How Germany's long-term care reassessment ensures fair support for worsening health

From Morning Routines to Medication: Millions in Germany Rely on Care Support

Getting up, washing, breakfast—even in the early hours of the day, many people in need of long-term care depend on assistance. Yet more tasks, such as administering medication or organizing the day's schedule, are often quick to follow. According to Germany's 2023 long-term care statistics, nearly 5.7 million people rely on this kind of support and care.

The level of assistance required varies depending on the individual's care classification. However, the independence of those in need of care can decline over time. Movements slow, the need for support grows, and suddenly, existing care arrangements are no longer sufficient. Financial aid tied to a lower care level may also become increasingly inadequate.

In such cases, it may make sense to review the current care classification to ensure continued access to necessary services. But what conditions must be met for someone in need of care to file a deterioration claim—and thus qualify for a higher care level?

No Strict Prerequisites—But a Valid Reason Is Key

In principle, no specific prerequisites must be met to submit a deterioration claim for long-term care. According to Techniker Krankenkasse (TK), one of Germany's largest health insurers, an application to upgrade a care level can be filed at any time with the responsible long-term care insurance provider. However, the request should be justified—meaning it should only be submitted if the individual's health has genuinely worsened since their last assessment by the Medical Review Board (Medizinischer Dienst, or MD). Only then are there realistic prospects of success and approval for a higher care classification.

How to File a Deterioration Claim: The Step-by-Step Process

The deterioration claim—or application for an upgraded care level—must be submitted in writing, as stated by AOK, another major German health insurer. According to the care portal pflege.de, the process closely resembles that of an initial application. A simple informal letter suffices, informing the long-term care insurance provider of changes in the individual's health and care needs while formally requesting a higher care level. Some insurers, including TK, also offer an online application option.

Once the claim is submitted, the long-term care insurance provider commissions a new care assessment by the MD. Private long-term care insurers typically engage Medicproof, the medical review service for private care insurance. Though MD and Medicproof operate separately, pflege.de notes that their assessors follow the same legally defined guidelines.

The Assessment: Six Key Areas Determine the Care Level

As with an initial application, the Federal Ministry of Health (BMG) states that an upgrade assessment evaluates the individual's independence across six domains of daily life. Points are awarded in each category, culminating in a total score that determines the care level under Section 15(3) of the Eleventh Book of the German Social Code (SGB XI):

• No care level: 0 to under 12.5 total points
• Care level 1: 12.5 to under 27 total points
• Care level 2: 27 to under 47.5 total points
• Care level 3: 47.5 to under 70 total points
• Care level 4: 70 to under 90 total points
• Care level 5: 90 to 100 total points

Note: The point thresholds for determining care levels differ slightly for children.