The Medical Service assessment: what counts on the day
The home visit sets the care grade for years: what the assessor wants to know, how answers are scored and how to prepare, even from abroad.
Checked by Radif Partners · Editorial policy · How we calculate
From report to grade: weight your module points
Weighted points (without module 5)
42.50
| Grade from this | 2 |
| Self-care weighted | 20.00 |
Module 5 (medication, doctor visits) can add up to 20 points.
Once a care application is filed, the long-term care fund (Pflegekasse) instructs the Medical Service (Medizinischer Dienst) or an independent assessor to establish whether care is needed and at which grade (section 18 of Book XI of the Social Code). The assessment normally takes place in the person’s home; it can be skipped only when the records are unambiguous or during a regional or national crisis (section 18a(2)). A first assessment may never be done purely by phone (section 142a). The assessor scores the criteria of six modules; self-care weighs most at 40 %, and of cognition and behaviour only the higher score counts. What matters is not the diagnosis but how much help from another person is needed: someone who only has to be prompted to wash and dress is already rated “mostly independent” and earns points. If nobody has come within 20 working days, the fund must send a list of at least 3 independent assessors. The report arrives with the decision, at the latest 25 working days after the application.
Who comes and what happens
The Medical Service announces the visit in writing or by phone and asks you to have ready any reports from care services, care diaries, medical records, current medication and decisions from other benefit agencies (assessment guidelines). The assessor is a nurse or a doctor; children are usually assessed by specially trained paediatric nurses or paediatricians (section 18a(10) SGB XI). With consent, the assessor should contact the family doctor and question the relatives who provide care.
The visit starts with the history: which conditions, since when, what has changed. The guidelines say that listing diagnoses is not enough; the question is how the illness affects daily life. The assessor then works through the modules, may ask to see particular movements and notes where someone else has to step in. Fluctuations between good and bad days and the strain on the carer are recorded too. At the end come aids, rehabilitation and prevention.
What each module covers
| Module | What the assessor looks at | Weight | Maximum |
|---|---|---|---|
| 1 Mobility | turning in bed, sitting, transferring, walking indoors, stairs | 10 % | 10.00 |
| 2 Cognition | recognising people, orientation, memory, decisions, spotting danger, conversation | 15 % | 15.00 |
| 3 Behaviour | restlessness, wandering at night, resisting care, anxiety, aggression, apathy | with module 2 | 15.00 |
| 4 Self-care | washing, showering, dressing, eating, drinking, toilet, incontinence, tube feeding | 40 % | 40.00 |
| 5 Illness and treatment | medication, injections, wound care, measurements, doctor and therapy visits, diet | 20 % | 20.00 |
| 6 Daily life and contact | structuring the day, sleep, keeping busy, planning, contact with others | 15 % | 15.00 |
How an answer becomes points
Modules 1, 4 and 6 use four levels (independent, mostly independent, mostly dependent, dependent), worth 0 to 3 points per criterion. The borderline cases are the ones families overlook. Under the guidelines, a person is already “mostly independent” if soap and flannel must be handed over, if they have to be prompted (even repeatedly) to start washing, if someone has to check the result or if a fall risk means they should not shower alone. “Mostly dependent” applies when the carer has to demonstrate or steer the task throughout, or take over a substantial part of it.
The engine shows the effect. With no help at all in self-care the module gives 0 weighted points. If the person only needs prompting for seven washing and dressing criteria, that is 7 raw points and already 10 weighted points. Add a little help with eating, which counts 3 times, and the raw total rises to 10 and self-care is worth 20 points (section 15 SGB XI). Those modest kinds of help alone already pass the grade 1 threshold of 12.5 points, before mobility, medication or daily life are even counted.
Only help that is regularly needed counts. Temporary or occasional problems are ignored, and the care need must be expected to last at least six months. After an operation with a good prognosis, talk openly with the assessor about how long help is likely to be required.
What this care grade brings per month in 2026
Benefits per month
€772
| paid to you | €599 |
| services | €0 |
| per year incl. annual budget | €12,803 |
Preparing in three steps
- Two weeks of notes. A care diary with time and type of help: when you reminded, supported or took over. The guidelines name care diaries and seizure logs as documents to be evaluated. Written in German if possible, or at least in plain English with times.
- Sorted documents. Doctors’ and hospital letters, medication plan, the care service’s records, decisions from other agencies such as a disability assessment. Put the folder on the table before the visit.
- Who is present. The main carer should be there. A legal guardian or the holder of a power of attorney must be notified by the fund. If language is a barrier, a relative or interpreter should help: the visit is held in German.
A classic mistake: on the day, the parent rallies and insists they manage everything alone. Write down beforehand what went wrong in recent weeks and ask for a separate conversation if needed. Children living abroad should plan a trip around the date or make sure a local carer who knows the routine is present. Check the likely outcome first with the care grade calculator, which goes through every criterion. Specific points for dementia and for children have their own pages.
Your rights in the procedure
| Right | What it means | Legal basis |
|---|---|---|
| Assessment at home | exceptions only for clear records or a crisis | s. 18a(2) |
| No phone interview for a first application | nor for objections or children | s. 142a(2) |
| List of independent assessors | after 20 working days without an assessment, at least 3 names | s. 18(3) |
| Decision | within 25 working days, otherwise €70 per week begun | s. 18c(1) and (5) |
| Report | sent with the decision, can also be requested later | s. 18c(2) |
| Aids recommended in the report | count as applied for if you agree | s. 18b(3) |
After the visit
The assessor sends the report to the fund, which decides and posts you the decision with the report unless you declined it (section 18c(2) SGB XI). The fund must explain the result in plain terms and point you to the ombudsperson who handles complaints about the Medical Service in confidence. Recommended care aids count as applied for if you agreed during the visit (section 18b(3) SGB XI). Compare the report criterion by criterion with your diary. If a rating is wrong, you have one month to object, or three if the decision was delivered to you abroad.