Applying for a care grade (Pflegegrad): application, assessment and appeal

You apply for a care grade (Pflegegrad) informally with the long-term care insurance fund (Pflegekasse); a phone call or short letter is enough, and benefits are paid from the month of application. The Medical Service (Medizinischer Dienst), or for privately insured people an assessment service appointed by the insurer, then assesses independence, usually at home. The fund must decide within 25 working days of receiving the application, and you can object to the decision within one month.

Step 1: submit the application

The application goes to the care insurance fund of the person who needs care. It is part of their health insurance fund (Krankenkasse), so you can reach it via the same phone number or address. No particular form is required at first. What matters is the date: under § 33 of Book XI of the Social Code (SGB XI), benefits are paid from the date of application, but not before the eligibility criteria are met. If you apply in a later month, benefits begin at the start of the month of application.

Tip: phone the fund, note the date and the name of the person you spoke to, then send a short written confirmation. The fund will send you a form to complete and return.

The application is made by the person in need of care. Relatives can apply on their behalf with a power of attorney or as a legal guardian.

Use the free care advice

After a first application, the fund must offer you an advice appointment within two weeks or issue an advice voucher (§ 7b SGB XI). On request, the advice takes place at home. See care advice and advisory visits.

Step 2: the assessment

The fund appoints the Medical Service or other independent assessors (§ 18 SGB XI). The assessment normally takes place in the person’s home (§ 18a(2)). You will be given an appointment; a relative or another trusted person can and should be present.

The assessors rate independence in six areas of life (modules), which produce a points score that determines the care grade.

Module	Weighting
Mobility	10 %
Cognitive and communication skills or behaviour and psychological problems (higher value counts)	15 %
Self-care	40 %
Coping with illness- and therapy-related demands	20 %
Organising everyday life and social contacts	15 %

Care grade	Points
1	12.5 to under 27
2	27 to under 47.5
3	47.5 to under 70
4	70 to under 90
5	90 to 100

What each module covers is explained in care grades 1 to 5.

Preparing for the visit

• Care diary: for one or two weeks, note what help is needed and how often, including at night. It is not mandatory, but it helps the assessors understand everyday life.
• Documents: have medical reports, hospital discharge letters, the medication plan, a list of aids and decisions from other agencies ready.
• Be candid: many people present themselves as more independent than they are day to day. Describe a typical day, and a bad one.
• Mention what you need: raise aids, home adaptations or rehabilitation. If the report recommends specific aids or care aids, they count as applied for with your consent (§ 18b(3)).

Step 3: deadlines and decision

Deadline	Rule
Fund instructs assessors	within 3 working days of receiving the application (§ 18(1))
No assessment after 20 working days	fund must name at least three independent assessors for you to choose from (§ 18(3))
Decision	no later than 25 working days after receiving the application (§ 18c(1))
Hospital, inpatient rehab, hospice, outpatient palliative care	assessment by the 5th working day if the conditions of § 18a(5) are met
At home with announced care leave or family care leave	assessment within 10 working days (§ 18a(6))
Delay caused by the fund	€70 for each week or part week (§ 18c(5))

No payment is due if the fund is not responsible for the delay. If it requests documents, the deadline is suspended until they arrive.

The decision letter states the care grade. Ask for the assessment report if it is not enclosed; you will need it for any objection. The care benefits calculator shows what you are entitled to afterwards.

Step 4: objecting to the decision

If you disagree with the outcome, you can lodge an objection (Widerspruch) within one month of being notified of the decision (§ 84 of the Social Courts Act, SGG), in writing or in person at the fund.

1. Meet the deadline: a single sentence is enough, for example “I hereby object to the decision of [date]. Reasons will follow.”
2. Check the report: compare the ratings for each module with your care diary.
3. Give reasons: state specifically where the assessment does not match daily life and enclose new medical reports.
4. Get support: care support centres (Pflegestützpunkte), social welfare associations or a lawyer can help.

If the person’s condition has worsened, you can also apply for a higher grade instead. The procedure is the same as for a first application.

After the decision

With a care grade you can claim benefits such as the care allowance or use a home care service. Our directory of home care services lists approved providers by region.

Planned reform

With the Care Reorganisation Act (Pflegeneuordnungsgesetz, PNOG, cabinet draft of 30 September 2026), the German government plans tighter thresholds for new assessments from 2027. Existing care grades are to remain. The law has not been passed; until it is enacted, today’s rules apply.

This article does not replace individual care or legal advice.

Sources: § 18 SGB XI, § 15 SGB XI on gesetze-im-internet.de