Gröhe: More assistance for persons in need of long-term care and their relatives

The Federal Cabinet passes the Second Bill to Strengthen Long-Term Care

On 12th August 2015, the Federal Cabinet passed the Second Bill to Strengthen Long-Term Care. The Act introduces a new definition of long-term care needs to the day-to-day practice setting. The Act is scheduled to enter into force on 1st January 2016. The new assessment procedure and the changes in the benefit amounts available to beneficiaries in the long-term care insurance are to enter into force by 1st January 2017.

The new definition of long-term care needs is finally now becoming a reality. This reform benefits everyone – those in need of long-term care, their relatives and our nursing professionals – since the real need for support will be recorded more effectively. From now on, benefit amounts will be determined by what a person can still do on their own and where he or she needs assistance and support – regardless of whether the need arises because of dementia or because of physical frailty. In this way, all persons in need of long-term care will have equal access to the benefits provided by the long-term care insurance. In addition, we are starting to provide support at a much earlier stage – for example, when a shower needs to be rebuilt to make it more age-appropriate, or when assistance is needed with the housework. This means that, in the medium term, it will be possible to provide assistance to up to 500,000 more people. Furthermore, we are relieving some of the burden on caregiving relatives and ensuring that they are better covered in the pension and unemployment insurance.

Federal Minister of Health Hermann Gröhe

As early as the beginning of 2015, support for persons in need of long-term care and their relatives was significantly expanded thanks to the First Act to Strengthen Long-Term Care. The Second Act to Strengthen Long-Term Care now ushers in additional improvements. In total, starting in 2017, an additional 5 billion euros will be available annually for long-term care. Furthermore, the index-linking of benefits that is stipulated by law will be introduced one year earlier than previously planned, in the year 2017. This will mean that an additional 1.2 billion euros, approximately, will be available, as early as 2017, to pay for long-term care insurance benefits. The financial situation of the long term care insurance allows for stable contribution rates, all the way into the year 2022. That is two years longer than previously estimated.

These new regulations on benefits and services systematically implement the aims of the new definition of long-term care needs – providing assistance in maintaining independence and making the most of a person's remaining abilities. The system previously in force that was based on three categories of care, as well as the need to additionally determine the existence of significantly restricted competence in daily matters (especially dementia), will be replaced by five uniformly valid grades of care applicable to all persons in need of long-term care. The benefits formerly granted to persons with considerably restricted competence to function in matters of daily life are now being integrated into the standard legislation on benefits. All persons in need of long-term care will therefore be receiving access on equal terms to the benefits provided by the long term care insurance.

The five grades of care

In future, physical, mental and psychological impairments will be rated equally in the recording and assessment process. The assessment will serve to measure the degree of a person's independence in six different areas that will – on the basis of different weightings – be subsequently combined to form an overall assessment. This will furnish the basis for assigning the person to a specific grade of care. The six areas are:

  • Mobility
  • Cognitive and communicative abilities
  • Behaviour and psychological problems
  • Self reliance
  • Coping with and independent handling of demands and pressures caused by illness or the need for therapy.
  • Organising everyday life and social contacts

Greater support for persons in need of long-term care

Amounts for the main benefits in euros

CG1 CG2 CG3 CG4 CG5
Non-residential cash benefit 125* 316 545 728 901
Non-residential benefit in kind 689 1298 1612 1995
Benefit amount for residential care 125 770 1262 1775 2005

(*As a sum of money that is available to pay for custodial care and caregiver relief benefits.)

Support will be available much earlier in the future. Persons who are assigned to care grade 1 will be those who do not yet require any considerable degree of support but, for example, require long-term care counselling, some adaptation of their living environment (for example, age-appropriate showers) or benefits in the area of general care. This will considerably widen the circle of persons who will be receiving long-term care benefits for the first time. In the coming years, an additional 500,000 claimants are expected as a result.

In the case of full-time institutional care, what is important for those affected is not the benefit amounts, but rather the size of the co-payment that they will be required to pay out of pocket. So far, this co-payment has risen whenever a person has been reassigned to a higher level of care. In future, the care-related co-payment will no longer increase with an increased need for long-term care. This will be a source of relief for many persons in need of long-term care. All persons in a nursing home who are in need of long-term care and are assigned to care grades 2 to 5 will be paying the same care-related co-payment. However, the specific amount will differ from one nursing home to another. The federal average for the care related co-payment in 2017 is expected to be some 580 euros. In addition, persons in need of long-term care will have to bear the cost of meals, accommodation and investments. These too will differ from one nursing home to the other.

Transfer of persons who have already been being classified as being in need of long-term care

Persons who are already receiving benefits from the long-term care insurance will be automatically, by statute, transferred to the new system. None of these persons will be required to make a new application for assessment. This will avoid unnecessary additional effort and stress on the part of those affected. In the process, the following applies: All persons who are already receiving benefits from the long-term care insurance will continue to receive these, at least at the existing level; most will even be receiving significantly more.

In concrete terms, the following applies: Persons who suffer from exclusively physical impairments will be automatically transferred to the next higher care grade. (Examples: Care level 1 will be transferred to care grade 2, care level III to care grade 4.) Persons with mental impairments will be automatically transferred to the next care grade but one. (Example: Care level 0 will be transferred to care grade 2, care level II, with restricted competence in day-to-day living, to care grade 4.)

Further new regulations

  • In residential long-term care facilities, every insured person will be entitled to additional care opportunities in the future. The facilities are obliged to arrive at corresponding agreements with the long-term care funds and to employ additional caregivers for this purpose.
  • The Second Act to Strengthen Long-Term Care reinforces the principle of 'rehabilitation before long-term care'. The granting of rehabilitation benefits serves to avoid, or at least delay, the onset of the need for long-term care. This is why the medical service is being obliged to implement a nationwide, standard, structured procedure for rehabilitation recommendations.
  • Caregivers, such as caregiving relatives, are now better secured within the pension and unemployment insurance. In future, the long term care insurance will be paying pension contributions for all caregivers who provide at least 10 hours of care per week, in the home, spread over at least two days for a person in need of care in the care grades 2 to 5. Pension contributions will also increase as the need for long-term care of rises. Any person who takes care of a relative who has an extraordinarily high need for assistance (care grade 5) will receive 25% more in pension contributions than was previously the case. Furthermore, more people will be receiving support. Indeed, relatives who take care of a person in need of long-term care who is suffering exclusively from dementia will be covered, in future, by the pension insurance. Coverage in the unemployment insurance will also be improved. From now on, the long-term care insurance will also be paying the unemployment insurance contributions for caregivers who leave their jobs to be able to take care of relatives in need of long-term care, for the entire duration of the caregiving period. As a result, caregivers are entitled to receive unemployment benefits, as well as the benefits provided by active employment promotion, if they do not succeed in making a seamless transition to employment after their period of caregiving. The same applies to persons who interrupt the receipt of benefits from the unemployment insurance in order to provide care.
  • The statutory regulations on information and counselling are to be restructured and expanded and the quality of counselling itself is to be improved. Also in the future, the long term care insurance funds will be obliged to offer courses for relatives and volunteer carers free of charge. In addition, the collaboration between the long term care counselling services and other local counselling services – for example, those organised by the municipalities – is to be improved by means of binding Land framework contracts.
  • Moreover, the Bill contains amendments that will make administrative tasks easier while reducing the amount of red tape encountered by insured persons and persons in need of care. One example is the expertise conducted by the medical advisory service of the statutory health insurance in order to assign a person to a specific care grade. In future, this will be automatically sent to the affected person; in other words, without the latter having to submit an application for assessment (with the possibility of appeal) as was previously the case. The Act also provides that, given the consent of the affected person, the recommendations of the medical advisory service, with regards to the provision of medical aids or nursing aids, can be equated with an application, thus avoiding the need for a reassessment by the long-term care fund or the health insurance fund.
  • The regulations governing the way in which quality is assured, controlled and displayed are being thoroughly revised and the self-administration's decision-making structures in this area are being streamlined. The Quality Assurance Arbitration Office pursuant to Section 113b of the Social Code XI will be re-organised into a quality committee and consequently into an efficient negotiation and decision-making body. Supported by a qualified administrative office, it will be the task of the committee to agree on a new procedure for quality control, within a statutory deadline, paying particular attention, in the process, to indicators for measuring the quality of outcomes. In addition, the procedure for displaying quality (the so-called long-term care seal of quality – a sort of MOT test for long-term care) is to be fundamentally revised. The self-administration has been commissioned with the elaboration of a concept for assuring quality in new forms of living such as group homes receiving care from non-institutional providers.
  • The Act strengthens the technical foundations of the work done in the area of long-term care and promotes the development of new concepts in the relevant facilities. The new definition of long-term care needs must be used as an opportunity to examine the existing level of staffing and adjust it to demand. Both those responsible at the Land level and the local long-term care facilities are required to do their part in this respect. Furthermore, the long-term care self-administration bodies are to develop and test a scientifically sound personnel allocation system.
  • In order to finance the introduction of the new long-term care need definition and the associated improvements in benefits and services, the long-term-care insurance contribution rate will increase by 0.2% to 2.55 or 2.8 percentage points for childless persons, from 1st January 2017.