Care levels in dementia


In dementia, patients suffer from limitations in thinking and in emotional and social aspects

Dementia is a psychiatric syndrome that can be part of various brain disorders. The course of dementia is usually chronic and continuous. This is partly related to the type of underlying disease - whether it is a degenerative (progressively impairing the brain) or a non-degenerative disease.
In dementia, various deficits occur on various levels of the functionality of the brain. Both limitations in thinking, i.e. in the cognitive abilities, as well as losses in emotional or social understanding are part of the clinical picture. Often the first thing you notice is a deteriorating short-term memory. Later language and sometimes even motor skills are deficient.

The further the disease and in most cases also the dementia progresses, the less independent the patient becomes in everyday life. More and more skills are lost and have to be replaced by another hand until full maintenance is required. The effort involved can vary depending on the severity of the dementia - this means that dementia patients are also assigned different levels of care.
The five different care levels help with a subdivision and must be determined by qualified personnel. The review of the nursing requirements is always preceded by an application for a nursing degree.

For general information see also: The dementia

Since the new care reform, which has been in force since January 1, 2017, the care levels have been replaced by the care levels. This has significantly improved the situation for people with dementia in Germany. Previously, people with dementia were only considered to be in need of care if they suffered from physical complaints in addition to dementia. Depending on how limited dementia patients are in coping with everyday life, they are given care levels 1, 2 or 3.

In addition to current information on these first three care levels, you will also find information on care levels 0 to 3, as the term "care levels" is still in circulation due to the recent change at the beginning of the year.

If there are other physical complaints and the need for care increases, those affected can also be classified in a higher care level.

Read more about this: Care levels and care levels


If relatives of dementia patients notice that independent care within their own four walls can no longer be guaranteed in the long term, the person concerned must receive nursing support. If you wish to remain in your own place of residence or if the money for a nursing home cannot be raised, you should apply for care assistance.
This can easily be done in writing without any complicated forms. The long-term care insurance company, which deals with the relevant problem, can be contacted via the health insurance company.
The application is followed by a free review of the patient's need for care. This is supported by the MDK, the Medical service of health insurance, which works together with the health and care insurance companies.
Before visiting a professional, it is advisable to keep a care diary with the daily tasks and to collect helpful notes. The report on the visit is then forwarded by the MDK to the health insurance, which decides on the allocation of care levels.

Often times, the reports from dementia patients are not very satisfactory for relatives. Even if there are restrictions in the everyday life of the patient and his fellow human beings, basic skills such as eating, dressing and hygiene can usually be carried out long after the clinical manifestation of dementia.
The patient's condition can also fluctuate depending on the day and give a distorted, positive picture of the overall situation during the visit.

If the relatives do not agree with the decision, a legal objection can be lodged and a new check can be requested.

Care level 1

Care level 1 is assigned to those in need of care who have not previously had a care level. This new level of care is particularly advantageous for patients with dementia.

MDK appraisers examine the care level application and assign this level of care to those in need of care with a score of 12.5 to <27 in the new assessment assessment. This score is calculated using various modules, such as

  • mobility
  • cognitive and communication skills
  • Behaviors and mental difficulties
  • Self-sufficiency
  • Coping with disease or therapy-related stress
  • Design of everyday and social life.

Care level 1 corresponds to a physical or mental impairment of independence, but this is still quite low. People with care level 1 receive neither care allowance for care at home nor care benefits in kind nor outpatient cash benefits.

However, you will receive an “earmarked outpatient relief amount” of € 125 per month.This amount is intended primarily to finance care, supervision and guidance of those in need of care for day-to-day structuring measures.

Care level 2

With the switch from care levels to care levels, all those in need of care with care level 0 and 1 were automatically transferred to care level 2. This level of care is also assigned to people whose independence is significantly impaired. This requires a score of 27 to 47.5 in the new assessment assessment.

Those in need of care receive a monthly care allowance of € 316 if they are cared for by relatives at home. You are also entitled to care benefits in kind amounting to € 689 per month, which are settled by the outpatient care services directly with the care funds themselves.

This means that people with dementia receive significantly more care allowance than before in the care tier system.

In addition, there is the new, uniform “relief contribution” of € 125 per month, with which those in need of care can pay for shopping help or domestic help, for example. If short-term care is required after a hospital stay, the long-term care insurance funds pay grants up to a maximum of € 1,612 per year for up to four weeks.

Care level 3

Dementia patients with previous care level 1 and people with care level 2 are now assigned care level 3. Furthermore, people in need of care with a severe impairment of independence. In the NBA of the MDK, the number of points to be achieved for care level 3 is between 47.5 and 70 points. Those in severe need of care receive a monthly care allowance of € 545 with home care by relatives and care benefits in kind by an outpatient care worker of € 1,298 per month. In addition, there is the mentioned relief contribution of € 125 per month for household help, shopping help or the like.

Care level 0

The criteria for assigning care levels are repeatedly discussed in public. A particularly controversial topic is dementia, especially the Alzheimer's dementiabut also other mental illnesses.
The classification is often referred to as unjust and inconsiderate felt. These states arise from the priorities, which are made in various decisions regarding the assessment.

The Basic care must be guaranteed. This includes the personal hygiene, the daily Dress, of the Go to the toilet and the Ingestion of food and the Drink. In addition, the paths that must be made to carry out the various activities must be mastered. free time activities and the Measures positively influencing illness become Not included.

Care level 1 means that a daily time expenditure of at least 90 minutes is needed to let the patient live in their own four walls. From this period must at least half all activities that are part of the basic care sector.
Especially dementia patients who often no major physical restrictions even with their illness, they are still able to brush their teeth independently or to dress completely in the morning if the things have been put out in the evening.
Exactly this independence should as long as possible be preserved and not oppressed by caring. However, the final report often misses precisely those minutes that the patient does not need any help to reach a level of care.

The Care level 0 provides a remedy here. This is a service that must also be approved, but for which "just"A"limited everyday skills"Must be present. Since 2015 you can do this monthly 208 euros financial support can be provided, which enables the patient to additionally receive geriatric psychiatric (Gerontopsychiatry = specialist field for mental illnesses in older people) To take advantage of offers.
The nursing reform passed in 2015 also means that people belonging to the patient group concerned receive a nursing allowance of 123 euros scheduled. Monthly can Benefits in kind from maximum 231 euros to be paid.

Care level 1

The allocation of the care levels depends on how much time is needed to care for the patient. This can be done by relatives or caregivers.

As with "Care level 0“Mentioned, care level 1 is due to a care effort of at least 90 minutes Are defined. It must over half the time on the support at at least two activities omitted, which cover the area of ​​basic care (Personal hygiene, daily dressing, going to the toilet and eating and drinking).
By the time that 90 minutes of care work have come together, the dementia must have progressed so far that it becomes appropriate Limitations in everyday action the patient comes. This point in time may vary depending on the type of Underlying diseasebut also occur sooner or later depending on the patient's condition.

If care level 1 is reached, this has been a since 2015 monthly care allowance of 244 euros. If a nurse is hired or a nursing service is entrusted with the care of the patient, up to 468 euros in kind paid.
If the costs of the nursing activities, whether independently or by specialist staff, exceed the payments by the health insurers, this usually cannot be changed. If, in the course of time, the assumption arises that the care level is no longer applicable and needs to be increased another request for review be asked.

Care level 2

From care level 2, patients are classified as heavily in need of care classified. A nursing effort of at least three hours a day be done. The basic maintenance activities should be two-thirds of the time, that is at least two hours a day, take and take place at three different times throughout the day. A Household supportwhich has to be done several times a week is also one of the necessary criteria.

Care level 2 is a strongly advanced dementia disease probably achieved. They usually exist at this point due to the mostly old age of the patients additional secondary diseasesthat additionally restrict the state.
A complete immobility and being bedridden all the time is not yet described here. The effort described can also come about by instructing or taking on a wide variety of activities, even if the patient is physically fit and good according to the circumstances foot is.

With care level 2, the care allowance is almost double that of the previous level. The rate has increased in 2015 due to the care reform in the previous years. If the nursing activities are taken over by relatives, income is paid Care allowance of 458 euros together. If the nursing activities are shifted to external specialists, you can Benefits in kind up to 1144 euros be taken over.

Care level 3

Care level 3 is the highest level that can be assigned for care needs. The award goes with one extremely poor condition of the patient and therefore means a lot of work for the caring people.
To the severe dementiawhich the patient has trained in the course of his or her underlying disease, others usually come age-related diseaseswhich often alone would make nursing intervention necessary. In terms of expenditure of time, must at least five hours a day nursing services are needed. This does not apply if care level 3 is to be approved, four hours on basic care activities. There must also be a need Around the clock To be able to provide help. Will help in the night hours between 10 p.m. and 6 a.m. needed, for example when going to the toilet at night, these count as normal hours in the total. The sole criterion for care level 3 is not sufficient that help is also needed at night if care services are not required for at least five hours throughout the day.

Since the third stage is the last, the nursing effort can still be increased, a Hardship regulation put into effect. This allows one repeated increase of payments through the cash registers. The criteria for this are again strictly defined.
There are two options: The minimum requirements of care level 3 must be clearly exceeded and the nightly effort must also exceed a person's abilities, as is the case with the Mobilization or positioning of severely overweight people may be the case.
If no more staff is required, but still at least seven hours Care time is needed to fulfill all tasks, the criteria for a hardship case are also met, as long as two hours of care at night occur.

Expressed in payments, relatives of patients with care level 3 receive 728 euros per month Support with self-sufficiency or else 1612 euros for nursing benefits in kind. The latter amount can be raised through a hardship application 1995 euros be topped up and ensure adequate care.