Care at home – the options

People in need of care who want to continue living at home can choose which supports to avail of. One option is to claim non-cash benefits for care at home. These include home care services and assistance from home care support services. The statutory care insurance funds cover these costs up to certain maximum limits.  

As a second option, people in need of care can also claim financial benefits such as the care allowance. The care recipients must then use this care allowance to ensure they have suitable care and assistance at home. 

Those in need of care and their loved ones providing care to them can mix and match the various benefits available for care at home to best suit their individual situation. Before a contract is concluded, the care service or professional caregivers selected must provide information about the likely costs in the form of a cost estimate. They also need to provide prompt information whenever there is a major change to these costs. In this way, care recipients should be able to understand the costs of their care arrangements.  

Part-time residential day or night care services and temporary fully residential short-term care services (respite care) are also options. Residents living in care communities can also access other benefits.

Recipients of care at home are entitled to non-cash benefits for care at home. This means that people in need of care are entitled to assistance from an approved non-residential care or support service or independent professional caregivers. These are professional caregivers such as geriatric nurses, who work independently of home care services. The care and support services and individual professional caregivers must have concluded a contract with the relevant long-term care insurance fund. The fund covers the costs of non-cash benefits for care at home up to a legally defined maximum amount. Which specific costs it covers depends on the care grade assigned to the care recipient. Care grade 2 is the minimum requirement. 

Home care services 

Home care services support people in need of care and their loved ones by providing care at home. In this way, they aim to help care recipients to continue living in their familiar environment. These services also support loved ones who are acting as caregivers, for example, by allowing them to more effectively combine their working life and their caregiving role.  

The home care services available include the following: 

• help with personal hygiene, nutrition, and exercise 
• help with orientation, help with everyday life and with maintaining social contacts 
• health care services at home as a health insurance benefit – for example, giving medication, changing dressings and injections 
• advising care recipients and their loved ones 
• help with communicating with services such as food delivery services, driving services, and transport to hospital 
• help with household chores, such as cooking and cleaning 

Home care support services 

Home care support services, like home care services, are a type of non-cash care benefit. They offer a wide range of support – both with care at home and with managing the household.  

In particular, home care support services provide help and support in the following areas: 

• orientation 
• everyday life 
• housekeeping  
• maintaining social contacts 
• helping with the care recipient’s social skills 

Home consultations are not part of the support service role. In the areas covered by both care and support services, the same rules apply to both in terms of long-term care insurance benefits. These concern care-related assistance measures, i.e. help with orientation, everyday life and maintaining social contacts, as well as help with managing the household. 

People in need of care may also decide not to avail of care and support services if loved ones, friends or volunteers are providing these for them. Long-term care insurance pays the care allowance for this purpose. 

Someone is entitled to the care allowance if, for example, they are being cared for at home by loved ones or other volunteers and they are at care grade 2 or higher. The care fund transfers the care allowance directly to the care recipient, who can then use it as they wish. Recipients often give the care allowance to the people looking after them to acknowledge the care they provide to them. The care allowance can be combined with non-cash benefits for care at home. As in the case of non-cash care benefits, the care allowance amount depends on the recipient’s care grade, i.e. the level of care they require.

The care allowance and non-cash benefits for care at home can be combined and claimed simultaneously. This helps care recipients to have their care tailored to their needs as far as possible. In these cases, the care allowance decreases in proportion to the value of the non-cash care benefits that are claimed. The long-term care insurance provider calculates the care allowance amount every month after examining the bill for non-cash benefits. 

When receiving care at home, care recipients are entitled to an additional relief allowance of up to 125 euros per month. This applies to care recipients at every care grade, including care grade 1.  

The additional relief allowance is for the specific purpose of relieving the burden on loved ones and other people helping to provide care or of increasing the care recipient’s independence and autonomy in everyday life.

If the additional relief allowance is not (fully) used in one calendar month, the amount remaining can be carried over to the following calendar months. The carry-over is possible up to the end of June the following year in each case. 

Care recipients can use the additional relief allowance for the following services: 

• day or night care 
• short-term (respite) care 
• approved care services (but not for self-care services at care grades 2 to 5) 
• everyday support options that are approved under federal state law (for example, support groups for people with dementia or services related to managing and maintaining the household)   

Anyone availing of the additional relief allowance for home care services can access nursing care support (orientation help, assistance with everyday tasks or maintaining social contacts), and help with managing the household. Only care recipients assigned to care grade 1 can also use it for help with personal hygiene, nutrition and exercise. 

To apply for the additional relief allowance, relevant documents need to be submitted to the long-term care insurance fund or private long-term care insurance company. 

Conversion entitlement 

Anyone who has not (fully) used up their entitlement to non-cash benefits for care at home can convert the unused amount and use it for everyday support options instead. Exactly what those options are depends on the federal state concerned. In all, a maximum of 40 percent of the total amount for non-cash benefits for care at home can be converted. 

If the private caregiver takes a vacation, is ill, or for some other reason is temporarily unable to look after the person in need of care, the rules governing respite care apply. The entitlement to respite care only applies after the caregiver has been caring for the care recipient in their home environment for at least six months. If the caregiver is only unavailable during certain hours, for example, due to having regular appointments, respite care can also be utilized by the hour.  

For respite care at care grades 2 to 5, long-term care insurance covers the costs of a replacement caregiver for up to six weeks, up to a limit of 1,612 euros per calendar year. Moreover, half of the sum for short-term care (i.e. up to 806 euros per calendar year) can be used for respite care.  

This is on condition that those delivering the respite care:

• are not related (up to the second degree) or related by marriage to the care recipient.
• do not live with the person in a shared household. 

Separate rules apply to loved ones who provide respite care. The long-term care insurance funds can provide advice on this. 

During a period of respite care, care recipients receive half of the previous (proportionate) care allowance for up to six weeks in the calendar year. In the case of respite care of less than eight hours per day, the long-term care insurance funds award the full care allowance.

Care recipients at care grades 1 to 5 can apply to their long-term care insurance fund for a subsidy of up to 4,000 euros for any necessary modifications to their home. The purpose of the modifications must be to enable care at home, make care at home easier, or restore independent living as far as possible. They should also help prevent professional caregivers or loved ones providing care from becoming overburdened by their caregiving role. 

Care recipients living in care communities are also entitled to this subsidy. Up to four members of a care community who are receiving care can receive 4,000 euros each, i.e. up to 16,000 euros in all. If there are more than four people with the entitlement, the overall sum is spread proportionately among the residents.  

Home adaptation subsidies are available, for example, for measures that are connected to substantial changes to the fabric of the building. These include, for example, widening doorways, making bathrooms compatible with caregiving, and installing ramps and stairlifts. The installation and adaptation of furnishings needed for caregiving purposes is also supported financially.  

Care recipients can also apply for the home adaptation subsidy a second time if the care situation changes in such a way that additional installations or adaptations are required.

Care recipients at care grades 1 to 5 who are being cared for at home are also entitled to care aids. These are devices and equipment that make care at home easier, alleviate the care recipients’ symptoms, or enable them to live a more independent life.  

The long-term care insurance scheme is responsible for covering the cost of these in cases where other providers, such as the health insurance scheme, are not required to do so. The latter may be responsible, for example, in case an illness or disability makes particular aids necessary. In this situation, the care fund is not the correct point of contact.  

The long-term care insurance scheme differentiates between technical care aids and consumable care aids. Technical care aids include e.g. care beds, positioning aids, and alarm systems. Care recipients over the age of 18 have to contribute 10 percent towards the cost of these, but with a maximum of 25 euros per aid. Larger technical care aids can often be hired. No personal contribution is required in this case. 

Consumable care aids include, for example, disposable gloves and bed pads. The long-term care insurance fund refunds up to 40 euros per month for these. 

For a guide to which care aids the long-term care insurance fund may pay for, refer to the list of aids specified by the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband).

There is more information on care at home on the website of the Federal Ministry of Health (Bundesgesundheitsministerium).

These Ministry publications answer many questions about care at home: 

Long-Term Care Guide

Care Benefits – A Reference Resource