Full inpatient nursing homes for people in need of care and how they are regulated

Basically, there are different types of homes such as residential homes for the elderly or nursing homes for the elderly.

In the area of social care insurance facility operators can apply for authorization to provide care within the framework of a so-called care mandate people in need of inpatient care

• to provide
• to care for
• to care for them.

A care contract is concluded for this purpose. The care contract contractually regulates the goods and services to which the insured persons are legally entitled between the care insurance funds and the facility operators. An essential prerequisite is that those affected require professional support and care under the constant responsibility of a qualified caregiver due to their need for care. Privately run care facilities are subject to the same licensing and remuneration regulations as municipal or non-profit facilities. The contractual stipulations in the care contract are always binding for all contracting parties. It applies that the (agreed) care remuneration and care rates between the cost bearers, i.e. the care insurance funds and social welfare providers, and the facility operators must be economical and appropriate to the services provided. Subsequent reimbursement of costs is not possible. No distinction is made between different providers here either.

Regulation: Sections 72, 71 (2), SGB XI Authorization to provide care; for the rights and obligations of care facilities, see also § 11 SGB XI )

Conditions for access to approved nursing homes

The prerequisite for benefits from the long-term care insurance funds is the existence of need for care . Whether and to what degree the need for care exists is determined in accordance with the guidelines of the GKV-Spitzenverband for determining the need for care ( assessment guidelines) in a structured procedure by the Medical Service or by other experts appointed by the long-term care insurance fund. For privately insured persons, the assessment is carried out by the medical service of the private insurance companies "Medicproof".
(see §§ 14, 15 and 18 SGB XI)

Almost the entire population in Germany is insured through one of the two compulsory insurance branches. The principle applies "Long-term care insurance follows health insurance" . Everyone who has statutory health insurance is automatically insured under the social long-term care insurance scheme. People who are covered by private health insurance against the risk of illness with entitlement to general hospital benefits are obliged to take out corresponding private compulsory long-term care insurance to cover the risk of needing long-term care.

The long-term care insurance funds as insurance providers, have a statutory duty to ensure that their policyholders receive the care they need as part of their service obligation. They do not have their own facilities, but to this end conclude Care contracts and remuneration agreements with providers of inpatient facilities and outpatient nursing and care services and contracts with individual suitable self-employed nursing staff.

Every facility that fulfills the admission requirements has a statutory entitlement to authorization to provide services. This means that there is a coexistence of facilities run by local authorities, non-profit organizations or private providers, which are available to those in need of care.

Type of financial contribution for licensed nursing homes and who is responsible for payment?

Social long-term care insurance benefits are intended to help alleviate the physical, psychological and financial burdens resulting from the need for long-term care. burdens the insured persons and their relatives alleviate . Long-term care insurance often does not cover all the costs of long-term care. It is therefore also referred to as a "partial benefit system".

As part of the benefit in kind according to § 43 SGB XI the long-term care insurance funds monthly costs for care-related expenses, including the costs of care and the costs of medical treatment care services in the

• Care level 2: in the amount of €770
• Care level 3: in the amount of €1,262
• Care level 4: in the amount of €1,775
• Care level 5: in the amount of €2,005.

People in need of care in care grade 1 receive an allowance of €125 per month.

Furthermore, those in need of care are entitled to additional care and activation in the care facility in accordance with § 43b SGB XI. The care facilities receive separate remuneration supplements for this, which are paid in full by the care insurance funds.

If the total care-related expenses of the individual exceed the the legally capped benefit amount of the long-term care insurance, the difference is difference as a personal contribution be borne by the person in need of care.

Since January 2017, the amount of the facility-specific co-payment has been the same for all people in need of full inpatient long-term care in care grades 2 to 5 within a care facility.

In order to protect those in need of care from being overburdened by rising care costs, the long-term care insurance fund pays a benefit supplement in addition to the benefit amount, which is differentiated according to care grade, on top of the care-related personal contribution of the person in need of care, which increases with the duration of full inpatient care: In the first year, the care insurance fund pays five percent of the care-related co-payment, in the second year 25 percent, in the third year 45 percent and from the fourth year permanently 70 percent.

In addition to the care-related co-payment, further costs are usually incurred for full inpatient care. These include costs for accommodation and meals. Residents of a facility may also have to pay separately calculable investment costs.

Other financial support for the costs of residential care

The federal states have the option of subsidizing the necessary investment costs of care facilities. To provide financial support for the investment costs of care facilities, the federal states are to use the savings made by social welfare providers as a result of the introduction of long-term care insurance. The federal states shall report annually to the Federal Ministry of Health on the type and scope of this funding and on the average investment costs for those in need of care associated with this funding.

Under certain conditions, the social welfare provider or the social welfare office will cover the costs of care if there are insufficient personal financial resources and relatives cannot be called upon to pay the care costs.

If long-term care insurance benefits are not sufficient to cover care needs and the person in need of care cannot pay their own share, benefits from the care assistance may be considered. Long-term care assistance is a subordinate social welfare benefit whose legal basis can be found in the Seventh Chapter of the Twelfth Book of the German Social Code (SGB XII). If the eligibility requirements, such as the need for care and financial need, are met, care assistance needs-covering is granted.