German care grade with dementia: how memory, behaviour and daily life count
With dementia the body rarely decides; memory, behaviour and the shape of the day do. How the assessment scores them, shown on three worked cases.
Checked by Radif Partners · Editorial policy · How we calculate
Dementia: does module 2 or module 3 count?
Counted for modules 2 and 3
15.00
| Module 2 weighted | 7.50 (band 2) |
| Module 3 weighted | 15.00 (band 4) |
| Counts | module 3 |
A dementia diagnosis alone does not produce a care grade in Germany; what counts is how much hands-on help daily life requires. Three modules matter most for dementia. Module 2 measures cognitive abilities such as orientation, memory and recognising danger, module 3 behaviour such as restlessness, wandering at night or resisting care. Together they carry 15 % of the total, but only with the higher of the two weighted scores (section 15(3) of Book XI of the Social Code). Module 6, daily life with routine, sleep and contacts, adds another 15 %. In our worked example a physically fit but forgetful woman reaches 37.50 points and care grade 2, which means €347 of care allowance (Pflegegeld) a month. A man with a similar memory who wanders at night reaches 47.50 points and grade 3; without his behaviour being scored he would have only 40.00. Support groups and volunteer helpers can be paid from the relief amount (Entlastungsbetrag) of €131 a month.
How many days of day care a month are covered
Covered days per month
18
| Day care budget | €1,357 |
| Allowance stays | in full (s. 41(3)) |
You pay meals and investment costs; the relief amount can cover them.
Which modules count with dementia
Until the end of 2016 Germany used care levels (Pflegestufen); since 2017 the report records, besides washing, dressing and eating, whether someone knows where they are, recognises danger and gets up at night (section 14(2) SGB XI). Three of the six modules matter most for dementia:
- Module 2, cognitive and communication abilities: eleven criteria, including recognising people, orientation in place and time, remembering, carrying out multi-step tasks, making decisions, recognising risks and following a conversation. Each ability is rated as present, largely present, present to a small degree or absent.
- Module 3, behaviour and psychological problems: thirteen criteria from physical restlessness and night-time restlessness through resisting care and delusions to anxiety and lack of drive. What counts is how often the behaviour occurs and calls for someone to step in.
- Module 6, daily life and social contact: structuring the day, resting and sleeping, keeping occupied, planning ahead, dealing with people face to face and keeping in touch with others.
Modules 2 and 3 share 15 % of the weighting, module 6 has its own 15 % (section 15(2) SGB XI). Self-care adds 40 %, and there prompting and supervising someone while washing, dressing and eating also score. If you have to tell your mother to shower every morning and stay nearby, that is help that counts.
Module 2 or module 3: the higher score decides
The two modules are not added. The law gives them one shared weighted score, made up of the higher of the two (section 15(3) SGB XI). In module 2 the raw total can reach 33, in module 3 65; each is divided into five bands with its own limits (Annex 2). In module 3 a few frequent behaviours are enough for the top band: from 7 raw points the full 15.00 weighted points apply. Frequency is scored under Annex 1 as follows: never or very rarely 0, rarely (one to three times in two weeks) 1, often (twice to several times a week but not daily) 3, daily 5 (Annex 1).
That is why it pays to prepare both modules separately. Enter the totals in the calculator at the top to see which one counts; the care grade calculator asks about every criterion.
Three worked cases from the engine
All three cases are calculated with this site’s assessment engine, criterion by criterion. Mrs A. is forgetful, gets lost outside the flat and misses appointments, but is calm and physically mobile. Mr B. still remembers a lot, but paces restlessly several times a week, gets up at night and sometimes resists help. Mrs C. has advanced dementia, needs prompting or full help with almost everything and recognises relatives only at times.
| Mrs A.: forgetful, calm | Mr B.: restless, awake at night | Mrs C.: advanced | |
|---|---|---|---|
| Module 2: raw, weighted | 16 · 11.25 | 9 · 7.50 | 25 · 15.00 |
| Module 3: raw, weighted | 2 · 3.75 | 8 · 15.00 | 12 · 15.00 |
| Counts | module 2 | module 3 | module 2 |
| Module 4 self-care, weighted | 10.00 | 20.00 | 30.00 |
| Module 6 daily life, weighted | 11.25 | 7.50 | 15.00 |
| Total points | 37.50 | 47.50 | 75.00 |
| Care grade | 2 | 3 | 4 |
| If only module 2 counted | 37.50 · grade 2 | 40.00 · grade 2 | 75.00 · grade 4 |
| Allowance per month | €347 | €599 | €800 |
For Mrs A. memory decides: module 2 is higher and her occasional anxiety in module 3 plays no part. For Mr B. it is the other way round. His behaviour lifts the shared score from 7.50 to 15.00, and that alone takes him from 40.00 to 47.50 points, across the line to grade 3 at 47.5. Had the family not mentioned his night-time rounds at the visit, he would have stayed at grade 2. For Mrs C. both modules are in the top band; no more than 15.00 points can come from them, and the rest comes from self-care and daily life.
Module 6: the daily life that often goes unrecorded
Module 6 is often underestimated with dementia, although it weighs more than mobility. It asks whether someone structures their own day and adapts to changes, sleeps calmly, keeps occupied, plans beyond today and stays in touch with others. What counts is the help needed for all this: guiding your father through the day, telling him when it is time to eat, collecting him for a walk and settling him in the evening are support in several criteria. For Mrs A., module 6 adds 11.25 points, exactly as much as her memory.
For the assessment, describe an ordinary day from morning to night, with every reminder, prompt and accompaniment. People with dementia often present better in front of strangers than they manage at home, and a separate conversation with the assessor can be requested; see the Medical Service assessment. If you live abroad, join by phone or send a signed, dated account of a typical week. If the dementia progresses, a request for a higher grade is the route to the right grade.
Support the fund pays for
For people with dementia, supervision and company often matter more than nursing in the narrow sense. Book XI provides specific everyday support services for this: dementia support groups, volunteer circles giving relatives a few hours off at home, day care in small groups, everyday companions and care companions (section 45a(1) SGB XI). They need recognition under the law of the federal state.
| Budget | at care grade 3 | what it can pay for with dementia |
|---|---|---|
| Relief amount | €131 a month | recognised support group, volunteer circle, everyday companion, day or short-term care |
| Conversion of the services budget | up to €598.80 a month | the same services, from unused home care budget |
| Day and night care | up to €1,357 a month | days at a centre with a set routine, night care for restlessness |
| Shared flat supplement | €224 a month | assisted shared flat, often designed for dementia |
The relief amount is refunded against invoices; at grades 2 to 5 a home care service may not be paid from it for self-care, but it may be paid for supervision and company (section 45b(1) SGB XI). Whatever is left at the end of the calendar year can be carried into the following half-year. If it is not enough, the conversion of the services budget adds up to 40 % of the unused home care budget for the same services, with the partial allowance reduced accordingly. Day care has its own budget and does not reduce the allowance (section 41 SGB XI). For afternoon restlessness in particular, a fixed routine at a centre gives many people stability and the family free hours. The calculator below shows how many days the budget covers.
If your parent lives in an assisted shared flat, the shared flat supplement applies on top (section 45f SGB XI). For a break for the family carer there is also the joint annual budget of €3,539 for respite and short-term care, which can bridge the weeks when a relative flies in from abroad.
How many days of day care a month are covered
Covered days per month
18
| Day care budget | €1,357 |
| Allowance stays | in full (s. 41(3)) |
You pay meals and investment costs; the relief amount can cover them.