Financing domestic help through the long-term care insurance fund – overview of entitlement, costs, application, and financing

to keep them in their familiar surroundings for as long as possible.

This primarily involves domestic tasks that can no longer be performed independently due to illness, age, or disability. Household support also greatly reduces the burden on family caregivers.

Difference: Domestic help vs. nursing professional

It is important to distinguish between a domestic helper and a nursing professional. While nursing staff from a nursing service are responsible for basic care, such as washing, dressing, or even treatment care, which includes administering medication and changing bandages, domestic helpers focus on the environment of the person in need of care.

A domestic helper does not provide medical services, but instead takes on various household tasks. They ensure that the home remains clean and that daily care is provided. However, a nurse and a domestic helper complement each other perfectly in everyday life.

Typical tasks of a domestic helper

The tasks of a domestic helper are varied and depend on the individual care needs of the person concerned. Classic tasks include:

• Cleaning the apartment: vacuuming, mopping, window cleaning, and bathroom cleaning.
• Laundry care: washing, drying, ironing, and putting away clothes.
• Nutrition: Shopping for groceries and cooking together or independently.
• Errands: Going to the post office, pharmacy, or government offices.
• Everyday support: Accompanying you to doctor's appointments or going for walks to promote social participation.

What does a domestic helper not do?

Despite broad support, there are clear limits. A domestic helper does not usually take on heavy manual work or gardening, unless this has been explicitly agreed.

Similarly, nursing tasks such as changing catheters or wound care should only be carried out by qualified nursing staff. Legal representation is also not part of a domestic helper's remit.

Domestic help via the nursing care insurance fund: The legal basis

The financing of domestic help is enshrined in the Eleventh Social Code (SGB XI). As soon as a need for care is determined by the Medical Service (MD) , those affected are entitled to long-term care insurance benefits.

These benefits serve to ensure home care and support in everyday life. A distinction is made between cash benefits, such as care allowance, and benefits in kind, such as care services or domestic help.

Entitlement to domestic help with a care level

Entitlement to domestic help depends largely on the assigned level of care . The higher the assigned care level , the more financial resources the long-term care insurance fund will provide to the person in need of care for household support.

It is advisable to apply for a care level from the long-term care insurance fund at an early stage in order to secure funding for domestic help. Even with minor limitations, care level 1 can be granted.

Domestic help Long-term care insurance for care level 1

People with care level 1 are not yet entitled to care allowance or traditional care benefits in kind, they do receive the so-called relief amount.

This amount of €131 per month can be used specifically for domestic help. The prerequisite is that the provider is recognized under state law. This is often the first level of support to prevent a worsening of the need for care.

Services and domestic help for care level 2 and above

From care level 2 , the options for financing domestic help expand significantly. In addition to the relief amount, parts of the care benefits in kind can also be used for housekeeping.

People in need of care in care grades 2 to 5 are also entitled to care allowance if they wish to organize help privately. The combination of different types of benefits enables comprehensive care in their own home.

The relief amount: €131 per month

The relief amount pursuant to Section 45b of SGB XI is a central pillar for financing domestic help. It is available to anyone in need of care from care level 1 to care level 5 in the same amount of 131 euros per month.

Important to know: The amount is purely a reimbursement. This means that you submit the service provider's invoice and are reimbursed for the costs, or the service provider bills the long-term care insurance fund directly. Unused amounts can be carried over to the next calendar half-year.

Conversion of care benefits in kind

A valuable tip for financing: If the care benefits in kind are not fully utilized for the care service, up to 40% of the amount can be reallocated to offers of support in everyday life.

This significantly increases the budget for domestic help. This "conversion entitlement" must be applied for at the long-term care insurance fund and allows for flexible adaptation to the actual living situation.

Use respite care to finance domestic help

If a private caregiver, such as a relative, is unable to provide care due to vacation or illness, respite care steps in. substitute care . An annual amount of €1,685 is available for this purpose.

This amount can also be used for domestic help if the need arises due to the absence of the primary caregiver. The prerequisite for this is that at least care level 2 and the caregiver has already been caring for the person concerned in their home environment for six months.

Domestic help from health insurance vs. long-term care insurance

There is often confusion about who is responsible. Health insurance companies pay for domestic help in cases of acute illness, after surgery, or during high-risk pregnancies, provided that the patient does not require nursing care. This benefit is usually limited to four weeks.

The long-term care insurance fund, on the other hand, is responsible for long-term support once a care level has been determined. While the health insurance fund requires a medical certificate, the long-term care insurance fund bases its decisions on a permanent assessment of the need for care.

The transition from occasional assistance in the event of illness to long-term support from the nursing care insurance fund always begins with the determination of the need for care. Since the care level is the basis for all further benefits, such as domestic help, the application process should be carefully prepared.

1. Submit the application informally

The first step is very simple: contact your insurance company's long-term care insurance fund. A phone call, email, or short informal letter stating "I am applying for long-term care insurance benefits" is sufficient.

Important: The date of the first contact is considered the date of application. Since benefits are only paid from the month of application (not retroactively for the period before that), you should not hesitate. The nursing care insurance fund will then send you a detailed form, which you must fill out and return.

2. Preparing for the visit from the Medical Service (MD)

As soon as the application has been received, the nursing care insurance fund commissions the Medical Service for those with statutory insurance or Medicproof for those with private insurance to provide an expert opinion. An expert will then contact you to arrange a home visit.

To prepare, you should:

• Keep a care diary: Over a period of one to two weeks, make a note of exactly where help is needed in everyday life (e.g., difficulty climbing stairs, forgetfulness when taking medication, or even the inability to run the household alone).
• Havemedical records ready: Reports from general practitioners and specialists, discharge letters from the hospital, and medication plans should be readily available.

3. The assessment (the NBA system)

The assessor uses the so-called "New Assessment Assessment" (NBA). This assesses the degree of independence.

Six different modules are tested in order to assess independence:

1. Mobility (e.g., moving around the home).
2. Cognitive and communication skills ( e.g., orientation).
3. Behavioral patterns and psychological problems ( e.g., anxiety, restlessness).
4. Self-care ( e.g., personal hygiene, nutrition).
5. Coping with illness- or therapy-related demands.
6. Organization of everyday life and social contacts.

4. The decision of the long-term care insurance fund

After the visit, the assessor will make a recommendation. The long-term care insurance fund will then send you a written notification. This will inform you whether and which level of care (1 to 5) has been recognized.

With a notification of your care level, you will also receive access to:

• The relief amount of €131, which you can use directly for domestic help.
• Consulting services in accordance with Section 37.3 of SGB XI (German Social Security Code).
• Subsidies for measures to improve the living environment.

5. Appeal against rejection

If the application is rejected or the care level is lower than expected, you have the right to submit a written appeal within one month of receiving the decision. . . It is often worthwhile to seek professional help from social welfare organizations or care advice centers in order to have the assessment reviewed by experts.

As soon as you receive the decision, you can take full advantage of the financing options for your domestic help (relief amount, reallocation of benefits in kind, or respite care).

Costs for domestic help: An overview

The cost of domestic help varies greatly depending on the type of employment and the qualifications of the person. It is important to distinguish between the gross hourly rates charged by agencies and the pure wage costs for private employment.

In addition, social security contributions and insurance play a role when hiring someone directly in your own household. Transparency is the key to correct financing here.

How much does a domestic helper cost per hour?

Anyone who hires a recognized service provider can expect to pay between €25 and €45 per hour. This amount covers not only the worker's wages, but also administration, insurance, and travel costs.

For private employment, for example on a mini-job basis, the costs are often between $13.90 and $20 per hour. However, it should be noted that private workers often cannot be billed via the tax relief amount, as this usually requires certification of the provider under state law.

Regional differences in prices for domestic help

The cost of domestic help varies across Germany. In metropolitan areas such as Munich, Hamburg, or Frankfurt, hourly rates are often significantly higher than in rural regions in eastern Germany or North Rhine-Westphalia.

Relatives should therefore always compare several offers from their specific region. Local care centers often provide information about the usual rates in the area.

Sample calculation for the monthly financing of domestic help

Suppose a senior citizen with care level 2 needs assistance with house cleaning and shopping four times a month for two hours each time.

• Hourly rate provider: 35 euros
• Total cost: 8 hours x $35 = $280 per month
• Coverage by relief amount: 131 euros
• Remaining balance: 149 euros
• This remaining amount can usually be covered in full by converting care benefits in kind (40% rule), meaning that the person affected does not have to pay anything themselves.

Hire privately or use a recognized provider?

The choice of provider is crucial for billing. Recognized providers usually have contracts with long-term care insurance companies. This enables direct billing of the relief amount.

A private individual often offers more continuity and a closer relationship, but is more complicated to manage in terms of tax and insurance. In addition, health insurance funds only grant funds from the relief fund for "neighborhood assistance" (private individuals) under strict regional conditions.

Applying for domestic help: step by step

1. Apply for a care level: If you have not already done so, submit an application to your long-term care insurance provider.
2. Determine requirements: What tasks need to be completed? How many hours are required?
3. Search for providers: Find approved services in your area.
4. Obtain a cost estimate: If necessary, submit this to the long-term care insurance fund for review.
5. Request service: After receiving the notification, commission the service provider.

What documents are required?

The following documents are important for the application and subsequent reimbursement:

• The decision on the level of care.
• Invoices from the service provider (must show the type of service and period).
• Proof of the provider's recognition under state law.
• For respite care: Informal application or special form from the health insurance fund.
• Bank details for reimbursement of costs, if applicable.

Billing: Direct billing vs. reimbursement principle

Most major providers use the direct billing method. This involves the person in need of care assigning their claim to the service provider, who then bills the long-term care insurance fund directly. This saves those affected the bureaucratic effort.

Under the reimbursement principle, the customer first pays the bill themselves and then submits it to the long-term care insurance company to get the amount back. This is often the case with smaller associations or neighborhood assistance programs.

Tax advantages and deductibility of costs

Not all costs are always covered in full by the nursing care insurance fund. However, you can claim the remaining portion you pay yourself deductible for tax purposes . Household-related services are tax-deductible under Section 35a of the German Income Tax Act (EStG).

You can deduct 20% of the costs, up to a maximum of €4,000 per year, directly from your tax liability. This requires a proper invoice and payment.

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Relief for family caregivers

Caregiving relatives are often under enormous pressure. Organizing domestic help can therefore be an important step toward self-care. When someone else takes care of cleaning the home or cooking, there is more time for valuable shared moments or even for your own relaxation.

Accepting help is not a sign of weakness. On the contrary: a stable home situation protects caregivers from burnout and ensures the quality of care in the long term.

Quality features: What to look for when choosing?

When looking for suitable support, you should not only consider the price.

Please note the following points:

• Website: Does the website look professional? Are services clearly listed?
• Initial contact: How quickly and politely is an email or phone call answered?
• Transparency: Are the costs per hour clearly communicated?
• Staff: Are the employees permanently employed and insured? Are there designated contact persons?

Data protection and privacy in your own home

Letting a stranger into your home requires trust. Reputable providers place great importance on data protection and privacy.

All data relating to those in need of care must be protected in accordance with the GDPR. In addition, domestic helpers should be bound to confidentiality. A reputable provider will sensitively discuss during the initial consultation which areas of the home are off-limits and how keys are to be handled.

FAQ - Frequently asked questions

1. Can I get domestic help even if I don't have a care level?

Yes, but then the nursing care insurance fund will not cover the costs. The health insurance fund may cover the costs in the event of temporary illness, otherwise the costs must be paid privately.

2. Does the relief amount expire at the end of the month?

No, unused amounts are carried over to the following month. They can even be saved up and used until June 30 of the following year.

3. Is the domestic helper allowed to go shopping for me as well?

Yes, running errands and shopping are part of the duties of a qualified domestic helper.

4. How can I find accredited providers in my region?

Your nursing care insurance fund will provide you with a list of approved nursing services and support services upon request. Online portals of the federal states can also help you here.

5. Does the nursing care insurance fund also pay for a cleaner from an online platform?

Only if this platform works with providers who are certified under state law. Purely private mini-jobs are usually not eligible for the tax relief amount.

6. What happens when the domestic helper is on vacation?

Recognized services usually provide a substitute. If you are privately employed, you must cover the vacation period yourself or apply for substitute care.

Conclusion: Domestic help via long-term care insurance

Financing domestic help through the long-term care insurance fund is an essential component of aging with dignity in your own home. With the relief amount from care level 1 and the expanded options from care level 2, tangible support can be provided.