When the costs of care are too much – help with care

People who are in need of care require everyday support. This support can be very complex and expensive. People who have been assigned a care level (specific level of care required) are therefore entitled to long-term care insurance benefits. However, these benefits often don’t cover all of the costs of a person’s care because they are paid at a fixed flat rate, calculated on the basis of the care level.

If the care support required costs more or if a person isn’t entitled to any long-term care insurance benefits, they will need to cover the surplus costs or all of the costs themselves. This affects, in particular, people with multiple severe disabilities or people who don’t have adequate insurance protection.

In such cases, people in need of care who have a low income or small pension can apply to the social welfare office for financial help with care (“Hilfe zur Pflege” in German) if they are unable to cover the cost of care themselves. In contrast to long-term care insurance providers, the social welfare office may sometimes cover all costs of care.

The social welfare office examines each application to determine whether and to what degree the person in need of care is entitled to financial help with care costs. The person must be in financial need in order to qualify. The social welfare office therefore calculates an individual threshold for income and assets that cannot be exceeded or may only be exceeded to a slight degree. The applicant must also be in need of care. This must have been verified previously by the long-term care insurance fund. Alternatively, the social welfare office will itself initiate a care assessment.

The social welfare office pays all of the benefits that are normally paid by the long-term care insurance fund. For example:

• home care: allowance for care provided by a home care service (non-cash care benefits) or for care organized by the care recipient themselves (care allowance)
• part-time residential care: allowance for day or night care in a care facility
• full-time residential care: funding to cover the costs of full-time care in a residential care facility
• measures to improve the home environment
• short-term care
• respite care allowance
• additional relief allowance: this can be used to provide relief for family carers or to pay for support options that promote the care recipient’s independence.
• care aids
• digital care applications: for example, apps that help with the organization and management of daily care routines

As in the case of long-term care insurance, people who have been assigned the lowest care level (1) are entitled to fewer benefits than those with higher levels. These include:

• care aids
• measures to improve the home environment
• additional relief allowance
• digital care applications

For people who have been assigned a care grade and have a low income level, the social welfare office covers the care costs that are actually incurred as supplementary assistance in addition to the benefits provided by long-term care insurance.

For people in need of care who are not entitled to any long-term care insurance benefits, the social welfare office pays care benefits at the same level provided by long-term care insurance funds.

The social welfare office provides help with care if a person’s income and assets are insufficient and if the person is not receiving any long-term care insurance benefits or their long-term care insurance benefits do not adequately cover their care costs. This applies in the following cases:

• The person’s care requirements are particularly complex and care costs arise that aren’t covered by the limited benefits provided by long-term care insurance.
• The person requires care on a temporary basis only – they are in need of care but it is expected that this need will apply for a period of less than six months. In this type of scenario, the long-term care insurance fund doesn’t assign the person a care grade and so they are not entitled to long-term care insurance benefits.
• The person isn’t covered by long-term care insurance – they have no entitlement to long­term care insurance benefits because the required contributory period is not fulfilled (i.e., the person hasn’t been insured for at least 2 years within the last 10 years) or because the person doesn’t have health and long-term care insurance.

In addition, financial help with care costs is only paid if the person has no entitlement to benefits from other social insurance agencies, such as health and accident insurance funds. Help with care is a “subordinate” benefit, meaning that it is not normally granted unless no benefits can be claimed from other providers.

People are only entitled to help with care if they are both in need of care and in financial need. Both types of need are assessed when a person applies for help with care.

The long-term care insurance fund determines whether someone is in need of care by conducting a care assessment. The social welfare office is bound by the decision made by the long-term care insurance fund as regards a person’s care level.

This means that an assessment by the long-term care insurance fund must already exist when the person applies for help with care. For people without insurance, the social welfare office itself will initiate a care assessment. It is conducted on the basis of the same criteria used by the Federal Medical Review Board on behalf of the long-term care insurance funds.

The social welfare office determines whether the person is in financial need. Regular income and assets have to be disclosed for this purpose. Help with care is possible if the person’s own income and assets slightly exceed or fall short of legally defined thresholds. When calculating an individual’s financial needs, the income and assets of their spouse or life partner are also assessed.

Calculating the income threshold for outpatient care

This income threshold is not a fixed amount. Rather, it is an amount specifically calculated on a case-by-case basis, which is made available to the person in need of care and any relatives who also live in the home for monthly living expenses.

This is based on a basic amount (currently 1004 euros) plus a family supplement of 352 euros (January 2023 figures) for each relative living in the household, as well as the cost of rent excluding electricity, heat and hot water. In addition, contributions towards health insurance and long-term care insurance may be paid for individuals with voluntary and private insurance.

If the individual’s income or the income of the household as a whole falls short of the threshold, the social welfare office will provide financial assistance to cover all care costs. If the income exceeds the income threshold, the costs are only covered in part.

The individual’s assets or the assets of the household as a whole are used to calculate the income threshold. However, some assets fall into a special category of exempt assets, which are not included. Examples of exempt assets are the residential property used by the individual themselves, a cash amount of 10,000 euros each for the individual and their spouse or life partner and a reasonable amount to be held in reserve for burial and grave maintenance.

The special case of full-time residential care

If both spouses or life partners reside in a residential care facility, all of their income and assets must be used for their residential care. This excludes exempt assets and a small monthly spending allowance. This also applies to people who are single.

If one spouse or life partner remains in the previously shared apartment or house, they are required to contribute towards the cost of residential care. However, they need to have sufficient funds remaining to continue to support themselves also. The social welfare office will determine the precise amount on a case-by-case basis, taking into account personal circumstances.

Advice

When calculating income and cost coverage, the social welfare office takes particular account of factors such as regular incomings (income, pensions and annuities, support payments by relatives, rental and leasing income, income from capital assets) and outgoings, benefits from other social insurance agencies and various special types of expenditure. Each of these may be considered in whole or in part only.

Due to the complexities involved, it is advisable to seek advice about your entitlements from the social welfare office or a care advice center.

Local care advice centers can be found on the website of the Center for Quality in Care (Zentrum für Qualität in der Pflege, ZQP).

More detailed information about relevant income and assets, as well as exempt assets and provisions for funeral expenses is available from the consumer advice center.

If a parent is in need of care and their income and assets aren’t sufficient to cover the costs of care, the social welfare office may place their adult children under an obligation to financially support the care of their parents – but only if their gross annual income exceeds 100,000 euros.

The social welfare office can also only place an obligation on the parents of children who are in need of care to pay support for the care of their children if their joint gross income exceeds 100,000 euros per year.

More information about parental support is available from the consumer advice center.

All you need to do to apply for help with care is call your social welfare office. However, it’s best to apply in writing for help with care so that you have documentation. Payments may be back-dated but only to your date of application and no earlier. The social welfare office will then send you an application form.

You need to apply to the local social welfare office that has responsibility for the area where you live. This particular social welfare office remains responsible for you, even if you move out of the area at a later date.

The following documents usually need to be attached to the signed application form:

• personal identification or passport
• documentary evidence of income or pension
• documentary evidence of assets where relevant
• assessment of the person’s care grade
• lasting power of attorney or guardianship directive if applicable
• invoices from care services or care facility
• documentation of outgoings, such as rental costs, provisions for funeral expenses or special expenditure

Once the social welfare office has checked all documentation and income, it will send notification of its decision on the application. If an applicant is unhappy with the decision, they can submit an appeal within a period of one month.

If you need more help with your application, care advice centers are another valuable resource.