German care grade 5: benefits and pension at the top grade
The grade for people who depend on help for everything. What it pays in 2026, how it can be reached below 90 points and what it means for the family caring.
Checked by Radif Partners · Editorial policy · How we calculate
What this care grade brings per month in 2026
Benefits per month
€1,163
| paid to you | €990 |
| services | €0 |
| per year incl. annual budget | €17,495 |
German care grade 5 (Pflegegrad 5) applies at 90 to 100 total points, the most severe limitations with special demands on care under section 15(3) of Book XI of the Social Code. In addition, the Medical Service can assign grade 5 below 90 points where a special needs constellation exists (section 15(4)). In 2026 the long-term care fund pays €990 a month in care allowance or services worth up to €2,299; a care service billing €1,800 uses 78.3 % of that budget and leaves €214.88 of allowance. Day and night care up to €2,085, the relief amount, care aids and the €3,539 annual respite budget come on top. With family care only that is €17,495 a year. For the main carer the fund pays pension contributions on the full reference value: one year of caring earns 0.9137 pension points and €38.85 of monthly pension. In a care home €2,096 goes to the home.
Who receives grade 5
Grade 5 describes people who depend completely on help in nearly every area: bedbound or mobile only with a hoist, without bladder or bowel control, often tube-fed, or with end-stage dementia that rules out communication. Arithmetically 90 of 100 points are needed. Because modules 2 and 3 only count with the higher value and every module has a cap, that only happens when almost every module reaches its top band (section 15 SGB XI).
The law adds a second route, the special needs constellation of section 15(4): the Medical Service assigns grade 5 for professional reasons although the points fall short, because care is exceptionally demanding. The criteria are in the national Medical Service assessment guidelines. If you think this applies, describe it in writing before the visit.
Benefits at grade 5
| Benefit at grade 5 | Month | Year |
|---|---|---|
| Care allowance (family only) | €990 | €11,880 |
| or services up to | €2,299 | €27,588 |
| Day or night care up to (additional) | €2,085 | €25,020 |
| Relief amount | €131 | €1,572 |
| Consumable care aids | €42 | €504 |
| Respite and short-term care | – | €3,539 |
| Care home: amount paid to the home | €2,096 | €25,152 |
Planning pays off at grade 5, because the budgets are large and complement each other. A care service for morning and evening personal care easily bills €1,800: 78.3 % of the services budget, leaving €214.88 of allowance. Night care from the day care budget and the relief amount come on top without any deduction.
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 |
The carer’s pension
Social security for the carer is highest at grade 5. For a carer caring at least ten hours a week over two days and working no more than 30 hours, the fund pays contributions on the full reference value when only the allowance is drawn, 85 percent with the combined benefit and 70 percent with services only (section 166(2) SGB VI). One year with allowance only earns 0.9137 points, €38.85 of monthly pension from July 2026; ten years caring for a parent or partner add €388.50 a month. For an adult child who moved back to Germany to care, these years count fully towards a German pension. See the carer pension calculator.
Tax
The carer’s lump sum at grade 5 is €1,800 a year, the same as at grade 4 (section 33b(6) Income Tax Act). Only someone who receives no money for caring can claim it. If the allowance is passed on to the daughter who cares, it is tax-free for her but the lump sum is lost, so compare €11,880 of tax-free allowance a year with the tax saved by the €1,800 deduction.
Children at grade 5
Children are compared with healthy children of the same age. Up to 18 months lower thresholds apply so that very ill infants do not fall below the line: 70 points are enough for grade 5 (section 15(7) SGB XI). See care grades for children.
Grade 5 in a care home
In a care home the fund pays €2,096 to the home (section 43 SGB XI). The family’s co-payment is still the same as at grade 2, because each home charges one uniform co-payment for all grades; the national average was €3,364 a month in year one. Specialised facilities, for example for ventilated patients, charge very different prices; the care home calculator accepts the EEE from a specific contract.
What else the family should organise
- A care service experienced in intensive or palliative care where needed; medical treatment care is paid by the health insurer.
- Night care or a night sitter so the main carer can sleep.
- The joint annual budget booked in advance: two weeks’ break in spring, two in autumn.
- Care aids such as a care bed, hoist and pressure-relief mattress applied for early; the fund must decide within three weeks.
- A lasting power of attorney (Vorsorgevollmacht) and an advance directive if they are missing, so relatives can act towards the fund, doctors and the home; without them a guardianship court often has to appoint a legal guardian first.
- A case conference at the Pflegestützpunkt when several services, doctors and aid suppliers need to work together, which is easier to arrange while a relative from abroad is in Germany.