Two funds, two jobs
Two systems need keeping apart. The care fund (Pflegekasse, SGB XI) covers everyday support: personal care, help in the household, companionship. The health insurance fund (SGB V) covers medical services at home, such as medication support or wound care as medical home care on a doctor's prescription. This article is about the first pillar: the care fund's benefits.
Almost all of these benefits require a recognised care grade. Applying for a care grade: step by step describes how to get there; what the grades mean is explained in Care grades 1 to 5.
The main benefit types
Care allowance (Pflegegeld)
If relatives provide the care themselves, the care fund pays a monthly care allowance to the person in need of care; the amount depends on the care grade, and your care fund can tell you the current figures. This includes the advisory visit under § 37 Abs. 3 SGB XI, which supports family caregivers professionally: Care allowance recipients in care grades 2 to 5 must have the advisory visit every six months; in care grades 4 and 5 an additional voluntary visit is possible every three months, and in care grade 1 the half-yearly visit is voluntary.
Important for understanding: the care allowance is not a wage and not the caregiver's income. It goes to the person in need of care, who uses it freely, usually as recognition for those who help.
In-kind care services (Pflegesachleistungen)
If a home care service takes over, that is called in-kind care. Within the approved budget the service settles directly with the care fund, for example for personal care or household support; you choose the necessary visits together with the service. If requested services go beyond the approved budget, the costs belong openly on the table beforehand; that is how we handle it too.
Combination benefit
Care allowance and in-kind services can be mixed: if the care service covers part and relatives the rest, the care allowance continues proportionately. That way the help adapts to family life.
Relief amount (Entlastungsbetrag)
All care grades additionally receive a monthly, earmarked relief amount (section 45b SGB XI), for example for companionship and relief in everyday life. It is not paid out but settled against invoices of recognised providers. Unused amounts can be saved up within certain periods; your care fund explains the details.
Respite care and short-term care
If the private caregiver is temporarily unavailable through holiday or illness, respite care steps in. Short-term care covers temporary residential stays, for example after a hospital stay. Since a legal reform both share a joint annual budget that can be used flexibly. More in the article Arranging respite care.
Care aids and the home environment
The care fund also contributes to consumable care aids, such as disposable gloves or bed protection pads, and can grant subsidies for home adaptations, for example a barrier-free bathroom conversion. Here too: apply first, then build or buy.
Allowance or in-kind: how to decide
The question arises in almost every family, and there is no universally right answer. Three considerations help.
First, strength: who provides the care today, and how long can that person carry it? Pure care allowance assumes someone can do the work permanently. Second, expertise: some tasks, for example in personal care or after a fall, work better and with more dignity with trained experience. Third, the future: the need usually grows. A combination that starts small is easier to extend than a complete switch later.
A typical picture from our consultations: the daughter covers shopping and companionship, the care service comes in the morning for personal care. The family uses the combination benefit, the proportional care allowance remains, and nobody burns out. Such arrangements can be calculated with the care fund or with us before you commit.
Three misunderstandings that cost money
First: benefits do not come automatically. Even with a recognised care grade, every benefit type has to be used or applied for; what stays unused eventually lapses. The relief amount is the most frequent quiet loss here.
Second: the combination is not set in stone. If everyday life changes, the ratio of allowance and in-kind services can be adjusted; talk to the care fund rather than staying in an ill-fitting split for fear of paperwork.
Third: whoever pays a care service privately without using the in-kind entitlement gives that entitlement away. Before the first contract, have it shown to you what runs through the care fund and what actually remains as your own contribution. How the two relate is also shown on Costs and care insurance.
How to find out what you are entitled to
Checklist: clarifying your entitlements
- Check the care grade: is there one yet, and does it still match the actual situation?
- Ask the care fund for a current overview of benefits with the applicable amounts
- Decide who provides the care: relatives, a care service, or both (combination benefit)
- Check the relief amount: is it being used, or is it quietly expiring?
- Plan respite care before exhaustion arrives
- Use advice services: the care fund, a care support centre, or a local home care service
Frequently asked questions about the benefits
No. Whoever uses both uses the combination benefit: the more in-kind care the service settles, the more proportionate the care allowance becomes. Your care fund or the care service shows you the exact calculation before the contract starts.
Not immediately, but eventually yes. Unused monthly amounts can be saved up for a while and then used together; your care fund names the applicable periods. In practice the unused relief amount is the most frequently wasted entitlement.
Yes, but fewer than from grade 2. At grade 1 mainly the relief amount, advice, care aids and subsidies for home adaptation are open. Care allowance and in-kind services begin at care grade 2.
Yes. The choice between allowance, in-kind services and combination is not a one-way street; it can be adapted to a changed situation. Report changes to the care fund so the billing stays clean.
Everything medical on a doctor's prescription: administering medication, injections, dressing changes and further medical home care under SGB V. These services are independent of the care grade and often come into the home in addition to the care fund's benefits.