Care level guide
Applying for a care level: the process and tips for the assessment visit
If everyday life no longer works well without help, it is worth applying for a care level (Pflegegrad). This guide explains how to apply to the long-term care fund (Pflegekasse), what happens at the assessment and how to prepare for the visit from the Medical Service (Medizinischer Dienst).
Why applying is worth it
Your care level determines which support the long-term care fund pays for. There are five care levels. The less independently a person manages everyday life, the higher the care level and the more benefits they receive.
Even care level 1 makes a difference. It gives you, for example, the relief allowance (Entlastungsbetrag) of 131 euros a month. You can spend this amount with a recognised everyday support service (Angebot zur Unterstützung im Alltag), for instance on household help for seniors with a care level. Even so, many older people and their families wait a long time before applying. The paperwork seems daunting, or they feel they can still manage on their own.
Keep in mind that benefits are paid from the month in which you applied. If you call early, you do not lose a month.
Applying for a care level: the process in five steps
Getting a care level is simpler than many people think. A phone call is enough for the first step.
Apply
Call your long-term care fund and say that you would like to apply for a care level. No formal application is needed. If you have statutory insurance, you reach the care fund through your health insurance fund (Krankenkasse).
Get an appointment
The care fund asks the Medical Service to carry out the assessment. For people with private insurance, Medicproof does this. You are given an appointment, usually for a visit at your home.
Assessment
An assessor talks to you and your family and looks at how independently you manage everyday life. This results in a score.
Decision
As a rule, the care fund must decide within 25 working days. It tells you your care level in a written decision (Bescheid), and benefits apply from the month you applied.
Objection, if needed
If the result does not reflect how much help you really need, you can lodge an objection (Widerspruch) within one month. Support it with concrete examples from your daily life.
What the Medical Service looks at in the assessment
The assessment is not about your diagnosis. The key question is how independently you manage everyday life and where you need help from others. To answer it, the Medical Service looks at six areas of life:
- Mobility: for example getting up, moving around the home, climbing stairs.
- Cognitive and communication skills: for example knowing the time and place, following a conversation, making decisions.
- Behaviour and psychological problems: for example restlessness at night, anxiety or resisting help.
- Self-care: for example washing, dressing, eating and drinking.
- Coping with illness-related demands: for example taking medication, keeping doctor's appointments, changing dressings.
- Organising everyday life and social contacts: for example planning the day, keeping busy, staying in touch with other people.
The ratings in the six areas add up to an overall score, which determines the care level:
- Care level 1: from 12.5 points
- Care level 2: from 27 points
- Care level 3: from 47.5 points
- Care level 4: from 70 points
- Care level 5: from 90 points
Below 12.5 points, no care level is granted. That is why it matters that the assessor gets a realistic picture of your daily life in every area.
Tips for the assessment visit
A visit from the Medical Service feels unfamiliar to most people. A little preparation makes it easier, and the result reflects your everyday life more accurately. These tips for the assessment have proven helpful:
Keep a care diary
In the weeks before the appointment, write down what you or your relative need help with, how often and for how long. Include what happens at night, and think of small things such as reminders to take medication or help buttoning a jacket. A care diary (Pflegetagebuch) makes sure nothing important is forgotten during the conversation.
Have a family member there
Ask someone you trust to be present at the appointment. Relatives often see everyday life from a different angle and can add what the person being assessed does not mention. Their presence also gives reassurance in a situation many people find stressful.
Do not play things down
Many people show their best side during the visit. That is understandable, but it can lead to a result that is too low. Describe an ordinary day and talk about the bad days too. Do not demonstrate anything you can usually only manage with great effort.
Have your documents ready
- doctors' reports and hospital discharge letters
- your current medication plan
- a list of your aids, such as a walking frame or hearing aid
- your care diary
- names and phone numbers of your doctors
What each care level makes possible
The benefits you receive depend on your care level. Here is a short overview of what matters most for everyday life at home:
From care level 1
- relief allowance of 131 euros a month for recognised everyday support services (a change is planned for 2027, see the note above)
- a grant of up to 4,180 euros per measure for an accessible bathroom conversion
- consumable care aids worth up to 42 euros a month
From care level 2
- care allowance (Pflegegeld) and care benefits in kind (Pflegesachleistung), separately or combined. At care level 2 this is 347 euros care allowance or up to 796 euros in benefits in kind per month.
- the conversion entitlement (Umwandlungsanspruch): up to 40 percent of the benefits in kind for everyday support services, as long as the amount is not used up by a nursing service
- the combined annual budget (Gemeinsamer Jahresbetrag) of up to 3,539 euros a year for respite care and short-term care
Our guide to household help paid for by your fund explains in detail how to use these benefits for help at home. What the conversion entitlement involves and how it affects the care allowance is covered in a separate article. And if you look after a relative at home, everything about short breaks is in our article on using respite care by the hour.
After the decision: how we support you in everyday life
Once your care level has been granted, the next question is who will help in everyday life. Alltagsdienst Sperling is a state-recognised everyday support service. We are not a nursing service. We help in the household and accompany people in daily life: with cleaning, laundry and shopping, but also with walks, conversation and company on the way to appointments. You can read more on our page about companionship and support for seniors.
We bill the relief allowance directly to your care fund, so no separate application is needed. For other benefits we help you with the application. And if you do not have a care level yet, we are happy to talk through how to go about applying.
Call us on 07121 159 10 58, Monday to Friday from 8:00 am to 2:00 pm. Our advice is free of charge.
Frequently asked questions
How do I apply for a care level?
Call your long-term care fund. If you have statutory insurance, you reach it through your health insurance fund. No formal application is needed, a phone call is enough, and benefits are paid from the month in which you applied.
How long does it take to get a decision?
As a rule, the care fund must decide on your application within 25 working days. The assessment also takes place during this time. Benefits apply from the month you applied.
Should a family member be present at the assessment?
Yes, that is strongly recommended. Relatives often know everyday life in detail and can add things that get forgotten in the conversation. Together with a care diary, this gives the assessor a realistic picture.
What can I do if the care level is too low?
You can lodge an objection with the care fund within one month of receiving the decision. Support it with concrete examples, for instance from your care diary. It is important not to miss the one month deadline.
Does the care fund pay for household help from care level 1?
Under current law, care level 1 gives you the relief allowance of 131 euros a month. It is intended for recognised everyday support services, such as our household help. According to the draft Long-Term Care Reorganisation Act, it is to be dropped for care level 1 from 2027, but this has not been decided yet.
Sources
- § 15 SGB XI (Social Code Book XI)
- § 18 SGB XI (Social Code Book XI)
- § 45b SGB XI (Social Code Book XI)
This article reflects the legal situation on the date given and is not legal advice. We review the amounts every year at the turn of the year.
