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This chapter explains how Germany pays for care services for the elderly, and what you have to do to get them. It covers the Pflegeversicherung, the compulsory long-term care insurance that is the fifth pillar of German social insurance, and it walks through the whole process: how a care level is assessed, how much money each level actually releases in 2026, what a care home costs you personally after the insurance has paid, and who is asked to fill the gap when the money runs out. It also covers the questions that matter most to foreign residents and that German-language guides rarely answer: whether you can use your German insurance to pay for a parent who still lives in your home country, what happens to everything you have paid in if you leave Germany, and how the European coordination rules work.
Two things are worth saying at the start, because they shape everything that follows. First, the Pflegeversicherung was never designed to cover the full cost of care. It is a Teilkaskoversicherung, a partial-coverage insurance, and it pays a fixed amount per month according to your care level. Everything above that amount is yours to pay. Second, almost nothing happens automatically. Care benefits exist only on application, and the date the application arrives is the date the money starts. Families routinely lose months of benefit because they waited until the paperwork felt manageable.
Pflegeversicherung: The Fifth Pillar Of German Social Insurance
German social insurance has five branches: health, pension, unemployment, accident, and long-term care. The Pflegeversicherung, the long-term care insurance, is the youngest of them. It was introduced in 1995 and its rules are set out in the Elftes Buch Sozialgesetzbuch, the Eleventh Book of the Social Code, usually written SGB XI. If you would like the wider picture of how the five branches fit together, the social security system overview chapter sets it out.
The rule that surprises most new arrivals is that the Pflegeversicherung follows your health insurance automatically. You do not choose it and you cannot opt out of it. If you are in the gesetzliche Krankenversicherung, the statutory health insurance, then you are in the soziale Pflegeversicherung, and your Pflegekasse, the long-term care fund, sits inside your Krankenkasse as a legally separate body with the same address. If you are privately insured, you must hold a private Pflegepflichtversicherung, a compulsory private long-term care policy, with your private insurer. The public versus private health insurance chapter explains which system you fall into and why that decision is hard to reverse.
This coupling has a practical consequence. Whatever you decided about health insurance when you arrived in Germany, possibly years ago and possibly without thinking about old age at all, also decided who will assess your care needs and who will pay your care benefits. It is not a separate decision you get to make later.
What You Pay For Care Services In 2026
The contribution rate for the soziale Pflegeversicherung has been 3.6 percent of your gross income since 1 January 2025, and the Bundesgesundheitsministerium, the Federal Ministry of Health, confirms 3.6 percent as the general rate. You pay this only on income up to the Beitragsbemessungsgrenze, the contribution assessment ceiling, which for 2026 is 69,750 euros a year, or 5,812.50 euros a month. Income above that ceiling is not charged. Employer and employee normally split the general rate evenly, 1.8 percent each. Saxony is the exception: because the state kept the Buß- und Bettag public holiday when the rest of Germany gave it up to fund this insurance, employees in Saxony pay 2.3 percent and employers 1.3 percent.
On top of the general rate sits the Beitragszuschlag für Kinderlose, the surcharge for the childless. It is 0.6 percentage points, it has been at that level since 1 July 2023, and the employee pays it alone. The employer does not share it. It applies from the age of 23, and people born before 1 January 1940 are exempt. So a childless employee outside Saxony pays 2.4 percent of their own income rather than 1.8 percent, and the total flowing to the Pflegekasse is 4.2 percent.
Parents pay less, but not in the way most people expect. One child removes the surcharge and nothing more: you pay the plain 3.6 percent. The reductions only begin with the second child. From the second to the fifth child, each child under the age of 25 takes 0.25 percentage points off the general rate, and the relief stops accumulating at a total of 1.0 percentage points, which is reached with five children. The reduction for each child ends at the end of the month in which that child turns 25. This means your care contribution can rise several times over your life as your children pass their 25th birthdays, with no change in your salary and no letter warning you.
The proof matters here. If your children were born abroad, your employer or your Krankenkasse will not know they exist, and the default assumption is that you are childless. You will pay the surcharge until you produce birth certificates. Refunds for past months are possible but are handled inconsistently and can be limited, so it is worth submitting proof of Elterneigenschaft, parental status, as soon as you start work rather than discovering the deduction on a payslip years later.
The Two-Year Waiting Period That Catches New Arrivals
This is the single most important rule in this chapter for anyone who has recently moved to Germany, and it is the one most guides bury. Paragraph 33 SGB XI sets a Vorversicherungszeit, a qualifying period of prior insurance. Before you can draw any care benefit at all, you must have been insured, either as a member or as a family member under paragraph 25 SGB XI, for at least two years within the ten years before you apply.
Read that carefully, because it is not the same as the health insurance rule. Health cover starts on day one of your membership. Care cover does not. If you moved to Germany fourteen months ago, joined a Krankenkasse immediately, paid every contribution on time, and then had a stroke, you would be insured for treatment and not yet entitled to care benefits. The two years do not need to be continuous and they do not need to be recent within the ten-year window, but they must be there. For children the law is generous: the qualifying period counts as met if one parent meets it.
The practical advice that follows is simple. If you are within your first two years in Germany and someone in your household has a serious diagnosis, find out immediately where you stand rather than assuming the insurance is there. Insurance periods completed in another EU or EEA state or in Switzerland are generally taken into account under the European coordination rules described later in this chapter, which is often what saves the situation. Time insured outside that area usually is not.
Pflegegrade: The Five Levels Of Care Need
Everything the Pflegeversicherung pays depends on one number: the Pflegegrad, the care level. There are five, numbered 1 to 5, and they replaced the older three-tier Pflegestufen system in 2017. The change was not cosmetic. The old system measured minutes of physical assistance, which systematically excluded people with dementia who could wash and dress themselves but could not safely be left alone. The current system measures Selbständigkeit, independence, across mental and physical life together.
The assessment produces a weighted score between 0 and 100, and paragraph 15 SGB XI turns that score into a level with fixed thresholds. From 12.5 to under 27 points is Pflegegrad 1, described in law as geringe Beeinträchtigungen, minor impairments of independence. From 27 to under 47.5 points is Pflegegrad 2, erhebliche Beeinträchtigungen, considerable impairments. From 47.5 to under 70 points is Pflegegrad 3, schwere Beeinträchtigungen, severe impairments. From 70 to under 90 points is Pflegegrad 4, schwerste Beeinträchtigungen, the most severe impairments. From 90 to 100 points is Pflegegrad 5, the most severe impairments with special demands on nursing care.
The gap between Pflegegrad 1 and Pflegegrad 2 is the one that matters financially, and it is much wider than the one-step numbering suggests. Pflegegrad 1 gives you advice, a monthly relief amount, help with home adaptation and consumable supplies, but no Pflegegeld and no monthly care budget. Pflegegrad 2 opens the actual benefits. A borderline assessment that lands at 26.5 points rather than 27 is therefore not a small difference. It is the difference between a few hundred euros of support a year and several thousand.
How The Medizinischer Dienst Assessment Works
You apply to your Pflegekasse. The fund then commissions an assessment. For people in the statutory system this is carried out by the Medizinischer Dienst, the Medical Service, abbreviated MD and known as the MDK until a 2021 reorganisation made it independent of the insurance funds. If you are privately insured, the equivalent body is Medicproof. In both cases a nurse or doctor visits, usually at home, and works through a standardised instrument known as the Neues Begutachtungsassessment, the new assessment instrument, or NBA.
The NBA has six modules, and paragraph 15 SGB XI fixes exactly how much each one counts. Module 1, Mobilität, mobility, counts for 10 percent. Module 4, Selbstversorgung, self-care, which covers washing, dressing, eating and using the toilet, counts for 40 percent and dominates the result. Module 5, coping independently with the demands of illness and treatment, such as taking medication or managing a wound or a dialysis schedule, counts for 20 percent. Module 6, shaping daily life and social contacts, counts for 15 percent.
Modules 2 and 3 work differently and this catches people out. Module 2 covers cognitive and communicative abilities, such as recognising people and orienting yourself in time and place. Module 3 covers behaviour and psychological problems, such as nocturnal restlessness, aggression or anxiety. They are assessed separately, but the law gives them a single shared weighted score worth 15 percent, and only the higher of the two counts. They are not added together. For a person with dementia who has both cognitive loss and behavioural symptoms, only the stronger of the two feeds the total.
Two things reliably lower an assessment unfairly. The first is a good day. Many older people rally in front of a visiting professional, answer briskly, and walk to the door unaided, and the assessor records what they saw. The second is the question of what someone can do rather than what they actually do. The instrument asks how independently a person performs an activity, so an honest answer is not that your mother can in principle shower, but that she has not showered without help for eight months. Keeping a Pflegetagebuch, a care diary, for a week or two before the visit, recording what help was actually given, when, and how long it took, is the single most effective preparation. Someone who knows the person well should be present and should speak up when the answers drift into optimism.
The Decision, The Deadline And The 70 Euros
Paragraph 18c SGB XI gives the Pflegekasse 25 Arbeitstage, working days, from the arrival of your application to tell you its decision in writing. Shortened deadlines apply in urgent situations, for example where the person is in hospital, in a rehabilitation facility or a hospice, or receiving outpatient palliative care, or where a relative has announced Pflegezeit. In those cases the fund must decide immediately once the assessor’s recommendation reaches it.
The deadline has teeth. Under paragraph 18c(5), if the fund misses the 25 working days it must pay you 70 euros for every commenced week of delay, and it must pay within 15 working days after the deadline expires. This is automatic. You do not have to ask for it and you do not have to prove any loss. There are two exceptions written into the law: it does not apply if the fund is not responsible for the delay, and it does not apply if the applicant is already in full residential care with at least Pflegegrad 2 established.
You receive the Gutachten, the assessor’s report, along with the decision. Read it. It is a detailed document that shows the points awarded in every module, and it is the only way to see where a decision went wrong. If the score is lower than the reality you documented, you have one month from receipt of the Bescheid, the formal decision letter, to lodge a Widerspruch, a formal objection. The one-month deadline is strict. Objections in care cases succeed often enough to be worth making, particularly where dementia is involved and where module 2 or module 3 was underscored, but only if they are specific: name the module, name the point score, and say what the person actually cannot do.
Pflegegeld: Cash For Care At Home
Pflegegeld is a monthly cash payment made directly to the person needing care, on the condition that their care at home is actually organised, typically by family. It is not a wage and it is not taxed. It is paid to the care recipient, who is free to pass it on to whoever does the caring, or not. According to the Bundesgesundheitsministerium’s official schedule of 2026 benefit amounts, Pflegegeld is 347 euros a month at Pflegegrad 2, 599 euros at Pflegegrad 3, 800 euros at Pflegegrad 4 and 990 euros at Pflegegrad 5. Pflegegrad 1 receives no Pflegegeld at all.
Set those numbers against reality before you plan around them. At Pflegegrad 5, which describes someone needing help with essentially everything, the state pays 990 euros a month for a family member to provide what would otherwise be round-the-clock professional nursing. Pflegegeld is a contribution towards the cost of family care, not a replacement for an income. Anyone considering giving up work to care for a parent should do that arithmetic explicitly rather than hopefully.
Drawing Pflegegeld comes with an obligation that is easy to miss. The Pflegekasse requires a Beratungseinsatz, a mandatory advisory visit from an approved care service, twice a year at Pflegegrade 2 and 3 and four times a year at Pflegegrade 4 and 5. The visit checks that care quality is adequate and that the carer is coping. It is not optional: if you skip it, the fund can reduce or stop the Pflegegeld.
Pflegesachleistung: Professional Care Services At Home
Pflegesachleistung, literally care benefits in kind, is the alternative to Pflegegeld. Instead of cash, the Pflegekasse pays an approved ambulanter Pflegedienst, an outpatient care service, directly for the care it provides in your home. You never see the money. The budget is considerably larger than the cash alternative, because professional care costs more than family care. For 2026 the ministry’s schedule sets it at up to 796 euros a month at Pflegegrad 2, up to 1,497 euros at Pflegegrad 3, up to 1,859 euros at Pflegegrad 4 and up to 2,299 euros at Pflegegrad 5.
The words up to are doing real work in that sentence. This is a ceiling, not an allowance. The care service bills for what it does, in standardised units called Leistungskomplexe, and the fund pays until the ceiling is reached. If the service does less, nothing is left over for you. If it does more, you pay the excess yourself. Pflegegrad 1 has no Pflegesachleistung budget, though the monthly relief amount described below can be spent on such services.
You are also not required to choose one or the other. The Kombinationsleistung, the combined benefit, lets you take both proportionally. If you use 60 percent of your Pflegesachleistung ceiling, you receive 40 percent of your Pflegegeld. This is what most families with a working carer end up doing: a care service comes in the morning to handle the physical nursing, and the family covers the rest of the day with the reduced cash benefit. Be aware that switching between the pure and combined forms binds you for six months, so it is worth modelling before you commit.
The Entlastungsbetrag And The Smaller Benefits
Alongside the two main benefits sits the Entlastungsbetrag, the relief amount: 131 euros a month in 2026, available at every Pflegegrad including Pflegegrad 1. It is earmarked money rather than cash. You cannot spend it freely; you pay for an approved service, submit the receipt, and are reimbursed. It is meant for day care, short-term care, approved everyday-support services such as a helper who does the shopping or sits with a person for a few hours, and for parts of a care service’s non-nursing work. Unspent amounts roll over within the calendar year and can be used until 30 June of the following year, after which they expire. A great deal of this money goes unclaimed every year simply because nobody knew it was there.
Several other benefits sit in the background and are worth knowing. Pflegehilfsmittel zum Verbrauch, consumable care aids such as gloves, disinfectant and disposable bed pads, are covered up to 42 euros a month. Technical care aids such as a hospital bed or a wheelchair are covered in full, though a co-payment of 10 percent up to a maximum of 25 euros per item can apply. Measures to improve the living environment, wohnumfeldverbessernde Maßnahmen, which means a stairlift, a walk-in shower, removing a door sill or widening a doorway, attract up to 4,180 euros per measure, and up to four times that, 16,720 euros, where several entitled people live together. Digitale Pflegeanwendungen, approved digital care applications, are covered up to 40 euros a month with a further 30 euros for supporting services. People living in a shared assisted-living group receive an additional 224 euros a month, with start-up funding of up to 2,613 euros per person capped at 10,452 euros per group, and a flat subsidy of 450 euros a month exists for certain communal living arrangements with care contracts under paragraph 92c SGB XI.
The home-adaptation grant deserves particular attention because it is renewable. It is granted per Maßnahme, per measure, not once in a lifetime. When the situation deteriorates significantly, a new adaptation becomes a new measure with a new entitlement. Families often assume they used up their one chance on the bathroom five years ago.
Verhinderungspflege And Kurzzeitpflege: The Shared Annual Budget
Verhinderungspflege, literally prevention-of-care, means substitute care: it pays for someone to take over when the usual carer cannot, whether because of holiday, illness, a work trip, or simply exhaustion. Kurzzeitpflege, short-term care, pays for a temporary stay in a care home, typically after a hospital discharge when someone is not yet able to return home safely. These used to be two separate budgets with different rules, different durations and a confusing set of transfer provisions between them. They were merged.
Since the merger there is a single Gemeinsamer Jahresbetrag, a shared annual amount, of up to 3,539 euros per calendar year, available from Pflegegrad 2 upward and covering up to eight weeks in the year. The ministry’s 2026 schedule states plainly that the shared annual amount is available for both types of benefit together. You can spend all of it on substitute care at home, all of it on a short stay in a home, or divide it as the year demands. That is a genuine simplification and it removed a trap that used to cost families money.
One restriction survives the merger. If the substitute carer is a close relative or someone living in the same household, the amount payable for Verhinderungspflege is capped at twice the monthly Pflegegeld: 694 euros at Pflegegrad 2, 1,198 euros at Pflegegrad 3, 1,600 euros at Pflegegrad 4 and 1,980 euros at Pflegegrad 5. The full 3,539 euros is available only where the substitute care is provided by someone who is not a close relative or household member, such as an agency or a neighbour. Necessary documented expenses, such as a relative’s lost earnings or travel, can be reimbursed on top of the capped amount. Importantly, Pflegegeld continues at half rate during Verhinderungspflege and Kurzzeitpflege, for up to eight weeks a year, so taking a break does not switch off the cash benefit.
Tagespflege, Nachtpflege And The Budget Nobody Uses
Teilstationäre Pflege, partial residential care, means Tagespflege and Nachtpflege, day care and night care: the person is collected in the morning, spends the day in a facility with meals, activities, therapy and supervision, and comes home in the evening. It exists precisely for the household where an adult child works full time and a parent cannot be alone. Transport to and from the facility is included in the benefit.
The critical and widely misunderstood point is that this is a separate budget. It is not deducted from Pflegegeld or Pflegesachleistung. For 2026 the ministry’s schedule sets day and night care at up to 721 euros a month at Pflegegrad 2, up to 1,357 euros at Pflegegrad 3, up to 1,685 euros at Pflegegrad 4 and up to 2,085 euros at Pflegegrad 5. A family at Pflegegrad 3 can therefore draw the full 599 euros of Pflegegeld and up to 1,357 euros of day care in the same month, in addition to the 131-euro relief amount. Very few families realise this, which is why day-care places often sit unfilled while carers burn out at home.
Stationäre Pflege And The Eigenanteil That Grows
Vollstationäre Pflege means moving permanently into a Pflegeheim, a care home. Here the design of the system becomes very visible. The Pflegeversicherung pays a flat monthly amount towards the nursing costs, and for 2026 that is 131 euros at Pflegegrad 1, 805 euros at Pflegegrad 2, 1,319 euros at Pflegegrad 3, 1,855 euros at Pflegegrad 4 and 2,096 euros at Pflegegrad 5. Everything else is the Eigenanteil, your own share.
The Eigenanteil has three components. The first is the einrichtungseinheitlicher Eigenanteil, the facility-uniform own share, abbreviated EEE: the part of the nursing cost the insurance does not cover, deliberately set at the same level for every resident of a home regardless of their Pflegegrad, so that deteriorating health does not raise the bill. The second is Unterkunft und Verpflegung, accommodation and meals. The third is Investitionskosten, the home’s building and maintenance costs, passed on to residents. Only the first of these is reduced by the length-of-stay subsidies described below.
The numbers are the reason this chapter exists. According to the Verband der Ersatzkassen, the association of substitute health insurance funds, in an evaluation published on 14 July 2026 and current as at 1 July 2026, the average Eigenanteil in the first year of a stay is 3,364 euros a month. That is 256 euros more than a year earlier. The EEE component alone rose by more than 12 percent in a year, from 1,583 to 1,775 euros. Accommodation and meals average 1,068 euros and investment costs 521 euros. The regional spread is wide: Sachsen-Anhalt averages 2,891 euros and Bremen 3,761 euros. For comparison, the same association’s evaluation as at 1 January 2026 put the figure at 3,245 euros, which shows how quickly this number moves. Check the current figure rather than relying on any number you read, including this one.
Against that, the average German statutory pension is nowhere near sufficient, even after the 4.24 percent rise on 1 July 2026 described in the pension and retirement plans chapter. This gap is structural, not exceptional. It is the normal outcome for a normal pensioner in a normal home, and it is why the sections on Hilfe zur Pflege and Elternunterhalt below are not edge cases.
There is relief that grows with time. Under paragraph 43c SGB XI, the Pflegeversicherung pays Leistungszuschläge, benefit supplements, staggered by how long you have lived in the home: 15 percent of your EEE from the first month, 30 percent after 12 months, 50 percent after 24 months and 75 percent after 36 months. This makes the Eigenanteil fall over the years, which is unusual for a German cost. Note carefully what it applies to. The supplement reduces only the nursing-cost share, the EEE. It does nothing for accommodation, meals or investment costs, and those keep rising. In practice the supplements have been steadily outrun by cost increases, which is why the average Eigenanteil climbs even though the subsidy percentages have not changed.
Hilfe zur Pflege: When The Money Runs Out
When pension, savings and the Pflegeversicherung together cannot cover the Eigenanteil, the fallback is Hilfe zur Pflege, help towards care, governed by paragraphs 61 to 66a SGB XII. It is administered by the Sozialamt, the local social welfare office, not the Pflegekasse, and it is means-tested social assistance rather than insurance. It is very common: a large share of care-home residents in Germany rely on it, and applying is not a mark of failure.
Being means-tested, it comes only after your own income and assets are used. Protected assets, the Schonvermögen, are modest: since 1 January 2023 the limit under the ordinance to paragraph 90(2) no. 9 SGB XII has been 10,000 euros per person, so 20,000 euros for a couple. Owner-occupied property is generally protected while the person needing care or their spouse still lives in it, which is precisely the protection that ends when both move into a home. State-subsidised pension products such as Riester are protected. The wider rules on means-testing, assets and how these benefits interact with each other are set out in the welfare programs and eligibility chapter, and this chapter does not repeat them.
Two points are specific to foreign residents and are important enough to state plainly here. First, Hilfe zur Pflege is a benefit under SGB XII, and claiming SGB XII benefits can affect your residence status and your naturalisation prospects in ways that Kindergeld and Elterngeld do not. Second, that risk attaches to the person claiming. Where an elderly parent with their own settled status claims Hilfe zur Pflege, the position of an adult child with their own permit and their own income is a different question from the parent’s. The social assistance for expats chapter works through which benefits are safe for a residence permit and which are not, and it is worth reading before anyone in your family signs an application.
Elternunterhalt: When Children Pay For Their Parents
Elternunterhalt, parental maintenance, is the obligation of adult children to contribute to their parents’ care costs. When the Sozialamt pays Hilfe zur Pflege, it can in principle recover the money from the children, because the parent’s maintenance claim against them passes to the office. For decades this was the thing German families feared most about a parent entering a home, and the fear was justified: the office would examine your income and assets in detail.
The Angehörigen-Entlastungsgesetz, the Relatives Relief Act, changed this on 1 January 2020, and the change is dramatic. Paragraph 94(1a) SGB XII now provides that maintenance claims against the children and parents of the person receiving benefits are not to be taken into account unless their annual total income exceeds 100,000 euros. The same paragraph adds a statutory presumption that the income of the person liable does not exceed that limit. That presumption is what makes the rule work in practice. The Sozialamt must assume you are under the threshold and cannot demand your payslips on a fishing expedition. Only where there are concrete indications of higher income can it investigate.
Three details decide most real cases. The threshold is individual, applied per child, so each child is measured alone and the incomes of siblings are not added together. It is measured on gross total income within the meaning of paragraph 16 SGB IV, not on what reaches your account, and it includes rental and investment income, which is how people with ordinary salaries occasionally cross it. And a spouse’s income does not count towards your own figure: if you earn 70,000 euros and your partner earns 90,000 euros, you are under the threshold. The result is that the overwhelming majority of adult children in Germany are now never asked to pay anything towards a parent’s care.
This rule is under real political pressure and you should watch it rather than assume it is permanent. According to reporting in June 2026, a draft Pflegeneuordnungsgesetz from Federal Health Minister Nina Warken would remove the 100,000-euro threshold and draw children in at lower incomes. That is a ministerial draft, not a law: no parliamentary procedure has concluded, the detailed design was expressly left to a separate legislative process, and there is no commencement date. Separately, several municipalities are challenging the 2020 exemption before the Bundesverfassungsgericht, the Federal Constitutional Court, with a decision reported as expected during 2026. As of today the 100,000-euro threshold and its presumption are the law and they apply. Neither the draft nor the pending case changes anything yet.
What The System Gives You For Caring Yourself
If you care for a relative yourself, you are a Pflegeperson in the legal sense, and that status carries benefits beyond the Pflegegeld that reaches the household. The most valuable is invisible: the Pflegekasse pays pension contributions on your behalf. The condition is that you care for at least ten hours a week, spread over at least two days, for someone with at least Pflegegrad 2, and that you work no more than 30 hours a week in paid employment alongside it.
The amounts depend on the Pflegegrad and on whether Pflegegeld or Pflegesachleistung is drawn. Per the ministry’s 2026 schedule, the fund pays up to 198.62 euros a month at Pflegegrad 2, up to 316.32 euros at Pflegegrad 3, up to 514.94 euros at Pflegegrad 4 and up to 735.63 euros at Pflegegrad 5. Over several years of caring this is a meaningful addition to a pension record, and it matters especially to foreign residents because pension contribution months also count towards the 60 months required for a Niederlassungserlaubnis, the permanent settlement permit. Caring for a relative can quietly keep that clock running while you are out of the labour market. The fund also pays unemployment insurance contributions of 51.42 euros a month for carers in certain situations, which preserves your entitlement to Arbeitslosengeld when the caring ends, as explained in the unemployment benefits chapter.
Carers are also covered by statutory accident insurance while caring, at no cost, and are entitled to free Pflegekurse, care training courses, from the Pflegekasse. Where a carer takes Pflegezeit, the fund pays subsidies towards their health and long-term care insurance of up to 230.71 euros and 47.46 euros a month respectively.
Time Off Work: Pflegezeit And Familienpflegezeit
German employment law gives you three separate rights to step back from work for care, and they can be combined. The first is the kurzzeitige Arbeitsverhinderung, short-term absence: up to ten working days per care-dependent person per calendar year, to organise care in an acute situation. It is available regardless of employer size and it is paid. The Pflegeunterstützungsgeld, care support allowance, replaces 90 percent of your lost net pay, rising to 100 percent if you received contribution-liable one-off payments such as a bonus in the previous twelve months.
The second is Pflegezeit, care leave: up to six months of full or partial release from work to care for a close relative at home. It applies at employers with more than 15 employees and you must announce it in writing ten days in advance. The third is Familienpflegezeit, family care leave: up to 24 months of partial release, working at least 15 hours a week, at employers with more than 25 employees, announced eight weeks in advance. Pflegezeit and Familienpflegezeit together are capped at 24 months in total.
Both longer forms are unpaid, which is the catch. To bridge that, the Bundesamt für Familie und zivilgesellschaftliche Aufgaben, the Federal Office for Family and Civil Society Affairs, offers an interest-free state loan, roughly half the difference between your net pay before and during the leave, repaid after you return. You apply to BAFzA directly, not through your employer. Both forms of leave carry protection against dismissal from the moment you announce them.
Caring For A Parent Who Lives Abroad
This is the question foreign residents ask most often, and the answer is an unwelcome one that should be stated without hedging: your German Pflegeversicherung will not pay for a parent who lives in your home country. There is no discretion here and no application worth making. The reason is structural. German long-term care insurance covers you as a member, and it covers certain family members through Familienversicherung, family insurance, under paragraph 25 SGB XI. That provision covers your spouse, your registered partner and your children. It does not cover your parents. Parents are not on the list, at any income, at any age.
Even if parents were on the list, a second condition would block it. Paragraph 25 requires the family member to have their Wohnsitz oder gewöhnlichen Aufenthalt im Inland, their residence or habitual abode in Germany. Someone living in Manila, Istanbul, Lagos or Sao Paulo cannot be family-insured in Germany at all. Both barriers apply independently. Your contributions, however many years of them, do nothing for a parent abroad.
What is left is limited but not nothing. If you support a parent abroad financially, those payments may be deductible from your German income tax as außergewöhnliche Belastungen, extraordinary burdens, under the rules for Unterhaltsleistungen, maintenance payments to dependants. The requirements are strict and evidence-heavy, the deductible ceiling is reduced for many countries according to an official country grouping that reflects local living costs, and you will need documentation the German tax office accepts. This is a matter for a Steuerberater, a tax adviser, and it is a tax deduction rather than a care benefit. If instead your parent moves to Germany permanently and joins the German system, they enter it like anyone else, which means the two-year qualifying period applies to them from the point they are insured, and an elderly parent joining German health insurance late is expensive and often difficult to arrange at all.
What Happens To Your Entitlement If You Leave Germany
Paragraph 34 SGB XI is the governing rule and it starts from a hard default: entitlement to care benefits rests, ruht, during a stay abroad. Two exceptions matter. For a temporary stay abroad, Pflegegeld continues to be paid for up to eight weeks per calendar year. And for stays anywhere in the European Union, the European Economic Area or Switzerland, the resting rule does not apply to Pflegegeld at all, so the eight-week limit falls away entirely.
Pflegesachleistung behaves quite differently, because it is a service rather than money. It continues abroad only where the carer who normally provides it accompanies the person on the trip. You cannot use a German care budget to buy care from a provider in another country. The same logic excludes residential care abroad: a German Pflegekasse does not pay for a place in a care home outside Germany, which is a disappointment to families who discover that the same care costs a third as much elsewhere.
If you leave Germany permanently, expect no money back. The pension system has a refund mechanism under paragraph 210 SGB VI that lets some people who leave before qualifying reclaim their own share of contributions, and the pension and retirement plans chapter explains it. SGB XI contains no equivalent. Care contributions are not refundable. They bought insurance cover for the years you were insured, and when you leave, that cover simply ends. If you later return to Germany and rejoin, your earlier insurance months still count towards the two-year qualifying period as long as they fall within the preceding ten years, which is a real if modest consolation for people who come and go.
EU Coordination And Cross-Border Care Services
Within the EU, the EEA and Switzerland, Regulation (EC) No. 883/2004 on the coordination of social security systems changes the picture substantially. Its central principle is that you are subject to one country’s system at a time, normally the country where you work, and that insurance periods completed in other member states are aggregated when a qualifying period is assessed. That aggregation is what rescues the two-year Vorversicherungszeit for someone who worked in France for a decade before moving to Germany last year.
The regulation splits care benefits by their nature. Pflegegeld is treated as a cash benefit and cash benefits are exportable, so it can follow you to another member state where Germany remains the competent country, which is exactly why paragraph 34 SGB XI removes the resting rule inside the EU and EEA. Benefits in kind work the other way: German Pflegekassen do not provide Pflegesachleistungen to people living in another member state. Those are provided by the institution in your country of residence, according to that country’s rules and at that country’s levels, with the cost settled between the institutions. This can cut either way. A German pensioner retiring to a member state with a thinner care system receives that country’s benefits in kind, not Germany’s.
Outside that area, coordination depends on whether Germany has a bilateral social security agreement with the country concerned, and long-term care is frequently outside the scope of those agreements even where pensions are inside it. Do not assume that an agreement covering your pension also covers care. If your plans depend on it, ask the Deutsche Verbindungsstelle Krankenversicherung Ausland, the German liaison office for health insurance abroad, which handles exactly these cross-border questions.
Private Pflegepflichtversicherung And Supplementary Cover
If you are privately insured for health, you must hold a private Pflegepflichtversicherung. It is compulsory and it is not the same product as the private health policy, though it usually sits with the same insurer. By law its benefits must be at least equivalent to those of the social system, so the Pflegegrade, the amounts and the benefit types described in this chapter apply in substance. Assessment is carried out by Medicproof rather than the Medizinischer Dienst. Premiums are risk-based rather than income-based, and unlike the statutory system there is no free family insurance, so a non-earning spouse and each child need their own contract and their own premium. Civil servants and their families receive Beihilfe, a state subsidy towards care costs, and insure only the remaining share.
Separately from the compulsory cover, private Pflegezusatzversicherung, supplementary care insurance, is sold to close the Eigenanteil gap. Given the figures earlier in this chapter, the gap it addresses is real. Whether a policy is worth its premium depends on your age, your health at the point of underwriting and the terms, particularly whether benefits are index-linked, since a policy paying a fixed 1,000 euros a month will be worth much less against a care bill in thirty years. This chapter does not recommend for or against, and nothing here is financial advice. If you look at one, compare whether it pays from Pflegegrad 1 or only from higher grades, and read the waiting periods.
Getting Advice, And The Documents To Sign Early
You have a statutory right to Pflegeberatung, care counselling, from your Pflegekasse, free of charge, and the fund must offer it proactively once an application arrives, with the counselling intended to take place within two weeks. On request it includes an individual Versorgungsplan, a care plan taking in all the social benefits and appropriate help in your case. Family carers can receive counselling alone, with the consent of the person needing care. If the fund cannot provide counselling within the deadline, it must issue you a voucher for an independent counselling service. In many regions, Pflegestützpunkte, local care support points, provide the same advice face to face and independently of any provider. This advice is free and genuinely useful, and it is under-used by foreign residents who assume it will not be available in a language they speak. Ask; many services can arrange it, and independent counselling in English exists in the larger cities.
Two documents matter more than anything else in this chapter and both must be signed while the person is still legally capable of signing them. A Vorsorgevollmacht, a healthcare and financial power of attorney, names the person who may decide for you when you cannot. A Patientenverfügung, an advance healthcare directive, records which treatments you do and do not want. Without a Vorsorgevollmacht, German law does not simply hand decisions to your spouse or children; the Betreuungsgericht, the guardianship court, appoints a Betreuer, a legal guardian, who may be a stranger. The emergency representation right that spouses gained in 2023 is narrow and lasts six months. For foreign families this is sharper still, because a power of attorney drawn up abroad may not be accepted by a German bank or hospital. If an elderly relative is moving to Germany or already lives here, treat these two documents as urgent rather than morbid. Where dementia is a possibility, urgent means now, because capacity is exactly what these documents require.
Palliative And End-Of-Life Care
Palliative care is paid for by health insurance rather than the Pflegeversicherung, which is a distinction that matters when you are working out who to call. Its purpose is comfort rather than cure. Specialisierte ambulante Palliativversorgung, specialised outpatient palliative care, known as SAPV, brings a team of palliative doctors and nurses to the home and is available around the clock. It is prescribed by a doctor and covered in full by statutory health insurance, with no co-payment. Most people say they want to die at home, and SAPV is the mechanism that makes that realistic.
Where care at home is not possible, a stationäres Hospiz, an inpatient hospice, provides end-of-life care. Hospice care in Germany is not billed to the dying person: health and long-term care insurance cover the great majority of the cost and the hospice funds the rest through donations and volunteers, so there is no Eigenanteil of the kind a care home charges. Ambulante Hospizdienste, outpatient hospice services, send trained volunteers to homes, hospitals and care homes for companionship and support of the family, and they are free. Bereavement support for the family usually continues afterwards. These services are consistently under-used, partly because families do not know they exist and partly because asking feels like giving up. Contacting a hospice service does not shorten anyone’s life or commit you to anything, and a doctor’s prescription for SAPV is worth asking about early rather than in the final week. Nothing in this chapter is medical advice; the treating doctor decides what is appropriate.
Tools For The Forms And The Numbers
Care generates an unusual amount of paperwork at exactly the moment a family has least capacity for it. A few browser tools can take some of the weight. Werkzeu.ge is built by Cryon UG, the company behind WeLiveIn.de, so treat this as a recommendation with an interest attached and judge the tools on whether they actually help. It is bilingual in German and English, hosted in Germany, uses deterministic formulas rather than AI, and is in beta until 30 November 2026, which means its own terms warn that tools may be incomplete or buggy. None of it is legal, tax, medical or financial advice, and none of it submits anything to an authority: it prepares and generates documents that you then file yourself.
The Formularamt is the most useful starting point and it is free without an account, in the tier the site labels Gast. It holds thousands of official federal, state and municipal forms, searchable, each with a source link, retrieval date, status and checksum, and each fillable in the browser with your entries staying on your device. Care applications are form-heavy and the forms differ by Pflegekasse and by municipality, so having them in one searchable place with a visible retrieval date is worth more than it sounds. Note that the free tier carries ads.
For the numbers, the Pflegegeld-Rechner works through what a given Pflegegrad releases and how combining Pflegegeld with Pflegesachleistung changes the result, which is the calculation most families get wrong. It is a Plus tool. The Krankenkassen-Beitragsrechner, also Plus, covers the contribution side, including how the childless surcharge and the per-child reductions land on your own payslip. The Renten-Rechner is free but requires a free account, the tier the site labels Kostenlos, and is useful for seeing what the pension contributions credited to a family carer add up to over several years.
For the letters, the Behördenbrief-Decoder (Plus) puts official German letters into plain language, which is directly relevant when a Bescheid arrives setting out a Pflegegrad you were not expecting. If you decide to challenge that decision, the Widerspruch-Baukasten (Plus) helps you build a structured formal objection. Because the objection deadline is one month and the fund’s own deadline is 25 working days, the Fristenwächter (Plus) is a reasonable place to record both dates, including the date your application arrived, since that is what the 70-euro payment is calculated from. Pricing changes during the beta, so check the current pricing rather than trusting a figure quoted anywhere else.
What To Do Next
If care is needed now, apply today. A phone call to the Pflegekasse is enough to start it, and the application date sets the date benefits begin, so an informal call followed by paperwork beats a perfect application submitted next month. Write down the date you applied and count 25 working days. Then start a Pflegetagebuch immediately and keep it until the assessor visits, recording what help was actually given rather than what could in principle be managed. Arrange for someone who knows the person honestly to be present at the assessment. When the decision arrives, read the Gutachten module by module against your diary, and if the score does not match what you documented, lodge a Widerspruch within one month, naming the modules and the points.
If care is likely rather than immediate, do the two things that only work in advance. Get a Vorsorgevollmacht and a Patientenverfügung signed while the person can still sign them, and confirm the person is over the two-year qualifying period. If they are not, find out whether insurance periods in another EU or EEA country close the gap. Book free Pflegeberatung from the Pflegekasse or a local Pflegestützpunkt before you need it; the advice is better when nobody is in crisis, and the counsellor can build a Versorgungsplan you keep for later.
If the money is the problem, work through the order the system expects: the person’s own income and assets, then the Pflegeversicherung and any other benefits, then Hilfe zur Pflege from the Sozialamt. Only after that does Elternunterhalt arise at all, and under paragraph 94(1a) SGB XII it arises only for children whose own gross annual income exceeds 100,000 euros, measured individually, with the law presuming you are under the threshold until there is concrete reason to think otherwise. Do not pay a Sozialamt demand and do not disclose your income in response to a general enquiry without checking that position, and take proper advice if you are anywhere near the line, because that rule is currently the subject of both a ministerial draft and a constitutional challenge. If claiming any SGB XII benefit is on the table for anyone in your family, read the social assistance for expats chapter first, because the consequences for a residence permit are not the same for every benefit or every person.
Finally, use the things that are already yours. The 131-euro Entlastungsbetrag, the day-care budget that does not touch your Pflegegeld, the 3,539-euro shared annual amount for Verhinderungspflege and Kurzzeitpflege, the home-adaptation grant that renews with each new measure, the free care courses, and the ten paid days off work in an acute situation are all sitting there unclaimed in a great many households. They are not charity and they are not favours. You have been paying for them out of every payslip.
Sources
The information in this chapter draws on the official sources and publications listed below, last reviewed in July 2026. It is general guidance for orientation, not individual legal, tax, or medical advice.
