Long-term care assessment: What needs to be done?

In order to apply for a care degree, the first step is to submit an application to the health insurance company. The long-term care insurance company then commissions the medical service to carry out an assessment. But what is the assessment about? How can you prepare for it? And what happens afterwards?

What is a long-term care assessment?

The care assessment clarifies the extent to which someone is in need of care on the basis of standardized assessment criteria. The assessment is carried out by the Medical Service. This is the social medical consulting and assessment service of the statutory health and long-term care insurance. MEDICPROOF is responsible for privately insured persons.

“According to the 11th Code of Social Law, persons are considered to be in need of care if they have health-related impairments of independence or abilities and therefore require assistance from others, cannot independently compensate for or cope with physical, cognitive or psychological impairments or health-related stresses or demands.”

The assessment determines the need for care and passes it on to the long-term care insurance fund, which then decides on the degree of care. If necessary, the assessor will also make recommendations for aids in the report for the long-term care insurance fund, which should make everyday care easier in the future.

What happens during a care assessment?

The medical service or MEDICPROOF contacts the person in need of care or the authorized representative to arrange an appointment. The assessment usually takes place at home. There, the assessor gets a picture of the situation – for this purpose, specific questions are asked that are based on defined assessment criteria. These are binding for all long-term care insurance companies, regardless of whether they have statutory or private insurance.

The goal of the assessment is to determine the actual need for support and thus determine the appropriate level of care. No one should have the feeling that they have to present themselves with surprisingly good services. They should also refrain from presenting their independence and existing abilities as worse than they actually are.

The home visit can last up to one hour. During the visit, the assessor will primarily talk to the person in need of care and find out what restrictions and care challenges he or she has to cope with and where exactly in everyday life another person has to help.

Tip: We strongly recommend that another person who is familiar with the situation and the challenges is present during the assessment. This can be a relative or a caregiver. In this way, the person concerned can be supported and perhaps also contribute important statements.

Which evaluation criteria are used?

In order to assess the need for care, the assessors determine the degree of independence in six areas of life. The “New Assessment Approach” (NBA) is a comprehensive, scientifically based assessment approach. Each of the six “modules” (areas of life) to be assessed comprises a different number of sub-items that are assessed. Points are awarded depending on the degree to which abilities or independence are still present, which are then added together and weighted differently:

1. Mobility (10%): How independently can the person move, get around? For example, can he maintain a stable sitting position? Can he climb stairs? Can he get up and move around on his own?
2. Cognitive and communicative abilities (15%): How does the person find his way in his everyday life in terms of location and time? Are risk situations recognized, assessed and prevented? Can decisions be made for oneself? Can the person hold conversations and communicate needs?
3. Behavioral and mental health problems (15%): How often does the person need help due to mental health problems, for example, anxious or aggressive behavior?
4. Self-care (40%): How independently can the person care for him/herself in everyday life: is help needed with personal hygiene, eating and/or drinking? Is it possible to visit the toilet without assistance?
5. Coping with and independently dealing with illness- or therapy-related demands and stresses (20%): What support is needed in dealing with illness and treatments? Can medication be taken by the patient? Can measurements (blood sugar, blood pressure) be taken independently? Can the affected person handle aids such as a walker or prosthesis independently and visit a doctor independently?
6. Organization of daily life and social contacts (15%): How independently can the affected person consciously organize the daily routine, pursue interests or maintain contacts? Be it through telephone calls, visits to the café, the skat club or a walk in the park.

Based on the overall assessment of all abilities and impairments, the person in need of care is assigned to one of five care grades.

How do you prepare for a care assessment?

• Keep a care diary: In the days leading up to the assessment, keep a written record of the amount of support needed. This makes you more aware of how often and where another person needs to intervene/help and makes it easier to answer the assessor’s questions.
• Schedule the appointment: when does the person need the most support? The appointment should take place at the exact time of day to be realistic about the need.
• On-site support: A family member or caregiver can provide support. Who is the right person for this? When scheduling an appointment, consider who should be present for the assessment.
• Prepare the apartment: If a visitor is coming, we are happy to tidy up. However, it is important to maintain a natural living atmosphere! Only in this way can the assessor get a realistic picture of the situation.
• Inform the person concerned about the appointment: Intimate questions are asked, things are discussed that can be perceived as unpleasant or embarrassing, private rooms such as bedrooms and bathrooms are examined. The goal should always be clear: to make everyday life easier by determining the degree of care and thus approving the appropriate care services.

Tip: Don’t sugarcoat anything, but don’t exaggerate either. The person concerned should receive the benefits to which he or she is entitled. Experts are experts – they are not easily deceived.