🏠 Home nursing care (§ 37 SGB V)
In brief
Home nursing care (häusliche Krankenpflege) covers medical treatment care (e.g. giving medication, blood sugar measurement, wound care, insulin administration), basic care (help with personal hygiene, nutrition, mobility) and household support. The condition is that you cannot carry out the necessary measures yourself and no person living in the household can do so. Home nursing care is prescribed by your treating doctor.
Step by step
- Get a medical prescriptionHave the specific measures you need (e.g. insulin administration, dressing changes) certified on the prescription form for home nursing care.
- Submit the prescription to the health insurerThe nursing service or you yourself submit the prescription to the health insurer; certain treatment care services need no separate approval, others do – the Häusliche Krankenpflege-Richtlinie (HKP-Richtlinie, home nursing care guideline) of the G-BA regulates this in detail.
- Commission a nursing serviceAfter approval, you commission an authorised outpatient nursing service to carry it out.
- Pay the co-paymentAs with other services, a statutory co-payment applies (10% of the costs, at least 5 and at most 10 euros per prescription, plus 10 euros per calendar day for the first 28 calendar days of a prescription in the calendar year) – up to the burden limit (see Co-payment exemption and burden limit).
- Apply for an extension in good timeIf the prescribed duration is not enough, the doctor must issue a follow-up prescription in good time; in justified exceptional cases the insurer can approve home nursing care beyond the standard duration if the Medizinischer Dienst considers it necessary.
Deadlines
- Home nursing care from the health insurer (§ 37 SGB V) is legally different from care benefits in kind from the long-term care insurer for a recognised care level (SGB XI). If you receive both at the same time, how they interact must be clarified in the individual case – ask the insurer or a care adviser to explain it to you.
- Whether a specific measure requires approval or not depends on the service list of the HKP-Richtlinie, which may change; if in doubt, do not rely on older leaflets.
- If a treatment care measure is refused although nobody in the household can provide it, an objection (Widerspruch) is worthwhile – insurers' reasons for refusal are not always legally correct.
In depth · legal basis, figures and practice – for advisers and professionals
Distinguishing treatment care, basic care and household support
Under § 37 SGB V, insured people receive home nursing care from suitable nursing staff if hospital treatment is necessary but cannot be carried out, or if home nursing care replaces or secures it (§ 37 Abs. 1 and 2 SGB V). Home nursing care covers the basic care and treatment care required in the individual case as well as household support. Treatment care includes medically prescribed measures such as giving medication, injections, dressing changes or blood sugar measurement; basic care includes help with personal hygiene, nutrition and mobility.
Condition of entitlement: no household member can help
The entitlement exists only to the extent that the insured person cannot carry out the necessary care measures themselves and no person living in the household can take them over to the extent required.
HKP guideline and approval requirement
In the Häusliche Krankenpflege-Richtlinie (HKP-RL, home nursing care guideline), the Federal Joint Committee (Gemeinsamer Bundesausschuss) specifies which measures can be prescribed, how often and for how long, and for which measures the health insurer can waive separate approval. For many standard treatment care measures, an approval waiver now applies if the prescription is issued by a contracted doctor – details change with amendments to the guideline.
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