How to make the care assessment a success: tips for visiting the medical service or Medicproof

The care assessment is a crucial moment for people in need of care and their relatives. This is because it determines whether a care level is approved and therefore which care services are covered by the care insurance fund. Many people find the home visit by the medical service (MD) or Medicproof very stressful. Uncertainty, fear of making the wrong decision and worries about doing something wrong are completely normal.

This comprehensive magazin will help you to prepare thoroughly, make the appointment with confidence and take sensible steps after the visit. With more than 30 tips, practical explanations and many examples, this article shows you the way to a successful care degree classification.

Why the care assessment is important

A need for care is often associated with restrictions in everyday life, health burdens and organizational challenges. Correct classification into the right care level ensures that those affected receive appropriate support, be it from a care service, relatives or a professional home help.

The assessment fulfills several tasks:

• Determining the need for care
• Assessment of independence in six areas of life
• Checking the scope of the assistance required
• Recommendation for aids or therapeutic measures
• Basis for the decision of the care insurance fund

This makes it all the more important not to leave the assessment to chance.

Overview of the Medical Service (MD) and Medicproof

What does the Medical Service (MD) do?

The MD is the official assessment service of the statutory health and long-term care insurance funds. Its assessors visit people at home to assess their abilities and limitations in everyday life.

Important features:

• neutral and independent
• Evaluation according to legally defined criteria
• Standardized procedure throughout Germany

What is Medicproof?

Medicproof carries out care assessments for privately insured persons. The same assessment standards and rules apply here too. The procedure is almost identical, but privately insured persons receive their assessor via their private long-term care insurance.

The procedure for an assessment appointment during a home visit

Date announcement and preparation

The care insurance fund or private care insurance company will inform you of the exact date. It can be postponed if, for example, important relatives do not have time or documents are missing.

Procedure for a home visit

The visit usually lasts between 45 and 90 minutes. The assessor:

• asks questions
• observes everyday situations
• Checks documents
• rates independence
• assesses risks
• documents all information

Important: The visit is not a test, but should be a snapshot of everyday care so that the assessor can assess the actual care needs.

After the appointment

The assessor prepares a report that is sent to the care insurance fund. Only on the basis of this is a decision made as to which level of care is approved.

The MDK assessment system explained simply

Since the 2017 care reform, the Medical Service (MD) no longer assesses the need for care on the basis of the "minute model", but using a points system that assesses the independence of the person in need of care in six clearly defined areas of life.

The goal: a realistic, holistic picture of the care recipient's support needs.

The six modules of the MD assessment system

The assessors evaluate independence in six different modules (areas of life).

Each module has a different influence on the overall assessment (different weighting).

Module 1: Mobility (10 % weighting)

The assessment is based on how independently the person can move around their home.

Typical tasks:

• Standing up and sitting down
• Moving (e.g. bed → chair)
• Moving around within the home
• Climbing stairs

The less independent the person is, the more points are awarded in this module.

Module 2: Cognitive and communication skills (7.5 %)

In Module 2, the assessor checks how well the person in need of care is mentally oriented, capable of making decisions and able to communicate. This module shows whether the person concerned can manage their everyday life independently in terms of thought and language or whether there are cognitive limitations.

What exactly is evaluated:

• Orientation to time, place and people:
  Can the person recognize what day it is, where they are and who the people around them are?
• Memory performance and retention:
  Is important information forgotten, such as medication, appointments or ongoing activities?
• Decision-making ability in everyday life:
  Can the person make decisions independently, such as what to wear or eat?
• Understanding and processing information:
  Are questions or instructions understood or does it have to be explained several times what to do?
• Communication and conversational skills:
  Can the person speak intelligibly, respond to questions and express themselves?
  Are there word-finding difficulties, confusion or problems with formulation?

In short, Module 2 assesses all the skills needed to mentally structure everyday life, plan actions and communicate with other people.

Module 3: Behavioral and psychological problems (7.5 %)

Module 3 is not about thinking or speaking, but about behavior and the emotional or psychological stresses that make care and support difficult. This area plays a particularly important role in dementia, depression and other mental illnesses.

What exactly is evaluated:

• Nocturnal restlessness:
  Frequent getting up, wandering, nighttime confusion or the need to leave the home.
• Aggressive or impulsive behavior:
  Verbal or physical aggression, defensive behavior during care, irritability.
• Fears and insecurities:
  Fear of falling, of staying alone, of leaving the home or of certain everyday situations.
• Tendency to wander off or disorientation:
  The person leaves their home without a destination or gets lost in their own surroundings, a typical symptom of dementia.
• Depressive or socially withdrawn phases:
  Withdrawal, lack of drive, lack of motivation, loss of interest, social withdrawal or general sadness.

In short: Module 3 describes behaviors and mental stress that require regular supervision, guidance or emotional support - often around the clock.

Why are Module 2 and Module 3 considered together?

Both modules assess mental and emotional independence.
To avoid double assessment, the following applies:

The MD/Medicproof only takes into account the module in which more points were achieved.

This means:

• If someone has severe cognitive problems → Module 2 counts.
• If someone shows mainly psychological behavioral problems → Module 3 counts.

In this way, each person receives a fair, uniformly assessed classification - depending on which restrictions are more significant in everyday life.

Module 4: Self-sufficiency (40 % weighting)

This is about the basis of daily care:

• Personal hygiene (washing, showering, brushing teeth)
• Nutrition (preparation, eating, drinking)
• Dressing and undressing
• Toileting and incontinence care

This module counts the most and often determines the level of care.

Module 5: Dealing with the demands of illness or therapy (20 %)

This is about medical measures:

• Taking medication
• Wound care
• Injections (e.g. insulin)
• Compression stockings
• Visits to the doctor
• Therapies
• Measure vital signs

The more support required, the higher the point value.

Module 6: Organization of everyday life and social contacts (15 %)

Among other things, the following are evaluated:

• Day structure
• Social contacts
• Employment
• Participation in everyday life
• Orientation in the daily routine

Example: Can the person decide for themselves how they want to organize their day?

How the modules are used to determine the level of care

Each module is awarded points (0-100). These points are multiplied by the respective weighting. At the end, a total point value is obtained from which the degree of care is determined.

The point limits of the care levels

Degree of care	Points range
Care level 1	12,5 – < 27
Care level 2	27 – < 47,5
Care level 3	47,5 – < 70
Care level 4	70 – < 90
Care level 5	90 - 100

Tips for the care degree assessment

Tip 1: Prepare documents and care diary in good time

Good preparation is half the battle and, in the case of the care assessment, even more. The documents show how high the actual need for care is.

Checklist for documents

• Diagnoses, laboratory values, doctor's letters
• Medication plan
• Reports from the nursing service
• Rehabilitation and discharge reports
• Prescriptions for medical aids
• Therapy plans
• Documentation of therapy-related requirements and stresses
• a current care diary

A care diary should contain at least two weeks of current entries.

Tip 2: Have relatives with you at the appointment

People in need of care often play down their limitations out of pride or shame. Relatives can portray everyday life realistically.

What relatives can contribute

• Notes on falls
• Description of the actual care effort
• Supplements for taking medication
• Explanations of night-time problems
• Information on mental stress

Relatives may and should supplement and correct the assessor.

Tip 3: Prepare for questions on cognitive and communication skills

The MD or Medicproof checks whether the person in need of care:

• Conversations understand
• can orient himself
• Makes decisions
• Recognizes dangers
• can make phone calls or communicate

Assessors test, for example, orientation ("What day is it today?"), memory or simple planning skills.

Tip 4: Document therapy-related requirements and stresses in detail

Many people in need of care have to perform medical procedures on a daily basis.

These include:

• Injections
• Medication management
• Associations
• Compression stockings
• Oxygen therapy
• Artificial nutrition
• Blood sugar control

The appraiser evaluates:

• whether these activities are possible independently
• how much time is required
• what risks exist if they are not carried out correctly

Tip 5: Do not conceal behavioral and psychological problems

This area is often underestimated, although it carries considerable weight for the classification.

These include:

• Restlessness, running away at night
• States of anxiety
• depressive phases
• Aggression
• Confusion
• Orientation difficulties

Don't worry: appraisers are used to dealing with sensitive issues in a professional manner.

Tip 6: Don't sugarcoat everyday life

Many people want to make a "good impression" on the day of their visit. But this harms the result.

You should not:

• Tidy up extra
• Hide tools
• Take on tasks that the person concerned would otherwise not be able to do
• Playing down complaints

The assessor must recognize what everyday life really looks like.

Tip 7: Realistically assess independence - per module

The care assessment comprises six areas ("modules"):

1. Mobility
2. Cognitive and communicative skills
3. Behavioral & psychological problems
4. Self-sufficiency
5. Dealing with the demands of illness or therapy
6. Organization of everyday life and social contacts

The assessor can only calculate the level of care correctly if all modules are presented honestly.

Tip 8: Get the nursing service and doctors on board

Nursing staff can:

• Create reports
• confirm the documentation of the care requirements
• Provide information on risks
• accompany the assessment

Female doctors can also provide certificates or statements.

Tip 9: Answer openly and calmly at the appointment

Answers such as "I can manage somehow" distort the assessment. Assessors do not evaluate how independent someone would like to be, but how independent they are.

Tip 10: Take notes immediately after the visit

Write it down after the appointment:

• What was said
• Which questions were asked
• Which situations were not seen
• Where misunderstandings arose

These notes will help with later steps.

Tip 11: Name all fall risks

Many people in need of care have:

• Gait instability
• Dizziness
• Balance problems
• motor restrictions

These must be addressed, as they increase the need for care.

Tip 12: Present aids openly

These include:

• Rollator
• Shower stool
• Gripper
• Incontinence material
• Care bed
• Positioning aids

Aids show how severe the restrictions are.

Tip 13: Describe food and drink realistically

Many people in need of care require help with:

• meal preparation
• the cutting of food
• the control of fluid intake
• remembering to eat and drink

These points are relevant for self-sufficiency.

Tip 14: Mention sleep problems and nocturnal stress

Night-time care is a major stress factor:

• getting up at night
• Toilet visits
• Confusion
• Runaway tendencies
• Pain

This information must be included in the expert opinion.

Tip 15: Specifically name personal hygiene problems during the care assessment

Washing, showering and dressing are decisive criteria.

Problems can be:

• Lack of strength
• Fear of showering
• Orientation difficulties
• Movement restrictions

Tip 16: Explain exactly how to handle medication independently

Can the person in need of care:

• take the medication yourself?
• Keep to the times?
• differentiate quantities?
• Recognize dangers?

If not, this increases the need for care considerably.

Tip 17: Take doctor and therapy appointments into account

Trips to the doctor, therapies and treatments are care-related expenses, especially in the case of mobility restrictions.

Tip 18: Describe social contacts and everyday life

Many people lose the ability to participate in social life in old age or due to illness.

Indications can be:

• Withdrawal
• Missing structure
• No daily planning
• Loneliness

Tip 19: Take feelings of shame seriously

If a person in need of care no longer wants to be washed or dressed, this is also a care problem and not a personal failure.

Tip 20: Present a realistic joint budget

Cooking, tidying up, cleaning, shopping and washing are only possible with sufficient independence.

Many people in need of care require help here, although they are reluctant to talk about it.

Tip 21: Openly address dangers in the household

Dangerous situations such as:

• Stove not switched off
• Tripping hazards
• forgotten medication
• Overflowing bathtubs

should be documented. This is the only way for Medicproof or the MD to determine how much assistance is really needed in everyday life.

Tip 22: Don't conceal the emotional burdens of relatives

The level of care not only takes into account physical limitations, but also the amount of care and supervision required.

Tip 23: Emphasize fluctuations in daily form

Many diseases (e.g. dementia, Parkinson's, multiple sclerosis) progress in waves.

Appraisers need to see the average and not the "good day".

Tip 24: Describe the pain in detail

These include:

• Chronic pain
• Acute pain
• Pain peaks
• Movement pain

Pain often means additional care.

Tip 25: Present incontinence realistically

urinary or fecal incontinence:

• the maintenance effort
• personal hygiene
• the laundry
• everyday life
• the necessity of aids

Tip 26: Include nutritional specializations

needs of the person in need of care:

• pureed food
• special diets
• regular reminder?

This is also maintenance work.

Tip 27: Document mental illnesses

Depression, anxiety disorders or dementia are relevant factors.

Tip 28: Include the living situation

Stairs, narrow rooms or unsuitable showers increase the amount of care required considerably.

Tip 29: Recognize repeated requests as a need for support

If the person constantly repeats questions or needs instructions several times, this means a real burden of care and can test the patience of family caregivers.

Tip 30: No false modesty - stay honest

Many people in need of care want to "be strong".
However, the assessment examines the actual need, not the wish.

What to do if the care degree decision is not right?

Many care degree assessments are too low or do not take important restrictions into account. This is not an isolated case: crucial information is often missing from the assessment, situations are misjudged or everyday life is not presented realistically.

The good news is that an appeal can be lodged against the decision.

Deadline: 1 month for the objection

After receiving the notification, you have one month to lodge an objection in writing.
Important: The date on the letter counts, not the actual date of delivery.

Filing an objection: step by step

Step 1: Submit an informal objection in writing

A short sentence will suffice at first:

"I hereby submit an objection to the decision of [date] within the deadline.
I am submitting the complete letter of objection at a later date."

This will secure the deadline and you can prepare yourself in peace.

The objection can be submitted:

• by post
• by e-mail (possible with many long-term care insurance companies)
• by fax
• in person with confirmation of receipt

Step 2: Request the complete expert opinion

Every person in need of care has the right to view the complete report.

This is important because it says:

• which modules were evaluated
• which points were awarded
• what the expert has observed
• which statements he has documented
• Why the care level was calculated in this way

Only then can you recognize where there are errors or gaps.

Step 3: Check expert opinion and mark errors

Typical errors in the expert opinion are

Embellishments

Example: "The person can dress themselves", although they only do not need help on good days.

Missing information

Example: Help required at night was not recorded.

Incorrect interpretations

Example: The assessor only saw a "good day", which does not correspond to everyday life.

Important restrictions are missing

z. e.g. risk of falling, tendency to run away, pain, incontinence.

Support services were not taken into account

z. e.g. help with trips to the doctor, meal preparation, medication therapy.

Step 4: Submit additional documents

In order to substantiate the objection, you should submit as much evidence as possible:

• Updated medical reports
• Statements from the nursing service
• Physiotherapy/ergotherapy reports
• Hospital reports
• Emergency reports or fall protocols
• Current care diary (at least 2-3 weeks)
• Photos or documentation of the domestic situation
• Short written statements from relatives

The clearer and more concrete, the better.

Step 5: Give detailed reasons for the objection

The justification should include the following points:

• Where the expert opinion is factually incorrect
• Which restrictions were underestimated
• Why certain modules were assessed incorrectly
• What problems exist in everyday life from experience
• What risks occur
• How much actual care work is required each day

Experts argue in a structured way, and the objection should be structured in the same way.

Step 6: Apply for a new assessment if necessary

If the case is particularly complex, the long-term care insurance fund can order a second assessment.

This is often done when:

• the first report contains gross errors
• new medical documents have been submitted
• In the case of applications for an increase, if independence has deteriorated and the need for care has increased.