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Source: BUS Sachsen-Anhalt (Linie6PLus)

Apply for help with care

Description

Persons who have health-related impairments of independence or abilities and therefore require the help of others may be entitled to assistance for care in accordance with the Twelfth Book of the Social Code (SGB XII). The reason for the need for help can be physical, cognitive or psychological impairments or health-related stress or requirements that cannot be compensated for and managed independently. The determination of whether and to what extent there is a need for care is carried out by the Medical Service of the Health Insurance (MDK). The MDK is commissioned by the responsible nursing care fund when an application for long-term care insurance benefits is submitted. The benchmark for the assessment is the degree of independence of the human being. The focus is on the question of how independently people can cope with their everyday lives. For this purpose, his abilities in various areas of life are assessed: mobility, cognitive and communicative abilities, behaviors and psychological problems, self-care, dealing with illness-related requirements and stresses, shaping everyday life and social contacts.

How independent a person still is, the MDK determine according to a points system. The following applies: The more points the person receives, the higher the degree of care and the more care and support needs there is. The social assistance provider is also in principle bound by the findings of the MDK. If someone is not insured for long-term care and thus no expert opinion of the MDK and no classification in a degree of care by the nursing care fund is available, the social assistance provider has to determine the necessary nursing needs and calls in the health office with the request for an opinion on the scope of the necessary care services. If possible, the desire to be cared for at home should be given priority over inpatient care according to social assistance law (§ 13 SGB XII).

In the case of home care, people in need of care are entitled to basic care and domestic care as a benefit in kind for care assignments of the outpatient services and social stations (home care assistance) Alternatively, it is possible to receive a care allowance if people in need of care can use it to ensure basic care and domestic care themselves. A combination of money and benefits in kind is possible.

The scope of benefits of long-term care insurance also includes offers in the event of prevention of the caregiver (home care), day or night care (semi-inpatient care) and short-term care (temporary inpatient care).

Persons in need of care are entitled to care in fully inpatient care facilities if home or semi-inpatient care is not possible or is not considered due to the specific nature of the individual case.

In addition, nursing aids and technical aids, subsidies for measures to improve the individual living environment as well as nursing courses for relatives and voluntary caregivers can be granted.

Caring relatives or caring neighbours and friends may, where appropriate, receive social security benefits for the carer in the form of contributions to the competent pension insurance institution

Depending on the type of benefit, the benefits of long-term care insurance are only covered by long-term care insurance up to certain maximum limits.

In the case of fully inpatient care, the costs for accommodation and food are not covered, as these are also to be borne in the home environment.

If it is not possible for people in need of care to assume uncovered remaining costs, social assistance benefits (SGB XII) can be considered in this respect.

However, social assistance as state aid only occurs if the income and assets of those in need of care - and, if necessary, the spouse or life partner - are not sufficient. Dependent relatives are only used if their total annual income is more than 100,000 euros (§16 SGB IV, Common Regulations for Social Security).

  • Long-term care insured persons first contact the responsible care fund to clarify which benefits they are entitled to and in what amount. Only if these benefits are not sufficient or are not entitled to any benefits at all, help for care can be applied for from the responsible social welfare institution.
  • In the case of persons not insured in the statutory long-term care insurance, this causes the need for care and the necessary need for help to be established by the health authority.
  • If the conditions are fulfilled and the income and financial circumstances do not prevent the granting of assistance for care, an approval notice is issued.

- In principle, only those in need of care of care levels 2 to 5 receive the benefits of assistance for care. Due to the low severity of their impairments, people in need of care level 1 are (only) entitled to care aids and measures to improve the living environment. In addition, a relief amount of currently a maximum of 125 euros per month is granted.

- There is no entitlement to assistance for care below care level 1.

- However, assistance for care is only granted to the extent that one's own resources are not sufficient, the person in need of care cannot bear the expenses for care himself from his or her income and assets and does not receive it from others, in particular the long-term care insurance. This may be the case if the persons in need of care are not insured in the long-term care insurance or do not yet meet the pre-insurance periods or if the benefits of the long-term care insurance are not sufficient.

The required evidence corresponds to that which is necessary for the decision to grant assistance under SGB XII (including assistance for subsistence).

In addition, in the case of applicants with long-term care insurance, the medical report of the MDK as well as the decision of the nursing care fund on the classification in a nursing care degree and the benefits from the long-term care insurance must be submitted.

In the case of non-nursing insured persons, a medical report should be attached; the assessment shall be initiated by the authority responsible for granting care assistance.

There are no fees.

Deadlines may have to be observed. Please contact the competent authority.

A decision on the application will be taken as soon as possible. The processing time depends, among other things, on the completeness of the information and the submission of the evidence required for the processing of the application.

An objection may be lodged against the decisions of the competent social assistance institutions within one month of notification.

After completion of the opposition proceedings by means of a notice of opposition, an action may be brought before the Social Court within one month of notification.

The text was automatically translated based on the German content.

Lower Saxony Ministry of Social Affairs, Health and Gender Equality

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