Social assistance; applying for care assistance

If you are in need of care and the benefits from the care insurance fund and your income and assets are not sufficient, you can receive care assistance benefits under certain conditions.

Persons who are in need of care are entitled to care assistance in accordance with Social Security Code XII if they and their spouses or partners who are not separated cannot reasonably be expected to raise the funds required for care assistance from their income and assets. Furthermore, an entitlement to care assistance only exists insofar as the need for care cannot be covered by other benefit entitlements (e.g. benefits from social care insurance or private care insurance). This means that people who are insured under social long-term care insurance or who are entitled to benefits from other benefit systems in the event of long-term care can receive supplementary benefits as part of long-term care assistance if the care benefits to which they are entitled are not sufficient to cover their overall care needs. If there are no overriding entitlements to benefits, the social welfare provider may also cover the total care requirement as part of the care assistance.

The amount of long-term care assistance benefits depends on the amount of long-term care insurance benefits and whether the beneficiary's own income or assets or those of persons obliged to provide maintenance can be used to cover the costs of care.

In the case of beneficiaries who are not covered by long-term care insurance, the entire care requirement may be covered by long-term care assistance benefits.

Care assistance benefits include, for example

• Home care (e.g. care aids, care allowance),
• partial inpatient care,
• short-term care,
• measures to improve the living environment,
• inpatient care (in a nursing home).

The Medical Service of the Health Insurance Fund determines whether and to what extent care is required.

The social welfare provider is generally bound by the findings of the Medical Service of the Health Insurance Fund.

• When applying, the following documents in particular are required:
  • Identity card or passport (or other documents that can identify the person beyond doubt)
  • If applicable, a statement from the long-term care insurance fund and an expert opinion from the medical service of the health insurance funds
  • Medical documents, if available
  • If applicable, notice from the pension office on the determination of a degree of disability (e.g. severely disabled person's ID card)
  • Proof of health and long-term care insurance
  • Rejection notice from the health or nursing care insurance fund, including justification
  • Proof of income
  • Proof of assets (e.g. for capital-forming insurance (life insurance, building society savings insurance, Riester pension contracts, death benefit insurance, funeral provisions and similar), savings accounts, land, real estate, valuables, motor vehicles)
  • Bank statements
  • Rental agreement, if applicable, letter of rent adjustment
  • Additional documents may be required. The scope of the documents required depends on the specifics of the individual case.

• In principle, only those in need of care in care levels 2 to 5 receive care assistance benefits. People in need of care in care level 1 are (only) entitled to care aids and measures to improve the living environment due to the minor nature of their impairments. In addition, a relief amount of currently a maximum of 125 euros per month is granted.
• However, care assistance is only granted to the extent that the person in need of care does not have sufficient resources of their own, is unable to cover the costs of care themselves from their income and assets and does not receive it from others, in particular the care insurance. This may be the case if the person in need of care is not insured under long-term care insurance or has not yet fulfilled the pre-insurance periods or the long-term care insurance benefits are not sufficient. The income limit in Section 85 of the Social Security Code XII applies to long-term care assistance (basic amount of twice the standard needs level 1 + 70% of the standard needs level 1 for other family members + reasonable accommodation expenses. If assistance is provided on an inpatient basis, it may be possible to use income below this income limit.

An appeal may be lodged against the decision of the competent authority within one month of notification.

Once the objection procedure has been concluded by a notice of objection, an action may be brought before the Social Court within one month of notification.

• People with long-term care insurance should first contact the relevant long-term care insurance fund to find out what benefits they are entitled to and how much they are entitled to. Only if these benefits are not sufficient or no benefits at all are due can care assistance be applied for from the responsible authority.
• In the case of people who are not insured under the statutory long-term care insurance scheme, this authority will arrange for the need for long-term care and the necessary assistance to be determined by the public health department.
• If the requirements are met and the income and financial circumstances do not prevent care assistance from being granted, an approval notice will be issued.

This assistance begins as soon as the competent body or a body commissioned by it becomes aware that the conditions for the benefit are met.

A decision on the application will be made immediately. The processing time depends, among other things, on the completeness of the information and the submission of the evidence required for processing the application.

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