Help for care: Authorisation Unfortunately this specification of service has not yet been completely translated.
Persons who have health-related impairments of self-employment or skills and therefore need help from others may be entitled to assistance for care under the Twelfth Book of the Social Code (SGB XII). The need for help may be due to physical, cognitive or psychological impairments or health-related strains or requirements that cannot be compensated and met independently. The medical service of the health insurance (MDK) shall determine whether and to what extent there is a need for care. The MDK is commissioned by the responsible nursing care fund when an application for care insurance benefits is submitted. The yardstick for the assessment is the degree of self-reliance of the human being. The focus is on how independently people can cope with their everyday life. To this end, his abilities in various areas of life are assessed: mobility, cognitive and communicative skills, behaviours and psychological problems, self-sufficiency, dealing with disease-related requirements and strains, shaping everyday life and social contacts. The MDK uses a points system to determine how independent a person is. The following applies: The more points the person receives, the higher the level of care and the more care and care is required. The social assistance institution is also, in principle, bound by the findings of the MDK. If someone is not insured for care and therefore does not have an expert opinion of the MDK and no classification in a care level by the nursing fund, the social welfare provider has to determine the necessary nursing needs and intervenes the health office with a request for an opinion on the scope of the necessary care services. Where possible, the desire to be cared for at home should be given priority over inpatient care under the Social Assistance Law (Section 13 SGB XII). Patients in the case of home care are entitled to basic care and home care as a benefit in kind for care assignments of outpatient services and social wards (home care assistance) Alternatively, it is possible to receive a care allowance if patients can thus provide basic care and home care themselves. A combination of money and benefits in kind is possible. The range of benefits of long-term care insurance also includes offers in case of prevention of the caregiver (home care), day or night care (semi-stationary care) as well as short-term care (temporary inpatient care). Patients in need of care are entitled to care in full-time care facilities if home or semi-inpatient care is not possible or is not considered because of the specific nature of the individual case. In addition, care aids and technical aids, grants for measures to improve the individual living environment and care courses for relatives and volunteer carers can be granted. Carers or carers and friends may, where appropriate, receive social security benefits for the carer in the form of contributions to the relevant pension insurance institution Depending on the type of benefit, the long-term care insurance benefits are only covered up to certain limits. In the case of full-time care, the costs of accommodation and meals are not covered, as these are also to be borne in the home environment. If patients are not able to cover uncovered residual costs, social assistance benefits (SGB XII) are eligible in this respect. However, social assistance as state aid only occurs if the income and assets of the persons in need of care - and possibly the spouse or civil partner - are not sufficient. Dependent relatives are only used if their total annual income exceeds EUR 100,000 each (Section 16 SGB IV, Common Social Security Rules).
The necessary evidence shall be the same as that necessary for the decision to grant assistance under SGB XII (including assistance for subsistence). In addition, the medical opinion of the MDK and the decision of the nursing insurance fund on the classification in a care degree and the benefits from the long-term care insurance must be submitted to the applicant insured persons. In the case of non-care-insured persons, a medical report should be attached; the assessment shall be initiated by the authority responsible for granting assistance for care.
In principle, only patients in care grades 2 to 5 receive the benefits of care assistance. Care grade 1 patients are (only) entitled to care aids and measures to improve the living environment due to the low level of impairment. In addition, a relief amount of currently a maximum of EUR 125 per month will be granted. There is no entitlement to care assistance below grade 1. However, care assistance is only provided to the extent that his or her own resources are insufficient, that the person or persons in need of care cannot bear the costs of care themselves from their income or assets and does not receive them from others, in particular the long-term care insurance. This may be the case if the persons in need of care are not insured in the long-term care insurance or if they do not yet meet the pre-insurance periods or if the benefits of the long-term care insurance are not sufficient.
As of January 1, 2017, the current care levels "0", 1, 2 and 3 were replaced by the five new care levels 1, 2, 3, 4 and 5. Since then, nursing degree 1, care level 2, care level 3, care level 4 and care level 5 have been used to classify the need for care of those affected. Under the Second Nursing Strengthening Act (PSG II), these amendments are intended to guarantee the same care services for the elderly with dementia as to those in need of physical care.
Care-insured persons first contact the competent care fund to clarify which benefits they are entitled to and how much. Only if these benefits are insufficient or are not available at all can assistance for care be requested from the competent social assistance institution. This prompts the health office to determine the need for care and the necessary need for assistance in the case of persons not insured in the statutory long-term care insurance. If the conditions are met and the income and financial circumstances do not preclude the granting of assistance for care, a decision on authorisation shall be issued.
Responsible for the content
Lower Saxony Ministry of Social Affairs, Health and Gender Equality
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