What the care grade means
Care grades 1 to 5 describe how strongly independence in everyday life is impaired: from minor limitations (grade 1) to the most severe (grade 5). The grade determines which benefits are open to you: care allowance, in-kind care through a home care service, further support. What the individual grades mean in daily life is explained in Care grades 1 to 5; an overview of the benefits is on Costs and care insurance.
Important: nothing happens without an application. The care fund only acts once you or an authorised person get in touch, and benefits start at the earliest from the month of application. So act early, even if you do not yet have every document together.
Who may apply
The insured person applies themselves. If they no longer can, an authorised person takes over, for example under a power of attorney, or the legal guardian. Relatives without authorisation can make contact and prepare everything; the signature, however, must come from the insured or the authorised person.
If no power of attorney exists yet, it is worth settling that now, while it is still possible together and in peace. It saves many detours later, not only with the care fund.
Step 1: submitting the application
The application goes to the care fund of the person needing care; it sits within their health insurer, and the phone number is on the insurance card. A phone call or an informal letter is enough: “I hereby apply for benefits of the long-term care insurance.” The forms are sent to you afterwards.
Note the date of your first contact: it counts as the application date and decides from when benefits can be granted. Whoever calls in October and receives the decision in December is paid from October, not from December.
Special case: hospital and rehabilitation
If the need for care becomes apparent during a hospital stay, the clinic's social service helps with the application and the assessment is accelerated so that care is in place after discharge. Approach the social service actively, ideally several days before discharge rather than on the last day. How the transition home succeeds is also described in First steps after the diagnosis.
Step 2: the assessment at home
After the application, the care fund commissions an assessment, for statutorily insured people usually through the Medizinischer Dienst, for privately insured people through Medicproof. The assessment happens at home, where everyday life takes place. What counts is not the illness itself but independence across six areas of life, from mobility and self-care to shaping the day.
The appointment is announced in writing or by phone. It usually lasts about an hour and takes the form of a conversation with small observations: how the person stands up, how steady the walk is, how transferring works. Nobody has to undress or perform exercises.
How to prepare the visit
Show everyday life as it really is; independence polished out of politeness creates a wrong picture that is hard to correct later. These preparations help:
Checklist for the assessment
- A list of all medicines with dosages
- Current medical reports, discharge letters and diagnoses
- An overview of aids in use (walker, shower stool, glasses, hearing aid)
- A care diary: for one or two weeks, note where help is needed daily
- Names and contacts of the treating doctors
- A trusted person who joins the visit and honestly completes the picture
- Raise the uncomfortable parts too: night-time help, incontinence, falls
The care diary is the most effective tool of all: it replaces memory with notes and takes the pressure off the appointment. How to keep one without it becoming a burden is shown in Keeping a care diary.
Step 3: the decision, and what follows
The care fund communicates the result in writing: the determined care grade and the benefits linked to it. Statutory deadlines apply to the processing; if the fund does not respond within a reasonable time, ask politely and note the conversation.
The real work begins with the decision: bringing the benefits into everyday life. First clarify whether care allowance, in-kind services or a combination fits your situation, and have the care fund or a care service calculate it with you. A clear introduction is What the care fund pays.
If you disagree with the result, you can object; the exact deadline is in the legal remedies notice of the decision. If the condition worsens later, an upgrade application is possible at any time. Both routes, cleanly separated, are described in Increasing a care grade.
Frequently asked questions about applying
No. The application, the assessment and the decision are free for insured people. The care counselling offered to you after the application is free as well.
The care fund is bound by statutory deadlines and usually responds within a few weeks; in urgent situations, for example after a hospital stay, it is faster. The application date remains decisive: benefits are granted from that month, not from the decision.
You then receive a decision with reasons and a legal remedies notice. Within the deadline stated there you can object and request the assessment report. Many refusals rest on everyday life having looked too independent during the visit.
Yes, the person themselves is assessed, in their home. A trusted person should be there in addition: they can add what remains unsaid out of pride or forgetfulness.
Yes. You can start privately at any time or seek non-binding advice. Whether and from when the care fund covers costs depends on the decision and the application date; we clarify that honestly in the first conversation.