Healthy living Support options for parents who are ill

Parents often have a lot to deal with during everyday life, with working mothers and fathers in particular juggling between their jobs, household duties and childcare. If one parent suddenly becomes ill, the usual structure of things can quickly become unstable. Families then face the challenge of restructuring everyday life and organizing help. 

In many cases, a parent becoming chronically ill or disabled also fundamentally changes everyday family life. Children sometimes have to take on responsibility at an early age, which can lead to strain and insecurities. Emotional challenges such as worries, fears or the feeling of being “different” can also be unsettling.

It is in these kinds of situations that families need support to cope with family life and raise children. Depending on the situation, there are various help services that can ease the load for affected parents and support children in their healthy development. Our article offers you an overview of various help services available to families if parents develop a temporary or longer term illness.

In the case of an acute illness, it can be useful to involve friends, relatives or neighbors – whether for grocery shopping, domestic tasks or childcare. But this kind of support is not always available. If this is the case, under certain conditions, home help services can take care of domestic tasks, for example by taking on everyday tasks such as laundry, cleaning, grocery shopping or cooking. Depending on requirements, they can also help with childcare.

When will health insurance funds cover the costs of home help?

Parents are entitled to home help under certain conditions. Key conditions include:

• The person’s inability to perform household tasks for health reasons must be medically certified.
• A child under the age of 12 or a disabled child in need of assistance lives in the household.
• No-one else lives in the household who could take on the domestic tasks.

People should contact their health insurance fund as early as possible to apply for home help. Applications cannot be made retrospectively.

Good to know: People with health insurance who do not have any children in the household can still be entitled to home help if unable to perform their domestic duties due to serious illness or the acute deterioration of an illness, especially after a stay in hospital, an outpatient operation or outpatient hospital treatment. Eligibility depends on them not having been assigned a care level of 2 to 5 and there not being anyone else living in the household who could perform the tasks.

Furthermore, some health insurance funds offer voluntary benefits (supplementary benefits known as “Satzungsleistungen”) and also support families when children aged between 12 and 14 live in the household. It is therefore worth inquiring directly with your own health insurance fund. 

Who can provide home help?

After approving an application, the health insurance fund must organize home help. If the health insurance fund is unable to do this or there is a reason for it to refrain from doing so, people can also organize their own home help. This is usually the desired option if insurance holders value having someone they trust run their household. The costs incurred can then be reimbursed by the health insurance fund.

Which costs are covered?

Health insurance funds generally cover reasonable costs. If a spouse or close relative performs the household tasks, health insurance funds only cover the costs if travel costs or a loss of earnings can be proven. For the costs to be reimbursed, they must usually not be higher than what a professional home help service would charge. In other words, the expenses must be reasonable and comparable. Close relatives include immediate relatives and up to second-degree relatives, i.e. parents, grandparents, siblings or brothers-in-law and sisters-in-law. 

What tasks can the person providing home help take on?

People providing home help take on activities that are unavoidable and essential when running a household. For example, these include grocery shopping, cooking, washing, ironing, sewing, cleaning and taking care of laundry, clothing and the house. Home help services also provide support with childcare, for example by feeding and supervising children. 

For how long is support available and does a co-payment apply?

People can apply for home help for a maximum of 4 weeks per case of illness. If a child aged under 12 or a child with a disability lives in the household, the entitlement extends to a maximum of 26 weeks.

The insurance holder must contribute 10 percent of the costs of home help each day, but a minimum of 5 euros and a maximum of 10 euros per day. Co-payment does not apply if home help is needed in the context of a pregnancy or birth.

What is a family support worker?

If parents are ill and need everyday support, a family support worker can help. Such workers are specially trained and not only provide support with household tasks but also with childcare.

If help is only needed for a limited period, health insurance funds may cover the costs within the scope of home help. This can be obtained by submitting an application and presenting a medical certificate.

In some cases, a family support worker can also provide support over the longer term within the scope of non-residential family support services. Further information in this regard is provided in the next section.

There are some emergency situations where parents or single parents are no longer able to independently cope with looking after their children, for example if one parent can suddenly no longer help out due to illness or a single mother needs support with her children on an everyday basis due to a chronic illness. In such cases, non-residential family support services can help if at least one child aged under 14 lives in the household. This support is free.

The aim of non-residential family support services is to enable children to remain in their usual environment and continue their normal daily routine despite difficult situations. The family support worker provides bridging support if the care provided by daycare facilities or family members does not suffice.

Family support workers take on an array of tasks. Just a few examples include:

• Caring for the children at home and playing with them.
• Collecting the children from daycare facilities or school.
• Taking the children to medical appointments, sports clubs or other appointments.
• Helping with homework.
• Taking on domestic tasks.

The youth welfare office is responsible for providing non-residential family support services. There are various independent providers of these services, for example social and church institutions. The work is performed by either professionally trained family support workers or trained voluntary family sponsors.

Who is eligible to apply for non-residential family support services?

An application for non-residential family support services can be made if:

• a child under the age of 14 lives in the household
• the parent who primarily cares for the child is unable to do so as a result of health or other compelling reasons (e.g., incarceration or death)
• the other parent or a family member is unable to take over the care
• the use of a daycare facility alone does not suffice
• the child should stay in his/her familiar home
• the health insurance fund does not pay for home help or the approved help is not sufficient.

To what extent are non-residential family support services possible?

The extent to which non-residential family support services are approved always depends on the individual needs of the family and the specific situation. For example, a family support worker could provide support for a few hours a day, for instance to get the children ready in the morning and take them to school or nursery and then collect them in the afternoon and look after them. In other cases, on the other hand, round-the-clock support may be required, for example if a single mother goes to a health resort and there is no other childcare option.

Non-residential family support services can also help if the health insurance fund has already approved home help. This can be useful, for example, if the home help support is not sufficient.

Example: health insurance funds usually pay for a maximum of 8 hours per day of home help. If more support is needed though, for instance because multiple children live in the household or a child needs special support, a non-residential family support worker can also help out, for example in the late afternoon or at the weekend.

Home help is also usually approved for a maximum of 26 weeks if a child under 12 or a disabled child who depends on help lives in the household. If further support is still required after this, this can be provided within the scope of non-residential family support services.

Example: following surgery, a mother is no longer able to perform domestic tasks and look after her three children. The father works full time, so can only provide support to a limited extent. The home help provided by the health insurance fund ends after 26 weeks, but the mother is still not able to look after the children and household by herself. In this case, non-residential family support services can help out until the mother has recovered from her operation.

How can I apply for non-residential family support services?

If parents need support for health reasons, the first thing they should generally do is apply for home help from their health insurance fund. If the application is rejected or the approved help does not suffice, they can then turn to the responsible youth welfare office. 

The employees consult with parents to determine exactly which support they need and help them submit an application. Compliance with all prerequisites is then checked. If the support is approved, the youth welfare office usually also arranges a suitable organization to provide the non-residential family support services. The parents/single parent can then liaise directly with this organization to discuss the level of support required and when the family support worker should come.

You can find for a youth welfare office near you on the website of the National Association of State Youth Welfare Offices (Bundesarbeitsgemeinschaft Landesjugendämter).

Parents with a chronic illness or disability sometimes face particular challenges in relation to family life. In such cases, parental assistance can help with factors such as:

• everyday childcare and support for children
• taking children to appointments, for example a pediatrician or school
• domestic tasks such as grocery shopping or tidying

The aim of this kind of assistance is to support parents with their self-determination and help them perform their role as a parent. The scope of the support is based on personal needs. It depends on factors such as personal limitations, the children’s age and support needs and other support options, for example support from relatives.

Who can obtain parental assistance?

Parental assistance is available to people with:

• a physical disability (for example impaired mobility, blindness or deafness)
• a mental illness (for example depression or addiction)
• chronic illnesses (for example rheumatism or cancer)
• learning difficulties or a cognitive impairment

Good to know: People are also entitled to parental assistance if only one parent has a disability or chronic illness. 

How do you apply for parental assistance?

The best way to obtain parental assistance is to make a written application to the responsible service provider. This is usually the organization providing the integration support. The responsible provider depends on your personal situation. If an application is accidentally sent to the wrong place, it will be forwarded to the appropriate service provider.

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). 

When completing an application, parents should describe their impairments and the areas of everyday life where support is required in as much detail as possible.

It is also important for all necessary documents to be submitted with the application. For example:

• proof of the disability or illness (e.g., a severe disability pass or a medical certificate)
• proof of income and wealth

A sample application and information about the necessary evidence can be found from page 98 of the brochure on parental assistance provided by the Federal Association of Disabled and Chronically Ill Parents (Bundesverband behinderter und chronisch kranker Eltern e.V.).

Following an application, a “needs assessment” is conducted. The service provider uses this to determine whether and how much help is needed. To assess the precise need for support, a home visit may take place or applicants may be invited to an interview.

It is also possible to obtain parental assistance in the form of a “personal budget”. In this case, instead of the service itself, people receive a monthly payment that they can use to independently organize and pay for parental assistance. Further information can be found in our article about the personal budget. 

Further information about parental assistance can be obtained from the Federal Association of Disabled and Chronically Ill Parents (bbe e. V.). This also provides a brochure on the topic of parental assistance, which is also available in simple language. The website also provides a nationwide search function for finding parental assistance.

Advice about parental assistance can be obtained from the Complementary Independent Participation Advice Center (Ergänzende unabhängige Teilhabeberatung – EUTB) among other sources.

If parents need support with raising their children, there are several services available from the youth welfare office. These are referred to as parenting assistance. This assistance ranges from consultations to accommodation in a home, depending on what is expedient and necessary on a case-by-case basis.

Parenting assistance aims to protect the well-being of children and adolescents as well as to help parents who can no longer cope on their own. The support should help to overcome difficult situations and safeguard the children's growth and well-being.

Who can receive parenting assistance?

There are various instances where parenting assistance can support families in difficult situations. For example, if:

• parents are no longer able to cope with everyday family life, for example due to the strains of poverty or persistent unemployment
• crises occur, for example following a separation or divorce or due to relationship conflicts
• one or both parents are no longer able to adequately care for their child due to a mental disorder or addiction
• the family is affected by violence or neglect
• children or adolescents with mental health problems or abnormalities react, for example, with aggression, self-harm or depression
• children or adolescents have severe learning difficulties and may frequently play truant from school

In other words, parenting assistance can be used whenever the well-being of children or adolescents is at risk. It can be obtained by all parents or guardians. It is also possible for children, adolescents and young adults to independently obtain help from the youth welfare office – including without their parents’ knowledge. 

What assistance is available and how is it applied for?

Parenting assistance comprises various support services for families, children and adolescents – depending on the family’s individual needs.

All family members can obtain support from family and parenting advice centers. In addition to parents and guardians, it is also possible for children, adolescents and other relatives to turn to advice centers. The youth welfare office either offers consultations itself or refers people to a local advice center. 

It is also possible to contact an advice center directly. Nearby advice centers can be found on the website of the Federal Conference for Parenting Advice (Bundeskonferenz für Erziehungsberatung).

You can find for a youth welfare office near you on the website of the National Association of State Youth Welfare Offices.

Parental advice services are voluntary and free. They provide easily accessible support, for example in cases of frequent family disputes, parental separation, questions about parenting matters or if a child is behaving abnormally. Many other counseling topics are also covered – depending on the personal situation.

If families need more intensive support, they can apply for parenting assistance from the youth welfare office. The team at the youth welfare office then look at exactly what support is needed within the scope of “assistance planning”. This usually involves multiple discussions before longer term help is planned.

The type of assistance that a family receives can differ greatly. Depending on the family’s needs, examples include:

• non-residential support in a familiar environment: A social education specialist regularly visits the family in their home or accompanies the children during their everyday life. Such specialists help to organize family life and with parenting matters. They also help children and adolescents cope with everyday life, for example at school or with friends.
• Semi-residential support in a day group: the child spends several afternoons a week in a group with other children.
• Residential support in a residential group or foster family: this is an important form of help if the child is temporarily unable to live at home.

Who offers parenting assistance?

Assistance is usually provided by independent organizations linked to the youth welfare services. These employee social education specialists who are able to optimally advise, assist and support families.

Who covers the costs?

All non-residential parental assistance is free for families. The city or municipality cover the costs.

If the child or adolescent is partly or completely cared for outside the family (for example in a care group home), the natural parents must contribute to the costs depending on their income. In the event of a low income, a cost contribution in the amount of the child benefit must be made.

Further information about parenting assistance can be found on the website of the National Association of State Youth Welfare Offices.

Having young children – and even during pregnancy and just after the birth – can pose many everyday challenges. Families with children under three can make use of numerous support options in the form of early prevention services. These are free of charge. 

The services are particularly aimed at parents/single parents who

• feel overwhelmed, helpless or exhausted by everyday life with their child
• feel like they may not be able to properly care for their child
• feel alone with their child 
• no longer know why their baby is crying so much
• argue a lot with their partner

The services include support from a family midwife or family pediatric nurse.
Full information about early prevention services can be found in our article Postnatal support for families.

You can search directly for early prevention services in your area on the website elternsein.info.

As individual youth welfare offices are responsible for setting up early prevention services, you will also find contact details for your local point of contact for early prevention support on the website of your local youth welfare office (“Jugendamt”).
You can find the relevant youth welfare office on the website of the Federal Association of Youth Welfare Offices (Bundesarbeitsgemeinschaft Landesjugendämter).

Voluntary support can be an important part of relieving the strain of everyday family life. Voluntary organizations offer various sponsorship and support services to assist families. These are partly aimed at parents with certain illnesses, for example an addiction, mental illness or cancer. 

With a sponsorship, volunteers regularly take care of children, playing with them, listening to them and doing things together. This gives children someone reliable to turn to if they cannot always turn to their parents.

The services differ from region to region. It is worth asking a local parenting advice center or family center whether there are any suitable services nearby.

In Berlin, for example, the Don’t Forget Me (Vergiss mich nicht) project arranges sponsorships for children with parents with an addiction. AMSOC e.V. uses sponsorships to offer support to children of parents with a mental illness.

Parents, single parents and other guardians with an illness can turn to various places for guidance and support:

The local youth welfare office is responsible for all matters relating to parental assistance, non-residential family support services and child protection.

You can find for a youth welfare office near you on the website of the National Association of State Youth Welfare Offices (Bundesarbeitsgemeinschaft Landesjugendämter).

Local parental and family advice centers also provide further assistance. Nearby advice centers can be found on the website of the Federal Conference for Parenting Advice (Bundeskonferenz für Erziehungsberatung).

Advice can also be obtained from independent providers with a link to youth welfare services, for example welfare organizations such as Caritas, Diakonie, the German Red Cross or the Workers' Welfare Association (Arbeiterwohlfahrt – AWO).

It is sometimes worth contacting local family centers. These often offer unbiased advice and are very familiar with local support services such as voluntary sponsorships.

The Complementary Independent Participation Advice Center offers support with all matters relating to participation, for example in questions of parental assistance.

The Consumer Advice Centers and the Independent Patient Advice Service for Germany (Stiftung Unabhängige Patientenberatung Deutschland – UPD) provide advice on patient rights and other health-related topics, for example.

Various associations and initiatives also provide advice and support to families with chronically ill parents:

The Federal Association of Disabled and Chronically Ill Parents promotes the exchange of experiences between parents, for example through regional discussion groups. The website also provides useful information for parents who are chronically ill or disabled.

The Netz und Boden (“Net and Ground”) initiative provides advice to families with mentally ill parents. 

NACOA Germany – the National Association for Children of Addiction (NACOA Deutschland – Interessenvertretung für Kinder aus Suchtfamilien e.V.) provides a Germany-wide search for non-residential support services for families with parents with an addiction.   

The Pausentaste (“Pause Button”) website provides information about the practical and psychological support available to children and adolescents with ill parents.