At the assessment, an assessor from the Medizinischer Dienst / MD (the medical service that assesses care needs) looks at how independent the person in need of care is in everyday life. Six areas of life are assessed and scored – and the Pflegegrad (care grade) follows from that. If you prepare well for the appointment and describe your normal everyday life honestly, you will get a realistic result.

Details

The assessment appointment usually lasts 45 to 90 minutes and takes place in the home. It is announced in advance in writing or by telephone; if the date does not suit you, you can move it. It is not an examination and it is not about diagnoses, but about a single question: how independent is this person in everyday life – and where do they need help?

The six modules and their weighting

• Module 1 – mobility (10 %): changing position in bed, holding a stable sitting position, transferring, moving around the home, climbing stairs.
• Module 2 – cognitive and communication skills and Module 3 – behaviour and psychological problems (15 % together): orientation in place and time, recognising people, taking decisions, holding conversations; restlessness at night, aggression, anxiety, resistance to care, a tendency to wander off. Only the module with the higher score counts.
• Module 4 – self-care (40 %): washing, showering, brushing teeth, dressing and undressing, preparing food and drink and taking it, using the toilet, dealing with incontinence. The largest weighting – this is where the most careful preparation pays off.
• Module 5 – coping with the demands of illness and treatment (20 %): taking medication, injections, blood sugar measurement, changing dressings, suctioning, visits to doctors and therapists, keeping to a diet.
• Module 6 – organising everyday life and social contacts (15 %): structuring the day, occupying oneself, planning ahead, keeping up contacts, using the surroundings outside the home.

The weighted points give an overall score between 0 and 100: Pflegegrad 1 from 12.5 points, Pflegegrad 2 from 27, Pflegegrad 3 from 47.5, Pflegegrad 4 from 70 and Pflegegrad 5 from 90 points.

The most common mistake: the good day

Many older people do not want to let on how things really are. On the day of the appointment they are especially well groomed and dressed, they answer everything politely and say “I can manage” – even where nothing has been managed alone for months. Time and again, this front costs a whole Pflegegrad.

Talk about it beforehand if you can: it is not about making yourself look worse than you are, but about getting the help you are entitled to. And: contradict politely but clearly during the appointment if an answer does not match reality. Ideally afterwards, if the situation allows – or with a written note prepared in advance that you hand to the assessor.

One more important point: what is assessed is the actual situation over a typical week, not the best moment and not the worst. Exaggerating is just as damaging as playing things down – assessors recognise both.

Who should be there?

The person who actually provides the care. They know everyday life, the nights and the incidents. The home care service can take part as well. Plan the appointment so that nobody is under time pressure.

After the appointment

Make a note the same day of what was discussed and what struck you. If you have not already done so, ask the Pflegekasse (long-term care insurance fund) for the full Pflegegutachten (assessment report). It is the only way to check the decision that follows.

What to do?

1. Confirm the appointment and choose a suitable time. Make sure the main carer is available. A time of day when the difficulties are visible is better than the calmest moment of the day.
2. Keep a Pflegetagebuch (care diary) – 14 days, every day, with times. Note what you help with, for how long and how often, and separate day and night.
3. Put your documents together (list below) and have them ready in a folder. Prepare copies for the assessor.
4. Write bullet points for each of the six modules – two or three concrete everyday examples for each. You are allowed to use these notes during the appointment.
5. Do not tidy up or rearrange anything beforehand in a way that hides the need for help. The home should reflect normal everyday life; aids such as a rollator, commode or care bed stay where they are.
6. Stick to everyday life in the conversation. Do not list diagnoses; describe what happens: “At night she gets up three or four times and cannot find the toilet.”
7. Ask if something is unclear, and correct politely if an answer played things down.
8. Make notes after the appointment and request the Pflegegutachten. If the decision is not right: lodge an appeal – there is a one-month deadline.

Checklist: have these documents ready

• Pflegetagebuch for the past 14 days
• recent doctors' letters, specialist reports, hospital and rehabilitation discharge reports
• medication plan (current, complete, including as-needed medication)
• list of aids (rollator, care bed, personal emergency call system, incontinence products, hearing aids, glasses)
• severe disability pass, decisions on official markers (Merkzeichen)
• documentation from the home care service, records of services provided
• Vorsorgevollmacht (lasting power of attorney), guardianship certificate, Patientenverfügung (advance directive), if available
• contact details of the doctors providing treatment
• your bullet-point notes on the six modules

Questions you should answer for yourself beforehand

• What happens at night? How often do you get up, and how long are you awake?
• What only works with prompting or instruction – even where it would be physically possible?
• Where is there a danger if nobody is there (cooker, stairs, medication, getting lost)?
• How many appointments, phone calls and errands do you take on in a week?
• What has got worse in the past six months?
• What do you do to keep things working – and what would happen if you were unavailable for a week?

Where can you get help?

The Pflegestützpunkte (care support points) will prepare you for the appointment in person if you wish, go through the modules with you and hand out forms for the Pflegetagebuch. The advice is free, independent and provider-neutral; it is also available as a home visit on request. Berlin has 36 Pflegestützpunkte, which provided around 115,000 advice sessions in 2023 (Landespflegeplan Berlin 2025); in Brandenburg there are Pflegestützpunkte in every county and independent city.

• Find an advice centre near you: Directory.
• Free care courses under § 45 SGB XI and information evenings about the assessment: Events.
• The step before: Applying for a Pflegegrad: step by step. The step afterwards, if something changes: Applying for a higher Pflegegrad.