Did you know – Providers of 24-hour care via the benefits in kind offered by nursing care insurance
Many people in need of care wish to continue living in their own homes even as their need for support increases – for example, in the case of progressive illnesses, limited mobility or the need for the permanent presence of a caregiver. At the same time, a key question arises: How can 24-hour care be organised – and how can it be financed?
A common misunderstanding concerns the care benefits provided by nursing care insurance. Time and again, we hear the question in our consultations: ‘Can I bill 24-hour care entirely through the care insurance fund?’ The short answer is no, but under certain conditions, parts of the services can be financed through care insurance and combined in a meaningful way. In this article, we explain what is possible with care benefits in kind, where the limits lie and what those affected and their relatives should pay attention to.
What does ‘24-hour care’ actually mean?
The term ‘24-hour care’ is not a legally defined care term. It is used colloquially for very different care models. It usually refers to a caregiver who:
lives in the household with the person in need of care or is regularly present
provides support with everyday tasks (household, cooking, accompaniment)
helps with basic care, mobility and orientation as needed
is available during the day and remains reachable at night
Note: Even in the case of so-called 24-hour care, this does not legally constitute round-the-clock working hours. Working hours and rest periods must be observed. In practice, this means that several people or complementary care services are often involved.
Who is generally entitled to benefits?
As a general rule, individuals requiring care from care level 2 onwards are entitled to long-term care insurance benefits, including care allowance, care benefits in kind and other supplementary benefits. 24-hour care is particularly useful for people who
- want to be cared for permanently in their home environment
- can no longer live alone
- want to avoid or delay being placed in a care home
- need a high level of support in everyday life, even outside of traditional care hours
Such care can be a great relief for relatives in particular – both emotionally and organisationally.
Care benefits in kind pursuant to Section 36 of SGB XI – what are they?
Care benefits in kind are a benefit provided by long-term care insurance for professional care by an approved outpatient care or support service. They include, among other things:
- Basic care (e.g. personal hygiene, dressing, mobility)
- Nursing care services
- Help with housekeeping
The amount of the care benefit in kind is graded according to the level of care required and is settled directly between the care insurance fund and the care service.
Important: The care benefit in kind is not a cash benefit, but is earmarked for recognised service providers.
Can 24-hour placement agencies bill for care benefits in kind?
In short: no. So-called 24-hour placement agencies that place care workers (often from other European countries) are not usually approved by the care insurance fund as outpatient care services.
This means that direct billing via care benefits in kind is usually not possible. Instead, the costs incurred are usually covered by care allowance, respite care benefits and private funds from the person in need of care or their relatives. This model is widely used in practice, but is not identical to the care insurance benefit system.
When is it possible to settle accounts for care benefits in kind?
Settlement via nursing care benefits is possible if the following conditions are met:
- Care is provided by an approved outpatient nursing or care service.
- The service is registered with and recognised by the nursing care insurance fund.
- The care workers employed are salaried employees.
- Statutory quality and working standards are complied with.
In these cases, nursing and care services – including those of an extended scope – can be billed via the care allowance.
Important: Again, this is not a flat-rate 24-hour billing, but rather the billing of individual service modules within the budget.
Combination of different services: How to expand financing
Since care benefits alone are usually not sufficient to cover comprehensive care, it is essential to combine several benefits.
- Care benefits (Section 36 of SGB XI): Care benefits are used to finance care and support services provided by approved outpatient care or support services. The amount of the benefit depends on the respective care level and is settled directly between the care insurance fund and the service provider.
- Relief amount (Section 45 SGB XI): The relief amount is 131 euros per month and can be used for recognised care and support services. These include, for example, supplementary care services or everyday support services.
- Respite care (Section 39 SGB XI): Respite care comes into effect when family members who provide care are temporarily unable to do so. It can also be used on an hourly basis and is suitable for financing additional care services on a pro rata basis.
- Care allowance (Section 37 SGB XI): Care allowance is paid when care is organised entirely or partially by the person receiving care. It is freely available to those in need of care and can be used, among other things, to co-finance private care services.
By cleverly combining these benefits, the personal contribution can often be significantly reduced.
Who is this model particularly suitable for?
Care that is (partially) financed by benefits in kind is particularly suitable for people in need of care
- with care level 2 or higher
- with high care needs in everyday life
- who want to continue living at home
- whose relatives need relief
- who are open to a modular care concept
Continuous care can provide a great deal of security, especially in cases of dementia, night-time restlessness or limited mobility – for both those affected and their relatives.
What should those affected and their relatives pay attention to?
Organising 24-hour care is complex. Important questions include:
- Is the provider recognised by the care insurance fund?
- Which services are billable and which are not?
- How are working hours and rest periods regulated?
- How high is the realistic personal contribution?
- Which services can be combined?
Our advice: seek independent advice at an early stage. Care insurance funds, care support centres and independent care advisors can help you avoid making the wrong decisions and incurring unnecessary costs.
Examples of providers of 24-hour care:
Depending on the model and regional availability, different providers may be considered, for example:
The eligibility for reimbursement of nursing care benefits does not depend on the name, but on the legal status and approval of the respective provider.
Conclusion: Good advice is half the battle
Care benefits cannot be used directly for every form of 24-hour care. However, under certain conditions – especially in the case of recognised outpatient services – parts of the care can be financed by long-term care insurance.
As every care setting is unique, personal advice is essential. Viva FamilienService provides employees and relatives with impartial and confidential advice on all aspects of care and financing options, and assists in finding suitable providers. Please feel free to contact us – we will help you find viable and suitable solutions for your individual care situation.