For many people who are dependent on support, being awarded a level of care and the associated benefits such as care allowance can make everyday life much easier. However, there is often confusion as to whether people with mental illnesses also have access to these benefits. We would like to clarify this.
It is important to understand that inhibitions and insecurities are often particularly high in the case of mental illness. Many of those affected are reluctant to seek help, even if everyday life becomes increasingly difficult to cope with. However, a care degree and the associated social benefits could bring considerable relief if only they were taken up. But what should you pay particular attention to when applying for a care degree for mental illness?
Is a care degree possible for mental illness?
A mental illness can affect a person's life in many ways and can often result in a high need for care. But the question arises: can people with such illnesses receive a care degree? The answer is yes, a care degree is also possible for mental illnesses.
This is because it is not only physical limitations that can lead to an increased need for care, but also mental illnesses such as depression, anxiety disorders or schizophrenia. The prerequisite for this is that the person's impairments lead to a significant restriction of their independence or abilities and they are therefore dependent on help.
However, applying for a care degree for mental illnesses can be more complex than for purely physical conditions due to their invisible nature and the difficulties in assessing the need for care. In such cases, medical reports, reports from therapists or a detailed description of the care needs by relatives can be helpful.
It is therefore advisable for those affected and their relatives to obtain thorough information and support when applying for a care degree in order to in order to ensure an appropriate classification.
How is the need for care defined in the case of mental illness?
The prerequisite for the need for long-term care is usually that the person must be expected to be in need of care for at least six months and to a certain degree of severity, as defined in the German Social Code XI.
Care is often different for people with mental illness. They may not require traditional care measures like people with physical disabilities. They may still be able to wash themselves, eat and drink and walk without assistance.
But what makes these people in need of care?
Can those affected receive care allowance?
People with a mental illness who are dependent on care may, under certain conditions, be entitled to care allowance under certain conditions. Care allowance is financial support paid by the care insurance fund to people in need of care. It is intended to help them remain in their own home environment for as long as possible.
The type of care for people with mental illness generally differs from "traditional" care. Nevertheless, the focus on daily care and support remains the same. The aim is to enable those affected to lead an everyday life that is worth living and as independent as possible.
Degree of care for depression and anxiety disorders
A depression or anxiety disorder can be a significant challenge for those affected and their families and can severely impair daily routines and independence, as the illness is usually accompanied by major restrictions in social interaction. In certain circumstances, it may be necessary to apply for a care degree in order to receive support from care insurance.
A degree of care for depression or anxiety disorder is determined by an assessment procedure carried out by the medical service of the health insurance funds (MD). The physical and mental abilities as well as the social contacts of the person concerned are assessed.
In the case of depression, criteria such as listlessness, concentration problems, mood swings or sleep disorders can be taken into account. Self-harm or suicidal thoughts can also play a role. It is important that these impairments persist over a longer period of time and have a significant impact on independence and everyday life.
The difficulty in applying for a degree of care for mental illness lies in precisely identifying the symptoms and difficulties of this illness and explaining them appropriately during the assessment.
However, this poses a challenge: as relatives, we want to ensure that the person in need of care is doing well. We often take the help and support we provide for granted. "Of course I help my parents," is a common refrain.
What mental illnesses are there?
Many people ask themselves: What are mental illnesses and which illnesses belong to them? There is a wide range of mental illnesses. Here you will find a brief overview of the most common mental illnesses in Germany:
- ADHD (attention deficit hyperactivity disorder)
- Anxiety disorders (including generalized anxiety disorder, panic disorder, social anxiety disorder, etc.)
- Autism spectrum disorder
- Bipolar disorder
- Borderline personality disorder
- Dementia
- Depression
- Eating disorders (e.g. anorexia nervosa, bulimia nervosa, binge eating disorder)
- Sleep disorders (e.g. insomnia, sleep apnea)
- Schizophrenia
- Personality disorders (e.g. histrionic personality disorder, narcissistic personality disorder)
- Post-traumatic stress disorder (PTSD)
- Sleep disorders (e.g. insomnia, sleep apnea)
- Somatoform disorders (e.g. somatization disorder, hypochondria)
- Obsessive-compulsive disorders
However, not every mental illness automatically results in a care level. This depends on how much support the person concerned needs.
Definition of the need for care for mentally ill people
The general definition of need for long-term care means that it must be continuous, but probably for at least six months, and at least at the level of severity specified in Section 15 of the Social Security Code XI.
When mental illnesses are present, care is often different to that for physical impairments. As a rule, those affected do not require the traditional care activities that are common with physical impairments. This means that the person in need of care may still be able to wash themselves, eat and drink, and even walk without assistance.
According to the German Social Code, people with mental illness are considered to be in need of care if they are unable to cope independently with everyday life and are dependent on care and support on a daily basis.
Carers therefore take responsibility for care and support to ensure that those affected can lead as independent a daily life as possible.
If the help in everyday life becomes so extensive that regular support is required, a care degree (and therefore care allowance) can be applied for.
According to the provisions of the German Social Code, people with mental illness are considered to be in need of care if they are unable to perform their daily routine tasks without regular care and support.
Mental illness is a potential reality for everyone after serious life events. But does depression automatically mean that you are in need of care? Are there even care levels for mental illness?
Since the introduction of the Care Strengthening Act II in 2017, not only physical but also mental illnesses are equally taken into account when assessing the need for care.
Under certain circumstances, an application for a care degree can therefore also be made for mental illnesses such as depression, autistic personality disorder, Asperger's syndrome, ADHD, borderline, dementia and others.
Essentially, the aim is to define the need for care not only in the case of physical limitations, but also in the case of mental illness. This means that the person concerned is unable to cope with everyday life independently and without daily care and support.
This means that she needs support with basic daily tasks such as washing, eating, drinking and moving around in order to lead a largely independent life.
If the need for care reaches a level that requires regular help in everyday life, a care degree (and the associated care allowance) can be applied for.
When should a care degree be applied for in the case of mental illness?
If a person has physical limitations, these are often recognizable at first glance. Mental illnesses, on the other hand, are often difficult to recognize. Those affected have no obvious injuries, missing body parts or other visible signs.
Those around them are often unable to recognize the level of suffering experienced by those affected. At the beginning of a mental illness, relatives are often unable to interpret the symptoms correctly as they are not yet fully developed.
There can be various reasons for this:
- The children do not have frequent contact with their father, who lives alone, and therefore do not notice his changes.
- The development of the disease was so gradual that nobody really noticed it.
- The symptoms are not yet very pronounced or they are vague.
- There is also the possibility that the idea that a serious mental illness is behind the change in behavior is suppressed. Mental health problems are often associated with shame and are therefore often not addressed.
At first, you may wonder why the person concerned withdraws, suddenly changes their behavior, misses appointments or doesn't answer the phone.
Early signs of mental illness can be diverse and vary depending on the type of disorder. However, some common signs can indicate that someone may be developing a mental illness:
- Altered behavior or personality changes, such as sudden withdrawal, increased irritability or aggressiveness.
- Mood swings, persistent sadness or excessive anxiety.
- Difficulties in coping with everyday tasks or in concentrating.
- Sleep disorders, such as insomnia or increased sleeping.
- Loss of interest in previous hobbies or activities.
- Physical complaints without a recognizable medical cause, such as headaches or stomach problems.
- Social withdrawal, avoidance of social interaction or isolation.
- Increasing substance abuse, such as alcohol or drug consumption.
- Thoughts of self-harm or suicide.
- Difficulty regulating emotions or extreme emotional reactions to everyday situations.
It is important to note that the presence of these signs does not necessarily mean that someone has a mental illness, but they may indicate a potential need to seek professional help and further investigation.
The longer mental illnesses last and the more they affect the well-being of the person affected, the more difficult the situation can become for family caregivers and the family environment.
An application for care benefits (care degree application) due to a mental illness may be necessary if:
- The person concerned is no longer able to live alone or cope with everyday life.
- Care and guidance by family caregivers becomes necessary.
- The progression of the disease has a concrete impact on the care of the person affected. This can, for example, lead to the affected person suddenly refusing to eat, neglecting personal hygiene or having impaired communication.
Tips for applying for a care degree due to mental illness
It is not the specific illness or diagnosis that plays a role in assigning a level of care, but rather the extent of independence and the associated limitations. Applying for a level of care for mental illness is the same as for any other illness.
The difficulty in applying for a care degree for mental illness lies in correctly identifying the symptoms and difficulties of this illness and making them clear in the assessment.
The real problem, however, is that as relatives, we want to make sure that our family member in need of care is doing well. We often take the help and support we provide for granted. We often hear sentences like: "Of course I help my parents, it's only natural."
BUT: If you do not declare the additional help and support you give your family member in need of care and do not emphasize this during the assessment, your relative will never receive a care degree. WHY? Because it is assumed that they can manage everything on their own and don't need any help.
Here are some examples that illustrate where the increased maintenance effort lies:
- People with anxiety need more attention. They may need to be persuaded to overcome their fear and do things that frighten them.
- People with dementia need help choosing their clothes, as they often no longer know what clothing is appropriate.
- People with depression benefit from social contact, but are often unable to maintain this alone. The carer must therefore coordinate everything and accompany the person affected.
- People with suicidal thoughts may refuse to eat or drink, which requires intensive care.
- Depressed people often have no daily structure and need constant encouragement and support to cope with their daily tasks.
- People who self-administer medication may take it incorrectly, which requires constant monitoring.
- When patients refuse care, a considerable amount of time is required to persuade and support them.
- Depending on the severity of the condition, autistic people can also receive a level of care if they need support to cope with everyday life.
The list could go on, but it's important to recognize how much extra support and time is needed for people with mental illness.
What level of care for mental illness?
It is not the specific illness or diagnosis that plays a role in assigning a care degree, but rather the extent of independence and the resulting limitations. The procedure for applying for a care degree for mental illnesses is identical to that for other illnesses.
What care levels are there?
A person's need for assistance is divided into care levels 1-5. According to the German Social Code, the following definitions apply:
Care level 1: minor impairment of independence or abilities.
Care level 2: considerable impairment of independence or abilities.
Care level 3: severe impairment of independence or abilities.
Care level 4: most severe impairment of independence or abilities.
Care level 5: most severe impairment of independence or abilities with special requirements for nursing care.
Criteria for the care assessment
For the allocation of a degree of care various criteria are taken into account, which are assessed using a points system.
- Mobility
- cognitive and communicative skills
- Behavioral and psychological problems
- Self-sufficiency
- Coping with and independently dealing with illness- or therapy-related demands and stresses
- Organization of everyday life and social contacts
Degree of care rejected for mental illness
The number of people with mental illnesses is increasing from year to year. If independence is severely restricted, a care degree should be applied for. However, the first application for care benefits is often rejected by the care insurance fund. There can be various reasons for this, such as
- Impairment is not severe: If the mental illness means that little or no support is required, the care degree is usually rejected.
- Inadequate preparation for the MDK assessment: Inadequate preparation by the medical service can result in the need for support in everyday life not being presented as acutely as it actually is (for privately insured persons, the assessment is carried out by MEDICPROOF, for those with statutory insurance, the MDK). People in need of care and their relatives should therefore prepare well for the MDK assessment. Read here how you can best prepare yourself and avoid having your care degree unjustifiably rejected.
- Misrepresentation of the need for care: People with mental illness experience good and bad days. On some days they can hardly do anything themselves, on other days things are better. In order not to appear careless or inactive on the day of the assessment, many of those affected mobilize all their strength, explain their situation to the assessor as well as possible and prepare their home properly. The assessor then sees a tidy home and a person who appears to have their life under control and maintains social contacts. A rejection of the care degree is likely in such cases. It is not a question of deliberately leaving the home untidy or presenting oneself in a worse light, but of ensuring that the assessment is as realistic as possible. The assessor must be able to correctly assess the situation of the person concerned.
- Misjudgement by the assessor: Another reason is that mental illnesses are difficult for the assessor to assess. Obvious physical impairments are easily recognizable, but mental problems such as anxiety or lack of motivation are usually not noticeable at first glance. It can therefore be difficult for the assessor to make a judgment as to whether and to what extent an impairment exists.
- Missing documents: A care degree cannot be granted if the necessary medical documents have not been submitted. It is therefore important that all formalities are submitted together.
- The illness has not been fully disclosed: It is often the case that those affected are ashamed of their mental illness, which is why important details are concealed. This gives the assessor the impression that the person concerned is more independent than they really are.
