Level of care 4

Definition

Care level 4 describes the “most severe impairment of independence”. Persons in need of long-term care who are assigned to this care level receive corresponding benefits from the long-term care insurance. Those affected must submit an application for a level of care that is reviewed by an expert from the medical service of the health insurance company (MDK) or MEDICPROOF in the case of privately insured persons. In addition to new applications for the need for long-term care, patients with care level 3 and care level 2 plus limited everyday competence also receive care level 4.

What are the requirements for level 4 care?

In order to receive the level of care 4, an application for the level of care must first be made. The application is made by the person concerned or by a legal guardian. An assessor from the MDK or MEDICPROOF then determines the level of care required for the application using the “New Assessment Assessment” (NBA).

The NBA consists of 6 different modules, each of which, with a certain number of points, leads to a test result that assigns a degree of care to the person in need of care.

• The “Mobility” module accounts for 10% of the NBA. This includes moving or relocating the person concerned in everyday life or a change of position/situation.
• “Cognitive and communication skills” account for 7.5% of the attainable score.

  This refers to local and temporal orientation and how the person in need of care is involved in discussions. Understanding the conversations and requests also play a role in the evaluation of the communicative skills.

• Only 7.5% of the module “Behavioral and psychological problems” is also included in the study. This refers to aspects such as nocturnal agitation or aggression, both physical and verbal.
• A total of 40% of the possible score is made up of topics that fall under the area of “self-sufficiency”.

  These include personal hygiene, dressing and the food and fluid intake of the person in need of care.

• The fifth module is called “coping and independent handling of requirements and burdens caused by illness or therapy”. It is 20% of the NBA’s questions and includes, for example, injections of medication, ostomy and wound care and visits to the doctor.
• The last module is “Shaping everyday life and social contacts”. This module accounts for 15% of the score of the new assessment.

  Maintaining contacts, self-employment and the organization of daily life are important aspects in the assessment of this module. A total of 100 points can be achieved. The prerequisite for obtaining Care Level 4 is that the person in need of care receives a score between 70 and under 90 points in the NBA.