Recognised offers for support in everyday life: The offers that are recognised vary from federal state to federal state. Therefore, you should inform yourself in advance at your long-term care insurance fund. According to the definition of the Federal Ministry of Health, these are, for example, care groups for dementia patients, helpers to relieve care-giving relatives for hours at a time in the home, day care, agencies to arrange care and relief services for people in need of care and care-giving relatives as well as comparable close caregivers, family relief services as well as everyday companions and care companions.

The advantage of the declaration of assignment is that you do not have to collect and submit bills. The disadvantage is that the declaration of assignment only makes sense if you authorise only one provider to bill you. Because: As soon as several providers settle directly with the health insurance fund, it is not clear in the case of a budget overrun whose bill should now be paid by the health insurance fund: the one from the outpatient care service or the one from the neighbourhood help? The one from the self-employed dementia caregiver or the one from the everyday companion? In the worst case, you will end up with a private bill - and you didn't expect it because you thought you were off the hook because of the declaration of assignment for all service providers and didn't think about the costs any more.

Therefore: In order to benefit from the declaration of assignment for the relief amount, only give it to one service provider. The service provider will then have an overview of the budget and can use it according to your needs. Of course, it is necessary that you trust the service provider - which is generally an advantage in such a sensitive area as care. However, dubious providers could use the declaration of assignment to charge services to your budget that they do not provide. If you are unsure, you can always ask the long-term care insurance company about the budget status even if you have issued a declaration of assignment - but again, this information only covers the invoices already issued up to the time of your call.

Although nationwide every person in need of care has the same amount available for care benefits in kind, depending on the care level: The prices are different for different providers. For example, if you compare the price lists of two care services, a so-called "large toilet" costs 31 euros with one provider, but 35 euros with the other. This means that the bottom line is that you get less service for the capped budget from the expensive provider. Theoretically, you can put the price lists of two care services next to each other and choose the cheaper one. In practice, however, you may not have a choice because the capacities of local outpatient care services vary greatly and are often limited.

The price differences, by the way, are due to the fact that outpatient care services are organised in different associations, which have negotiated different remuneration with the long-term care insurance funds. In addition, personnel costs play a role, which also differ greatly from one federal state to the next. In this respect, a higher price is not an indication that a care service wants to enrich itself.