Care Participation benefits – support for people with a disability

People with disabilities should be able to participate in society on equal terms with others and in a self-determined manner. This concept is known as participation. Participation includes, for example, attending school or vocational training, working, living a self-determined life and enjoying leisure time to the full. Depending on an individual's limitations, they may sometimes need support in these areas. The purpose of participation benefits is to enable and fund this support.

Participation benefits are designed to: 

• prevent or reduce disability or prevent a disability from worsening
• mitigate the consequences of a disability
• ensure that a person can continue to work as effectively and for as long as possible in a field that suits them
• avoid or reduce the need for long-term care
• prevent people with disabilities from having to rely on social security benefits
• promote personal development and self-determined, independent living
• facilitate participation in society

A wide range of measures are used to achieve these aims. Depending on the needs of the individual, participation benefits may, for example, cover the costs of a personal assistant, medical rehabilitation or special aids, such as accessible computers. Some people may receive a personal budget rather than receiving the necessary non-cash benefits and services directly. This normally involves a cash payment that people can use to organize and pay for the aids and services they need themselves.

Participation benefits are available for various spheres of life. They are accordingly categorized into benefit groups:

• Benefits for medical rehabilitation
• Benefits to enable participation in working life
• Benefits to secure livelihood and other supplementary benefits
• Benefits to enable participation in education and training
• Social participation benefits

The legal framework governing participation benefits is set out in the Ninth Book of the German Social Code. This framework was adjusted in recent years as a result of the Federal Participation Act (Bundesteilhabegesetz). German legislation seeks to promote the participation and self-determination of people with disabilities and thus complies with the United Nations Convention on the Rights of Persons with Disabilities.

Participation benefits are designed for people with a disability or a severe disability, as well as for those who are at risk of disability. Disabilities can be defined as physical, mental or intellectual impairments that can act as barriers to equal participation in everyday life and in the world of work. Examples of these impairments include:

• certain internal diseases
• motor impairments
• cognitive impairment
• mental health conditions
• sensory impairments, affecting hearing or vision, for example
• learning disabilities

A disability results from the interaction between these individual impairments and the barriers a person encounters in their environment. Examples of such environmental barriers include trams or buses that are not fully accessible. As a result, people with certain disabilities are unable to use them or can only use them to a limited extent. To be considered a disability, the impairment must also have lasted or be very likely to last longer than six months.

It is not necessary for a disability or severe disability to have been officially recognized in order to receive participation benefits. The prerequisite is that the person must have a disability that is threatening their ability to participate in society on equal terms. 

Anyone with a disability is entitled to participation benefits. It is irrelevant how the disability came about, i.e. whether it was present at birth or developed later due to an accident or illness. However, different funding agencies may be responsible for the relevant participation benefits depending on the cause of the disability.

Benefits for medical rehabilitation (rehab) aim to prevent, eliminate, reduce or compensate for disabilities. Rehab measures also seek to prevent the worsening of existing disabilities. Where possible, rehab also aims to prevent people from becoming unable to work, requiring long-term care or becoming prematurely reliant on social security benefits.

Medical rehabilitation benefits can differ greatly depending on each individual's personal situation. Rehab measures usually take place in a hospital or a special rehabilitation facility. Medical rehabilitation benefits cover, for example:

• outpatient or inpatient treatments
• medication and medical dressings
• therapeutic services, such as physiotherapy or speech and language therapy
• medical aids, such as walking aids or communication aids for people with a hearing or vision impairment
• early intervention and support for children with a disability 
• psychotherapy
• self-help supports
• digital health apps
• functional capacity assessments and occupational therapy to determine whether someone can return to their previous job
• gradual reintegration measures to facilitate a return to work
• training to promote social competence and practical life skills

People with and without disabilities should, as far as possible, have equal opportunities in the labor market. Benefits to enable participation in working life are intended to make it easier for people with disabilities to participate in working life according to their capabilities. Details of the various benefits that are available to enable participation in working life are provided below. 

Career preparation

Various career preparation supports are available to help people with disabilities choose a career and take up training in the relevant area. These also include basic training courses, which may be necessary for people with a disability, for example, basic training in assistive technology for the blind.

Training and apprenticeships

Various supports are available for people with a disability who want to undertake vocational education and training. These include:

• training and apprenticeships in a vocational school and regular workplace, which can be adapted, if necessary, to the needs of the individual
• training/apprenticeships in a special vocational rehabilitation facility
• skilled practitioner training (“Fachpraktiker-Ausbildung” in German), which focuses more on the practical skills needed for a specific occupation and less on theoretical aspects

If these training options are not possible due to the severity of the disability, other training opportunities are available in workshops for people with disabilities. These workshops provide 1:1 support and allow people to learn skills that match their interests and capabilities. Workshops for people with disabilities also aim to support them in transitioning into the general labor market.

Training budget

A training budget is also available to help people with disabilities transition into the general labor market. The budget is available to people who work or are capable of working in a workshop for people with disabilities and enables them to undertake standard vocational training. 

Companies that take on people with disabilities as trainees/apprentices are reimbursed for trainee allowances and social security contributions via the training budget. Other costs are also covered, such as the costs of supporting and guiding trainees in the company or vocational school.

Supported employment

Supported employment aims to support people with disabilities to find employment that is subject to social security contributions. Supported employment programs include individual in-company qualifications (“InBeQ”). These allow people with disabilities to find and try out a job in a company. They receive intensive training and are given an opportunity to learn the specific knowledge and skills needed for the job.

Ongoing job support (“Berufsbegleitung”) is also possible as part of supported employment. Ongoing job support is available to people with disabilities who are in employment but who need support in order to stay in their job.

Budget for work

The budget for work enables people with a disability to obtain employment in the general labor market. The budget for work is available to people who:

• are working or could work in a workshop for people with disabilities or a similar facility
• cannot currently or cannot yet be employed in the general labor due to the nature or severity of their disability and wish to begin standard vocational training

The budget for work reimburses employers for the greater part of their wage costs for employees with disabilities. This acts as a form of compensation for any lower work performance by employees with disabilities compared to those without disabilities. The budget for work can also be used to fund ongoing support and guidance in the workplace for people with disabilities.

Other benefits to enable participation in working life

There are many different benefits to enable participation in working life, including additional aids and measures. For example, support is available for people to start their own business and funding can be provided for career changes, professional development courses or job coaching. These benefits also include workplace aids and personal assistants for work.

An overview of the various benefits available to enable participation in working life is provided (in German) in the leaflet Berufliche Rehabilitation: Ihre neue Chance (“Rehabilitation in Working Life: Your New Opportunity”), published by the German Pension Insurance Organization (“Deutsche Rentenversicherung”). 

Livelihood-securing benefits and other supplementary benefits are provided alongside benefits for medical rehabilitation or for participation in working life. 

Livelihood-securing benefits include financial assistance such as sickness benefit, injury benefit and transition benefit (“Übergangsgeld”). These benefits are intended to provide financial security for people who have no income, for example, due to illness or rehabilitation measures.

Supplementary benefits can be used to cover or subsidize social security contributions. Rehabilitation sports and functional training are also covered by supplementary benefits. If travel costs are incurred as a result of medical rehabilitation or a benefit to enable participation in working life, these may also be covered under supplementary benefits. The costs of a home help or childcare may also be covered in such cases.

Children, adolescents and adults with disabilities should be able to participate in education and training on equal terms with those without disabilities. Benefits to enable participation in education and training include supports for:

• preparing for school, for example, in a daycare facility
• school education
• vocational training
• academic degree programs
• further education or training in a school or college

People with disabilities are entitled to support, for example, to enable them to attend school or to remove any barriers that arise due to their disability. Benefits to enable participation in education and training include, for example, any aids or assistance they may need in this context. Possible benefits include: 

• a school support assistant
• a personal assistant – for example, to interpret sign language or help with getting around
• aids, such as special computers
• accommodation in a residential school
• special education support

However, benefits to facilitate participation in education and training go above and beyond the examples listed, and may take very different forms. The catalog of benefits is not set in stone because the benefits, are adapted to the individual. People may also avail of these benefits during full-day programs, breaks or compulsory work placements. Support is also available for distance learning.

Having a disability should not present a barrier to receiving an education at state schools and universities. Educational institutions should therefore be as accessible as possible. Accommodations can be made to remove barriers for people with disabilities in school or university. For example, they may be able to take oral exams in place of written ones.

Social participation benefits help people with disabilities to lead independent lives and to organize their daily routines and leisure time in a self-determined manner. Many different benefits are available.

Housing

Housing benefits are intended to enable people with disabilities to live in a home that allows them to lead a self-determined life. Support is available to help them find housing and to adapt their home to suit their needs. This may involve adapting an apartment to make it accessible for people with disabilities, for example, by fitting a walk-in shower.

Personal assistants

People with disabilities can also claim personal assistance benefits as part of social participation benefits. This allows them to have a personal assistant to support them on a daily basis. Personal assistants may, for example, accompany their clients to appointments with authorities, take care of household chores or help with caring for children. A personal assistant may also be funded for leisure-time activities, such as sports or cultural events.

Mobility

If a person is unable to use public transport due to their disability, they are entitled to mobility support benefits. These include transport, for example, a personal transport service and, if necessary, financial support for a car. For example, people with disabilities may receive payments to fund them in obtaining their driver’s license, buying a car and modifying it to meet their needs. In this case, the payment consists of a subsidy based on the individual's level of income. Repairs and the costs of running a car may also be covered.

Other social participation benefits

In addition to benefits for housing, personal assistants and mobility, other benefits are available to people with disabilities to promote their participation in society. These include: 

• Special education supports for children before they start school: These include various therapies, for example, as part of an early intervention program. These aim to promote the development and independence of the child as far as possible.
• Supports for foster family placement: These supports enable people with disabilities to be placed in a suitable foster family.
• Supports to help people acquire or maintain practical skills: In groups or on training courses, people with disabilities can, for example, learn how to undertake household tasks and other life skills.
• Supports to facilitate communication: These supports for people with hearing and speech impairments seek to improve facilitate communication, for example, through the use of a sign language interpreter.
• Aids to remove barriers to accessibility, such as an accessible computer.

Various bodies have responsibility for different social participation benefits. These bodies are referred to as rehabilitation funding agencies (“Reha-Träger” in German). The funding agencies provide the benefits to which a person is entitled.

The funding agency responsible in each individual case depends on which supports are needed and on the reason for the disability. For example, the Federal Employment Agency (Bundesagentur für Arbeit) is usually responsible for benefits to enable participation in working life. However, if a disability has been caused by a work-related accident, an accident insurance fund is responsible instead. In individual cases, the funding agencies will decide among themselves which is responsible for providing a particular benefit.

The various funding agencies responsible for participation benefits are as follows:

• the Federal Employment Agency: for benefits to enable participation in working life
• statutory health insurance funds: for medical rehabilitation benefits
• statutory pension insurance funds: for benefits to support reintegration into working life
• statutory accident insurance funds: for benefits in the event of work-related accidents and occupational diseases
• funding agencies for integration assistance: primarily for benefits to support independent living
• funding agencies for public youth welfare, usually youth welfare services: for participation benefits for children and adolescents with mental health conditions
• funding agencies for the compensation of soldiers and funding agencies for social compensation: for people who have suffered damage to their health as a result of violence, for example

You can determine which funding agency is responsible for benefits in your case by using the rehab responsibility navigator provided by the Federal Association for Rehabilitation (Bundesarbeitsgemeinschaft Rehabilitation, BAR).

In most cases, you will need to submit an application in order to avail of participation benefits. It is often helpful to seek advice from a contact point for the funding agencies or a center offering complementary independent participation counseling (EUTB) before submitting an application. Staff at an EUTB center will discuss with you which participation benefits you need. They can then help you fill in your application form and submit it to the correct funding agency. Alternatively, you can apply directly to the relevant funding agency yourself. 

The process for submitting an application differs depending on the individual agency involved. You can usually find information about the process on the funding agency’s website. Many funding agencies provide forms that you can download and complete. In some cases, you can also submit an application using an online form. You may also need to provide additional documents to support your application. For example, you need a prescription from a doctor in order to apply for medical rehabilitation benefits. 

It can sometimes be difficult to know which funding agency is responsible for the supports you need. However, if you happen to submit an application to the wrong funding agency by mistake, that agency is obliged to forward your application to the correct agency. 

Contact points for the funding agencies or centers offering complementary independent participation counseling (EUTB) can help you to submit your application.

What happens after I submit my application? 

After you submit your application for participation benefits, an assessment of needs (“Bedarfsermittlung”) is carried out. In the assessment of needs, the funding agency verifies the limitations your disability places on you and which areas of life are affected. The aim is to identify which benefits you need to improve your participation. Personal preferences are taken into account, which means that, under certain circumstances, you may be able to choose where and from which agency you will receive participation benefits.

The assessment of needs may determine that you need various types of participation benefits, such as benefits to enable participation in working life and social participation benefits. This means that more than one funding agency may be responsible for your benefits. In this situation, a “participation plan” is created to coordinate and align the benefits provided by the different funding agencies. Participation plans are intended to ensure that people with disabilities are provided with supports tailored to their individual needs in as seamless a manner as possible. 

A participation plan specifies, for example:

• which funding agency is responsible for which benefits
• how the individual's needs were assessed and the outcome of the assessment
• which achievable participation goals have been defined
• the outcome of the participation plan meeting

The participation plan can be modified on an ongoing basis, for example, if the individual's life circumstances or participation goals change. One funding agency takes responsibility for creating the participation plan. This funding agency is then responsible for including the other relevant funding agencies. 

When is a participation plan meeting held?

A participation plan meeting may be held to facilitate more effective coordination between the parties involved. The purpose of a participation plan meeting is to discuss the individual’s need for benefits, the aim of these benefits and the support measures required. Participation plan meetings seek to enhance the participation of individuals in receipt of participation benefits. A meeting is only held if the individual who is to receive the participation benefits agrees.

A participation plan meeting can be proposed by the funding agencies involved or by the person who is in need of the participation benefits. 

The following parties usually attend a participation plan meeting: 

• the person who is in need of the participation benefits
• if necessary, their legal representative or another person they trust, such as a family member or partner
• all funding agencies involved
• if requested, service providers, i.e. staff from the facility or clinic in which rehabilitation measures are to be carried out

What can I do if my application is not approved?

Following the assessment of needs or the creation of a participation plan, you will receive notification of the decision that has been made by the competent funding agency in regard to your application. This will inform you as to whether and to what extent your application for participation benefits has been approved. 

If your application for participation benefits was rejected even though you are eligible for these benefits, you may lodge an objection against the decision within a period of one month from receipt of the decision. An objection means that the funding agency must review your case to determine whether your application for participation benefits should be approved. If you then receive notification that your objection has also been rejected, you may file a complaint in relation to this decision within a period of one month. 

In some cases, applications may be delayed or not processed by the deadline, so that you are left waiting for a participation benefit that you urgently need. If this happens, you may organize the support or service you need yourself and apply for reimbursement for the cost retrospectively. It is also possible to take court proceedings to obtain provisional benefits. However, if you do so, you run the risk of having to bear the costs of any participation supports you organize yourself if the funding agency subsequently decides that you do not need them. In situations like these, it’s best to seek advice and, if necessary, legal assistance.

Given the wide range of participation benefits available, seeking advice in relation to your individual situation is often essential. This can help you to gain an overview of the options open to you before you submit an application for participation benefits. It can also help you to figure out how and where to submit your application. 

You can seek advice from a contact point for the funding agencies or from a center offering complementary independent participation counseling (EUTB). Both sources offer this advice free of charge. 

Contact points for the funding agencies provide comprehensive advice about the various participation benefits available. EUTB centers provide advice independently of the funding agencies. EUTB in particular aims to enhance the self-determination of people with a disability and those at risk of disability. 

Advice centers provide people with a disability with a range of information, in particular information about: 

• their rights and obligations
• various participation benefits
• the personal budget
• the various funding agencies and which are responsible for which benefits 
• submitting an application for benefits and how the application is then processed

You can search for your local contact points for the funding agencies on the “ansprechstellen.de” website of the Federal Association for Rehabilitation (BAR).

On the website for complementary independent participation counseling (EUTB), you can find details of the various sources of advice and find an advice center in your local area.