If your baby is born with a serious illness or disability, or becomes seriously ill or disabled over time, they may need more care than a healthy baby. If this increased need for support is expected to last for more than six months, you can apply for help from social long-term care insurance. There are several ways to arrange for your child to be cared for at home. Accordingly, you can also get different types of benefits. On the one hand, you can have money paid out. On the other hand, you can also take advantage of additional or substitute help from an outpatient care service. In addition, you have the option of paying for a person to support you in the household or to look after your child at times via long-term care insurance.
In order for your child to receive long-term care insurance benefits, an assessment must first take place during which both the need for care and the so-called ‘degree of care’ required are determined. People are considered in need of care if their independence or abilities are restricted for health reasons and therefore require help from others. These can be physical, mental or emotional impairments. The condition is that the impairment must be severe and expected to last at least six months.
You may be unsure whether to apply for long-term care insurance benefits for your child. You may have already received the application and have questions about it, or you may want to know what rules the assessors will use to assess your child. Many questions usually arise in connection with the need for long-term care and long-term care insurance. There are also a lot of things that can go wrong when you apply for benefits. For example, you may have misunderstood something in the application or you may not have prepared well enough for the assessment. Therefore, to avoid disadvantages for you and your child, you should seek professional advice. The long-term care insurance companies are legally obliged to offer you comprehensive counselling on long-term care within two weeks of your application.
The advice can be provided by the long-term care insurance fund itself. However, many long-term care insurance companies and social welfare offices also refer patients to so-called ‘long-term care support centres’. These are independent counselling centres that provide free and neutral advice on all aspects regarding the need for long-term care and long-term care insurance. If you wish, the staff there will also help you to submit the application correctly. If you want them to, they'll prepare you for the appraisal. If you want or need to appeal, they will show you how to get the best benefits for you and your child. Whether you want to take advantage of this counselling is up to you. Everything that is discussed during counselling is subject to data protection and confidentiality. The advisors will show you your options. They may also make recommendations. But the decisions for you and your child are yours to make.
The degree of care is the result of an assessment of your child's illness or disability. It expresses the severity of the need for care. There are five different degrees of care. Care degree 1 means a comparatively minor impairment. Care level 5 corresponds to the most severe form of impairment. Your child is only entitled to benefits from the long-term care insurance if a degree of care has been determined. The degree of care affects what benefits your child can get and how much money is available for certain services.
There are long-term care insurance benefits to which everyone who has a degree or care is entitled. One of these is the so-called ‘relief amount’. You can use it to fund help with household chores or childcare. On the other hand, you get a certain amount of money every month for consumables such as gloves, surgical masks and disinfectants. In addition, there is money for necessary renovation measures such as the installation of a shower at ground level or a stair lift. The costs of aids such as walking aids, shower chairs, bath lifts, wheelchairs and nursing beds are also covered. If your child has a degree of care, you can also attend ‘care courses’ free of charge and get advice on caring for your child.
There are benefits that your child is not entitled to until they reach care level 2. This includes, among other things, a so-called ‘care allowance’, if you yourself or another person provides the care privately. There is also the possibility of receiving a certain amount of money each month for an outpatient care service. This is called ‘care in kind’. In order to enable relatives who provide care to take time out from time to time or to provide a temporary replacement if the relative is absent, there are the so-called ‘prevention care’ and ‘short-term care’ options. Under certain conditions, long-term care insurance also provides social security for caregivers. For example, pension insurance points can be earned. The important thing to know is that it is your free choice how you organize the care of your child.
A care allowance is paid monthly to the person in need of care. In the case of minor children, the custodial parent determines the account to which the money is transferred. As the legal guardian, you are free to decide how best to use the care allowance for your child. If you receive Unemployment Benefit II (Arbeitslosengeld II) from the Jobcenter or benefits from the Social Welfare Office (Sozialamt), the care allowance is not counted as income. If you would like to be supported by an outpatient care service, you can also apply for a combination of care allowance and care benefits in kind. The care service can, for example, support you with care work that is too strenuous for you alone, or for which special expertise is needed. The more support you receive from the care service, the less care allowance you will receive.
If you have statutory health insurance, you make the application to the care insurance fund of your health insurance company on behalf of your child. If your child does not have regular statutory or private health insurance, contact the Social Welfare Office. The Social Welfare Office may also be responsible if long-term care insurance benefits are insufficient or if the duration of care is expected to be shorter than six months. It is best to call the office responsible for you before submitting the application. By doing so, you will ensure that your child's care benefits can be approved as early as possible. Otherwise, this will only be possible from the date on which the completed application is submitted to the long-term care insurance fund or the Social Welfare Office.
With the application, you also initiate the assessment procedure for your child. You will receive a letter telling you when an assessor will be coming to your home. At the assessment, your child will be observed and a discussion will take place with you and possibly other relatives. This involves checking whether your child is in need of care and, if so, what the level of care is. After the assessment, it usually only takes a few days for you to get a decision. It states whether a degree of care has been awarded and if so, which one. As a rule, the decision must be received no later than 25 working days after you have submitted the application.