Full-time residential care

Care facilities support people who can no longer manage to care for themselves and go about their daily lives in their own home. Full-time means that a care recipient is cared for 24/7 in a care facility, including at weekends.

Trained nursing and care staff support care recipients in all aspects of their lives in which they require support. In addition to nursing and care, healthcare, provision of meals and accommodation, this also includes meeting a person’s social needs, for example, by enabling them to meet and interact with others and have a sense of companionship and community. The residents are also assisted with the routine tasks of everyday life. Full-time residential care is intended not only to cater to the critical needs of their patients but also to offer them quality of life as their new home and focal point for their lives.

Long-term care insurance subsidizes the costs of nursing and care for people with a care grade of 2 or higher. The remaining costs have to be covered by the residents themselves. Long-term care insurance providers will only grant a subsidy in cases where an agreement is in place between the care facility and the provider. These care facilities are considered as “approved” by long-term care insurance providers.

If you are unable to cover the costs of full-time residential care yourself, you can apply to your local social welfare office for help with care costs if certain criteria are met.

It is also possible to apply for a housing benefit (“Wohngeld”) in certain circumstances. Applications must be submitted to the local housing benefit authority.

More information about the housing benefit for residents of full-time residential care facilities is provided by the Federal Ministry of Health (Bundesministerium für Gesundheit).

Private compulsory long-term care insurance

There are no differences between statutory and private long-term care insurance policyholders in terms of entitlement to benefits or the amount of the personal contribution.

Further information for private long-term care policy holders is provided by Compass Private Pflegeberatung GmbH.

Reasons for residential care

There are several reasons why people may choose full-time care in a residential care facility. For example, a person in need of care may require so much support that it is no longer feasible to look after them at home. In other cases, there may be no loved ones to provide care. In addition, some care recipients may choose full-time residential care as the best option for them.

Operators of care facilities calculate the following costs:

• Nursing and care
• Food and accommodation
• Investment costs
• Training costs
• Optional add-on services

Nursing and care

These include

• Assistance with essential aspects of daily life, such as washing, eating and drinking and using the toilet
• Post-treatment care – for example, giving medication, applying and removing dressings and taking blood pressure measurements
• Care and support – for example, help with personal matters, everyday tasks and social life

For people with care grade 2 to 5, the insurance fund will pay a flat-rate subsidy towards these costs. Residents also need to cover some of the costs themselves. They are required to pay a facility-specific base rate for residents, known as the “EEE” (“Einrichtungseinheitlicher Eigenanteil”). The amount charged differs between individual facilities. However, it is the same for all residents within one facility and is not based on care grade.

Food and accommodation

These include, for example, meals and cleaning of the resident’s room.
These costs are the same for all residents within a care facility and are not covered by the insurance fund. These costs are also referred to as “hotel costs”. If a resident has a health condition that prevents them from eating normally because they have to be fed through a stomach feeding tube (PEG), the full charge for food does not apply.

Investment costs

These include, for example, the costs of renting the building or doing repairs and maintenance and may be passed on to care recipients. These costs are also not covered by the long-term care insurance fund and must be paid as part of the personal contribution. If a person’s income and assets are not sufficient to cover investment costs, the social welfare authorities in some federal states may grant them a subsidy known as “Pflegewohngeld” (residential care allowance). Information about this is available from the care facility or the local social welfare office.

Training costs

The costs of paying trainee staff members may be passed on to residents.

Convenience services and add-on services

These include, for example, individual agreed convenience services for accommodation and food, as well as special services for care and support – such as a room with special equipment, a read aloud service or the use of common rooms for private celebrations. 

Residents are charged for these costs. Add-on costs must always be contractually agreed. Otherwise, the resident cannot be charged for them.

Every month, the care facility produces an invoice of costs to be covered personally by each resident. The costs that are covered by long-term care insurance are settled between the care facility and the insurance provider directly. If you have queries about your bill or suspect that an error has been made, help is available from care advice centers, such as care support points or care advice from Compass for those with private long-term care insurance.

Costs in the event of an absence

If you are absent from the care facility for an extended period, for example, due to a stay in hospital or a vacation, the costs of care, accommodation and food must be adjusted as of the fourth day of your absence.

For more information about costs in the event of an absence, contact a consumer advice center.

Costs of cancellation

Residents can cancel their contract with the care facility at the end of each month in accordance with the terms of the contract. The cancellation must be made in writing and the care facility must be notified by the third working day of the month. If you are in receipt of long-term care benefits, you are only required to pay the care facility for the days on which you actually reside there. From the day that you move out, you are no longer obliged to pay the facility, even if the notice period has not yet ended.

For more information about a resident’s right to cancel their contract, contact a consumer advice center.

If your care grade is between 2 and 5, you receive a flat-rate subsidy from your long‑term care insurance provider towards the costs of nursing, care and post-treatment care. You are required to cover the remaining costs yourself.

The amount of monthly subsidy paid depends on the care grade:

• Care grade 2: 770 euros per month
• Care grade 3: 1,262 euros per month
• Care grade 4: 1,775 euros per month
• Care grade 5: 2,005 euros per month

People with care grade 1 are not entitled to any full-time residential care benefits. However, if they opt to reside in a care facility, they will receive a subsidy of 125 euros per month.

You have to apply for benefits for residential care from your long-term care insurance fund or private care insurance provider. A care advice center can help you with this.

Supplement to the personal contribution to the cost of care

Long-term care insurance providers supplement all policyholders’ personal contribution to the cost of their care. This supplementary payment increases with the duration of a person’s stay in a full-time residential care facility as listed below:

• within the first year: 15 percent of care costs
• within the second year: 30 percent of care costs
• within the third year: 50 percent of care costs
• from the fourth year onwards: 75 percent of care costs

You do not have to apply for this supplementary benefit, which adjusts automatically and individually depending on the duration of your stay at the care facility. When calculating the duration of the stay, the only consideration is the length of time for which full-time residential care benefits have already been claimed.

For more information about the supplement to the personal contribution to the cost of care, contact a consumer advice center.

Additional benefits for health promotion and support services

Residents in full-time and part-time residential care facilities are also entitled to services for prevention, health promotion and health maintenance – in addition to the essential healthcare they receive.

These services are intended to promote their physical and mental health and improve their social lives. They may be provided on an individual or communal basis.

There is no need to apply for these services and payment is settled directly between the care facility and the long-term care insurance provider. In other words, residents cannot be charged for them. If you have any questions about the services available in your facility, you should talk to a member of staff or to the facility manager. 

People living in a full-time residential care facility for people with disabilities can apply to their long-term care insurance provider for a subsidy towards the costs. They must have care grade 2 to 5 in order to apply.

In this case, the subsidy is based not on the care grade or the amount of care they require but rather the total fees charged by the care facility. The total fees charged by the care facility are calculated on the basis of the agreement reached between the operator of the facility and the relevant social welfare authority.

The long-term care insurance provider will cover the costs of 15 percent of the care facility fees up to a maximum of 266 euros per month.

The fixed amount covers the costs of

• nursing
• care
• post-treatment care
• care aids

More information is available from the Supplementary Independent Participation Advice Center (Ergänzende unabhängige Teilhabeberatung – EUTB) or your care insurance fund.

For older people and people in need of care, it is particularly important to have regular medical check-ups. Treating illnesses and health problems at an early stage can prevent complications.

For this reason, care facilities are obliged to have cooperation agreements in place with general practitioners, specialist doctors and dentists, as well as for treating residents with medication. The care facility will provide information about the frequency of doctor’s visits, how doctors can be contacted, the arrangements for on‑call medical services and care and for the provision of medication.

Residents are also entitled to consult a doctor of their choice. The costs are settled as usual via the electronic medical data card.

If an acute problem occurs and the usual doctor or doctors who treat the patient cannot be contacted, the non-emergency medical assistance service can be contacted by dialing 116 117 – just as is the case for people living in their own homes. In the event of an emergency, it is essential to dial 112 for emergency services.

For other important numbers to call in the event of urgent health problems, acute crises and poisoning, see the article Numbers to call in the event of an emergency.

Today, a wide range of full-time residential care options is available. Care facilities differ in terms of their equipment and amenities, the nursing and therapeutic services they offer and their overall approach.

At the same time, people in need of care have different needs and expectations, as well as different personal understandings of high-quality care. For example, some people prefer a wide range of services to support everyday tasks, while, for others, high-quality healthcare provision is a priority.

It is therefore important to compare services and prices when choosing a facility:

• It is advisable to consider which aspects are important before looking for a facility so that an initial selection can be made on this basis.
• The benefits and costs of the pre-selected care facilities can then be compared.
• It is also advisable to visit the facility, clarify any questions you may have and ask to see a room. Some residential facilities also offer trial stays.

Relevant criteria and questions include the following:

• Principles and approach – what are the values underpinning the care facility? How are the autonomy and independence of the residents encouraged? What is the facility’s approach to empowerment, health promotion and the prevention of violence?
• Quality: What professional qualifications do the staff have? What is the result of the annual quality review by the Medical Review Board?
• Medical care: How is the provision of medical care by doctors organized at the facility?
• Communication and cooperation: How does the facility ensure seamless coordination and collaboration between staff? How are residents and their loved ones kept informed?
• Accommodation and surroundings: Can I choose between a single room and a multi-bed room? Is it possible to bring my own furniture? Are there good local transport connections?
• Services and add-ons: What services are provided on a daily basis that cater to the individual’s personal interests and needs?
• Costs: What is the total cost of the personal contribution?

The quality of the care facility is an important criterion. In addition to an individual’s personal understanding of what constitutes good care, there are also professional criteria that should be met. The Center for Quality in Care (Zentrum für Qualität in der Pflege) offers a guide with useful hints for identifying high-quality care.

The Federal Medical Review Board (Medizinischer Dienst Bund, KöR) provides information about how the quality of full-time residential care facilities is determined and reviewed.

The Home Directory (“Heimverzeichnis”) website of the Society for the Promotion of Quality of Life in Older Age and with Disability (Gesellschaft zur Förderung der Lebensqualität im Alter und bei Behinderung gGmbH) lists facilities that have been awarded the “Grüner Haken” (green check mark) quality seal, a recognized indicator of high quality of life in older age.

For more help with decision-making and information about important considerations when choosing a care facility, refer, for example, to the Center for Quality in Care (Zentrum für Qualität in der Pflege, ZQP), consumer advice centers and the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth (Bundesfamilienministerium).

Pre-contractual information

If you choose a care facility for your initial shortlist, you are entitled to ask for “pre‑contractual information” from the operator of the facility. This allows you to obtain detailed information about the facility in advance and to compare different facilities with one another. If you conclude a contract with the operator at a later date, the company is bound by the information they have given you.

Comparison lists and search portal

Various portals are available, where users can search for facilities based on individual criteria and view the results of the quality inspection. These search portals are provided, for example, by various health insurance and long-term care insurance funds and by the Home Directory (“Heimverzeichnis”) website of the Society for the Promotion of Quality of Life in Older Age and with Disability (Gesellschaft zur Förderung der Lebensqualität im Alter und bei Behinderung gGmbH).

The care insurance funds’ lists of services and price comparisons also provide a good overview of approved care facilities. These can be accessed online or requested from the insurance funds free of charge.

Reputable search portals include:

• Heimverzeichnis gGmbH – a website operated by the Society for the Promotion of Quality of Life in Older Age and with Disability (Gesellschaft zur Förderung der Lebensqualität im Alter und bei Behinderung): Home Directory (Heimverzeichnis)
• Federal Association of Public Health Insurance Companies (AOK-Bundesverband): Care Navigator (Pflegenavigator)
• Federal Association of Company Health Insurance Funds (BKK-Dachverband): CareFinder (PflegeFinder)
• Association of Substitute Health Insurance Funds (Verband der Ersatzkassen – VDEK): Care Guide (Pflegelotse)

The Center for Quality in Care (Zentrum für Qualität in der Pflege) provides information and guides about the quality of care facilities and a care facility search function.

Consumer advice centers can provide more information about full-time residential care – for example, about moving into a care facility, the rights of care facility residents, contracts, contract cancellation, costs and complaint management.