Care grades at a glance

Care grades are classifications that the long-term care insurance provider uses to rate how independently a person can manage their everyday life and how severely affected their mental, psychological and physical abilities are.

There are five different care grades. The following applies: the greater the need for long-term care, the higher the care grade. A higher care grade is in turn associated with higher long-term care benefits, i.e. people with a need for long-term care receive more monetary or non-cash benefits for their care.

However, the care grade does not affect the kind of benefits you can claim. You can decide between care at home and care in a residential care facility. Only people assigned care grade 1 have fewer care benefits available to them.

This tiered care grades also apply to the care needs of babies and children but the care grade need is determined and calculated slightly differently. You can find more information about this in the care assessment article.

When the long-term care insurance fund approves your application for care benefits, its letter will also stipulate what care grade you are being assigned.

The care grade assigned to people in need of long-term care depends on how difficult it is for them to cope with their everyday life independently for health reasons and how much they rely on nursing support. In other words, it depends how great their need for long-term care is.

There are five care grades. The greater the need for long-term care, the higher the care grade. Care grade 1 corresponds to the lowest care need and care grade 5 the highest. 

• Care grade 1: little impairment of independence or abilities 
• Care grade 2: considerable impairment of independence or abilities 
• Care grade 3: severe impairment of independence or abilities 
• Care grade 4: extreme impairment of independence or abilities 
• Care grade 5: extreme impairment of independence or abilities combined with special requirements for nursing care 

It is therefore not possible to simply assign an illness or disability a set care grade. People with one and the same illness can receive different care grades. The decisive factor for the assessment is how severely an illness specifically affects the person’s ability to deal with daily tasks.

The extent to which aids can be used is also decisive. If a person in need of long-term care is not dependent on personal assistance, for example due to a walking aid or modifications to improve accessibility, and is therefore independent, this can affect the care grades. 

How is a person’s care grade determined? 

A care assessment is performed to determine an individual’s care grade. An assessor from the Medical Service (MS) comes to the care recipient’s home to do this. This home visit determines the areas of life in which the person is experiencing physical, mental or psychological impairments or health-related stress that they cannot counteract or manage independently and how severe they are. 

You can get information about the questions, the process and how the care grade is calculated in the care assessment article.

Further information about preparing for the care assessment is provided by the Medical Service Federation in over ten languages.  

What does “special combination of needs” mean? 

People with severe physical impairments and an extremely high care need can be assigned to care grade 5 under certain conditions, even if they do not formally meet the requirements in the care assessment.

This applies if the person in need of long-term care can no longer walk, stand or grasp things, even with aids, but is psychologically and mentally healthy. Examples of this include complete paralysis of all limbs, vegetative state and movement disorders that very severely affect the motor function of the hands and feet, such as stiffness or a tremor. 

Not everyone who relies on help in their everyday life is entitled to care benefits. The definition of a “need for long-term care” is important as it describes when people are considered to be in need of long-term care within the meaning of the law and thus entitled to claim long-term care insurance benefits.

The need for long-term care in terms of long-term care insurance means:

• A person is dependent on nursing support and the care of others during everyday life because their independence or certain abilities are impaired for health reasons in six basic areas of life.  
• Physical, mental and psychological impairments are equally and comprehensively taken into account. 
• The impairments must be expected to last for at least six months and their degree of severity must also meet a certain minimum level. 

The key questions are: How independent is the person in need of care? What resources are available to them? What type of support do they need?  

Before the long-term care insurance reform in 2017, the focus was on the care recipient’s need for assistance. The focus at that time was largely on physical restrictions. People who were restricted in everyday life due to mental or psychological impairments, but were still physically fit, did not receive any care benefits. Only when these impairments had an affect on physical activities laid down in the law at the time was the claim to care benefits recognized.  

The need for care was measured using care levels 0 to 3. The categorization changed to incorporate care grades 1 to 5 with the change of the definition of a “need for long-term care”. 

Care grade 2 or above means that there are physical, mental or psychological impairments or health-related stress so severe that the person in need of long-term care is regularly dependent on support from others.

Therefore, people assigned care grades 2 to 5 are in principle entitled to all long-term care insurance benefits. However, they must choose whether they: 

• Want to use benefits for full-time residential care in a home 
• Want to receive benefits for home care 
• Want to be cared for at home by relatives or by a nursing service 

There is a difference in the amount of the budget: the higher the care grade, the more money or budget is put aside for long-term benefits to cover the basic need for care and support. These include: 

• Nursing care allowance for care by relatives and volunteer carers 
• Care benefits in kind for care by professional nursing staff 
• Day and night care for temporary accommodation in a semi-residential facility 
• Full-time residential care in a home 

For all other benefits, a maximum amount is set that has nothing to do with the care grade. For example: 

• Short-term care: short-term care in a care facility 
• Respite care: temporary care, for example, by a nursing service if a carer is unable to attend 
• Additional relief: budget that can be used to take advantage of everyday support and care services, but also to increase or supplement certain benefits 
• Measures to improve the home environment: financial subsidies to make the care recipient’s apartment or house fully accessible 

Care grade 1 indicates that there is a low need for long-term care and the person is still largely able to manage their everyday life independently.

In this case the person is therefore not entitled to as many benefits. The benefits available are there to help the person gain or regain their independence in the relevant areas of their life and stop the need for long-term care from getting any greater.

These benefits are possible with care grade 1:

• Additional relief: budget that can be used to take advantage of everyday support and care services, but also to increase certain benefits  
• Care advice: individual advice and support, for example in relation to choosing social services and other help services 
• Care review visits at home: regular help, practical support and guidance from nursing staff and advice on how to improve the care situation 
• Group home allowance for people in need of long-term care who live in a care group home 
• Supply of nursing care aids: consumable products, technical furniture or devices that make care easier or enable a more independent lifestyle 
• Digital care applications (DiPA) and additional support using apps or web applications that support everyday nursing care 
• Measures to improve the home environment: financial subsidies to make the care recipient’s apartment or house fully accessible 
• Additional benefits during caregiver leave, family caregiver leave and short-term inability to work, for example, health insurance grants or compensation for lost salary 
• Care courses for loved ones and voluntary carers 
• Grant for full-time residential care: the long-term care insurance provider pays a monthly subsidy of 125 euros for care grade 1. 
• Additional support and empowerment in residential care facilities: activities that promote physical and mental health and abilities and encourage the social life of the residents 

The need for long-term care is not an immutable state. It can get worse, but it can also get better or come to an end.

It is therefore possible for the long-term care insurance provider to increase the care grade, but also to reduce or completely revoke it. The regulations for this only apply to people with statutory long-term care insurance. The regulations for people with private insurance can be found in the insurance documents. Compass care consulting for private long-term care insurance providers also advises on this.

A repeat assessment must be carried out to have the care grade upgraded or downgraded. This can be for various reasons: 

• A person’s independence and abilities improve. Those with statutory insurance are obligated to report this to the long-term care insurance provider. The long-term care insurance provider also responds to specific indications from other sources, for example, if it learns that rehabilitation has been carried out.  
• During the assessment, the assessors also evaluate how the care need is expected to develop. If there is a possibility that the care need will partially or completely end, the assessors from the long-term care insurance provider recommend a deadline for a repeat assessment.  
• If care benefits were only initially granted for a limited period of time, the long-term care insurance provider automatically arranges a reassessment before the end of this. 
• The care recipient applies for an upgrade. 

When will a care grade be increased? 

Anyone who finds that their health has deteriorated and needs more support can apply to the long-term care insurance provider or the private long-term care insurance provider for an upgrade. 

As with the initial assessment, the long-term care insurance provider will ask the Medical Service to determine the severity of the care need during the care assessment. It will then communicate the result by official notification. 

Anyone who does not agree with the findings of the assessment and the decision of the long-term care insurance provider can lodge an appeal. 

When is a care grade downgraded? 

It is possible for the long-term care insurance provider, at a later point, to assign someone a lower care grade or even none at all. However, this is only possible if the conditions have significantly changed. For example, if the care recipient wasn’t able to use their arm after an accident, but has recovered this ability.  

A repeat assessment that has resulted in a lower care grade than before is not enough on its own to downgrade the care grade. The long-term care insurance provider must adhere to the following procedure: 

• The long-term care insurance provider must list what significant changes have occurred since the previous review.  
• The long-term care insurance provider must offer the care recipient the opportunity to comment on the planned downgrade. This is called a hearing. 
• If the care recipient does not agree, they can give clear reasons for this in the hearing.  
• If the long-term care insurance provider still wants to downgrade or revoke the care grade, they send a notice of termination.  
• The care recipient can lodge an appeal against the notice of termination even if they didn’t express themselves during the hearing. 

People who were transferred from a “care level” to a “care grade” as part of the 2017 care reform have legal protection of status quo. They can be upgraded, but not downgraded to a lower care grade. There is an exception: if an assessment determines that there is no longer any care need, the care grade can be revoked.

More information on the conditions under which a care grade can be increased or reduced, the hearing and the legal protection of status quo is provided by the consumer advice centers.