Apply for inpatient home care for persons with long-term care insurance
Description
As a person with long-term care insurance, you are entitled to care in a nursing home or other fully inpatient facility if home or semi-inpatient care is not possible or is out of the question due to the specificity of your case.
In addition to the actual care services, the scope of services also includes social care and medical treatment care.
The maximum monthly amount that care funds pay for inpatient care services depends on your degree of care (as of 2021):
- for care level 2 maximum EUR 770,00
- for care level 3 maximum EUR 1,262
- at care level 4 maximum EUR 1,775
- for care level 5 maximum EUR 2,005
In most cases, the costs of inpatient care are higher than the amount covered by your nursing care fund. You then pay a co-payment. Within an institution, this is the same for all residents, regardless of the degree of care. For example, if you have care level 5, you pay the same amount as someone with care level 2.
From January 2022, your own contribution to care-related expenses will be reduced. The nursing care fund then pays a supplement to your own contribution. The supplement depends on the duration of the inpatient care.
This surcharge on your own contribution is
- 5 percent for a benefit of full inpatient care of up to and including 12 months,
- 25 percent for a benefit of full inpatient care of more than 12 months,
- 45 percent for a benefit of full inpatient care of more than 24 months,
- 70 percent for a benefit of full inpatient care of more than 36 months.
The cost of care in a nursing home can vary greatly between institutions. In addition, you carry yourself:
- Costs for accommodation and meals
- may be costs for predictable investments. These are costs that the nursing home has, for example for building rent or purchases. These costs can be passed on to the residents of the facility
- under certain circumstances costs for additional services. These are also referred to as "comfort services". This means, for example, a single room, special meals or special care services.
If you cannot afford the additional costs yourself, your relatives will have to pay for it. However, children only have to contribute to the costs of the care facility from an annual gross income of more than EUR 100,000. If your relatives are also unable to cover the costs, you will receive state support from the social welfare office.
If you live in a nursing home during the week and are cared for at home by relatives at the weekend, you can also apply for home care benefits, such as care allowance or care aids.
If you need help choosing a suitable care facility, contact your nursing care fund or your nearest care center.
- You have care level 2, 3, 4 or 5
- If you have care level 1, you can apply for the relief amount
- You cannot be cared for at home or on a semi-inpatient basis
- If you already have a nursing degree: if applicable, notification of the nursing care fund on the determination of the degree of care (report of the Medical Service of the Long-Term Care Insurance)
- if applicable: power of attorney, supervisor card
- where applicable: medical documents
- if applicable: severely disabled person's pass
Depending on the individual case, further documents may be required. Please contact your health insurance company for more information.
You do not have to pay anything for the application.
You will only receive the benefit from your long-term care fund from the month in which you submitted the application, but at the earliest from the date on which the eligibility requirements are met. If the application is not submitted in the calendar month in which the dependency occurred, but later, the benefits shall be granted from the beginning of the month in which the application was submitted. Therefore, you should submit the application in good time.
If the nursing care fund does not issue the written notification within 25 working days after receipt of the application or if one of the assessment deadlines specified in the law is not complied with, the nursing care fund must pay you EUR 70.00 immediately after expiry of the deadline for each week of exceeding the deadline. This does not apply if the nursing care fund is not responsible for the delay or if you are already in full inpatient care and at least care level 2 has already been determined.
Processing usually takes about 2 to 6 working days.
For a quick processing and decision, your nursing care fund must have the necessary information and, if necessary, necessary documents complete and meaningful.
The nursing care fund decides on applications promptly.
Please note that the stated processing time is an average value of all care insurance funds. It may vary in individual cases.
The exact processing time also depends on the complexity of the individual case and can be extended accordingly. The same applies if documents or documents are sent by post to you or your nursing care fund.
If the need for long-term care or the entitlement to care benefits has not yet been determined in your case or an application for an upgrade with regard to the degree of care is made, the Medical Service must be involved.
The processing of your request is usually extended by about 3 to 4 weeks.
- Contradiction
- Action before the Social Court
- Forms: yes
- Online procedure possible: Many statutory care insurance funds offer an online procedure.
- Written form required: no
- Personal appearance required: no
You can, for example, submit the application for inpatient home care by post and – in the case of many care insurance funds – hand it in personally at the office or submit it online.
- You submit the application for inpatient care to your nursing care fund. If you are unable to do so yourself, you can authorize someone in writing.
- If you have not yet been diagnosed with a degree of care of at least 2, the nursing insurance fund commissions the medical service or other independent expert services to check whether there is a need for care to at least this extent.
- The nursing care fund evaluates the report, examines your application and informs you of the result.
- Your nursing care fund can give you a list of approved nursing homes where you can compare services and prices.
- Your nursing care fund bills the benefit directly to the care facility you have chosen.
In some federal states, you can apply for nursing home allowance in addition to the benefits of your nursing care fund.
You can change the nursing home at any time.
Federal Ministry of Health
22.11.2021
The text was automatically translated based on the German content.
