If you have to be cared for after a hospital stay, you can get in-home care. Health insurance partly pays for this.
Since 2018, it is legally determined that patients who have been discharged from hospitals or were treated on an outpatient basis are entitled to home care, the so-called Unterstützungspflege (home care support). The following texts explain how to apply for this, how much it costs and who can apply for it.
Unterstützungspflege – what is that?
According to the German Code of Social Law (Sozialgesetzbuch § 37 Abs. 1a SGB V), Unterstützungspflege is defined as follows:
According to section 1 clause 1, insured persons receive the necessary basic care and household assistance due to severe illness or acute deterioration of an illness, especially after a hospital stay, after outpatient surgery or after outpatient hospital treatment, provided that there is no need for care of Pflegegrad (degree of care) 2, 3, 4 or 5 according to Book Eleven (German Code of Social Law). Section 1 clauses 1 and 2 apply accordingly.
This means that professional nurses support you in your personal hygiene, cooking, cleaning your apartment, running errands, helping you get down and upstairs, to cut a long story short: they support you in coping with everyday life. This is a service of your health insurance, so it doesn’t work completely without bureaucracy. Also, not everyone is entitled to get help from the health insurance.
Who can apply for Unterstützungspflege?
Persons who cannot do certain things on their own anymore after a hospital stay and don’t get help from another person in their household, they are entitled to make an application. In addition, you must not correspond to Pflegegrade (degrees of care) 2 to 5.
Two examples: Martin Kraus, 69 years old, is a widower, lives alone in his apartment and had surgery on his hip. His son lives in the same city, but he works full-time. Thus, Mr. Kraus is entitled to apply for Unterstützungshilfe after his hospital stay because he cannot do certain things on his own any more (such as buying groceries for example or cleaning his apartment).
It would be similar for Marie Vollmer, 32 years old. She has a three-years-old daughter, is a single mother and has to do a chemotherapy due to her cancer condition. She will be so exhausted during her treatment because of the drugs, that she needs help. Her doctor can prescribe Unterstützungspflege for her.
How to Apply for Help
The household help has to be prescribed by a doctor and approved by the health insurance. It would be best if you already talked to your family doctor about the issue before the treatment. A hospital doctor can also prescribe the Unterstützungspflege. In this case, it is recommended to talk to them at an early stage, because it can take some days for the health insurance to approve the application. Hence, just talk to your family doctor or a hospital doctor about it. He will fill in the application with you and arrange the necessary formalities.
How much does the Unterstützungspflege cost?
The health insurance pays 90 percent of the costs, you pay 10 percent. However, you pay a maximum of 10 euros per day and at a minimum of 5 euros per day. If you are cared for by a care service for 14 days who charge you 1,400 euros, your proportionate costs are 140 euros. In addition, you pay 10 euros per medical prescription, so for the example above a total of 150 euros.
If you don’t want to receive care from an outpatient care service, you can also be cared for by a neighbor or friends. They receive between 5 euros and 9.50 euros per hour from your health insurance. Let’s assume that your neighbor visits you to help you for a remuneration of 8 euros per hour and 5 hours per day. She would have earned 560 euros in 14 days, 66 euros of which are paid for by you (10 percent of the costs + 10 euros for the medical prescription).
Whether you choose an outpatient care service or your best friend, you have to get the approval from your health insurance before the beginning of the care. The doctor often takes a note of the carer when filing the application. You can tell them that you would like to be cared for by a private person or choose an outpatient care service together. You have the right to choose the care service yourself. If you don’t know any care service, your health insurance helps.
The health insurance’s contribution to Unterstützungspflege is limited to a maximum of 1,612 euros per year.
How long can I claim Unterstützungspflege?
The family doctor is allowed to prescribe 14 days of Unterstützungspflege, the hospital doctor can prescribe 7 days. After that period, the family doctor checks whether further care is necessary and can issue another prescription if required. He then prescribes the so-called Sicherungspflege (secured care), because you need further help if you cannot cope with everyday life yet. Under certain circumstances, the Medical Service of the health insurance (Medizinischer Dienst, MDK) verifies the necessity of further help. Unterstützungspflege can be granted for a maximum of 8 weeks per year.
Which services does Unterstützungspflege comprise?
When the doctor prescribes the help, he also writes down what kind of support you need. This is where you can get help with:
Personal hygiene: showering, bathing, combing your hair, dental hygiene, continence training, help going to the toilet
Food: cooking and feeding if necessary
Mobility: help to get dressed and undressed, getting up and going to bed, repositioning or transferring from wheelchair to bed, walking stairs
Housekeeping: setting and clearing the table, doing the groceries, waste disposal, cleaning the apartment/house, doing the laundry, ironing, running errands.
Medical treatment (must be carried out by examined caregivers): wound care, injections, putting on surgical stockings.
You are not automatically prescribed all the services. Your doctor examines in which areas you need help. The extent of the services also has an influence on the choice of the nursing staff. If you need wound care for example, you need an outpatient care service in any case. If you only need help with household and running errands, you can also ask a friend or family.
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