Care Grades (Pflegegrade) in Germany Explained

Long-term care insurance in brief

Germany has a statutory long-term care insurance (soziale Pflegeversicherung) as a separate branch of social insurance (section 1(1) SGB XI). Everyone in the statutory health insurance is insured in it by law; people with private health insurance must take out private long-term care insurance (section 1(2)). The bodies responsible are the long-term care insurance funds (Pflegekassen); their tasks are carried out by the health insurance funds (Krankenkassen, section 1(3)). Benefits are granted on application, from the date of application but not before the conditions are met (section 33(1) SGB XI), and the care grade largely determines which benefits are possible. Long-term care insurance covers part of the costs of care; it is not a full-cost insurance.

Who counts as in need of long-term care?

Section 14(1) SGB XI defines persons in need of long-term care (Pflegebedürftige) as people whose independence or abilities are impaired for health reasons, so that they need help from others. They cannot compensate for or cope with these impairments or health-related burdens on their own. The need must be permanent, meaning expected to last at least six months, and it must reach at least the severity described in section 15. Section 14(3) adds that impairments which stop someone managing the household without help are taken into account within the criteria of the six areas.

The six areas of section 14(2) SGB XI are the backbone of the whole system – and a useful checklist for your own observations:

The five care grades (section 15 SGB XI)

The grade is determined with a nursing-science assessment instrument with six modules that correspond to the six areas (section 15(1) and (2) SGB XI). In each module, the individual findings earn points and fall into one of five severity bands, from no impairment to most severe impairment. The modules are weighted, and the weighted points are added up to a total of up to 100 points (section 15(2) and (3)):

The total score sets the care grade (section 15(3) SGB XI):

Exceptions exist: people with certain special care constellations and an exceptionally high need for help can be assigned Pflegegrad 5 for nursing-science reasons even with fewer than 90 points (section 15(4)). For children, abilities are compared with those of age-appropriate healthy children (section 15(6)), and children up to 18 months are classified differently: the same point ranges lead to one grade higher, starting with Pflegegrad 2 (section 15(7)). Points are not a diagnosis: the grade says how much independence is impaired, not which illness causes it.

The assessment (Begutachtung)

The care insurance fund commissions the Medizinischer Dienst (MD) or other independent assessors to check whether care dependency exists and which care grade applies (section 18(1) SGB XI). The insured person is to be visited and assessed in their own home; if they do not consent, the fund can refuse the benefits applied for (section 18a(2)). An assessment without a home visit is only possible by way of exception in the cases named in section 18a(2) – when the file already settles the result clearly, or during a national or regional crisis situation that prevents a home visit. The tasks of the Medizinischer Dienst are carried out by nursing professionals or physicians working closely with other suitable professionals; the same applies to other independent assessors (section 18a(10) and (11)). The assessor looks at the six areas of section 14(2); the areas “activities outside the home” and “household management” are also recorded, although they are not weighted in the points (section 18a(3)).

For privately insured people, the Federal Ministry of Health states that the assessment is carried out by Medicproof (Bundesministerium für Gesundheit, 2026). The law itself does not name a company: private insurers must apply the same standards as the social long-term care insurance when they establish care dependency and assign a care grade (section 23(6) no. 1 SGB XI, referred to in section 18a(12)). The report also contains recommendations, for example on prevention, rehabilitation, aids and changes to the home (section 18b(1)). If no assessment has taken place within 20 working days of the application, the fund must, as a rule, offer the applicant a list of at least three independent assessors (section 18(3)).

The fund must inform the applicant of its written decision no later than 25 working days after the application arrives (section 18c(1) SGB XI). Shorter periods apply to the assessment itself in certain situations: at the latest on the fifth working day if the applicant is in hospital or in an inpatient rehabilitation facility and an assessment there is needed to secure further care, or family caregiver leave (Pflegezeit or Familienpflegezeit) has been announced to or agreed with the employer; the same shortened period applies in a hospice or with outpatient palliative care (section 18a(5)). At home without palliative care, an announced or agreed Pflegezeit or Familienpflegezeit means an assessment within ten working days (section 18a(6)). In these cases the fund decides without delay once it has the recommendation (section 18c(1)). The 25-day period is suspended while a delay continues for which the fund is not responsible (section 18c(5)) and interrupted while the fund waits for documents it has requested as essential (section 18c(6)). If the fund misses the deadline, it has to make a payment to the applicant – unless it is not responsible for the delay, or the applicant is in full residential care and at least Pflegegrad 2 has already been established (section 18c(5)).

If the Medizinischer Dienst expects the impairments to decrease, the care grade can be time-limited; the total limit may not exceed three years, and the fund must review the case before the limit expires (section 33(1) SGB XI).

Main benefits – by name

Which benefits are available depends on the care grade, the care setting and the person’s situation. The monthly amounts are set in the law and in official notices and have been adjusted over time, so this guide names the benefits but does not list euro amounts. Please check the current figures with the care insurance fund or an official source.

Details matter. The relief amount under section 45b is earmarked: it is meant to relieve family and other close caregivers and to support the independence of the person in need of care. It is reimbursed against receipts, not paid in advance, and may be used for day or night care, short-term care, services of outpatient care services under section 36 (in grades 2 to 5 not for self-care) and support offers recognised under state law (section 45a). No separate prior application is needed for the entitlement to arise; unused amounts can be carried over into the following half-year (section 45b(1) and (2)). The counselling visits under section 37(3) serve quality assurance and practical support for caregivers (section 37(3a)). They can be carried out by an approved care service, a recognised counselling centre or – if neither can provide it locally – a registered nurse commissioned but not employed by the fund (section 37(3b)); care advisers under section 7a and qualified counselling staff of local authorities may also carry them out (section 37(8)). If a recipient does not call up the compulsory counselling, the fund has to reduce the care allowance appropriately and, if it happens again, withdraw it (section 37(6)). Staff who deliver the additional activation support in inpatient care facilities are called additional support and activation workers (Betreuungskräfte, section 43b SGB XI).

What this means for your daily work

The care grade is decided by the care insurance fund on the basis of the independent assessment – not by the care team. Still, your work provides the everyday picture that makes needs visible. The following points are general professional knowledge and good practice, not legal rules; follow your employer’s procedures.

• Use the six areas as an observation frame. Note changes in mobility, orientation, behaviour, self-care, treatment demands and social contact in the care documentation, in clear, factual language and with dates.
• Report significant changes the same day to the registered nurse (Pflegefachkraft) or the management, according to your workplace routine. Decisions about the care plan stay with the responsible team; acute health problems go to the physician or the emergency route set by your employer.
• Who applies? The insured person applies to their care insurance fund (section 33(1) SGB XI). Relatives or an authorised representative can act for them only with the necessary authority. Care staff do not apply on their own initiative; they can point the person or relatives to counselling and to the right contacts, as the employer’s process allows.
• If you think the need has grown, say so to your nurse in charge. SGB XI has no separate rule on who asks for a new assessment. Benefits are granted on application (section 33(1)), and a decision with lasting effect is to be changed for the future if circumstances change significantly (section 48(1) SGB X). In practice, the person in need of care or their authorised representative usually contacts the fund. The law also provides that the home assessment is repeated at appropriate intervals (section 18a(2) SGB XI). Ask the fund or an official counselling service about the right steps in an individual case.
• Prepare for the assessment visit as your employer directs: up-to-date documentation, aids in use, medication lists and the presence of a trusted person can help the assessor understand daily life. Do not influence the assessor’s judgement or over- or under-state needs.
• Respect confidentiality and data protection. Give information to relatives or third parties only on the basis of consent, authority or another legal basis and your employer’s rules.

Recognition – neutral facts and official links

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GermanSocialLab offers self-study courses with voluntary self-reflection (not graded) and a confirmation of participation after working through all modules. Legal status: 1 November 2026. This guide describes the situation in Germany in general terms; it provides professional information and does not constitute legal advice or recognition advice. Benefit amounts are not listed because they are adjusted from time to time; check current figures with the care insurance fund. Rules and practice can differ between employers – always follow your employer’s procedures and ask the competent authority. Created with AI assistance and editorially reviewed.