Pflegegrad nach Schlaganfall beantragen: Schritt-für-Schritt Anleitung

A stroke can fundamentally change life from one moment to the next. Applying for a care level assessment after a stroke therefore becomes an important, yet often confusing task for many affected individuals and their relatives.

In adults, this incident is one of the most frequent causes of permanent impairment. The German long-term care system is divided into five care levels , with the severity of the need for care being expressed by the level assigned. Depending on the classification, those affected can receive varying degrees of financial support – from €347 in care allowance for care level 2 to €990 for care level 5.

Many questions arise initially: Which care level is appropriate after a stroke? When should one submit the application for continued care? Who is even eligible to apply for a care level? The good news: Applicants will receive a letter from their long-term care insurance provider within 25 working days at the latest, as the provider is required to process the application within this timeframe.

This step-by-step guide helps those affected and their relatives to understand and successfully complete the process of applying for a care level after a stroke.

Care level after a stroke: When and why it is necessary

In Germany, approximately 196,000 people suffer a stroke for the first time each year. This is a neurological condition in which the blood supply to a part of the brain is interrupted – either by a blocked or ruptured blood vessel.

What happens after a stroke?

The interruption of blood supply leads to the death of nerve cells in the brain, which has different effects depending on the affected region. Typical consequences include paralysis, speech disorders, cognitive impairment, depression, and urinary and fecal incontinence. Approximately 78.7% of all strokes are due to a cerebral infarction, while 12.6% are caused by a continuous hemorrhage and 2.7% by a subarachnoid hemorrhage. In severe cases, around 30% of all affected individuals die within one year.

Statistics show that every second patient who survives a stroke requires care and is severely disabled due to brain damage. Up to 40% of those affected experience long-term limitations in their activities of daily living, such as swallowing difficulties .

When is someone considered to be in need of care?

According to the Long-Term Care Strengthening Act: „Persons in need of care within the meaning of the German Social Code, Book IX (SGB IX), are those who have health-related impairments to their independence or abilities and therefore require assistance from others.“ The central criterion is the degree of independence in six care-relevant areas:

1. mobility
2. Cognitive and communicative skills
3. Psychological problems
4. Self-sufficiency
5. Coping with modern, illness-related demands
6. Structuring daily life and social contacts

A person is considered independent if they can perform an activity alone or with assistive devices. However, if someone requires support from other people, they are considered to be in need of care.

What level of care is possible after a stroke?

The classification into one of the five care levels is carried out by the Medical Service (MD) or, in the case of other private insurance companies, by MEDICPROOF. The decisive factor is not the diagnosis of „stroke,“ but the extent of the individual’s limitations.

Care level 1 : For individuals with minor impairments following a mild stroke who are largely able to live independently.

Care level 2-3 : In cases of significant to severe limitations in independence, such as problems with personal hygiene, food intake or mobility.

Care level 4-5 : For the most severe impairments requiring continuous care, often involving serious paralysis or cognitive limitations.

Factors that increase the likelihood of needing care after a stroke include: older age, female sex, a previous stroke, functional impairment in legs or feet (3.3 times increased chance), speech impairment or impairment in arms or hands (2.5 times increased chance), and diabetes mellitus (1.8 times increased chance).

Requirements for applying for a care level

Applying for a care level assessment after a stroke is subject to certain conditions that must be strictly observed. Early application is particularly important, as benefits can only be granted from the date of application.

Who is eligible to submit the application?

Generally, the care level assessment must be applied for by the person affected by the stroke themselves. However, in cases of severe impairment following a stroke, authorized representatives or legal guardians can also undertake this task. It’s important to know that an informal application or even a phone call to the long-term care insurance provider is considered a first step and is counted as the application date. However, a written application must then be submitted.

What conditions must be met?

In order to receive a care level after a stroke, the following conditions must be met:

• The applicant must have paid contributions into long-term care insurance for at least 2 years within the past 10 years or be covered under family insurance.
• There must be a demonstrable limitation of independence that necessitates external assistance.
• The need for care is expected to last at least 6 months or is indefinite.

Furthermore, if the person concerned is still receiving inpatient treatment at the time of application, benefits can only be granted from the day of discharge. If the need for care already existed before the application, benefits will be paid from the beginning of the month in which the application is submitted at the earliest.

Care level for stroke: What applies since 2017?

Since January 2017, the previous three levels of care have been replaced by five care grades. This change is based on a new definition of care dependency, which focuses less on the time spent providing care and more on the remaining independence of the person in need. As a result, people with cognitive impairments after a stroke now have better chances of receiving support.

Anyone who already had a care level rating before 2017 does not need a new appointment with the Medical Service. However, it may be worthwhile to apply for a higher rating if your condition worsens, or to submit an application for the first time if previous attempts were unsuccessful.

Applying for a care level after a stroke – step by step

The process of obtaining a care level assessment after a stroke involves several consecutive steps. Below you will find the exact procedure from initial contact to receiving the decision.

Contact your long-term care insurance provider

In Germany, long-term care insurance is integrated into the statutory health insurance system. An informal application is sufficient to begin the process – this can be done by phone, in writing, or online. Important: This initial contact is considered the official application date, which is crucial for determining when benefits will begin.

Request and complete the form

After initial contact, the long-term care insurance provider will send detailed application forms. These should be filled out carefully and completely to avoid delays. If you have any questions, care support centers or the insurance provider’s care advisory service can offer assistance.

Prepare documents and evidence

The following documents should be kept ready for the further process:

• Current hospital and rehabilitation reports
• Medical findings and diagnoses
• Medication plans
• List of tools used
• If available: Care log or care documentation

Schedule an assessment appointment

Once the application has been received by the long-term care insurance fund, they commission the Medical Service (MD) or, for privately insured individuals, Medicproof, to conduct the assessment. The assessor will schedule an appointment for a home visit. A caregiver should definitely be present during this visit.

Wait for the care level assessment notice.

The assessor summarizes their findings in a report, which is then submitted to the long-term care insurance provider. Within 25 working days of the application, the provider must send a written notification. This notification contains information about the assigned care level and the corresponding benefits.

File an appeal if rejected

If you disagree with the decision, you can file a written objection within one month of receiving it. While a detailed explanation is not immediately required, it significantly increases your chances of success and can be submitted later. During the objection process, the long-term care insurance provider will review its decision, usually by commissioning a second expert opinion.

Understanding and preparing for care assessments

The assessment is crucial for the correct classification after a stroke. Thorough preparation significantly increases the chances of receiving an appropriate level of care.

Procedure of the assessment by the Medical Service

Once the long-term care insurance fund receives the application, it commissions the Medical Service (MD) to conduct the assessment. The MD schedules an appointment for a home visit or, in exceptional cases, a telephone interview. The assessment lasts approximately one hour and is carried out by specially trained nursing professionals or physicians. During the assessment, the actual support needs are determined and the individual’s independence in daily life is evaluated.

Important criteria for classification

The assessment evaluates six areas of life (modules):

1. Mobility (10% weighting)
2. Cognitive and communicative skills (15%)
3. Behavioral and psychological problems (15%)
4. Self-sufficiency (40%)
5. Dealing with illness- or therapy-related requirements (20%)
6. Organization of daily life and social contacts (15%)

The focus is not on the time spent, but on the level of independence. The less independent the person is, the more points are awarded.

What documents will be helpful for the appointment?

The following documents should be available:

• Current hospital and doctor reports
• Medical plan
• Discharge reports from rehabilitation facilities
• Care diary or notes on daily life
• List of assistive devices used (wheelchair, walker, etc.)
• Disability ID card (if available)
• Nursing documentation resigned (if nursing service is available)

How many points correspond to which care level?

The total score determines the level of care required:

• Care level 1: 12.5 to under 27 points
• Care level 2: 27 to under 47.5 points
• Care level 3: 47.5 to under 70 points
• Care level 4: 70 to under 90 points
• Care level 5: 90 to 100 points

A caregiver or relative should definitely be present during the appointment to contribute important information about the care situation.

Conclusion

Applying for a care level assessment after a stroke undoubtedly presents a challenging task, especially for those affected and their relatives in an already difficult life situation. Nevertheless, this step proves essential to obtain the necessary support and financial assistance.

In summary, applicants should note that the process begins with the initial contact with the long-term care insurance provider and must be completed within 25 working days. Thorough preparation for the assessment by the Medical Service plays a crucial role in ensuring the correct classification. It is particularly important that all relevant medical documents are readily available and that a caregiver is present during the appointment.

Equally important is the fact that it is not the diagnosis of „stroke“ itself, but rather the actual extent of the limitations that determines the level of care required. The six assessed areas of life – primarily self-care and mobility – ultimately determine the score and thus the level of care.

If the assigned care level does not correspond to the actual needs, there is also the option of filing an appeal within one month. This option should definitely not be overlooked if the classification seems too low.

With the correct care level, those affected can access comprehensive support services – from financial assistance to in-kind benefits. These services enable a dignified life despite the limitations following a stroke and significantly relieve the burden on family caregivers.

Although the bureaucratic process may initially seem overwhelming, the effort is definitely worthwhile given the long-term benefits. Early application, thorough preparation, and, if necessary, the use of advisory services are therefore crucial for successfully applying for an appropriate level of care after a stroke.

FAQs

Q1. How do I apply for a care level after a stroke?
First, contact your long-term care insurance provider to submit an application. Fill out the forms they send you and prepare the relevant medical documents. An assessor will arrange a home visit. After the assessment, you will receive notification of your care level within 25 working days.

Q2. Which documents are important for applying for a care level?
Please have the following documents ready: current hospital and doctor reports, medication plan, discharge reports from rehabilitation facilities, a care log, a list of used aids, the severely disabled person’s ID card (if available) and the care documentation (if a care service is used).

Q3. What level of care is possible after a stroke?
The level of care depends on the exact extent of the impairments, not on the diagnosis itself. All levels of care from 1 to 5 are possible. For mild impairments, level 1 may be assigned, while for the most severe impairments, level 4 or 5 is possible.

Q4. How long does the process take from application to decision?
The long-term care insurance fund must send a written decision within 25 working days of application. In urgent cases, such as hospital discharge, an assessment can be carried out within two weeks.

Q5. What can I do if I disagree with the assigned care level?
If you disagree with the decision, you can file a written objection within one month of receiving it. A detailed explanation increases your chances of success. In the objection procedure, the decision is reviewed again, often with a second assessment.