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.
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 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.