Contact the relevant long-term care insurer and request an application for long-term care insurance benefits. The long-term care insurer will also provide you with detailed advice. If your family member is in the hospital, you can also contact the hospital's social service team.
Only if you have the appropriate power of attorney. If this is not the case, and if the family member who needs care cannot sign for him- or herself, an urgent petition for legal custodianship (Betreuung) must be submitted to the Amtsgericht (Local Court).
The long-term care insurer will contact a body known as Medizinischer Dienst der Krankenversicherung (MDK) to request that this body perform an assessment of the person's care needs.
The following time limits apply:
No. It is always necessary to pay a contribution unless the care is provided by family members. If the income and assets are not sufficient to cover the additional costs, it is necessary to file an application with the Sozialamt (Social Welfare Office) at the same time that a long-term care agreement is signed. In case of doubt, you should always file an application, since social assistance benefits are never granted retroactively, but instead only take effect when the application is filed.
There is a special category of exempt assets called Schonvermögen. Examples include:
Items that are essential in order to begin/engage in professional or vocational training or work activities (such as a car)
People who are unable to perform their activities of daily living without help for a period that is estimated to last six months or longer due to a physical, mental, or psychological illness or disability are considered to need care. "Activities of daily living" encompasses the areas of body care, feeding, and mobility. In addition, there must be a need for assistance with domestic activities (cleaning, washing up, laundry, shopping, etc.) several times per week.
The benefits that a person who needs care receives depend on his or her classification by Medizinischer Dienst der Krankenversicherung (MDK). The amount of the benefit depends on the level of care granted: Long-term care insurance benefit rates
It is recommended that you, as the person providing care, be present during this assessment so that you can also provide information on the nature and scope of the assistance that is needed. Since people who require care are often uncomfortable telling others about how much help they need, it is often the case that they tell the assessor that they can do certain things on their own even though they actually need help to do those things. This can lead to a lower assessment of their care needs or even to their not being acknowledged as needing care. With this in mind, please talk with your family member before the assessment process and make it clear that the affordability of care depends on his or her classification.
If the application for acknowledgment of a care category is rejected, the applicant can file an appeal within one month after receiving the rejection notice. (The postmark date counts for this, so save the envelope the notice comes in!)
If a person demonstrably regularly requires outside help (according to the MDK assessment), but the level of need for help does not meet the criteria for care level (Pflegestufe) I, the Sozialamt will grant benefits if the person is unable to finance the assistance services using his or her own resources.
Following or instead of a hospital stay, patients can be treated at a geriatric rehabilitation facility. Further treatment at a geriatric rehabilitation facility is a good idea if intensive treatment is needed in order to continue rehabilitation activities (such as following an operation or broken leg).
Insured parties can receive healthcare services at home in order to prevent or shorten a hospital stay. Home healthcare (häusliche Krankenpflege) services encompass the necessary basic care and treatment as well as domestic help. A claim to home healthcare exists only if there is no person living in the same household who can care for the patient to the necessary extent. For this health insurance benefit to be approved, it must be prescribed by a doctor. Home healthcare is especially recommended in cases where a patient requires care temporarily, because long-term care insurance benefits do not apply in these cases. Home healthcare is subject to a limited term. It typically cannot be prescribed for longer than four weeks. Longer periods of care may be granted in specific cases. Medizinischer Dienst der Krankenversicherung (MDK) decides on this. Copay (Zuzahlung): The patient pays 10 percent for the first 28 days in a calendar year.