Out-of-hospital intensive care at home: entitlement, prescription, co-payment

Out-of-hospital intensive care (außerklinische Intensivpflege) is a benefit of German statutory health insurance under § 37c SGB V for people who need a qualified nurse present at all times, for example because of ventilation or a tracheostomy tube. The rules have applied in full since 31 October 2023. Only specially qualified doctors may prescribe it. Insured people aged 18 and over pay a co-payment limited to the first 28 calendar days a year; for care at home this is 10 % of the costs plus €10 per prescription.

Who is entitled to out-of-hospital intensive care

The entitlement applies to people with statutory health insurance whose need for medical treatment care is particularly high. In the words of the law, a suitable nurse must be permanently present for individual monitoring and readiness to intervene, or a comparably intensive nursing input is required. Typical situations are permanent or intermittent ventilation and a tracheostomy tube, but other conditions can qualify too.

The benefit covers the treatment care needed to secure the doctor’s treatment goal, plus advice from the health insurance fund, especially on choosing the place of care. The legal text is in § 37c SGB V.

This is different from ordinary home nursing care. For individual tasks such as changing dressings, standard home nursing care is enough, as described in our guide to home care service costs.

Prescription and potential assessment

Who prescribes

The prescription is issued by a panel doctor (Vertragsarzt) who is specially qualified to care for patients with intensive care needs outside hospital. The treatment goal is discussed and set individually with you, and palliative care expertise is involved where needed. The details are set out in a directive of the Federal Joint Committee (Gemeinsamer Bundesausschuss).

What the potential assessment means

For patients who are ventilated or have a tracheostomy, each prescription includes a potential assessment (Potenzialerhebung). It checks whether ventilation time can be reduced, up to full weaning from the ventilator or removal of the tracheostomy tube. The findings and the steps needed are documented. Authorised doctors and hospitals can also carry out this assessment.

For families this matters: the assessment is not a formality but a way to identify chances of greater independence. Ask which goals have been agreed and who is responsible for working towards them.

Where intensive care can take place

Place of care	Examples
Residential care facility	nursing home under § 43 SGB XI
Integration assistance facilities	premises under § 43a SGB XI
Intensive care residential unit	specialised shared flat under § 132l SGB V
Own household or other suitable place	home, family, assisted living, school, nursery, sheltered workshop

Reasonable wishes about the place of care must be met. The health insurance fund checks whether medical and nursing care can be ensured at the chosen place, or can be made secure within a reasonable time. Personal, family and local circumstances are taken into account, and the outcome is recorded in a target agreement (Zielvereinbarung) with you.

The Medical Service (Medizinischer Dienst) assesses the conditions in person at the place of care, and the health insurance fund reviews them every year. If you refuse an assessment in your home, the benefit may not be provided there.

Costs and co-payment

Situation	What applies
Own home or other suitable place	co-payment of 10 % of the costs plus €10 per prescription, for the first 28 calendar days a year
Care facility, integration assistance facility or residential unit	co-payment of €10 per calendar day (§ 61 sentence 2 SGB V), for the first 28 calendar days a year
Under 18	no co-payment
Residential care facility	entitlement also covers accommodation, meals and investment costs; the care insurance benefit is offset

If the health insurance fund cannot provide a qualified nurse, it reimburses a reasonable amount for a nurse you arrange yourself. A personal budget is also possible. If a resident’s health improves and the entitlement ends, benefits continue for six months for people with care grades 2 to 5.

It is still worth applying for a care grade, because long-term care insurance can add further benefits. Which combination applies in your case is best clarified with the health insurance fund and a care adviser.

Choosing an intensive care provider

Intensive care services need a contract with the health insurance funds for this benefit. When choosing, check the following:

• Contract and qualifications: does the service hold a contract for out-of-hospital intensive care, and what additional training does the team have, for example in ventilation?
• Staffing: how is permanent presence ensured, including nights, weekends and sickness?
• Consistent staff: how large is the team that will work in your home?
• Treatment goal: how does the service work with the prescribing practice on weaning or tube removal?
• Emergency plan and hygiene: are there clear procedures for emergencies, equipment failure and infection control?
• Involving the family: how are relatives trained and kept informed?

General questions are in our checklist for choosing a home care service, and approved services in your area are listed in the home care directory. For support for yourself as a relative, see our guide for family carers.

This article is general information. It does not replace medical, nursing or legal advice. Decisions about treatment and care should be made together with your care team.