Caring For Relatives – What Next?
Information and Advice for Caring Relatives and Affected Persons
Illness and a need for care can have a significant impact on everyday life and future plans. Solutions often need to be found quickly.
Dealing with a need for care and support is a major challenge. There are a lot of things to think about and arrange. We would like to help you understand the terminology and the eligibility criteria and provide useful points of contact. We recommend that you read our information in sequence.
This information is also available in other languages.
Additional sections of the Pflegestärkungsgesetz II (PSG II) (Law on Strengthening Long-Term Care) came into force in January 2017.
There are now five care categories instead of three. Some of the care entitlements provided by care insurance have changed. Information on the subject of care provided by the Bundesministerium für Gesundheit (Federal Ministry of Health) can be found here.
1. How does a need for care arise?
A need for care arises:
- mostly as a result of an acute event such as a heart attack, a stroke or a fall
- slowly, for example as a result of a progressive form of dementia or other disease
- as a result of ageing, as body functions decrease (e.g. moving around, eating and drinking, temporal and geographical orientation)
- among children and young people (e.g. as a result of complications during birth, chronic diseases, accidents)
Before a need for care arises, the person concerned may often require support in the home (e.g. shopping, cooking, cleaning, and washing).
2. Clarifying important issues
Major steps and decisions should be discussed with everyone involved. The aim is to find out how much support is required and what might be the best solution for all parties. Most care-dependent people want to remain at home and be looked after by relatives. However, you should consider whether a division of care provision might be sensible. If the home environment is unsuitable or the person concerned might suffer from social isolation, a move to another form of care provision might also be a good idea (e.g. residential facility, assisted living community).
3. Hospital stay
In the hospital, it is important that you have a discussion with the doctor and social services and/or the so-called care transition team or the case manager responsible for the care unit in which the affected person is being treated. Ask who exactly is dealing with your questions and concerns.
4. When is a person in need of care entitled to benefits?
The degree of independence is the determining factor in establishing a need for care. The main concern is what the person affected is still able to do on his/her own and where he/she needs support – irrespective of whether the person is suffering from dementia of from physical limitations.
The following areas are considered:
- Cognitive and communicative abilities (e.g. geographical and temporal orientation, participation in conversation)
- Behaviour and psychological problems
- Self-sufficiency (e.g. showering, getting dressed and undressed)
- Dealing with illness and illness-related requirements
- Structuring of everyday life and social contacts (e.g. rest and sleep, maintaining social contacts)
The need for care must be expected to last for more than six months. If the need for care is expected to last less than six months (e.g. after an operation), the affected person may be entitled to home nursing (Häusliche Krankenpflege).
5. What are the care categories and what benefits do they receive?
The following care categories (Pflegegrade) apply from 2017:
- Care Category 1: Minor impairment of independence
- Care Category 2: Considerable impairment of independence
- Care Category 3: Severe impairment of independence
- Care Category 4: Severest impairment of independence
- Care Category 5: Severest impairment of independence and special combination of needs
The care insurance fund pays the following benefits:
Care Category Care Allowance Payment in Kind Relief Payment
1 125 Euro*)
2 316 Euro 689 Euro 125 Euro
3 545 Euro 1.298 Euro 125 Euro
4 728 Euro 1.612 Euro 125 Euro
5 901 Euro 1.995 Euro 125 Euro
* Care Category 1 receives only a monthly relief payment of up to 125 Euro.
This payment is solely for the relief of caring relatives and is intended to be used for the following (among others):
- Costs of day and night care or short-term care
- Services offering support in everyday life
The Bayerische Staatsministerium für Arbeit und Soziales, Familie und Integration (Bavarian Ministry for Labour and Social Welfare, Family and Integration) provides a lot of relevant information.
6. Who determines whether there is a need for care?
Firstly, an application for care services must be submitted to the (care) insurance fund with which the affected person is insured. This application does not need to be in writing; it can also be made by telephone.
For persons with statutory insurance, the Medizinische Dienst der Krankenversicherung (MDK) (Health Insurance Medical Service) arranges an appointment to visit and advises which documents and information might be helpful. This also applies to children.
For persons with private insurance, the assessment is carried out by MEDICPROOF or by an assessor authorised by the private care insurance fund.
It is a good idea to create a care diary and for another person to be present at the appointment (e.g. family member or carers).
The assessor can also advise on suitable nursing aids (Pflegehilfsmittel) and suggest modifications to improve accessibility.
7. Notification by the care insurance fund
The care insurance fund issues a notification about the result of the assessment. The insurance fund is obliged to communicate in writing within five weeks of the application as to whether and at what care category the person concerned has been assessed.
If you are dissatisfied with the result of the assessment, you may submit an appeal within 4 weeks of receiving the notification.
If you think that a care category is no longer sufficient, you should discuss this with your doctor or outpatient care service and request that the category be increased.
Dementia is an illness which progresses slowly. It is not easy to differentiate between the early signs of dementia and age-appropriate memory gaps or depression. The symptoms of dementia depend on the type of disease. Only a visit to the doctor can provide clarification as to whether and what type of dementia is concerned.
9. Advice and support services
You should first contact the responsible care insurance fund. Every care insurance fund has a statutory obligation to offer advice (Beratungsauftrag). People in need of care are entitled to personal advice and support from a care advisor. These advisors help you to choose and obtain welfare benefits and other support services, which are intended to support people who need care, support or advice. There are many such services in Munich.
10. Types of care provision
There is now a wide variety of types of care provision to support people in need of care. There are many different options depending on the desires and needs of the person concerned, as well as on the amount of care required.
11. General rules on remits, advice and funding in social welfare
The benefits provided by the care insurance fund and the means of the affected person (e.g. pension, salary and assets) are often insufficient to ensure the provision of care required. In social welfare, the remaining uncovered costs (e.g. if the cost of the assisted living community is higher than the money paid by the care insurance fund) can be applied for from the responsible welfare authority.
12. Home-based support services
Anyone experiencing difficulty in managing their household needs independently and/or who is in need of a minimum level of support may apply to the Social Welfare Centre of the City of Munich for the assumption of these costs.
Support is available for people who are not categorised within nursing level 2 or higher.
Essentially, this concerns the following forms of assistance:
- Assistance with the ongoing management of household needs (including help with cleaning the apartment, washing clothes, shopping, cooking)
- and/or minor assistance for personal needs (washing hair, help with getting in / out of the shower or bath)
- or assistance within a person’s social environment in view of their mild physical limitations (e.g. accompaniment to a doctor's surgery)
13. Aids and nursing aids
The prescription of aids (Hilfsmittel) (such as wheelchairs, care beds and toilet seat raisers) should be discussed with the doctor. Information about the provision of aids can be found at Rehadat and at the Spitzenverband der gesetzlichen Krankenversicherung (GKV).
Nursing aids (Pflegehilfsmittel) include devices and materials which are essential for home care, or which facilitate home care and which enable people in need of care to lead an independent lifestyle.
14. Supplementary long-term care services
These are voluntary service benefits provided by the City of Munich, which are not paid for by a long-term care or health insurance policy. The aim is to help improve the quality of care for those people in need of care in Munich. Supplementary long-term care services are provided in the form of out-patient care services or through other service providers, which then bill their services directly to the Social Welfare Department of the City of Munich.
15. What happens if the caring relative has an accident?
If carers have an accident and have to go to hospital, relatives can be left uncared for. An emergency card has been developed which you can carry on your person at all times. The card details the name of the person in need of care and provides an emergency checklist, which includes information about the person’s disease, the attending doctors and so on.
Please view the PDF file available on the website www.beim-pflegen-gesund-bleiben.de operated by the Unfallkasse Nordrhein-Westfalen.
16. Advance directives and legal support
The person in need of care may eventually be unable to manage his/her affairs in full or in part, because he/she suffers from a psychological illness or a physical, mental or emotional disability.
You can make arrangements in advance to ensure that relatives make decisions in accordance with the wishes of the affected person.
It is a good idea to discuss these issues early on and address specific details. A living will, known as an advance directive (Patientenverfügung) and a care directive (Betreuungsverfügung), can be very helpful in this instance.
17. What if I am dissatisfied with the provision of care?
There may be questions about the provision of care and dissatisfaction with care in all types of care provision. It is important to address problems with the people concerned at an early stage. If you cannot solve these problems yourself, you should seek help.
18. Combining work and care of relatives
Many companies and organisations provide support for their employees to combine their work and care responsibilities. Ask your employer about your options.
In companies which employ more than 15 people, you are entitled to unpaid leave from work for up to six months.
You may also obtain partial leave during care leave (Pflegezeit), i.e. work and care on a part-time basis, unless prevented by urgent operational requirements.
Family Care Leave (Familienpflegezeit)
Your employer may also have introduced family care leave. This is a voluntary benefit. Family care leave enables you to reduce your weekly working hours for a maximum period of 24 months by up to 15 hours to care for a close relative. This family care leave includes protection against dismissal.
Collective Agreement (Tarifvertrag)
It is worth taking a look at the applicable collective agreement. This may include benefits designed to combine work and family responsibilities which go beyond statutory requirements.
Care Support Allowance (Pflegeunterstützungsgeld)
Since January 2015 care insurance has included a care support allowance (Pflegeunterstützungsgeld). This provides compensation for ten days paid leave from work to care for a relative. The care support allowance is only granted on request. This request should be submitted immediately to the care insurance fund responsible for the person in need of care. The fund will provide further information.
19. Death and dying
Dealing with the subject of death and dying is unavoidable when it comes to persons in need of care. There are many institutions and facilities in Munich which can provide support for the affected person and their relatives, carers or friends. These include e.g. hospices and palliative facilities or volunteer organisations.
The Referat für Gesundheit und Umwelt (Department of Health and the Environment) has relevant information which you can view here.
This glossary provides explanations of some of the specialist terms which are used in our texts.