🧾 Care level in chronic illness
In brief
A care level (Pflegegrad) is assessed regardless of the diagnosis, according to how independently you can still manage everyday activities – such as mobility, self-care, coping with illness-related demands and organising daily life. Many chronic illnesses (e.g. advanced chronic kidney disease requiring dialysis, severe rheumatoid arthritis, advanced COPD) can lead to a care level, but it does not arise automatically – an application to the long-term care insurer (Pflegekasse) and an assessment are required.
Step by step
- Submit the application to the PflegekasseThe application can be made informally (also by phone with written confirmation) and should be made early because of retroactive effect.
- Prepare for the assessment appointmentThe Medizinischer Dienst (Medicproof for privately insured people) usually carries out a home visit; a care diary of your actual support needs helps with the assessment.
- Assessment across six areas of lifeAssessed are mobility, cognitive and communication abilities, behaviour and mental health problems, self-care, coping with illness- or therapy-related demands, and organising daily life and social contacts.
- Check the notice of decisionThe notice of decision (Bescheid) states the care level determined (1 to 5) and the benefits that follow from it.
- File an objection within the deadlineIf the care level is too low or refused, you can file an objection (Widerspruch) within one month and ask for a second expert opinion.
Deadlines
- Home nursing care from the health insurer (§ 37 SGB V) and care benefits from the Pflegekasse for a care level (SGB XI) are different systems with different responsibilities – a care level does not automatically replace home nursing care and vice versa.
- Not every serious chronic illness automatically leads to a high care level; what matters solely is the actual support need in everyday life asked about in the assessment instrument.
- For the full procedure, all types of benefit (care allowance, care benefits in kind, respite care, etc.) and the specifics of a simultaneous disability, see the detailed topic page "Care level in disability" in the Wegweiser Disability.
In depth · legal basis, figures and practice – for advisers and professionals
Assessment instrument
Under §§ 14, 15 SGB XI, need for care is determined using an assessment instrument in six modules: mobility, cognitive and communication abilities, behaviour and mental health problems, self-care, coping with and independent handling of illness- or therapy-related demands and burdens, and organising daily life and social contacts. From the weighted scores, one of five care levels results.
Significance for chronically ill people
The module "coping with and independent handling of illness- or therapy-related demands" specifically captures efforts that are typical in chronic illnesses – such as medication management, blood sugar checks, wound care or doctor visits – and, where the support need is corresponding, can contribute to the care level even if mobility is still largely intact.
Decision period
The Pflegekasse must decide on an application within 25 working days of receipt; shorter periods apply, among other cases, if the applicant is at home and has no care level yet, or in palliative care. If the period is exceeded, a payment of 70 euros per week or part week of delay may become due from the Pflegekasse.
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