Level of care 2
With the change from care levels to care grades, all patients with care levels 0 and 1 were automatically transferred to care level 2. In addition, this level of care is attributed to people whose independence is significantly impaired. This requires a score of 27 to 47.5 in the new appraisal assessment.
Those in need of care receive a monthly care allowance of 316€ if they are cared for at home by relatives. In addition, they are entitled to care benefits in kind of 689€ per month, which are settled by outpatient care services directly with the care insurance companies themselves. Dementia patients receive thereby clearly more care money than before in the care stage system. In addition, there is the new uniform “relief contribution” of 125€ per month, with which those in need of care can pay for example for shopping assistance or domestic help. If short-term care is needed after a stay in hospital, the nursing care insurance funds pay subsidies of up to € 1,612 per year for up to four weeks.
Level of care 3
Dementia patients with previous care level 1 and people with care level 2 are now assigned care level 3. Persons in need of long-term care with a severe impairment of independence. In the NBA of the MDK, the score to be achieved for care level 3 is between 47.5 and 70 points.
The severely care-needy persons receive a monthly care allowance of 545€ with a home care by relatives as well as care benefits in kind by an ambulant care service of 1. 298€ per month. In addition there is the mentioned relief contribution of 125€ monthly for domestic help, purchasing assistance or the like.
Maintenance level 0
The criteria for the allocation of care levels is a recurring topic of public debate. A particularly controversial topic is dementia, especially Alzheimer’s dementia, but also other mental illnesses. The classification is often perceived by relatives as unfair and inconsiderate.
These conditions are caused by the priorities that are set in various decisions regarding the assessment. Basic care must be guaranteed. This includes personal hygiene, daily dressing, going to the toilet and eating and drinking.
In addition, the routes that have to be taken to carry out the various activities must be mastered. Leisure activities and measures that positively influence the illness are not included. Care level 1 means that a daily time of at least 90 minutes is required to allow the patient to live in their own four walls.
At least half of this time must be spent on activities that belong to the area of basic care. In particular, dementia patients, who often do not have any major physical limitations, are still able to brush their teeth on their own even with their disease or to dress completely in the morning when things have been laid out in the evening. It is precisely this independence that should be maintained as long as possible and not be suppressed by care.
However, the final report often lacks exactly these minutes, which the patient does not need help to reach a level of care. Care level 0 provides a remedy here. This is a service that must also be approved, but for which “only” a “limited everyday competence” must be present.
Since 2015, financial support amounting to 208 euros per month has been available, enabling patients to take advantage of additional gerontopsychiatric (gerontopsychiatry = the specialist area for mental illness in older people) services. The nursing reform adopted in 2015 also provides for a nursing allowance of 123 euros for persons belonging to the patient group in question. Monthly benefits in kind of a maximum of 231 euros can be paid.As already mentioned in “Care level 0”, care level 1 is defined by a nursing effort of at least 90 minutes.
More than half of this time must be spent on assistance with at least two activities that cover the area of basic care (personal hygiene, daily dressing, going to the toilet and taking in food and drink). By the time 90 minutes of nursing time are accumulated, the dementia must have progressed so far that the patient’s daily activities are restricted accordingly. This point in time can occur sooner or later, depending on the type of underlying disease, but also on the individual condition of the patient.
If care level 1 is reached, this results in a monthly care allowance of 244 euros since 2015. If a nurse is hired or a nursing service is commissioned to care for the patient, up to 468 euros are paid in kind. If the costs of nursing activities, whether carried out independently or by specialist staff, exceed the payments made by the health insurance funds, this usually cannot be changed. If, over time, it becomes apparent that the level of care is no longer appropriate and needs to be increased, a new application for review can be made.
