Organize care flexibly—without registering a single designated caregiver with the long-term care insurance fund.

Mr. M. is 78 years old and has been living alone in his apartment in Stuttgart since his wife’s death. Following a stroke, he needs daily assistance. His daughter visits on Mondays and Wednesdays, his neighbor accompanies him to doctor’s appointments, and on Fridays, a friend helps him with grocery shopping.

When Mr. M. applies for a long-term care allowance from his long-term care insurance provider, he is asked: “Who is your primary caregiver?” Mr. M. doesn’t know how to answer and fears he might lose his long-term care allowance. This concern is unfounded. What many people don’t know is that the law does not require a single designated caregiver. The only thing that matters is that the care is actually provided.

Long-term care allowance without a designated caregiver—that sounds contradictory at first. In fact, however, there is a clear legal entitlement to long-term care allowance, even if no specific caregiver is registered with the long-term care insurance fund. This magazin what the law actually says, what conflicts may arise with the long-term care insurance fund, and how you can secure your entitlement to long-term care allowance.

What Is a Long-Term Care Allowance? Basics of Long-Term Care Insurance

The Care Allowance is a cash benefit provided by social long-term care insurance under Section 37 of SGB XI. It is paid to people in need of care who organize their own home care, for example through family members, friends, or neighbors. Unlike in-kind long-term care benefits, where an outpatient care service bills directly, individuals in need of care receive the long-term care allowance directly into their bank account and can use it freely to pay for care assistance they organize themselves.

Important to know: The care allowance always belongs to the person in need of care, not the caregiver. It can be passed on to family members, used for a part-time job, or applied toward other care services; the decision rests with the person in need of care.

When is a person eligible for a long-term care allowance?

The requirements for eligibility for a long-term care allowance are straightforward:

• The individual has been assigned a recognized care level of at least Care Level 2.
• Nursing care is provided at home (in-home care)—not in a nursing home.
• Care is provided in an appropriate manner.
• An application was submitted to the long-term care insurance fund, and the need for long-term care was assessed by the Medical Service (MD).

There is no care allowance for Care Level 1; instead, the relief payment of 131 euros per month applies instead. Starting with Care Level 2, there is a clear legal entitlement.

Care Allowance and In-Kind Care Benefits: The Difference

In addition to the care allowance, which is a cash benefit, there is also the in-kind care benefit: In this case, an outpatient care service provides specific care services, such as personal hygiene or administering medication, and bills the long-term care insurance fund directly. Anyone who does not use the full amount of benefits in kind can receive the remaining portion as a proportional care allowance; this is called a combined benefit. For example, a person in need of care with care level 2 can use 50% of the benefits-in-kind budget through a care service and then receives 50% of the care allowance paid out monthly.

Care Allowance Without a Caregiver: What the Law Actually Says

This point comes as a surprise to many people in need of care and their relatives: Nowhere in Book XI of the Social Code does it require the designation of a single, specifically named caregiver as a prerequisite for receiving a care allowance.

Section 37 of SGB XI refers to “self-procured care aids” and thus presupposes that home care is ensured in an appropriate manner. What “appropriate” means is determined by the actual outcome of the care, not by formal records. Whether a daughter comes to help, a neighbor lends a hand, several friends pitch in, or multiple family members take turns providing care: what matters is that care is ensured.

Ms. K., who is 84 years old and has a care level of 3, lives alone. Her two sons share the responsibility of caring for her: one takes care of her Monday through Wednesday, and the other takes over for the rest of the week. In addition, a neighbor checks on her every day.

When the long-term care insurance provider asks about a “registered caregiver,” both sons are unsure. Yet the legal situation is clear: Their entitlement to long-term care benefits exists regardless of whether a specific person is registered—as long as care is provided, that is sufficient.

The legislature has deliberately left this leeway to accommodate flexible care arrangements: care tandems consisting of several family members—which offers particular advantages for caring for relatives at home—rotating caregivers, help from neighbors, or a combination of family members and an outpatient care service—all of these are legally permissible and do not preclude eligibility for the care allowance.

What Long-Term Care Insurance Providers Sometimes Require—and Which of These Requirements Are Legitimate

In practice, things sometimes look different. Long-term care insurance providers regularly request that a caregiver be designated, sometimes via forms and sometimes via letters. Their reasons are understandable: The providers want to know who is providing home care and need a contact person for the required counseling visits.

However, the law is clear on this point: The long-term care insurance fund may not reject an application for long-term care benefits solely on this basis, nor may it reduce or cancel the benefits simply because a caregiver has not been named, as long as home care is actually provided. Anyone who receives such a letter should not panic—but they should take action.

Long-Term Care Allowance Table: Amounts by Care Level (2025/2026)

The amount of the long-term care allowance is based on the recognized care level, which is key to determining the amount and scope of benefits. The long-term care allowance is paid starting at care level 2, monthly in advance to the bank account of the person in need of care:

Degree of care	Care Allowance/Month	Consultation Visits
Care level 1	No Care Allowance	Not mandatory; for Care Level 1, counseling services are available on a voluntary basis.
Care level 2	347 Euro	Every six months
Care level 3	599 Euro	Every six months
Care level 4	800 Euro	Quarterly
Care level 5	990 Euro	Quarterly

The long-term care allowance is earmarked for home care. In the event of a hospital stay or rehabilitation, the long-term care allowance continues to be paid for up to 28 days per calendar year; after that, the entitlement is suspended. The amount of the long-term care allowance does not change depending on whether a caregiver has been designated or not.

Common Disputes with Your Long-Term Care Insurance Provider—and How to Respond

"You must designate a caregiver."

Many people in need of care and their family caregivers come across this phrase. It sounds like an obligation, but it isn’t. The letter from the long-term care insurance fund is generally for administrative purposes; the named person would primarily play an organizational role in handling inquiries and coordinating counseling visits, but this is not a requirement for eligibility: The fund wants to ensure that counseling visits can be coordinated in accordance with Section 37(3) of SGB XI.

Your response could be: Home care is appropriately provided by several individuals. I would like to point out Section 37 of SGB XI, which does not require the designation of a single caregiver as a prerequisite for eligibility for the care allowance. In most cases, such a written statement regarding the organization of care is sufficient.

Threat to Switch to In-Kind Long-Term Care Benefits

Some long-term care insurance providers have announced that they will switch from cash benefits to in-kind benefits if no caregiver is designated. This switch is permitted only if there are genuine doubts about the availability of home care or if counseling visits are consistently not taking place.

Anyone who briefly outlines the care plan in writing and adheres to the consultation visits is on the safe side. A change in care arrangements made against the will of the person in need of care without a valid reason can be challenged by filing an objection, with the support of care support centers or a social law attorney.

Consultation Visits: A Requirement, Not an Option

Anyone receiving a care allowance is required to participate in regular home visits by a counselor. These visits serve to ensure the quality of home care. The frequency depends on the care level:

• Care Levels 2 and 3: Consultation visit every six months (twice a year)
• Care Levels 4 and 5: Quarterly counseling visits (four times a year)

If counseling appointments are missed, the long-term care insurance fund may reduce the long-term care allowance or temporarily suspend it. It is therefore worth making these appointments a priority and notifying the fund in a timely manner if you are unable to attend.

Ms. S. is 71 years old, has a care level of 3, and is cared for by her sister and a neighbor. When she forgets an appointment for a consultation, she receives a letter from the long-term care insurance fund. On the advice of the local long-term care support center, she explains the situation in writing and promptly schedules a make-up appointment. Her long-term care allowance is not reduced.

Conclusion: Missing an appointment does not necessarily mean you will lose your care allowance; the key is to communicate with the long-term care insurance fund promptly and proactively.

Organizing Care Without a Dedicated Caregiver: Here's How to Do It

Flexible care arrangements without a single primary caregiver are not the exception but are quite common in everyday life. Several family members, friends, and professional support can complement each other effectively when organization and communication are in place.

Care Tandems, Care Allowance for Family Members, and Shared Responsibility

Two or more family members share the caregiving responsibilities equally, and this recognition of shared responsibility helps ease the burden in everyday life. This can be divided by day of the week, by task (one person handles personal care, another handles doctor’s appointments and shopping), or by availability. It is important to have a clear agreement about who takes on which task and when, and who steps in if someone is unavailable.

Involve Neighbors and Volunteers

People in the immediate circle—neighbors, friends, volunteers, as well as friends who are not family members but who help out in daily life—can be valuable components of the caregiving structure. While they are not the primary caregivers, they significantly lighten the burden on family caregivers: a visit, a trip to the store, or an accompaniment to the doctor’s office—these are concrete contributions that, together, ensure consistent care.

Use outpatient nursing services as a supplement

Anyone who has specific care services (particularly personal care or medication administration) provided by an outpatient care service and arranges for family members to handle the rest can take advantage of the combined benefit: A portion of the in-kind benefits budget is used for the care service, and the remaining amount is paid out proportionally as a care allowance. This flexible combination of professional care services and a care allowance is expressly provided for and permitted by law and offers practical advantages for many families when family members and the care service work together.

Documentation: Your Most Important Argument to the Long-Term Care Insurance Fund

If you keep a record of your care routine, you’ll be on the safe side. It doesn’t have to be a detailed care log; a simple overview is often enough:

• Who is responsible for which tasks on which day?

• Who can be reached in case of an outage?

• What other assistive devices or services are used?

You can present this overview during your consultation visit and include it with any responses to inquiries from the long-term care insurance fund. It demonstrates that care is organized, reliable, and secure, even without a registered caregiver.

An Overview of Respite Care and Other Services

The care allowance is not the only benefit provided by long-term care insurance that is relevant to people receiving care at home. The following benefits are particularly important, especially in cases where care is organized flexibly without a designated caregiver:

Respite Care: When the Caregiver Is Unavailable

Respite Care is provided when a caregiver is temporarily unable to provide care, for example, due to illness, vacation, or an emergency. The long-term care insurance fund covers up to 3,539 euros annually in combination with short-term care.

Important new regulation effective July 1, 2025: The previous six-month prior care period requirement is being eliminated. This means that individuals in need of care will be able to receive respite care in the future even if their caregiver has not provided care for them for at least six months prior. This makes respite care significantly more accessible, especially in the first few months following the determination of the care level.

Reimbursement amount: 131 euros per month for all care levels

In addition to the care allowance, individuals in need of care starting at Care Level 1 are eligible for a relief allowance of 131 euros per month. This allowance may be used for approved relief services, such as assistance with daily activities, household-related services, or care services. Any unused portion of the allowance may be carried over to the next calendar half-year.

Short-Term Care and Day Care

Short-term care provides temporary inpatient care (e.g., following a hospital stay) when home care is temporarily unavailable. Day care supplements home care without completely replacing the care allowance: When day care is used, half of the care allowance continues to be paid.

Checklists and Sample Wording

Checklist: Am I eligible for a long-term care allowance?

• Do you have a recognized care level (at least Care Level 2)?
• Is the care provided at home (not in a nursing home)?
• Is care provided by family members, friends, neighbors, or a combination of these guaranteed?
• Has an application been submitted to the long-term care insurance fund?
• Has an evaluation been conducted by the Medical Service (MD)?

If you can answer “yes” to all of the questions, you are eligible for a care allowance, regardless of whether a specific caregiver has been designated.

Checklist: Communicating with the Long-Term Care Insurance Fund

• Keep all correspondence with the long-term care insurance provider in its entirety and date it.
• Schedule and attend counseling appointments on time (for care levels 2 and 3: every six months; for care levels 4 and 5: every three months).
• In complex care situations, seek support early on from a care resource center or care counseling service.
• If you have questions about the organization of care: please include a brief written description of the care arrangements.
• If your long-term care allowance is reduced or discontinued: File an appeal within the deadline (usually one month after the date of the decision).
• If you have any questions, contact your local care support center or social services organization—you have every right to free counseling, especially if inquiries from your health insurance provider are adding to the stress of balancing caregiving with work or your current job.

Sample Wording: Statement on the Organization of Care

Dear Sir or Madam,

I hereby inform you that my home care is adequately provided for. Care is provided by several people in my circle who share the caregiving responsibilities. According to Section 37 of SGB XI, designating a single caregiver is not a legal requirement for receiving the care allowance. The care is reliably organized.

I am available to answer any questions and will conduct the required counseling visits in accordance with Section 37(3) of SGB XI within the prescribed time frame.

Sincerely,

Conclusion: You are eligible for a long-term care allowance even without a caregiver.

Care allowance without a caregiver—this is not only possible, it reflects the reality for many people in need of care in Germany. Flexible care arrangements, shared responsibility, and supplementary support from neighbors or professional services are recognized by law, precisely because rigid single-caregiver models often entail disadvantages in practice.

What matters is not the registration of a name—but rather that home care is actually provided. Anyone who can prove this has a solid claim to a care allowance and should not be unsettled by standard forms or letters of demand from the long-term care insurance fund. The purpose of the regulation is precisely to ensure that care is actually provided, not the form of registration.

Frequently asked questions (FAQ)

Am I eligible for a care allowance even if several family members are providing care?

Yes. The law does not require a single caregiver. If a daughter, son, and neighbor jointly provide care, they are entitled to the care allowance. It can also be transferred to family members who provide care if they take over the caregiving responsibilities. For example, a son can help care for his mother at home and receive the care allowance for doing so.

Can the long-term care insurance provider stop my long-term care allowance because I don't want to designate a caregiver?

No. Designating a caregiver is not a legal requirement for eligibility for the long-term care allowance. As long as home care is ensured, the long-term care allowance may not be discontinued solely because no caregiver has been designated.

How much is the long-term care allowance for each care level?

Care Level 2: 347 euros, Care Level 3: 599 euros, Care Level 4: 800 euros, Care Level 5: 990 euros, monthly in each case. The amount does not change depending on whether a caregiver is registered.

What happens to the long-term care allowance during a hospital stay?

The care allowance continues to be paid during an inpatient hospital stay for up to 28 days in a calendar year. After that, entitlement is suspended until home care resumes.

Can the long-term care insurance provider force me to accept in-kind long-term care benefits instead of a long-term care allowance?

No, not without a valid reason. A switch to in-kind benefits is only permitted if home care is truly unavailable or if counseling visits are permanently suspended. You can file an appeal against an unjustified switch. The assessed need for care and the recognized care level remain the decisive factors in determining which benefits are eligible in the first place.