Rights and conditions for moving to a residential care home
Information about Rights & Duties of #Care provision
Information about Rights & Duties
Rights and conditions for moving to a residential care home
There are various different kinds of residential care homes, such as retirement homes and nursing homes. In the field of statutory nursing care insurance, operators of establishments run according to a range of organisational and nursing concepts can apply for a permit to provide residential treatment, care and support for care-dependent individuals under what is referred to as a _supply agreement_. This supply agreement is a type of contract between nursing care insurance companies and operators of care establishments that sets out the benefits in cash and in kind to which insured individuals are legally entitled. One important eligibility criterion is that the insured individuals must have long-term nursing care needs that mean they require professional support and care as well as constant monitoring by a qualified carer.
Legal provisions: Section 72 and Section 71, para. 2 of the German Social Code, Part XI [SGB XI] _ Eligibility for care
What criteria must a person meet in order to be eligible to enter a public/state-run care home?
Private care homes and care homes run by local governments or non-profit organisations are essentially open to all people. In order to receive financial support under their nursing care insurance, residents must be dependent on nursing care. Whether or not this is the case is determined by the Medical Service or other assessor contracted by the individual's nursing care insurance company as part of a structured procedure and in accordance with a set of assessment guidelines. Care-dependent individuals requiring a degree of care classified as between 2 and 5 according to the German system are eligible for a place in a fully residential care home. In such cases, nursing care insurers will make fixed insurance payouts directly to the care home.
Almost everyone in Germany has insurance through one of the two branches of compulsory insurance. Nursing care insurance is part and parcel of statutory healthcare insurance, meaning that anyone with statutory healthcare insurance is automatically covered by statutory nursing care insurance as well. People with private healthcare insurance who are insured against the risk of illness and hospitalisation must also take out insurance to cover the risk of them requiring nursing care.
As insurance providers, the nursing care insurance funds are subject to a statutory service guarantee in connection with their service obligation to ensure that the people they insure receive adequate care. They do not operate their own care establishments, but instead conclude supply contracts and compensation agreements with operators of residential care homes and outpatient care and support services, as well as with certain self-employed carers where appropriate.
Any establishment that meets the authorisation requirements has a legal right to obtain a permit to provide services. Those in need of care may choose from among different types of establishment: private establishments, establishments run by local government, and establishments run by not-for-profit organisations.
What kind of financial contribution is required for public/state-run care homes, and who is responsible for paying it?
Statutory nursing care insurance is intended to help mitigate the physical, psychological and financial consequences of care-dependency for insured persons and their relatives. However, nursing care insurance does not cover all of the costs incurred by policyholders in relation to their care; it only offers specific in-cash and in-kind benefits (principle of partial performance). If the total costs of an individual's care exceed the legal ceiling for nursing care insurance contributions, the difference in costs must be borne by the care-dependent individual. In addition, the cost of living (accommodation, food, capital costs/maintenance) must be borne by care-dependent individuals themselves. People in financial difficulty may receive welfare benefits to help pay the costs of their care (see in particular Section 28ff; care benefits in accordance with Sections 61 to 66 of the German Social Code, Part XII).
Are there rules on how much privately-run care homes can charge for their services?
The same authorisation and compensation rules prescribed by law apply to private care homes as to care homes run by local government or not-for-profit organisations. The contractual provisions set out in the relevant supply agreement are always binding on all contractual parties. These provisions specify that the nursing care compensation rates and care fees agreed between the funding agencies (i.e. the nursing care insurance funds and welfare agencies) and operators of establishments must be cost-efficient and performance-based; subsequent reimbursement of costs is not possible. There is no differentiation between the different types of establishment.
Any compensation amounts that exceed the nursing care insurance ceiling or, in residential care, the costs of accommodation and food (and capital costs where applicable) are charged to the person requiring care by the care establishment itself. Since January 2017, within a particular establishment the amount of residents' own care-related, establishment-specific contributions has been the same for all persons in full-time residential care and in need of a degree of care between levels 2 and 5.
Separate, supplementary compensation that is not chargeable to care-dependent individuals themselves may be claimed by residential care homes in the form of employment subsidies for the provision of care and leisure activities for care-dependent individuals. This compensation may not exceed 5% of existing staff costs. In addition, upon request these subsidies may be used to cover the recruitment of carers to new or existing roles. The amount of these subsidies depends on the size of the establishment.
Is financial support available to cover the costs of residential care?
As a result of the funding provided by the federal states for investment measures in care homes, those establishments do not have to raise their fees in order to cover the costs of investments. This means that even care-dependent individuals with a low income will be in a position to cover their own contributions out of their own income. In this way, the investment funding programmes contribute to preventing welfare dependency and reducing welfare costs.
Under certain conditions, welfare providers/the Welfare Office [ Sozialamt ] will bear the costs of care if an individual does not have sufficient financial resources and cannot rely on relatives to pay the costs of their care.
If an individual's nursing care insurance is not sufficient to cover their care needs and they cannot afford to pay their own contributions themselves, they may be eligible for nursing care welfare payments . These welfare payments are a form of subordinate welfare benefit that find their legal basis in the German Social Code, Part XII, Chapter 7. If the conditions for eligibility are met, i.e. if the person is care-dependent and in need of financial support, they will receive needs-based welfare payments.
Under the provisions on benefits in kind found in Section 43 of the German Social Code, Part XI, each month the nursing care insurance funds will cover the costs of care-related expenses including those in relation to personal support and medical treatment up to the following amounts:
Care level 2: €770
Care level 3: €1262
Care level 4: €1775
Care level 5: €2005 Individuals classed as falling under care level 1 will receive a monthly allowance of €125.
Care-dependent individuals are also entitled to additional support services and activities in the care establishment (Section 43b of the German Social Code, Part XI).
See Section 6 and Section 11 of the German Social Code, Part XI