Healthcare Key information when having an accompanying person in hospital

For many people, hospital stays are times of uncertainty and stress. In some cases, it can therefore be helpful to be accompanied by a trusted person. This particularly applies in the case of young children, who feel safer with a parent nearby. This can in turn aid their recovery. However, it can also help people with dementia or disabilities to have a trusted person by their side. They can find the unfamiliar environment of a hospital particularly challenging, for example if they struggle to describe their symptoms or understand medical information.

An accompanying person can provide support by creating a sense of familiarity, helping patients deal with unfamiliar situations and simplifying communication with the treatment team. In most cases, patients are accompanied by someone who remains in the hospital with them during their stay, including overnight. This service is often referred to as “rooming-in”. Many hospitals enable this co-admission of parents, relatives or other trusted people – either in the patient’s room itself or immediately nearby.

If the rooming-in of an accompanying person is medically necessary, the costs incurred can be covered by the health insurance fund. The doctor providing treatment in the hospital decides whether a medical need exists. The precise conditions that need to be fulfilled for costs to be covered by insurance partly depend on who is to be accompanied. Under certain circumstances, even the costs of an accompanying person during inpatient rehab treatments are covered by the responsible rehabilitation funding agency.

Many pediatric hospitals allow rooming-in. This means that a parent can stay the night in the same room as the child or be accommodated nearby. As accompaniment is regarded as medically necessary for children under 9, an accompanying person can usually be roomed-in. Health insurance also covers the cost of an accompanying person for older children if medically necessary.

Accompanying people do not have to be parents. Other trusted people, such as grandparents or other close caregivers, can also take on this role. What matters is that the person represents an important form of support for the child and the accompaniment is medically necessary.

Care for siblings

In some cases, a sibling can be roomed-in as an additional accompanying person. This can be necessary, for example, if the accompanying mother still has a young child who is regularly breastfed.

If a parent accompanies a child to hospital, this often impacts everyday life at home. If the parent can no longer perform household tasks, health insurance funds may cover the cost of home help under certain circumstances. The first prerequisite for this is that a child who is under the age of 12 or dependent on help due to a disability lives in the household. Furthermore, there must be no-one else in the household who could perform the tasks. For example, if the other parent also lives in the household, the health insurance fund will check whether it is possible and reasonable for this parent to take over the household management. If this is not the case, there may be an entitlement to home help.

Health insurance funds approve and decline requests for home help on a case-by-case basis. Further information on home help can be found in the article Support options for parents who are ill.

Carefully preparing for a hospital stay can help to alleviate fears and make children feel safe. The information portal kindergesundheit-info provided by the Federal Institute for Public Health offers tips on how to gently prepare your child for a hospital stay (in German).

The unfamiliar environment, changed routines and contact with strangers can be unsettling even for grown-ups, especially people with certain disabilities or dementia, who sometimes find it difficult to express themselves or make their needs known. In such situations, it can be extremely useful to be accompanied by a trusted person who knows their personal habits, gives them a sense of security and can help them communicate with hospital personnel.

Prerequisites for accompaniment

Accompaniment is only permitted if necessary for medical reasons or due to a patient’s needs as a result of a disability.

Needs as a result of a disability usually exist if people with a disability:

• regularly rely on support from a trusted person during everyday life or
• only require support in certain situations, e.g. due to the particular stress associated with a stay in hospital.

A medical need can exist, for example, if:

• a person refuses to stay in hospital unaccompanied
• the treatment team’s instructions can only be understood and implemented with support
• the accompanying person needs to be involved in the treatment

Where possible, the patient’s doctor should specify in advance in the hospital referral letter that an accompanying person is medically necessary. The hospital should also be informed as soon as possible that an accompanying person is to be admitted with the patient.

Who can provide accompaniment?

Accompaniment can be provided by various people. This can include a personal assistant who supports the patient during everyday life, for example. However, relatives or other close companions can also take on this role. The accompanying person does not have to be related to the patient.

Exception: rooming-in of a caregiver within the scope of the personal budget

Anyone who funds a caregiver for home care through a personal budget (employer model) can apply to be accompanied by said caregiver during a hospital stay. Acceptance is subject to certain conditions. During the stay, the caregiver ensures that the usual level of support is still provided. The entitlement to the caregiver being paid for by the personal budget still exists during the hospital stay.

Patients should apply to their health insurance fund for the rooming-in service at an early stage. The health insurance fund will check whether rooming-in is necessary for medical or care reasons and thus decide whether to provide cost coverage. A medical certificate on the need for an accompanying person additionally supports any application.

Tips on preparing for a hospital stay in the case of disability can be found in the article Healthcare provision for people with a disability.

Further information and helpful tips on the topic of people with disabilities in hospital can be obtained from the Federal Association for Vital Help (Bundesvereinigung Lebenshilfe e.V.).

Detailed information about hospital stays in the case of people with dementia can be obtained from the German Alzheimer’s Society (Deutsche Alzheimer Gesellschaft e.V.) Selbsthilfe Demenz (self-help dementia) and the Dementia guidance portal (Wegweiser Demenz) provided by the Federal Ministry of Family Affairs, Senior Citizens, Women and Youth.

For statutory health insurance to cover the cost of an accompanying person during a hospital stay, the medical need must usually be confirmed. This need is automatically assumed in the case of children aged under nine. This means that parents of young children do not need a certificate for their health insurance fund.

For all other patients, the referring doctor can confirm the medical need prior to the hospital referral. Doctors providing treatment can also issue a certificate confirming the medical need. This can be formulated however they see fit and can be particularly helpful in the case of unplanned, emergency or repeat hospital stays. It is generally valid for two years.

Ultimately, the doctor providing treatment in the hospital decides whether the presence of an accompanying person is medically necessary. Upon discharge from the hospital, patients receive a written certificate indicating the medical need and the rooming-in duration. This certificate serves as the sole form of evidence for health insurance funds.

In the case of planned stays, you should notify the hospital as soon as possible that you would like an accompanying person to be roomed-in. It is also useful to contact the hospital at an early stage in the event of special requirements, so that suitable accommodation can be provided. Hospitals usually try to accommodate the accompanying person in the same room. However, accommodation can sometimes be provided nearby or outside the hospital, for example in a hospital guest house or a hotel.

The organizational rules of the hospital or rehab clinic, such as hygiene regulations or quiet times, also apply to accompanying people. In principle, the accompanying person can be changed during a stay, but the hospital must always be consulted about this.

In rare cases, the hospital can refuse to room-in an accompanying person, for example for organizational reasons. In such situations, patients can look at alternative options in collaboration with the hospital’s social service team and the health insurance fund, for example flexible visiting times during the day.

If there is a medical need for an accompanying person to be roomed-in, the patient’s statutory health insurance provider usually covers the costs of their accommodation and meals. The accompanying person does not incur a co-payment. Costs are usually settled directly between the hospital and the health insurance fund.

Many hospitals also allow accompanying people to be roomed-in without a medical need. In such cases, the cost usually has to be borne independently. The level of cost depends on the specific institution. Hospitals can be asked about costs in advance.

If privately insured patients are accompanied when in hospital, the cost coverage depends on their specific policy. Here, it is advisable to consult the insurance provider at an early stage.

Cost coverage when accompanying children

In the case of all children under 9, health insurance covers the costs of rooming-in a parent or another accompanying person. No medical certificate is required as the medical need is assumed at this age.

Health insurance also covers the cost of an accompanying person for older children if medically necessary. This can be the case in the event of certain emergencies or with children or adolescents with a disability who rely on support. In such cases, the doctor in the hospital must certify the medical need in writing.

Cost coverage for inpatient rehabilitation

In the case of rehabilitation, a cost bearer other than statutory health insurance can sometimes be responsible, for example statutory pension insurance. Statutory pension insurance usually covers the costs of an accompanying person for children under 12 or for older patients if their accompaniment is medically necessary. However, different cost bearers can have different rules. It is therefore advisable to consult them directly in advance.

Cost coverage for the accompaniment of people with a disability

Who covers the costs of accompaniment for people with a disability depends on who provides the accompaniment and why it is required:

• Accompaniment by relatives or close companions:
  If the prerequisites have been fulfilled, the patient’s statutory health insurance usually covers the costs of the accompanying person’s accommodation and meals.
• Accompaniment by personal assistants:
  If the accompaniment is provided by an integration assistance service, the responsible integration assistance cost bearer usually covers the costs.

Coverage of travel expenses

In some cases, health insurance will also cover an accompanying person’s travel expenses for the journey to the hospital. Again, the accompaniment must be certified as medically necessary by the doctor providing treatment.

Health insurance can cover the cost of public transport, taxis or mileage (based on a flat rate), for example. Costs are usually settled directly with the health insurance fund by submitting receipts and a medical certificate.

In some cases, the costs of travel to and from a rehab clinic are also covered.

Accompanying people who incur a loss of earnings due to staying with a patient in hospital may sometimes be entitled to child or general sickness benefit. The first port of call in such situations is usually their own health insurance fund.

Child sickness benefit when accompanying children

Parents who stay with their child in hospital as an accompanying person should notify their employer as soon as possible. Parents of children under 12 are entitled to leave from work during the accompaniment period.

In some circumstances, parents can also apply to their health insurance fund for child sickness benefit. An entitlement usually exists when accompanying children under the age of 12. However, it can also exist for older children or adolescents if they have a disability and the accompaniment is medically necessary.

One key difference from caring for a sick child at home is that, during a stay in hospital, the payment of child sickness benefit is not limited to a certain number of days. This means that it is generally paid for all days on which the accompanying parent stays with the child in hospital.

Child sickness benefit must be applied for from the accompanying parent’s health insurance fund. A certificate from the hospital is usually required to this end. This confirms how long the accompanying person remained in hospital and, if required, that the accompaniment was medically necessary.

Detailed information about child sickness benefit and leave from work can be found on the portal kindergesundheit-info.de provided by the Federal Institute for Public Health (BIÖG) – in German only.

Sickness benefit when accompanying other people

If an accompanying person suffers a loss of earnings due to the hospital stay, they can receive sickness benefit from their health insurance fund.

However, this only applies if the following prerequisites are met:

• The accompanying person and patient both have statutory health insurance.
• The accompanied person receives integration assistance benefits.

To receive sickness benefit in this case, the accompanying person must submit a claim to the statutory health insurance fund. The claim must be supported by official confirmation from the hospital that the joint admission was medically necessary.

The first ports of call for questions relating to accompaniment in hospital are usually the doctor providing treatment, the responsible cost bearer and the hospital’s patient admissions team.

Advice on this topic is available from several sources, including the Independent Patient Advice Service for Germany (Stiftung Unabhängige Patientenberatung Deutschland – UPD).

In the event of questions, people with disabilities and their relatives can contact the complementary independent participation counseling service (Ergänzende unabhängige Teilhabeberatung – EUTB).