The risk of becoming in need of care can affect anyone. In principle, everyone is therefore obliged to insure themselves against this risk with a social or private long-term care insurance fund.

According to the current legal situation, a person is in need of long-term care if, due to an illness or disability, they require a considerable amount of long-term assistance for the usual and regularly recurring activities of daily living. However, it is not the illness or disability that is decisive for determining the need for care, but rather the resulting need for help with daily activities.

On January 1, 2017, the previous care levels "0", 1, 2 and 3 were replaced by the five new care grades 1, 2, 3, 4 and 5 to classify the need for care of those affected.

The Medical Service of the Health Insurance Fund (MDK) determines whether and to what extent care is required. The MDK is commissioned by the responsible long-term care insurance fund when an application for long-term care insurance benefits is submitted.

The MDK uses the new NBA assessment instrument to determine how independent a person still is based on a points system. The following applies: the more points the person receives, the higher the care level and the more care and support services the respective care insurance fund will approve.
The following classification of care levels with the required number of points applies:

• Care level 1: Minor impairment of independence (12.5 to under 27 points)
• Care level 2: Significant impairment of independence (27 to under 47.5 points)
• Care level 3: Severe impairment of independence (47.5 to less than 70 points)
• Care level 4: Severe impairment of independence (70 to under 90 points)
• Care level 5: Severe impairment of independence with special care requirements (90 to 100 points).

The social welfare provider is also bound by the findings of the MDK. If someone does not have long-term care insurance, the social welfare provider will contact the relevant health authority with a request for an opinion on the need for long-term care.

People in need of care at home are entitled to basic care and domestic care as a benefit in kind (home care assistance)
Alternatively, it is possible to receive a care allowance if those in need of care are able to provide basic care and domestic care themselves.
A combination of cash and benefits in kind (combined benefit) is possible.

The long-term care insurance benefit framework also includes services when the caregiver is unavailable (home care), day or night care (partial inpatient care) and short-term care (temporary inpatient care).
People in need of care are entitled to care in fully inpatient care facilities if home or partial inpatient care is not possible or cannot be considered due to the special nature of the individual case.
In addition, care aids and technical assistance, subsidies for measures to improve the individual living environment and care courses for relatives and voluntary carers can be granted.
Caring relatives or caring neighbors and friends may receive social security benefits for the carer in the form of contributions to the relevant pension insurance provider.

Long-term care insurance benefits are covered by long-term care insurance up to certain maximum limits, depending on the type of benefit, which you can find out from your long-term care insurance fund in your specific case. In the case of full inpatient care, the costs of accommodation and meals, which you would also have to bear in a home environment, are not covered.
If it is not possible for those in need of care to cover the remaining uncovered costs, social welfare benefits (SGB XII) may be available.
However, social assistance as state aid only comes into play if and to the extent that self-help and help from dependants - usually relatives in a direct line or spouses - is not sufficient.