responsibility finder
Schleswig-Holstein

Request home care for long-term care insureds with disabilities

Source: Zuständigkeitsfinder Schleswig-Holstein (Linie6PLus)

Service Description

Do you live as a person with a disability in a residential home or another fully inpatient facility that enables you to participate socially and supports you in integrating into working life? If so, your long-term care insurance fund will cover 15 percent of the costs under certain conditions.

However, the nursing care insurance fund pays a maximum of EUR 266.00 per month. You bear the remaining costs yourself. If your income is not sufficient for this, you are entitled to benefits from the basic security in old age and in case of reduced earning capacity or housing allowance. For this, you must apply to the social welfare agency. As a rule, this is the social welfare office in your place of residence.

This also applies to special forms of housing such as a residential home or a residential group for people with disabilities. In this case

  • the focus must be on shared living and integration into society,
  • the Housing and Care Act must be applied, and
  • the extent of care largely corresponds to care in a fully inpatient facility.

If you are at home with your relatives on weekends or vacations, you are entitled to the following benefits for this time:

  • Care benefits in kind: This refers to the services of an outpatient care service. Your entitlement to care benefits in kind is reduced by the amount paid by the long-term care insurance fund in that month for accommodation in a residential home or boarding school. For example, if you are at home 10 days a month, the amount your long-term care insurance fund paid for the 20 days you spent in the residential home or boarding school will be deducted from the amount you are entitled to in-kind benefits each month.
  • Long-term care allowance: If you are assisted by family members or volunteers during the time you are at home, you may receive caregiver allowance. For each day you spend at home, you will receive 1/30th of the monthly care allowance. The day of arrival and departure each counts as a full day at home. You will receive care allowance even if you receive care benefits at the same time. Your care allowance will not be reduced as a result.


Process flow

You can submit the application for cost coverage for care in a fully inpatient facility for people with disabilities by mail, for example, as well as - for many long-term care insurance funds - in person at the office or submit it online.

  • Submit the application for full inpatient care in facilities for people with disabilities to your long-term care insurance fund. If you are unable to do so yourself, you can authorize someone in writing.
  • The long-term care insurance fund will review your application and inform you of the result.
  • After your application has been processed, your long-term care insurance fund will transfer the monthly benefit contribution directly to your facility.
  • Your long-term care insurance fund can also give you a list of approved facilities for the disabled, where you can compare services and prices.
Requirements
  • You have care degree 2, 3, 4 or 5.
  • You live in a
    • in a fully inpatient facility for people with disabilities or
    • comparable form of living.
Which documents are required?
  • If applicable: power of attorney, guardian's card
  • Notification from the nursing care insurance company about the degree of nursing care (expert opinion of the medical service of the nursing care insurance company)
  • if applicable: medical documents
  • If applicable: severely disabled person's ID card
  • Proof of health and long-term care insurance

Depending on the individual case, further documents may be required. Please contact your nursing care insurance fund for more information.

What are the fees?

You do not have to pay anything for the application.

What deadlines do I have to pay attention to?

You will receive the benefit from your long-term care insurance fund only from the month in which you submitted the application, but at the earliest from the time when the eligibility requirements are met. If the application is not made in the calendar month in which the need for long-term care occurred, but later, the benefits will be granted from the beginning of the month in which the application was made.

Processing duration

Processing usually takes about 2 to 6 working days.

For a quick processing and decision, your care insurance fund must be provided with the necessary information as well as any required documents in a complete and meaningful manner.

The care insurance fund decides on applications promptly.
Please note that the processing time given is an average value for all care insurance funds. It may vary in individual cases.

The exact processing time also depends on the complexity of the individual case and may be longer accordingly. The same applies if documents or records are sent to you or your long-term care insurance fund by mail.

If the need for care or the entitlement to care benefits has not yet been determined in your case, or if an application is made to upgrade the care level, the Medical Service must be involved. This usually extends the processing of your request by about 3 to 4 weeks.

Legal basis
Appeal
  • Objection
  • Action before the social court
Applications / forms

- Forms: yes

- Online procedure possible: many long-term care insurance companies offer an online procedure.

- Written form required: no

- Personal appearance required: no

Author
Technically approved by

Federal Ministry of Health

Process flow

You can submit the application for cost coverage for care in a fully inpatient facility for people with disabilities by mail, for example, as well as - for many long-term care insurance funds - in person at the office or submit it online.

  • Submit the application for full inpatient care in facilities for people with disabilities to your long-term care insurance fund. If you are unable to do so yourself, you can authorize someone in writing.
  • The long-term care insurance fund will review your application and inform you of the result.
  • After your application has been processed, your long-term care insurance fund will transfer the monthly benefit contribution directly to your facility.
  • Your long-term care insurance fund can also give you a list of approved facilities for the disabled, where you can compare services and prices.

Requirements

  • You have care degree 2, 3, 4 or 5.
  • You live in a
    • in a fully inpatient facility for people with disabilities or
    • comparable form of living.

Which documents are required?

  • If applicable: power of attorney, guardian's card
  • Notification from the nursing care insurance company about the degree of nursing care (expert opinion of the medical service of the nursing care insurance company)
  • if applicable: medical documents
  • If applicable: severely disabled person's ID card
  • Proof of health and long-term care insurance

Depending on the individual case, further documents may be required. Please contact your nursing care insurance fund for more information.

What are the fees?

You do not have to pay anything for the application.

What deadlines do I have to pay attention to?

You will receive the benefit from your long-term care insurance fund only from the month in which you submitted the application, but at the earliest from the time when the eligibility requirements are met. If the application is not made in the calendar month in which the need for long-term care occurred, but later, the benefits will be granted from the beginning of the month in which the application was made.

Processing duration

Processing usually takes about 2 to 6 working days.

For a quick processing and decision, your care insurance fund must be provided with the necessary information as well as any required documents in a complete and meaningful manner.

The care insurance fund decides on applications promptly.
Please note that the processing time given is an average value for all care insurance funds. It may vary in individual cases.

The exact processing time also depends on the complexity of the individual case and may be longer accordingly. The same applies if documents or records are sent to you or your long-term care insurance fund by mail.

If the need for care or the entitlement to care benefits has not yet been determined in your case, or if an application is made to upgrade the care level, the Medical Service must be involved. This usually extends the processing of your request by about 3 to 4 weeks.

Legal basis

Appeal

  • Objection
  • Action before the social court

Applications / forms

- Forms: yes

- Online procedure possible: many long-term care insurance companies offer an online procedure.

- Written form required: no

- Personal appearance required: no

Author

Technically approved by

Federal Ministry of Health

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