Help for care (social assistance)

Persons who have health-related impairments of their independence or abilities and therefore need help from others may be entitled to assistance with care according to Book XII of the Social Code. The reason for the need for assistance may be physical, cognitive or mental impairments or health-related burdens or demands that cannot be compensated for and managed independently. The Medical Service of Health Insurance (MDK) determines whether and to what extent there is a need for care. The MDK is commissioned by the responsible long-term care insurance fund when an application is made for long-term care insurance benefits. The standard for the assessment is the degree of independence of the person. The focus is on the question of how independently the person can manage their everyday life. For this purpose, their abilities in various areas of life are assessed: Mobility, cognitive and communicative abilities, behaviour and psychological problems, self-care, dealing with illness-related demands and stresses, organising everyday life and social contacts.

The MDK uses a points system to determine how independent a person still is. The following applies: The more points the person receives, the higher the degree of care and the greater the need for care and support. The social welfare agency is also bound by the MDK's findings. If a person does not have long-term care insurance and therefore does not have a report from the MDK and no classification in a care degree by the long-term care insurance fund, the social welfare agency must determine the necessary care needs and calls in the health authority for this purpose with a request for an opinion on the scope of the necessary care services. If possible, the wish to be cared for at home should be given priority over inpatient care according to social welfare law (§ 13 SGB XII).

Persons in need of care are entitled to basic care and domestic help in the form of benefits in kind for care provided by outpatient services and social centres (home care assistance). Alternatively, it is possible to receive a care allowance if persons in need of care are able to provide basic care and domestic help themselves. A combination of money and benefits in kind is possible.

The benefit framework of long-term care insurance also includes offers when the caregiver is unable to attend (home care), day or night care (partial 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 care or partial inpatient care is not possible or cannot be considered due to the special nature of the individual case.

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

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

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

In the case of full inpatient care, the costs for accommodation and meals are not covered, as these must also be borne in the home environment.

If it is not possible for those in need of care to cover the uncovered remaining costs, benefits from social assistance (SGB XII) may be considered.

However, social assistance as state aid only comes into play if the income and assets of the person in need of care - and, if applicable, of the spouse or partner - are not sufficient. Dependants are only included if their total annual income exceeds 100,000 euros (§ 16 SGB IV, Common Rules for Social Insurance).