Asking for a higher German care grade: when it pays and what it risks
When daily life has become much harder since the last decision: what the request looks like, what the assessor scores again and from when more money arrives.
Checked by Radif Partners · Editorial policy · How we calculate
How close is the next care grade?
Points missing for the next grade
3.75
| Grade today | 3 |
| Extra allowance after | €201 |
| Extra services budget after | €362 |
A request for a higher care grade (Höherstufung) makes sense when the person’s condition has worsened for good since the last decision. An informal letter to the long-term care fund (Pflegekasse) is enough; it then orders a new assessment, for which the Medical Service pulls the previous report and describes how things have changed. Book XI of the Social Code sets no waiting period after the last decision. Legally, the higher grade amends a decision with lasting effect under section 48 of Book X; more money is paid at the earliest from the month in which the request reaches the fund (section 33(1) SGB XI). Moving from grade 3 to grade 4 adds €201 of care allowance and €362 of services a month, so waiting three months costs €603 in allowance alone. The new report scores every module again, though: if it shows a substantial improvement, the fund may lower the grade for the future after hearing you. People transferred from an old care level in 2017 keep their grade as long as any need for care remains (section 140(3) SGB XI).
When a higher grade is the right route
A care grade decision stays in force until it is changed. If the condition gets worse afterwards, the decision no longer fits, but the fund will usually only act once the family asks. Typical triggers are a fall with a fracture, a stroke, progressing dementia, new incontinence or a hospital stay after which the person can no longer get up alone. The new limitations must be expected to last at least six months (section 14(1) SGB XI); a bad flu or the first weeks after an operation do not qualify.
If the decision was already too low when it was issued, the objection is the tool. The four procedures around a care grade differ mainly in who starts them and from when money flows.
| Procedure | fits when | Deadline | Effect |
|---|---|---|---|
| Request for a higher grade | the condition worsened after the decision | none | more money from the month of the request at the earliest |
| Objection (Widerspruch) | the decision was too low from the start | 1 month from notification | back pay from the original application |
| Review request (Überprüfungsantrag) | the deadline passed and the report was wrong | none | back pay up to 4 years |
| Repeat assessment by the fund | the fund has concrete signs of improvement | no request | a lower grade only applies for the future |
How to make the request
There is no compulsory form. Long-term care benefits are paid on request (section 33(1) SGB XI), and an informal letter to the fund is enough. Many funds then send their own form, which you can fill in but need not wait for: the month of your first letter is what counts. Say briefly what has changed and since when, for example that since a hip fracture in March your mother can no longer shower alone or get to the toilet alone at night.
The more concrete the paperwork, the easier it is for the assessor to record the change:
- Reports since the last assessment: hospital discharge letter, specialist findings, rehabilitation report.
- A two-week care diary showing not just the help given but what the person used to manage alone and no longer can.
- The current medication plan and prescriptions for therapy or nursing care.
- The last report for your own comparison; the assessor will pull it anyway.
Write a short German summary at the top if your notes are in English; the case handler and the assessor work in German.
What the new report does differently
For a higher grade request the assessor does not start from scratch. Under the assessment guidelines she must pull the existing reports, assess the development since then and document it in detail. Simply referring to the earlier report is not enough: the interim history records how the illnesses developed, what improved or worsened in each module and why. If she recommends a lower grade, she must also explain what reduced the limitations.
Unlike a first application, a structured phone or video interview is allowed from age 14 if the insured person agrees (section 142a SGB XI). For people with cognitive impairment, mental health problems or language barriers a support person must then take part, and for someone with dementia living alone the assessor must check especially carefully whether the format works. If daily life is easier to show than to describe, decline the call and ask for a home visit.
Worked example: why not every decline is enough
A woman in her late seventies had 53.75 points in her last report, which is care grade 3. After a fall she can only walk around the flat with help, needs much more support showering and dressing, and moves up one band in both mobility and self-care. The engine gives 66.25 points: she stays at grade 3, 3.75 points short of the next grade. Only when daily life also falls apart, because she wakes several times a night and can no longer plan her day, does module 6 reach the top band and the total rise to 73.75 points, which is grade 4.
| Module (weighted) | last report | after the fall | with daily life disrupted |
|---|---|---|---|
| 1 Mobility | 5.00 | 7.50 | 7.50 |
| 2 and 3 Cognition or behaviour | 11.25 | 11.25 | 11.25 |
| 4 Self-care | 20.00 | 30.00 | 30.00 |
| 5 Illness and treatment | 10.00 | 10.00 | 10.00 |
| 6 Daily life and contact | 7.50 | 7.50 | 15.00 |
| Total points | 53.75 | 66.25 | 73.75 |
| Care grade | 3 | 3 | 4 |
The lesson: in the request and at the visit, describe not only the event that triggered it but every change across all six modules. Sleep, daily structure and contacts (module 6) and accompanying the person to doctors and therapy (module 5) are often overlooked, although together they carry 35 % of the weighting. The calculator at the top shows how far the next grade is; the care grade calculator takes you through every criterion. The calculator below shows what each month of waiting costs.
What a late application costs
Allowance lost
€1,041
| Allowance per month | €347 |
| paid from | month of application (s. 33) |
The fund does not pay for months before the application.
What the higher grade brings beyond the allowance
| Change | from total points | Extra day care per month | Care home: fund pays more | Extra monthly pension per year of care | Extra tax lump sum |
|---|---|---|---|---|---|
| 1 to 2 | 27.0 | €721 | €674 | €10.49 | €600 |
| 2 to 3 | 47.5 | €636 | €514 | €6.22 | €500 |
| 3 to 4 | 70.0 | €328 | €536 | €10.48 | €700 |
| 4 to 5 | 90.0 | €400 | €241 | €11.66 | €0 |
A higher grade feeds several budgets at once. The day care budget grows, and so does the amount the fund pays a care home. The care-related co-payment in a home stays the same, because within one home it is uniform for grades 2 to 5; in a home the higher grade changes what the fund pays, not what the family pays. For the carer, pension contributions (section 166(2) SGB VI) and the tax lump sum (section 33b(6) Income Tax Act) rise. The carer pension calculator shows how much pension builds up.
The risk: the grade can also fall
A request for a higher grade opens up the whole assessment. If mobility has improved markedly after rehabilitation while memory is fading, the total may end up below the old score. A reduction requires a substantial change in circumstances and in principle only applies for the future (section 48(1) SGB X). Before setting a lower grade the fund must hear you and give you the chance to comment (section 24 SGB X). You can object to the new decision.
People who were transferred from an old care level into a care grade on 1 January 2017 enjoy special protection: their grade is kept at any new assessment unless it leads to a higher grade or finds that there is no longer any need for care at all (section 140(3) SGB XI). Everyone else should check honestly before applying whether anything has improved, and work through the modules once themselves.
Helping from another country
If your father lives in Germany and you live abroad, you can make the request with a power of attorney. It counts as made on the day it reaches another social security office, a municipality or a German mission abroad (section 16 SGB I). Ask the fund to tell you the date of the assessment early, and make sure someone who knows daily life is present. If a phone or video interview is offered, you can join as the support person. How the visit itself works is explained under the Medical Service assessment; what each grade pays is on the pages for care grade 3 and care grade 4.