What does "dependent on care" mean?
Anyone who regularly, permanently and to a considerable extent depends on help due to illness or disability in everyday life may be entitled to benefits from long-term care insurance. But the person affected must first be classified as requiring care.
The concept of long-term care is redefined by the Nursing Act II: Since January 1, 2017, all those people who are in need of care due to a physical, mental or emotional illness or disability in the field of personal care, nutrition, mobility and home care Duration - expected to last for at least six months - to a significant or greater extent. In determining this need for care is checked whether and how the patient concerned can handle his everyday life alone.
Up to now, the determination of the need for care focused mainly on physical limitations and on the need for help with physical tasks (such as washing, dressing, eating, etc.). Mental and mental impairments (as in dementia) were neglected.
The Nursing Welfare Act II provides for another innovation from January 2017: in the future, the long-term care needs will be divided into five levels of care (and not in three levels of care as before).
Anyone who is already classified as requiring care (according to the old definition), but must not be re-examined. Rather, here is an automatic transition from the previous care level in the appropriate level of care. Nobody has to fear a deterioration (ie a reduction in care benefits).
The new assessment tool is only used in patients who have not yet been classified as requiring care:
To determine the need for long-term care of a person insured by law, an application must first be submitted to the long-term care fund (located at the health insurance fund). The Nursing Fund then gives the medical service of the health insurance funds (MDK) or another independent expert the task of determining the need for care of the patient.
For privately insured persons, the application is submitted to the respective private insurance company. This then instructs the Medical Service MEDICPROOF to determine the need for care.
Appointment for the review
The appointment for the assessment is agreed with the patient or his relatives or caregivers - the expert (nurse or doctor) does not come unannounced into the house or in the facility in which the patient lives.
At this appointment, the applicant will also be asked to provide relevant documentation for the assessment. These include, for example, reports of caring services, nursing diaries (*) and comparable personal records of the insured, medical records, information on current medications, as well as reports and notices from other social benefit providers.
* Nursing Diary: records of a nursing person about any help that is given to the patient (such as eating, dressing, etc.) and the time taken by the individual relief measures.
What is being reviewed?
The assessor assesses the following six areas of life ("modules"):
- Mobility (mobility as in the morning getting up and going to the bathroom, climbing stairs, etc.)
- Cognitive and communicative skills (orientation over time and place, understanding of facts, recognizing risks, understanding what other people say, etc.)
- Behavior and mental problems (fears, aggression, defense against care measures, etc.)
- Self-care (independent washing, dressing, eating, drinking, etc.)
- Coping with and independent handling of illness or therapy-related requirements and burdens (self-contained medication, independent medical care, etc.)
- Organization of everyday life and social contacts (independent organization of the daily routine, contact with other people, independent participation in social events, etc.)
Self-employment and skills in each area of life are evaluated. Depending on the total number of points, the assessor suggests a certain level of care or does not determine the need for care. On the basis of this report, the statutory or private health insurance will decide on the application for long-term care. A few weeks may elapse between the application and the decision.