Care provision for long-term care recipients – who does what?

For many care recipients and their loved ones, it is difficult to gain an overview of how long-term care provision is organized in Germany. It’s not always immediately obvious which key player is responsible for which aspects of care provision and where help can be accessed. 

For example, different bodies are responsible for assessing the need for care, the payment of financial subsidies, nursing care support and care advice. In addition, responsibilities for certain areas may sometimes overlap between various bodies.

People with an assigned care grade can avail of long-term care insurance benefits. Alongside long-term care benefits (financial subsidies), they are also entitled to free, neutral and wide-ranging advice.

People who do not have an assigned care grade are not entitled to long-term care insurance benefits from long-term care insurance providers. In certain cases, their statutory health insurance will cover the cost of essential care services.

Anyone requiring long-term care will receive long-term care insurance benefits subject to certain preconditions. The benefits consist of financial subsidies paid by the long-term care insurance provider. This is important for many people because long-term care can be very expensive – especially when a high level of personal support is required on a frequent basis. 

Before a person receives these benefits, the insurance provider checks whether all eligibility criteria are met.

Long-term care insurance funds and private insurance providers

The long-term care insurance funds, as social care funding organizations, pay care benefits to people with statutory long-term care insurance. People with private health insurance receive long-term care insurance benefits from private insurance companies.

Applications for care benefits must be submitted as a claim for benefits from the long-term care insurance fund or private insurance company.

The care grade that has been assigned to an individual determines which long-term care benefits they are entitled to and the amount of financial subsidies they receive. The care grade determines what degree of care a person requires.

Medical Review Board and Medicproof

In order for a care grade to be assigned, those with statutory insurance require an assessment report by the Medical Review Board. This body checks whether the person has a need for care that entitles them to long-term care insurance benefits. 

An assessor generally comes to the person’s home to conduct a care assessment. The long-term care insurance fund decides, on the basis of the report, whether and which care grade should be assigned.

For people with private long-term care insurance, this assessment is conducted by Medicproof, the medical service for private health and long-term care insurance providers.

Health insurance

Health insurance covers the costs of medical and psychotherapeutic services, medical aids and therapeutic services, as well as medical post-treatment care.

Subject to certain preconditions, it also offers benefits for care provision if the need for care is of a short-term and temporary nature only. This may include home nursing, home help, transitional care and short-term care.

Social welfare office (Sozialamt)

If an individual does not require care in the sense of long-term care insurance or if they have inadequate insurance cover, they may be eligible for help with care costs from the social welfare office in certain cases. This is also the case if the long-term care benefits paid by the long-term care insurance fund are insufficient. The individual must be in financial need in order to qualify.

If a person is assigned a care grade, they are dependent on other people for their care. This means that their need for assistance or care cannot be adequately met by medical aids, home renovation measures and rehabilitation measures.

Care recipients can receive different types of personal support. In principle, people are free to choose who care for them – family members and loved ones can provide care but professional help can also be sought.

Family caregivers

The vast majority of care recipients are cared for by family caregivers and volunteers. Anyone who cares for another person for at least 10 hours per week is recognized a carer by long-term care insurance providers, subject to certain conditions. Carers receive social security benefits and additional pension points. Family caregivers can avail of various advice and training options, which enable them to properly attend to caring tasks and to balance their caring role with their daily lives.

Care and support services

Care and support services employ nursing and care staff who come to a person’s own home to care for them. The long-term health care benefits that can be used to fund this type of support is referred to as a non-cash care benefit (or care benefit in kind). In some cases, care and support services can also be funded by the additional relief allowance benefit.

Care facilities

Both full-time residential and partial residential care facilities are available.

Partial residential care means that a person spends part of the day or night being cared for in a care facility. However, they live in their own homes most of the time. 

Full-time residential care means that a care recipient is cared for 24/7 in a nursing home, including at weekends.

Various costs are associated with partial and full-time residential care in a care facility. For those assigned care grade 2 or higher, a subsidy from the long-term care insurance fund is paid towards nursing and care costs. For those in partial residential care, the subsidy may also cover the costs of a transport service if needed. The amount of the subsidy paid depends on the care grade. As the subsidy is not generally enough to cover all nursing and care costs, individuals are also required to pay a personal contribution known as a co-payment (“Eigenanteil”). The amount of the co-payment depends on the individual care facility.
Other costs, such as the costs of food and accommodation, must be covered by the care recipient.

Temporary stays in a care home: short-term care

Care recipients may also be cared for in a care facility for a limited time only. This type of short-term care may provide respite if, for example, a person who normally lives independently requires support following a stay in hospital. Short-term care can also be useful if family caregivers are unavailable for a limited period.

The care grade determines who covers the costs for short-term care. As of care grade 2, the long-term care insurance fund pays a yearly fixed amount for care. The subsidy paid as respite care allowance can also be used to fund short-term care.
If a person without an assigned care grade or with care grade 1 requires short-term care, the health insurance fund will cover part of the costs in certain cases.
The costs for accommodation and meals have to be covered by individuals themselves. 

Doctors and psychotherapists

Doctors are responsible for providing medical care. They prescribe medication, therapeutic services and medical aids for their patients. 

Psychiatrists and psychotherapists provide care to people with mental health problems.

Psychiatrists are medical doctors who have completed further specialized training. They are authorized to prescribe psychotropic medicine for people with psychiatric illnesses. Psychotherapists have usually studied psychology or medicine before specializing in psychotherapy. Having trained for several years, they offer various psychotherapeutic approaches.

For those with statutory health insurance, the costs are settled directly via their electronic medical data cards (eGK) when they are treated by doctors who have been approved by their health insurance fund. Patients with statutory health insurance are required to pay for treatment at a private practice out of their own pockets. 

Those with private health insurance initially pay for treatment themselves – both in private practices and in practices of statutory health insurance physicians. They can subsequently submit a claim for a reimbursement of costs to their insurance provider. The number of sessions of psychotherapy that are covered by private health insurance is specified in the individual insurance policy.

Therapeutic treatments/services

Treatments provided by services are also known as “therapeutic services”. Therapeutic services must be prescribed by a doctor in order for their costs to be covered by the health insurance fund. 

Therapeutic services include:

• physiotherapy
• occupational therapy
• podology (medical foot care and treatment)
• speech therapy
• dietary advice

Hospitals, health resorts and rehabilitation facilities

These facilities provide patients with treatments that require an intensive level of care or that must be carried out by specialists. For example, hospitals offer surgical and special medical treatments. 

The purpose of a visit to a health resort is to help people avoid health problems that are likely to occur by means of therapeutic measures and guidance. 

The aim of medical rehabilitation (rehab) is to make it easier for people to return to their everyday life and work following an illness.

Treatments in hospitals, health resorts and rehabilitation facilities may be provided on an inpatient or outpatient basis. A visit to a health resort or rehab must be medically prescribed and approved by the health insurance provider.

Care recipients and their loved ones are entitled to avail of various advice and support options. People who are interested in becoming voluntary carers can also seek advice. Various advice options are set out below.

Long-term care insurance funds and private insurance providers

Long-term care insurance funds are obliged to provide those they insure with comprehensive and individual advice – for example, in relation to:

• financial subsidies
• medical aids
• treatments
• the various ways in which care can be organized
• advice and support
• training
• respite services
• social security

They advise both people in need of care and their family caregivers. Free advice is available to individuals after they have submitted a claim for long-term care insurance benefits to their long-term care insurance fund. If the long-term care insurance fund does not provide the advice itself, it will issue a voucher for advice from a qualified care advice center.

Privately insured individuals and their family caregivers can avail of advice from Compass private Pflegeberatung gGmbH, working on behalf of their private insurance company. It is an independent subsidiary of the German Association of Private Health Insurers.

Care support points and local advisory centers

Care support points are publicly funded services offering free and independent advice on care-related issues. Municipalities and welfare and social associations often provide advice in conjunction with or on behalf of long-term care insurance funds.

However, care support points are not available in all federal states, and other municipal advisory centers often take responsibility for advising on care. The structure and availability of care support points also differ from region to region. 

You will find all care support points and local advisory centers located near you in the database of the Center for Quality in Care (Zentrum für Qualität in der Pflege, ZQP).

Care services

Nursing care specialists employed by care services also have an advisory role. They provide guidance and training and offer information materials on how people in need of care can deal with certain care situations and health conditions. They also provide tips for how to best manage certain care tasks when care service professionals are not present.

You will find more information about the role of care services in the article “Non-cash care benefits: care service support”.

Consumer advice centers

The consumer advice centers in each federal state offer information and advice on issues of interest to consumers and provide support with legal problems. 

Some consumer advice centers offer information and advice on legal and contractual issues in the area of care and health.

Centre for Quality in Care (Zentrum für Qualität in der Pflege, ZQP)

The Centre for Quality in Care conducts research and gathers expert knowledge relating to the subject of care. It makes this information available to care recipients and family caregivers in the form of practical guides that can be easily understood. 

You can search for advisory centers close to you in the database of the Centre for Quality in Care.

Voluntary services and local community helpers provide key support for older people, as well as those with an illness or in need of care. In many regions of Germany, a wide range of voluntary support services is available for older people, as well as for those with an illness or in need of care. These services can also be used by people without an assigned care grade.

Volunteers and care facilities come together in networks to improve the care of people in need of long-term care and those with a chronic health condition. 

There are many supports and initiatives in Germany, both large and small. Information about local supports is available from municipalities, advisory councils for senior citizens and family members, as well as care support points, for example.

A selection is listed below:

Care Network Germany

Care Network Germany is a Federal Ministry of Health initiative. It enables people working in care to network with one another and exchange information and experiences. On the portal, care facilities and voluntary services can also publish appeals for help and offer support.

More information is available from the Federal Ministry of Health’s Care Network Germany (Pflegenetzwerk Deutschland) portal.

Local alliances for people with dementia

Local support networks for dementia help people find services locally, bring participants together under one umbrella, coordinate and align available supports and develop new supports where needed.

You can find contacts for your region on the website of the Network of Local Alliances for People with Dementia (Netzwerkstelle Lokale Allianzen für Menschen mit Demenz.).

Voluntary and local community services

Voluntary services and people from the local community offer hourly support for older people and people in need of long-term care. For example, they may provide visiting or chaperoning services or help with shopping.

More information about voluntary services is available from the “Aging at home” (“Zuhause im Alter”) service portal of the Federal Ministry of Family Affairs (Bundesfamilienministerium).

Social associations and voluntary welfare associations

These associations concern themselves with care at various levels. For example, they may offer practical support in the form of professional and voluntary support services, social counseling and socio-legal advice. At a political level, they advocate for the rights of older people, those in need of care, as well as people with disabilities and chronic illnesses. 

Various voluntary welfare associations, such as the Workers’ Welfare Organization (Arbeiterwohlfahrt, AWO), the German Red Cross (DRK) and Diakonie, offer advice on various care-related topics.

Self-help

Self-help groups offer support, advice and opportunities to exchange information and experiences on a voluntary basis. Members of self-help groups have health impairments and are experts in their area. 

You can search for suitable self-help groups in your region on the website of the National Contact and Information Point for Encouraging and Supporting Self-Help Groups (Nationale Kontakt- und Informationsstelle zur Anregung und Unterstützung von Selbsthilfegruppen – NAKOS).

For more information, see our self-help area. 

The quality of nursing homes, day care facilities and care services is inspected on a regular basis to ensure that users of these services can rely on a certain level of quality.

The Medical Review Board checks whether specific standards are maintained by care facilities and care services. It checks, for example, whether the care provided is tailored to the needs of the individual care recipients and based on medical and nursing standards.
One part of the inspection is conducted by Careproof GmbH, the inspection service for private long-term care insurance providers. Both bodies apply the same guidelines to their inspections.
The results are recorded in quality reports, which are intended to help individuals find the service that suits them best. 

The results of the quality inspections conducted by the Medical Review Board are publicly accessible, for example, in the Care Navigator (Pflegenavigator) of the Federal Association of Public Health Insurance Companies (AOK), in the CareFinder (PflegeFinder) of the Federal Association of Company Health Insurance Funds (BKK) or in the care guides (Pflegelotsen) of the Association of Substitute Health Insurance Funds (Verband der Ersatzkassen).

What points of contact are available for help if I have any problems?

If problems still occur despite these measures, for example, deficiencies in long-term care provision in a care facility or incorrect billing by care services, there are various options for making a complaint. For more detailed information, see the article “Deficiencies in long-term care – who can I turn to for help?”