Non-cash care benefits: care service support

Anyone who requires support from an outpatient care or support service can apply for non-cash care benefits to assist them with this. Long-term care insurance providers offer these benefits to help cover the costs of home care services. 

The care benefit does not usually cover the full cost of the everyday care needs. Insurance holders must pay the remaining costs themselves.

Non-cash care benefits are considered if a person in need of care desires or requires professional care. This can be because they do not have any relatives to provide the care or their relatives are unable to provide this alone, for example. In some cases, care services are tasked with certain activities to relieve strain on family caregivers or to prevent stress and strain.

Furthermore, additional benefits can sometimes be received, for example to adapt a home to specific needs or to support family caregivers.

Who can provide services covered by non-cash care benefits? 

Services covered by non-cash care benefits can only be provided by outpatient care services, support services, or independent caregivers who have concluded a supply contract with the statutory long-term care insurance funds. This is also known as approval from long-term care insurance funds. This should ensure high quality and simplify the billing process for people in need of care.

Care services provide assistance with physical care, treatment care, support, domestic help, and care review visits, for example. They must be under the responsibility of trained care specialists. In addition to professionally trained care specialists, outpatient care services can also employ domestic assistants or care assistants.

Instead of a care service, you can also commission a support service. Such services only provide domestic support and assistance. A support service can be useful, for example, for people with dementia or mental impairments who are still largely physically fit. Support services must also be under the responsibility of a trained specialist and employ qualified personnel, ideally from the fields of healthcare, care, and social welfare.

Independent caregivers are people with a care qualification who work in a freelance capacity. They offer the same services as care services. At present, there are only a few independent caregivers in Germany.  

What rules apply to people with private long-term care insurance? 

The same criteria and entitlements apply to people with private long-term care insurance as those with statutory insurance. However, they will receive an invoice that they initially have to settle in full and can then submit to their insurance company. The insurance company will refund the costs up to the maximum amount for the designated care level. 

The care focuses on people’s overall well-being. As such, care specialists primarily support people with almost all tasks relating to physical, mental, and psychological health and that enable as self-determined a life as possible.  

Examples include:   

• physical care measures: help eating and drinking, getting dressed and undressed, going to the toilet, and with personal hygiene  
• care support measures: everyday companionship, communal cooking, walks, and cemetery visits as well as support with hobbies and social contact  
• help with household chores: doing the laundry, changing the bedding, or cleaning the home  
• where applicable, treatment care in the home, such as wound care or administering medication  
• advice on care matters: for example, how to remain mobile and promote mobility as well as how to prevents falls, how to prevent pressure sores, how to deal with pain or wounds, how to use medical aids or digital care applications (DiPA), as well as tips on eating and drinking

advice on organizational matters: procuring medical aids, organizing hospital visits and hospital stays, or applying for a higher care level or other long-term care insurance benefits.

What is professional care guidance?

Care specialists also have the important task of strengthening the care skills of people in need of care and their relatives: they provide guidance, advice, and information materials on how people in need of care can deal with certain care situations and help themselves during certain activities if the care service is not present. 

You can also avail of the advisory services provided by a care support point at any time.

What tasks does a support service undertake? 

Support service staff provide assistance in the fields of support, everyday companionship and domestic assistance. Guidance on independence is again a primary factor here. The support service does not perform physical care measures. If these are regularly required, a care service must be commissioned. 

Non-cash care benefits are a monthly budget for financing care at home. This can mean specialists from a care service, a support service, or an independent caregiver. 

The amount of non-cash care benefits to which a person is entitled depends on the severity of the need for long-term care. The higher the care level, the higher the monthly amounts: 

• Care level 2: 761 euros
• Care level 3: 1,432 euros  
• Care level 4: 1,778 euros  
• Care level 5: 2,200 euros   

People with a care level of 1 are not entitled to non-cash care benefits but can still apply for a care or support service. They can use the additional relief allowance of 125 euros per month to help cover the costs of this.

Further information in this regard can be found in the article on the additional relief allowance. 

Does care at home incur any other costs? 

Non-cash care benefits do not usually cover the full cost of the everyday care needs. Insurance holders must pay all remaining costs themselves. If their income and assets do not allow this, they can sometimes apply for help with care costs.

Patients usually also have to contribute to the care services’ investment costs and training levy. These include office rental, leasing costs, and maintenance and repair costs, for example. The amount of the investment costs varies from care service to care service. However, these costs must only be paid if this has been contractually agreed.

What activities can be financed using non-cash care benefits? 

Non-cash care benefits can only be used to finance support at home. Support with activities outside the home can be financed in other ways: 

• The additional relief allowance can be used to finance support services from a care service.
• In some cities and municipalities, voluntary support and visiting services provide assistance. These accompany people when going shopping or visiting a museum, for example, and can be associated with low costs.
• In the event of a regular need for support outside the home, such as when attending school, a training facility, or university, the care assistance is covered by integration assistance or the health insurance provider. 

You are only entitled to non-cash care benefits if you fulfill the following prerequisites:  

• You have a long-term care need classed at care levels 2 to 5.  
• The care is provided at home.  
• The care is provided by a care or support service that has concluded a supply contract with the statutory long-term care insurance fund.   

An application for non-cash care benefits must be submitted to the care recipient’s long-term care insurance fund or private long-term care insurance provider. This can be done in writing or by telephone. Once the application has been received, you will be sent a form on which you can specify the desired benefits.

You must then select a care service, support service, or authorized specialist and enter into an agreement.

It is possible to switch between non-cash care benefits, care allowance, or a combination of the two (combination benefits) at any time and without a transition period. An application is required to this end. No new care assessment is usually required when switching between the benefits. 

In addition to non-cash care benefits, you can also use other long-term care insurance benefits to finance care at home.

The following benefits do not affect the amount of the non-cash care benefits:  

• Additional relief allowance
• Partial residential care  
• Care aids
• Home improvement measures  

However, it is not possible to receive non-cash care benefits and benefits for full-time residential care at the same time.

It is also possible to use some of the non-cash care benefits to top up other benefits: 

• Combination with care allowance  
• Conversion into additional relief  

How can I combine non-cash care benefits with the care allowance?

Non-cash care benefits are one of two benefits available for care at home that are permanently paid to finance an everyday, continual care need. The other benefit, care allowance, is paid if the person in need of care is cared for by relatives or volunteers.

You can choose either one of the two benefits or a combination of them. The combination benefit is possible if you receive care support from both relatives and professional caregivers. In such cases, you will receive the two benefits proportionally. For example, if you receive 40% of the amount to which you are entitled for non-cash care benefits, you will receive 60% of the care allowance for your care level.

An application for combination benefits must be submitted to the long-term care insurance fund.

There are two options when doing this:  

• The first option is to stipulate the ratio in which you wish to receive the two benefits. You are bound to this decision for six months and will receive the proportional care allowance at the start of the month.  
• The second option is to receive the benefits flexibly: you use as much of the non-cash care benefit amount as you need during the month and are paid the remaining percentage as care allowance. In this case, however, you must wait for the care service to calculate the amounts, so care allowance is paid later and in a varying amount.  

How can I convert non-cash care benefits into an additional relief allowance?  

Each month, up to 40% of the non-cash care benefits can be converted into an additional relief allowance. This benefits people with mental or psychological disorders, for example, who often rely on support more than care.

Maximum amounts for the conversion to additional relief allowance:  

• Care level 2: 304.40 euros  
• Care level 3: 572.80 euros  
• Care level 4: 711.20 euros  
• Care level 5: 880 euros  

This is only possible if the non-cash care benefits have not been fully used at the end of the month. There is no need to apply for the conversion in advance. However, as with other reimbursable benefits, you must pay out the amounts then submit the receipts to the long-term care insurance fund to obtain a refund.  

The Federal Ministry of Health (Bundesministerium für Gesundheit) provides examples of calculations for the conversion entitlement.

Certain support services must be provided by all care and support service providers. For example, all care services must offer physical care and treatment care. Despite this, it is still worth comparing several service providers before entering into an agreement. This is because the additional services and prices can differ from provider to provider. 

There are also care services that offer an additional specialist field or that specialize in certain target groups.  

Examples include:

• Psychiatric care: support and care for people with mental illnesses
• Pediatric care: support and care for children in need of care
• Intensive medical care: support and care for people who require intensive medical care, for example people who need artificial ventilation. 
• Intercultural, culturally sensitive, and LSBTI*-sensitive care: care services with a cultural or religious focus, for example, and that offer communication in other languages or have employees who are trained to deal with different cultures, religions, and sexual or life orientations. 

People in need of care are generally free to select their care service – irrespective of their underlying condition, disability, culture, sexual orientation, and other personal characteristics. However, specializations and specialist fields can make care easier and relieve strain on the person in need of care.

What should I consider when selecting a care service?

When starting your search, note down the things that matter to you, your wishes, and your personal needs, and use these as a basis for an initial shortlist.  

Important questions include:  

• What assistance should be provided by the care or support service?
• How often should the care or support service visit you? 
• Should the care service specialize in a specific area, for example intensive medical care, or offer a specific language? 

Next, arrange a home visit from the shortlisted service providers and ask them to fully explain how they work.

You should ask the following:  

• Whether the care or support service can consider individual wishes, such as adhering to certain times, always receiving support from the same people, or receiving support from someone of the same gender
• Which services are provided by trained specialists and which are provided by care assistants
• Whether there is a contact person for requests and complaints, and how any complaints are dealt with
• How the care service’s billing process works  

Finally, you should ask for a cost proposal for a specific service package. This enables you to compare prices and see whether the non-cash care benefit budget available to you will cover everything or how much you may need to pay from your own pocket.

How can I assess the quality of care and support services? 

The quality of outpatient care services is an important selection criterion. In addition to an individual’s personal understanding of what constitutes good care, there are professional criteria that should be met.  

The Center for Quality in Care (Zentrum für Qualität in der Pflege, ZQP) offers a guide with information on how to recognize good care services. 

How can I find a care or support service near me? 

Lists of approved care services near you and price comparisons can be obtained, for example, from care advice centers or your long-term care insurance fund. There are also several online search portals. 

Reputable search portals include:

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)

If you have selected a care service, support service, or independent caregiver, you should enter into a written care or service agreement with the provider. Make sure you receive the agreement early enough to give you time to check all the details and obtain advice if necessary.

The agreement should regulate the following aspects:

• Contracting parties
• Services and costs
• Cost proposal
• Care records
• Care documentation
• Billing
• Liability
• Termination 

Information about these and other contractual aspects and termination periods can be obtained from the consumer advice centers.

What should I consider in relation to the billing process with the care or support service?

At the end of the month, you will receive a care record. You must sign this for the service provider to be able to invoice the long-term care insurance provider. Always check the record carefully before signing.

Services can sometimes be invoiced that have not been provided to the agreed extent or at all. In such cases, the consumer advice centers recommend contacting the care service and asking for the record to be amended. By doing this, billing errors can often be dealt with quickly and in a mutually agreeable manner. 

Insist on a written cost proposal so that you have an overview of the costs that you will incur from the outset. This proposal should provide a written agreement as to the individual services and their respective costs for which the care service is responsible. The level of costs borne by the long-term care insurance fund and the level of the personal contribution should also be clear.

The cost proposal should be part of the care agreement. To enable you to monitor the billing process between the care service and the long-term care insurance fund, the agreement should also stipulate that you will always receive a copy of the care service’s invoice to the long-term care insurance fund.

In the event of questions or uncertainties, you can take the bills to an advice center, such as a care support point or a consumer advice center. People with private long-term care insurance can contact Compass Private Pflegeberatung.

Further information about cost proposals and the billing processes with care services can be obtained from the information portal provided by the consumer advice centers.