The term "home care" describes the circumstances and organizational conditions under which care and support for people in need of care is possible in your own home or in the home of close relatives.
In need of care are people who, due to illness (physical, psychological) or disability, are unable to carry out all normal everyday matters (personal hygiene, nutrition, movement and housekeeping) without outside help.
In most cases, home care is provided by relatives; support from care services is possible.

In order to assess the degree of need for care of a patient, the medical service of the health insurance fund divided those affected into care levels until 2016. Since 2017 they have been referred to as care levels. The duration of the necessary help in minutes is particularly important for the division. The long-term care insurance company assumes the costs of an expected need of care of more than 6 months.

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The care levels

Care level 1

Care level 1 applies to people who are “heavily in need of care” who need help with basic care, nutrition or mobility at least once a day. Household support is also required. The daily average is a minimum of 90 minutes of care, of which more than half must be omitted for basic care.

Additional information: The new care level 1 - you have to pay attention to this

Care level 2

If a patient needs help with personal hygiene, nutrition or movement at least three times a day, care level 2 is assigned, which includes people in need of care. The average minimum length of care in care level 2 is two hours for basic care. Three hours a day are set aside for the total care time (including household), since these patients also need help with housekeeping.

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More information can be found here: Care level 2

Care level 3

Care level 3 is granted if the patient is in need of the most severe care. Those affected are dependent on outside help at all times (even at night). Skills for personal hygiene, independent eating and drinking as well as independent locomotion are restricted. Patients with care level 3 also need help in the household. On average, a minimum care time of 5 hours is assumed in this care level, of which at least 4 hours are spent on basic care (personal hygiene, eating, storage in the care bed, etc.).

More information can be found here: Care level 3

Care level 0

Care level 0 (“in need of care”) summarizes people who are slightly restricted in everyday life. You are able to do many things on your own, but need, for example, help or guidance with personal hygiene (washing, brushing teeth, showering, etc.) or running the household (e.g. when shopping, cooking, cleaning).

Who will pay for home care?

Long-term care insurance is one of the 5 pillars of the German compulsory social insurance system. However, long-term care insurance is a partially comprehensive insurance that does not cover the entire financial risk in the event of a need for care, but supports care in the form of cash benefits or benefits in kind based on fixed rates. The amount that is not covered is to be paid by the person in need of care or their family as a contribution.

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Long-term care insurance pays if the expected duration of home care is more than 6 months. In addition, the long-term care insurance covers the purchase of care aids such as disposable gloves (up to € 40 per month) and subsidizes renovation measures in the apartment with € 4,000 per measure (e.g. having a walk-in shower installed, etc.) or the installation of an emergency number. In addition to statutory long-term care insurance, private supplementary long-term care insurance can be taken out.

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If the expected need for care is likely to be less than 6 months, e.g. after a fall with a fracture of the femur, etc., the general practitioner can prescribe “home nursing care” by a nursing service. These services fall under the statutory health insurance scheme.

Our next article could also be of interest to you: Levels of care in dementia

Does long-term care insurance apply to home care?

Yes. With the contribution to long-term care insurance, every insured person is entitled to receive benefits in cash or in kind from long-term care insurance. However, unlike statutory health insurance, long-term care insurance is a partially comprehensive insurance. So she only takes on part of the financial costs incurred in the case of need for care.

Private supplementary long-term care insurance can close this gap. Long-term care insurance pays different amounts of money depending on the patient's level of care, which fall into two categories: Care allowance is paid when care is provided entirely by relatives. If care is provided by an outpatient care service, no money is paid out, but care benefits in kind. A combination of care by relatives and care services is also possible; the care allowance is then paid on a pro-rata basis.

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Home care by relatives

Relatives do most of the care work in Germany. Since July 1st, 2008, caregiving relatives can take so-called care leave to look after family members in need of care. Possible are:

  • Max. 10 days off work if a relative needs unexpected care in order to organize further care
  • a reduction in hours or unpaid leave for 6 months if the employer has more than 15 employees
  • the use of family care leave (since 01.01.2015 there has been a legal entitlement if the employer has more than 25 employees). For a period of max. 2 years, the weekly working hours are reduced (but at least 15 hours), but the salary is only reduced by half of the reduced working hours. After returning to the company with the original number of hours, the salary remains reduced until the payment of the advance payment has been made.

If home care is completely taken over by relatives, the care fund pays monthly:

  • Care level 1: 0 € (but subsidies for housing adaptation, home emergency call, etc.)
  • Care level 2: 316 €
  • Care level 3: 545 €
  • Care level 4: 728 €
  • Care level 5: 4.901 €

The amounts are higher if an outpatient care service is (additionally) involved in home care, but are then paid out as benefits in kind. Caregiving relatives are also well covered: Those who care for relatives for more than 14 hours a week, or who are able to work less than 30 hours a week due to the care, are automatically insured for pensions and accidents. In addition, the long-term care fund pays support for short-term inpatient care, e.g. can be used in the event of vacation or illness of the caring relatives.

If the nursing leave is already 6 months or more, the nursing care fund also pays once into the so-called "preventive care" in order to pay for an inpatient nursing stay during the vacation of the caring relatives. Short-term care allowance due to illness and preventive care allowance can both be applied for in the same year.

This topic may also be of interest to you: Care levels and care levels

Where and how can I apply for home care?

When applying for home care, the long-term care insurance fund with which the person requiring care is insured is the right contact.

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The first step in getting financial support for home care is to apply for a care level. This is informal, e.g. possible through a phone call or letter. You will then be sent the necessary forms with which you can apply for a care level and care allowance. Depending on the information you provide in this application, the long-term care insurance company can consult the MDK (Medical Service of the Health Insurance Fund) to check the extent of the need for care.

After the application for care allowance has been approved, the person in need of care must choose a type of home care. It is possible to have the care carried out entirely by relatives or other close people. The care can also be carried out completely by an outpatient care service. Combinations of both are also possible. Depending on the decision of the person in need of care, the health fund pays care allowance or supports you in the form of benefits in kind (care service).

What requirements must be met in order to receive home care?

The basic requirement for home care in the form of cash benefits (care allowance) or benefits in kind (care service) from the care fund is that the expected length of care will be over 6 months. If care is only required on a short-term basis, you must apply for home nursing care through the health insurance company.

The second prerequisite for receiving care at home is the presence of restrictions in everyday life (personal hygiene, nutrition, mobility, household) that justify a level of care and thus support from the long-term care insurance fund.

Short-term home care after hospitalization

Short-term, temporary care after a stay in hospital must be prescribed by a doctor and is then covered by statutory health insurance. Nursing at home after a hospital stay can only be prescribed if the sick person cannot undertake the activities of treatment care (e.g. dressing change, anti-thrombosis prophylaxis), basic care and / or housekeeping himself, and no relatives living in the same household can undertake these activities can.

Home care after a stroke

There are no differences in terms of organizational issues in home care after a stroke. Neither the level of care, nor the application for home care and the support options from an outpatient care service do not differ. However, a stroke is a very drastic event for health, and many of the affected patients suffer from physical limitations and disabilities after a stroke. Caring for stroke patients can therefore be particularly challenging.

For detailed information, see: Cure after a stroke

What tools do you need for home care?

The scope of the aids required depends on the patient's degree of care. This includes:

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  • Aids for basic care: Nursing bed, nursing mattress, damp towels, incontinence linen, urine bottle, bed escape warning system
  • Aids for personal care: washcloths, towels, wash bowl, shower stool, bathtub entry aid, bathtub lift
  • Aids for mobility: forearm crutches, walkers, wheelchairs, electric vehicles
  • Care aids: disposable gloves, disinfectants, bed protection inserts, face masks

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