Entitlement to domestic help without a care level: Your guide to support in everyday life

An unexpected accident, a serious illness, or the period following an operation—life can change from one moment to the next. Suddenly, everyday tasks that were previously taken for granted become difficult: shopping, cleaning, or doing laundry. In such situations, many people worry about how they will manage in their own homes.

The good news is that even if you do not yet have a care level (formerly known as a nursing care level), under certain circumstances you are legally entitled to support in the form of domestic help. In this magazin , you magazin everything you need to know about your entitlement to domestic help without a care level, what costs are covered by your health insurance, and how to submit your application correctly.

When does the health insurance fund's domestic help come into effect?

Many affected individuals are unaware that domestic help is a benefit provided by statutory health insurance and is not necessarily linked to long-term care insurance. The legislature has recognized that medical recovery is only possible if household management is ensured.

You are generally entitled to domestic help if you are unable to continue running your household due to a serious illness, an acute worsening of a condition, or after a hospital stay.

The role of the medical certificate

The key to getting help is your doctor. He or she must certify that you need domestic helper is medically necessary. This often happens within the framework of so-called home nursing care or to ensure the goal of medical treatment. Without this medical certificate of necessity, the insurance company will usually reject the application.

A key requirement is that no one living in the household is able to take on the tasks involved. If, for example, a healthy spouse or adult child lives in the household, the health insurance company assumes that this person will take on the tasks. However, if the partner is employed or has health restrictions of their own, entitlement may still apply.

Trigger: You will receive help in these situations

After a hospital stay or outpatient surgery

After a surgery or prolonged hospital treatment, the body is often weakened. The road back to everyday life requires rest. This is where the entitlement to domestic help without a care level most often comes into play. The help serves to avoid readmission to the hospital.

In case of serious illness or acute exacerbation

A hospital stay is not always a prerequisite. Severe flu, a slipped disc, or an acute episode of a chronic illness (e.g., multiple sclerosis flare-up) can also mean that you are temporarily unable to manage your household.

Pregnancy and childbirth

Expectant mothers are also entitled to domestic help without a care level. If during pregnancy complications arise that require bed rest, or if the mother is weakened after giving birth, health insurance companies often cover the costs of domestic help.

Children in the household: The special rule

If there are children in the household who are younger than 12 years of age at the start of the benefit or who are disabled and dependent on assistance, the entitlement is extended. In this case, assistance can often be granted for a longer period of time, as the care of the children must be ensured.

Distinction: domestic help, caregiver, or nursing service?

What does a domestic helper do?

A domestic helper takes care of the organizational and practical aspects of living. Typical tasks include:

• Cleaning (vacuuming, mopping, bathroom cleaning)
• Cooking and preparing meals
• Shopping for groceries and everyday necessities
• Laundry and ironing
• Childcare

What a domestic helper is not allowed to do

It is important to understand that a domestic helper is not a substitute for a nurse. They do not perform nursing tasks such as personal hygiene (washing, showering), wound care, or administering injections.

When does the nursing service come into play?

If you require medical assistance, such as changing dressings or insulin injections, this is considered treatment care. This is provided by certified nurses from a nursing service. Home nursing (medical) and domestic help (domestic) are requested in combination.

Application and approval

The application to the health insurance company

The application must be submitted to the health insurance company before the service begins. Retroactive applications are often rejected. Call your insurance company and ask them to send you the form for "domestic help" or download it online.

Submit a medical certificate

The application form usually includes a section that must be completed by the attending physician. They indicate why the assistance is necessary (diagnosis), how many hours per day are required, and for how long the support is needed.

Selection of the service provider

In the application, you can often specify whether you want to hire a professional care service or social institution, or whether you will find a private replacement yourself (neighbors, friends). Health insurance companies often have contracts with certain providers.

Duration and scope of support

As a rule, domestic help is approved for a period of up to 4 weeks. This applies in particular to cases where there are no children under the age of 12 living in the household.

Extension in exceptional cases

If there is no improvement after four weeks, the doctor can apply for an extension. The health insurance company will then review the medical service again.

Extended entitlement with children

If there are children in the household who need to be cared for, the entitlement often lasts for up to 26 weeks. This is a significant improvement for young families in times of crisis.

Costs and financing of domestic help

The cost of domestic help varies depending on the provider and region. Professional service providers often charge hourly rates of between approximately $15 and $35 per hour. If the health insurance fund has approved the assistance, the service provider usually bills these costs directly to the health insurance fund.

The statutory co-payment

As with medications, you as an insured person must pay a co-payment. This is usually 10% of the costs, but at least €5 and at most €10 per day.

• Example: If the assistance costs €60 per day, you pay €6. If it costs €120 per day, you pay €10.

Reimbursement of expenses for private helpers

If you arrange for a private individual (e.g., neighbor, friend) instead of a service provider, the health insurance fund will reimburse the costs to a reasonable extent. A fixed amount is often set for this. Currently, many health insurance funds pay approximately €10.25 per hour for a maximum of 8 hours per day.

• Important: Relatives and in-laws up to the second degree (e.g., children, parents) cannot claim remuneration for work, but can be reimbursed for travel expenses and loss of earnings.

Special features for privately insured persons

For privately insured individuals, domestic help is often not a standard benefit. It depends heavily on your chosen tariff. Check your policy or ask your insurance company directly. Such benefits often have to be insured as an additional module.

Alternative: Care level 1 and the relief amount

If the limitations are permanent (expected to last longer than 6 months), you should consider applying for a care level. You are entitled to long-term care insurance benefits from care level 1 onwards.

The relief amount of 131 euros

From care level 1 , you are entitled to the so-called relief amount . This amounts to €131 per month (earmarked). You can use this money to finance domestic helpers who are recognized under state law.

• This is a valuable opportunity to receive long-term help with household chores, even if the health impairment is not severe enough to qualify for care level 2.

Difference from care level 2 and higher

From care level 2 , you will also receive care allowance or care benefits in kind. The relief amount of €131 per month remains available to you even in the higher levels (2 to 5) and can be used specifically for household support.

Privately funded assistance for seniors

Many seniors feel weaker in old age, but do not meet the criteria for short-term domestic help from their health insurance (no acute illness) or for a care level. In this case, the costs must be borne privately.

Mini-job vs. self-employed domestic help

You have two main options:

1. Mini-job: You hire a domestic helper as an employer under the mini-job scheme. You pay the wages and low flat-rate contributions. Advantage: You are legally covered by accident insurance, for example.
2. Freelancers/agencies: You book a worker through an agency or platform. You receive an invoice. This is more expensive, but easier from an administrative point of view.

A major advantage: you can claim expenses for "household-related services" on your taxes. 20% of the labor costs (up to a maximum amount) can be deducted directly from your tax liability.

Practical example: The case of Monika S.

To clarify the procedure, let's look at a specific example.

The situation:

Monika S. (68) lives alone in a three-room apartment. She does not have a care level. After falling in her garden, she suffers a complicated arm fracture. Surgery is necessary. She is discharged from hospital after five days. Her right arm is in a cast; she cannot cook, clean, or lift heavy objects. Her children live 200 kilometers away.

The problem:

Monika urgently needs support to recover at home, otherwise she will need short-term care.

The solution:

1. Step 1: While still in the hospital, Monika speaks with social services. The hospital doctor issues a certificate of necessity for domestic help for an initial period of 14 days. Scope: 2 hours per day for shopping, tidying up, and meal preparation.
2. Step 2: The application is immediately faxed to Monika's health insurance company. Since no one living in the household can help, the application is approved.
3. Step 3: Monika contacts a licensed provider of domestic help in her area.
4. Step 4: Help arrives on the day of discharge. Monika only has to pay the statutory co-payment (10% of the costs, max. €10 per day).

Result:

Thanks to the domestic help provided by her health insurance, Monika can stay in her own home and focus on her recovery. After three weeks, she is fit enough to manage her daily routine on her own again.

Where can I find suitable domestic help?

Care support centers and advice centers

Almost every city has care support centers. These provide impartial advice and often have lists of providers of domestic help and caregivers.

Online platforms and agencies

There are numerous placement portals on the Internet. Pay attention to reviews and whether the workers are insured.

Recommendations and local notices

The "bulletin board" at the supermarket or asking around among your friends and acquaintances often helps. If you hire someone privately, be sure to draw up a proper contract and register with the Minijob-Zentrale (mini-job center).

What you should pay attention to in contracts

If you hire private or commercial help:

• Task description: Define exactly which activities (mopping the floor, cleaning windows, shopping) are to be carried out.
• Notice periods: Stay flexible.
• Liability: What happens if something breaks while cleaning? Liability insurance is essential.
• References: Ask to see references or recommendations.

Frequently asked questions (FAQ)

Below, we answer many typical questions that we receive from those affected.

1. Can I list my daughter as a domestic helper?

Yes, you can employ family members. However, health insurance does not pay wages for close relatives (first and second degree). Travel expenses and any loss of earnings, for example if your daughter takes unpaid leave to provide care, can be reimbursed.

2. How long does it take for the application to be approved?

In urgent cases (e.g., after a sudden accident), health insurance companies often make a decision within 24 to 48 hours. It is advisable to follow up by phone and mark the application as "urgent."

3. What happens if the 4 weeks are not enough?

If your doctor confirms that you are still unable to run your household for health reasons, a follow-up application can be submitted. However, this is decided on a case-by-case basis by the health insurance fund.

4. Am I entitled to domestic help if I have care level 2?

From care level 2 onwards, long-term care insurance benefits take priority (care allowance, benefits in kind). Domestic help via health insurance is then only available in very specific exceptional cases if the illness has nothing to do with the need for care. In most cases, the help is then financed via the relief amount or the care allowance.

5. Does the health insurance fund also pay for gardening?

No. The health insurance company's domestic help is responsible for basic care (meals, hygiene in the living area, laundry). The garden, stairwell, or major spring cleaning are not usually included.

Summary and conclusion

The entitlement to domestic help without a care level is an important instrument of our social system for supporting people in acute health crises. It closes the gap when you are unable to work due to illness but do not require long-term care.

The most important points at a glance:

• Reason: Acute illness, hospital treatment, surgery, or pregnancy.
• Condition: Medical certificate and no one living in the household who can help.
• Duration: Usually up to 4 weeks (longer with children under 12).
• Costs: You pay a maximum of €10 per day; the rest is covered by statutory health insurance.
• Alternative: If you have permanent limitations, apply for a care level and take advantage of the relief amount of €131 per month.

Don't be afraid to take advantage of these services. A clean home and healthy diet are the basis for your recovery. Talk to your doctor and insurance company early on to ensure that you receive care at home.