Nursing Care System

Those insured under the statutory health insurance do not have to submit a separate application to be included in nursing care insurance- If you have statutory health insurance, you are automatically also included in nursing care insurance. This general rule also applies if you receive benefits from the Jobcentre or the Federal Employment Agency.

If you have private health insurance, however, you must separately apply for a nursing care insurance plan.

If you receive asylum seeker benefits, you are not covered by nursing care insurance. However, according to § 6 Asylum Act, you are entitled to benefits that are essential for your health, and this can also include nursing care costs. These benefits must be applied for at the Social Welfare Office ("Sozialamt")- to do so, you can seek help from a counselling centre. To find a counselling centre in your area, visit the website of the Refugee Council.

If you need nursing care, you can seek advice from experts immediately. Counselling will help you to not only deal with mental stress caused by the situation but also to find the best solution for your specific case. An adviser can explain to you the relevant regulations and clarify the necessary steps ahead.

If you have health insurance, this is where you should start. In addition to the health insurance contributions, every insured person automatically pays a certain amount to the so-called nursing care fund ("Pflegekasse"), which is designed to support people in need of nursing care. The carrier of your nursing care insurance is your health insurance company. The health insurance companies have independent nursing care advisers, who can give you advice at no cost. If necessary, the advisers also come to your home for the session.

In addition to German, some counselling centres also offer consultation in other languages. The nursing care advisers often work in so-called care support points ("Pflegestützpunkt"). To find one of these support points nearby, you can contact your health insurance or check  bdb.zgp.de online database.

You can also initially seek advice from an Adult Migration Counseling Office (MBE). Their service is free of charge, and their staff speak different languages. Visit bamf.de to search for an Adult Migration Counseling Office (MBE) in your area.

To benefit from nursing care insurance, you must apply to your health insurance. You can submit this application in writing, by telephone or per e-mail. On the website of your health insurance company, you will usually find the proper form. Don't forget to ask for a confirmation for the receipt of your application. The Nursing Care Fund will then have 25 working days to assess if nursing care is necessary and get back to you. The nursing care insurance commissions an independent appraiser who visits you at home to assess your condition.

Please note: To receive benefits from the statutory nursing care insurance, you must have made contributions for at least two years in the last ten years.

The first thing an appraiser does is making an appointment to visit you at home, i.e. they cannot just appear at your door unannounced. If you have relatives or other caregivers, they should also be present for the interview. They can describe the situation to the evaluators and provide him/her with their opinion regarding the type, extent and place of support required. Keep in mind that on the day of the appointment, you need to have all your medical certificates and similar documents ready.

During their visit, the appraisers estimate how independent the patient can function in the following six areas:

• Mobility
• Mental and communication skills
• Behaviour and mental problems
• Self-sufficiency
• Independent treatment of illness or therapy-related requirements, such as independent and regular intake of medication
• Managing everyday life and social communications, e.g. whether the person can plan their day independently, how they can interact with other people or occupy themselves

Based on these points you will be assigned a "nursing care level" ("Pflegegrad"). There are five levels of care, from minor impairments of independence (nursing care level 1) to the heaviest Impairment of autonomy (nursing care level  5).

Once the appraiser's report is ready, the nursing care insurance will decide on your application, and their conclusion will be sent to you via post. If your application is rejected or the level of care is too low in your opinion, you can file an appeal within four weeks. On pflege.de you can learn more about the subject- but the information there is provided in German. You can also seek help from a nursing care support point nearby- to do so visit the bdb.zgp.de. online database.

With the "nursing degree calculator" on pflege.de you can calculate the nursing care degree you are likely to be assigned in advance (or even afterwards)- so you can quickly and easily find out if you are entitled to nursing care and if so, what level of care you are probably going to be assigned. The "nursing degree calculator" is only available in German.

In principle, there are three different forms of care: the person in need of care can be tended on an outpatient ("Ambulant"), semi-stationary ("teilstationär") or inpatient ("stationär") basis.

• For outpatient care, an outpatient nursing service is provided at your home every day or several times a week through which professionals present you with everything you need. If you have relatives who look after you, they can either take over the care completely or help the nursing care staff. You can read more about this type of care in our chapter "Home care".
• Semi-stationary care refers to the care provided in a nursing home if it takes place only at certain times of the day. Semi-stationary care is mostly offered as a daytime or nighttime care service. So if you can be cared for at home, but are alone (in some hours of day/night) and unable to take care of yourself, the semi-stationary care becomes relevant. Such services can be appropriate, for instance, for people in need of care, whose relatives work during the day or for those whose need for care has increased due to a brief illness.
• There is also the possibility of full-stationary care, which means you live in a care centre ("Pflegeheim"). The full inpatient care is often authorised only if there is no other way of taking care of the person.

Each of these forms of care has its advantages and disadvantages. Which one suits you best depends on your specific conditions, your nursing care level and your financial resources. The stationary care is particularly very costly. In general, the higher your level of nursing care, a more significant percentage of costs will be covered by the nursing care insurance. However, nursing care insurances never cover all fees.

Seek advice so that you are informed in detail which services you can claim and which options are suitable for you. If your condition or necessities change, you should notify your nursing care insurance as soon as possible, so that the services you are provided can be adjusted accordingly.

On Heimverzeichnis,  you can search for a suitable nursing home- care centre in this directory offer professional care services. Statutory health insurances can also provide you with information regarding care options. On AOK-Pflegenavigator, for instance, you can search for nursing care providers and care homes nearby. On pflegelotse.de, besides nursing care providers and care homes, you can also search for counselling services around you. The Care Home Selection Checklist or Nursing Care Selection Checklist can help you decide what is best for you.

If auxiliary means such as Wheelchairs or walking aids are necessary, the nursing care takes over the associated costs. If you need such items, first talk to your doctor, as the nursing care insurance will demand a prescription from your doctor.

You will also receive a financial subsidy from the nursing care insurance for necessary everyday supplies such as disinfectants, gloves, etc.- you do not need to hand in a recipe for such items; all you need to do is to submit an application to the nursing care insurance.

Nursing care insurances usually do not cover all the costs. The additional charges then have to be borne by the people in need of care themselves, their relatives or - when necessary - the Social Welfare Office. You can, however, sign up (in advance) for private supplementary health insurance, which covers the remaining costs in the case of need for nursing care. Many insurance companies offer proper supplementary insurances. Private supplementary care insurance is partly subsidised by the state. You can find more information on self-provision at bundesgesundheitsministerium.de.

If you are no longer able to manage your affairs, you need one or more people to represent you legally, i.e. make decisions on your behalf. To be prepared for all eventualities, it makes sense to sign at least one so-called lasting power of attorney ("Vorsorgevollmacht"). By signing such a document, you can regulate who can make decisions for you if you cannot do so yourself anymore. If you would like to learn more about the lasting power of attorney, visit pflege.de. It may also make sense to sign an advance healthcare directive ("Betreuungsverfügung") and a living will ("Patientenverfügung").

In case it is already too late (and you are looking after a relative who has not issued a power of attorney and can no longer do so) you can have a guardian ("Betreuer") appointed by the Guardianship Court. To do so, you must file a petition for care ("Betreuungsantrag") at the district court of your relative's place of residence. In case you need help, consult with the staff of an Adult Migration Counselling Centre- you can search for one of their branch offices at bamf.de.

If you are mistreated, e.g. if you are neglected or in case your caregiver is violent, you can contact the helpline of Krisentelefon in your area. You can also search for an advice centre on bdb.zqp.de. You can also contact a Care Support Point ("Pflegestützpunkt") nearby for help.

Qualified health care staff are urgently needed in Germany, which means there are many job opportunities in this field. With specific language skills, such as Arabic or Turkish, you can increase your chances of employment in this area even further. To work in the care sector, you can choose between many vocational training and study programs.

Care-related jobs you can practice after vocational training include:

• Elderly care Assistant ("Altenpflegehelfer/in")
• Elderly care ("Altenpfleger/in")
• Anesthesia Assistant ("Anästhesietechnische/r Assistent/in")
• Skilled housekeeping and outpatient care ("Fachkraft für Haushaltsführung und ambulante Betreuung")
• Skilled nursing care assistant ("Fachkraft Pflegeassistenz")
• Healthcare professional and pediatric nurse ("Gesundheits- und Kinderkrankenpfleger/in")
• Healthcare professional and pediatric nurse assistant ("Gesundheits- und Krankenpflegehelfer/in")
• Healthcare professional and nurse ("Gesundheits- und Krankenpfleger/in")
• Domestic and family care professional ("Haus- und Familienpfleger/in")
• Midwife ("Hebamme/Entbindungspfleger")
• Curative education and social therapy assistant ("Heilerziehungspflegehelfer/in")
• Curative education and social therapy ("Heilerziehungspfleger/in")
• Business person in the Healthcare sector ("Kaufmann/-frau – Gesundheitswesen")
• Medical Assistant ("Medizinischer Fachangestellter")
• Social worker ("Sozialbetreuer")
• Social assistant ("Sozialassistent/in")
• Socio-educational assistant for children ("Sozialpädagogische/r Assistent/in / Kinderpfleger/in")

Care-related jobs you can practice after university education include:

• Bachelor of Science in Health Care and Nursing
• Bachelor of Science in Nursing (including vocational training)
• Bachelor of Arts in Care (including vocational training)