If the need for help has grown, you can apply for a higher Pflegegrad (care grade) at any time. An informal letter to the Pflegekasse (long-term care insurance fund) is enough; it will then arrange a new assessment. What matters is that you can back up the change with examples and documents.

Details

The need for care changes. After a fall, after a stroke, with advancing dementia or simply over the years, the Pflegegrad once assessed often no longer matches reality. You can then apply for a Höherstufung (an upgrade to a higher care grade) – the Pflegekasse calls this an “Antrag auf Neubegutachtung” (application for a new assessment) or a “Verschlechterungsanzeige” (notification of deterioration).

When does a higher care grade make sense?

Whenever the person in need of care permanently needs more help than at the last assessment. Typical reasons:

• a stay in hospital, an operation, a fall with consequences
• advancing dementia, increasing disorientation, restlessness at night
• new incontinence, help with eating and drinking becoming necessary
• walking only with help or not at all, wheelchair use, being confined to bed
• medication, wound care or insulin can no longer be managed independently
• behaviour that makes constant supervision necessary

Temporary deteriorations – flu, for example, or the weeks immediately after an operation – are as a rule not enough. An exception is situations in which no further improvement can be expected.

Are there deadlines or waiting periods?

No. You do not have to wait for any minimum period since the last assessment, and you may apply more than once. The same time limits apply as for a first application: the Pflegekasse must decide within 25 working days (§ 18c SGB XI); if it culpably fails to do so, it pays 70 euros for every week of delay begun.

Here too the rule applies: the higher benefits are paid from the first day of the month in which the application is made – not only from the date of the decision. Hesitating therefore costs real money.

Can you also be downgraded in the process?

At a new assessment the whole situation is assessed afresh, so in theory a lower Pflegegrad is also possible. In practice this rarely happens, because the Pflegekasse may only lower the grade if independence has genuinely improved – and it has to give reasons for that. Anyone experiencing a real, lasting deterioration need not let this worry stop them from applying. If in doubt, get advice at a Pflegestützpunkt (care support point) beforehand.

What tips the balance

What counts is not the diagnosis but independence in everyday life: what can the person still do alone, where do they need guidance, and where does someone have to take over? The assessment covers six modules (mobility; cognitive and communicative abilities; behaviour and psychological problems; self-care; coping with demands arising from illness; organising everyday life). The strongest lever usually lies in self-care (40 per cent weighting) and – especially with dementia – in modules 2 and 3.

The most convincing argument is a direct comparison: what did the last assessment report say, and what is different today? That is why you should have the old assessment report to hand. If you can no longer find it, request it informally from the Pflegekasse.

What additionally becomes possible

A higher Pflegegrad means more money and more room for manoeuvre (as at July 2026): Pflegegeld (cash care allowance) of 347 € (Pflegegrad 2), 599 € (3), 800 € (4) and 990 € (5) per month; Pflegesachleistung (care benefits in kind) of 796 €, 1.497 €, 1.859 € and 2.299 € respectively. Regardless of the grade, the Entlastungsbetrag (monthly relief amount) of 131 € a month (from Pflegegrad 1) and the joint annual amount for Verhinderungspflege (respite care) and Kurzzeitpflege (short-term residential care) of 3.539 € (from Pflegegrad 2, since 1 July 2025) remain in place. The amounts were not increased for 2026.

What to do

1. Gather the changes. Make brief notes on what is different today compared with the last assessment – with dates and concrete examples wherever possible.
2. Apply informally. One sentence is enough: “Hiermit beantrage ich die Überprüfung des Pflegegrades wegen einer dauerhaften Verschlechterung und bitte um eine erneute Begutachtung.” (I hereby apply for a review of the care grade because of a lasting deterioration and request a new assessment.) Note the date and keep a copy.
3. Request the old assessment report and go through the scores for the six modules. That shows you where you need to start.
4. Keep a Pflegetagebuch (care diary) – for at least 14 days, with daytime and night-time hours recorded separately. It is the most important piece of evidence.
5. Have your documents ready: recent letters from doctors, discharge reports, medication plan, records of falls, documentation from the care service, prescriptions for aids.
6. Use the advice available. The Pflegestützpunkt will go through the situation with you, free of charge and independently.
7. Bring the person providing the care to the appointment. Whoever provides care every day can describe the need best. Describe a normal day – not the best one.
8. Check the decision. If the result is not enough, you have one month to lodge an appeal.

Where to get help

You do not have to judge this on your own. The Pflegestützpunkte in Berlin and Brandenburg give free, independent advice, go through the old assessment report with you and help with the wording. In Berlin there are 36 locations; in Brandenburg there are Pflegestützpunkte in every district and independent town.

• An advice centre near you: Addresses (service type “Beratungsstelle / Pflegestützpunkt”, then filter by borough or district).
• Care courses and groups for relatives in which exactly these questions are discussed: Events.
• Preparing for the appointment: Checklist: preparing well for the MD assessment.