German care grades for children: how they are assessed and what parents get
A child is measured not against adults but against healthy children of the same age: the assessment rules, the special rule for babies and the rights of expat parents.
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Care grade for a child: the rule up to 18 months
Care grade
3
| under the adult scale | 2 |
| Allowance | €599 |
Up to 18 months one grade higher (section 15(7) SGB XI).
Children can receive a German care grade (Pflegegrad) from infancy. Under section 15(6) of Book XI of the Social Code the yardstick is a child of the same age developing normally: only help beyond what any child of that age needs counts. Up to the child’s 11th birthday the assessment guidelines use age tables; after that the adult points apply. Children up to 18 months have a special rule (section 15(7)): only behaviour, illness and treatment, and serious feeding problems are assessed, the latter worth a flat 20 points, and the child is placed one grade higher than an older child with the same score. In our worked example a baby with feeding problems reaches 45.00 points and care grade 3; on the regular scale it would be grade 2. The care allowance, €599 a month at grade 3, is received by the parents for the child. For a disabled child it does not cost them the carer’s tax lump sum of €1,100, and a parent caring at least 10 hours a week builds up German pension rights.
The yardstick: a healthy child of the same age
A two-year-old cannot dress alone and a four-year-old does not go to the doctor alone. That is not a need for care, it is childhood. The law therefore does not measure children against adults but compares their independence and abilities with those of children of the same age developing normally (section 15(6) SGB XI). Only the extra need counts: help that a healthy child of the same age would not require.
For the practical scoring, the assessment guidelines contain tables recording, for every criterion in modules 1, 2, 4 and 6, the age from which children usually manage independently. Criteria where a healthy child of that age would still be dependent are not scored. These tables run up to the child’s 11th birthday; after that the adult points system applies, although a separate children’s form is used up to 18. Prompting and reminders that any teenager needs do not count.
Two modules have no age limits and are scored in full for every child: module 3 (behaviour and psychological problems) and module 5 (managing the demands of illness and treatment). For chronically ill children module 5 is often decisive. It covers blood sugar testing and insulin injections, inhalations and suction, physiotherapy, speech or breathing exercises that parents carry out at home, and taking the child to doctors, therapists and, expressly, early intervention services (Frühförderung) (Annex 1, module 5).
Up to 18 months: separate rules and one grade more
Babies are naturally dependent in every area. Without a special rule they could hardly reach a care grade and would need constant reassessment as they develop. So for children up to 18 months only modules 3 and 5 are scored. Self-care is replaced by a single question: are there serious feeding problems that cause an exceptionally care-intensive need for help? If yes, the self-care module receives a flat 20 raw points. The assessor also always checks whether both arms and both legs are unusable, which creates a special need regardless of age.
With the points found this way the child is placed one grade higher than an older child or an adult (section 15(7) SGB XI):
| Total points | Grade from 18 months and for adults | Grade up to 18 months | Allowance up to 18 months |
|---|---|---|---|
| 12.5 to under 27.0 | 1 | 2 | €347 |
| 27.0 to under 47.5 | 2 | 3 | €599 |
| 47.5 to under 70.0 | 3 | 4 | €800 |
| 70.0 to under 90.0 | 4 | 5 | €990 |
| 90.0 to 100 | 5 | 5 | €990 |
Under the assessment guidelines the child keeps this grade until the end of the 18th month of life without being reassessed, as long as the parents do not request a higher grade and a repeat is not clinically necessary, for instance because surgery is expected to change the need markedly. After that the regular scale of section 15(3) applies, without a new assessment being required. For the family this means the benefits may change around the child’s eighteen-month mark, so watch for the decision and check that it matches how your child is developing.
Two worked examples
A baby with a chronic lung condition receives medication and inhalations four times a day and is taken once a week each to physiotherapy and early intervention. That makes 4 raw points and 15.00 weighted points in module 5. A second baby has the same therapies but feeds so poorly that every meal takes a long time and needs close supervision: the question about serious feeding problems is answered yes.
| Baby 1: therapy, no feeding problems | Baby 2: feeding problems as well | |
|---|---|---|
| Module 5 weighted | 15.00 | 15.00 |
| Self-care (feeding) weighted | 0.00 | 30.00 |
| Total points | 15.00 | 45.00 |
| Care grade up to 18 months | 2 | 3 |
| Grade on the regular scale | 1 | 2 |
| Allowance up to 18 months | €347 | €599 |
The feeding question weighs heavily: the flat 20 raw points lift self-care into the band worth 30.00 weighted points and the second baby to grade 3. Check your own case with the calculator at the top: enter the total points and say whether the child is under 18 months. For older children the care grade calculator goes through the criteria one by one; keep the comparison with healthy children of the same age in mind.
How a child is assessed
Parents apply informally to the care fund, as described under applying for a care grade. Children are normally assessed by specially trained assessors qualified in paediatric nursing or as paediatricians (section 18a(10) SGB XI). A phone interview is ruled out for children (section 142a SGB XI). The assessor takes a detailed child-specific history and forms her own picture. Have the reports from the children’s hospital and paediatrician, therapy and support plans, the medication plan and a care diary ready, recording above all what goes beyond the routine of a healthy child: suction at night, tube feeding, watching for seizures, the drives to therapy. If your documents are in English, a short German summary helps.
Money, tax and pension for parents
| Care grade | Allowance per month | Allowance per year | Carer’s tax lump sum per year | Monthly pension per year of care |
|---|---|---|---|---|
| 2 | €347 | €4,164 | €600 | €10.49 |
| 3 | €599 | €7,188 | €1,100 | €16.71 |
| 4 | €800 | €9,600 | €1,800 | €27.19 |
| 5 | €990 | €11,880 | €1,800 | €38.85 |
Care allowance. It belongs to the child and the parents receive it (section 37 SGB XI). The family decides how to use it. It is not counted as income for citizen’s income, housing benefit or other social benefits (section 13(5) SGB XI). The other home care budgets, such as the relief amount, are explained on the care allowance page.
Carer’s tax lump sum. Anyone paid for caring normally loses the lump sum. For parents the law makes an exception: allowance they receive for their disabled child is not treated as income, however it is used (section 33b(6) sentence 2 Income Tax Act). Parents can therefore have both. If both care, the amount is divided by the number of carers, €550 each at grade 3. The highest grade held during the calendar year counts, and the child’s tax identification number must be on the return. More under carer’s tax lump sum.
Pension. A parent who cares for a child with at least grade 2 for at least 10 hours a week on at least 2 days, and works no more than 30 hours alongside, is compulsorily insured in the German pension scheme, with contributions paid by the care fund (section 3 SGB VI). At grade 3 with allowance only, one year adds €16.71 of monthly pension. If both parents share the care equally, the contribution base is split by share (section 166(2) SGB VI) and each earns €8.35. For an expat parent these are German pension periods like any other. The carer pension calculator adds them up over several years.
Carer’s lump sum: what it saves in tax
Tax saving per year
€330
| Full lump sum | €1,100 |
| Your share | €1,100 |
Only if you receive no payment for the care (section 33b(6) EStG).
Families living between countries
To qualify, the insured person must have been in the German care insurance for at least 2 of the 10 years before the application; for a child it is enough if one parent meets this prior insurance period (section 33(2) SGB XI). On trips to an EU or EEA country or to Switzerland the allowance continues; elsewhere it is suspended after 8 weeks per calendar year (section 34 SGB XI). For the tax lump sum, by contrast, what matters is that the care takes place in a home in the EU or the EEA.