German care grade 4: the money when care shapes the day
From here, care sets the family’s daily rhythm. What grade 4 pays in 2026 and how care at home compares with a care home.
Checked by Radif Partners · Editorial policy · How we calculate
What this care grade brings per month in 2026
Benefits per month
€973
| paid to you | €800 |
| services | €0 |
| per year incl. annual budget | €15,215 |
German care grade 4 (Pflegegrad 4) applies at 70 to just under 90 total points, which section 15(3) of Book XI of the Social Code describes as the most severe limitations of independence. In 2026 the long-term care fund pays €800 a month in care allowance when relatives provide care, or up to €1,859 for a registered care service. Many families combine both: a care service in the morning and evening billing €1,200 uses 64.6 % of the services budget and leaves €283.59 of allowance. On top come the relief amount of €131, consumable aids up to €42, day or night care up to €1,685 and the joint annual budget of €3,539. With family care only, that totals €15,215 a year. For the carer the fund pays pension contributions on 70 % of the reference value, so one year of caring adds €27.19 of monthly pension. In a care home €1,855 goes to the home.
Grade 4 in daily life
Between 70 and 90 points a person depends on help in almost every area. Typical is the man after a severe stroke who gets from bed to wheelchair only with help, has to be washed and dressed and needs support eating; or the woman with advanced dementia who still walks but is restless at night, resists care and no longer looks after herself. Self-care, weighted at 40 percent, carries most of the score; its top band alone gives 40 points (section 15 SGB XI).
Grade 4 is also where many families reach their limits. The carer rarely sleeps through the night and hardly leaves the house. The money from the long-term care insurance is therefore not just income but a tool to buy relief, and that is how it is best used.
Benefits per month and per year
| Benefit at grade 4 | Month | Year |
|---|---|---|
| Care allowance (family only) | €800 | €9,600 |
| or services up to | €1,859 | €22,308 |
| Day or night care up to (additional) | €1,685 | €20,220 |
| Relief amount | €131 | €1,572 |
| Consumable care aids | €42 | €504 |
| Respite and short-term care | – | €3,539 |
| Care home: amount paid to the home | €1,855 | €22,260 |
Night care is little known but valuable at grade 4: it comes from the same budget as day care and does not reduce the allowance or services. If someone needs supervision at night, it gives the main carer sleep without money missing elsewhere.
Mixing a care service and the allowance
The combined benefit is the norm at grade 4. A service that helps with washing and dressing in the morning and getting to bed in the evening easily bills €1,200 a month: 64.6 % of the €1,859 budget, which brings the allowance down to €283.59 (section 38 SGB XI). The chosen split binds for six months, but billing follows the actual invoice each month.
How much allowance is left next to a care service
Allowance per month
€358.92
| Services budget used | 40.1 % |
| full allowance | €599 |
| you pay | €0 |
Planning breaks
The joint annual budget of €3,539 matters most at grade 4. Four weeks of short-term care so the main carer can have treatment or a holiday are almost fully covered at usual rates, and half the allowance continues: €373 for 28 days. A son or daughter who lives abroad can use these weeks to come over and take stock. The respite and short-term care calculator shows how the pot divides.
Pension and protection for the carer
For a carer who cares at least ten hours a week over two days and works no more than 30 hours, the fund pays German pension contributions (section 44 SGB XI). At grade 4 with allowance only, 70 % of the reference value of €3,955 counts (section 166(2) SGB VI), €2,769 a month. One year equals 0.6396 pension points and €27.19 of monthly pension; five years add more than €136 a month for life. See the carer pension calculator. A carer who takes no money for caring can also claim the carer’s lump sum of €1,800.
Aids and the home
At grade 4 a care bed with a lifting aid is almost always needed, often also a hoist, a commode chair and positioning cushions against pressure sores. The fund usually lends technical aids; the co-payment is ten percent, at most €25 per aid. It must decide on an application within three weeks, otherwise the aid counts as approved. Widening a door for a wheelchair or converting a bathroom is subsidised with up to €4,180 per measure. See care aids and home adaptation grants.
Home or care home?
The care home question arises more often at grade 4. At home up to €15,215 a year flows to the household or to services; in a home the fund pays €1,855 a month to the home and the family pays the co-payment, which averaged €3,364 a month in year one on 1 July 2026. The care home calculator uses your state’s average and shows how long pension and savings last.
On to grade 5
From 90 points comes grade 5 with €990 of allowance. If someone is just below that line and their condition worsens, for instance with tube feeding or being fully bedbound, request a higher grade from the Pflegekasse without waiting for the next routine review.