After your application, the Pflegekasse (long-term care insurance fund) sends an assessor from the Medizinischer Dienst (MD, the medical service that assesses care needs) to your home. The visit usually lasts one to two hours. The question is not which illnesses there are, but how independently everyday life can still be managed.

Details

The Medizinischer Dienst carries out assessments on behalf of the Pflegekasse. For people with private insurance, the company Medicproof does the same job. The basis is the Neues Begutachtungsassessment (NBA, the new assessment instrument): it measures independence, not the time spent on care and not the diagnosis. Two people with the same illness can therefore receive very different Pflegegrade (care grades).

The six modules and their weighting

• Module 1 – mobility (10 %): getting up, transferring, moving around the home, climbing stairs
• Module 2 – cognitive and communication skills and Module 3 – behaviour and psychological problems (15 % together; only the higher of the two scores counts): orientation, remembering, holding conversations; restlessness at night, anxiety, aggression
• Module 4 – self-care (40 %, the most important module): washing, dressing, eating and drinking, going to the toilet
• Module 5 – coping with demands arising from illness and treatment (20 %): medicines, dressings, injections, appointments with doctors, therapies
• Module 6 – organising everyday life and social contacts (15 %): daily structure, activities, keeping up contacts

All the modules together produce a score of between 0 and 100 points. From 12,5 points there is Pflegegrad 1, from 27 points Pflegegrad 2, from 47,5 points Pflegegrad 3, from 70 points Pflegegrad 4 and from 90 points Pflegegrad 5. For details see: Understanding Pflegegrade 1 to 5.

Which deadlines apply

The Pflegekasse must send you its decision no later than 25 working days after your application arrives. If it misses the deadline without good reason, you are entitled to a payment of 70 Euro for every week of delay that has begun – but you have to claim it yourself. In hospital or in rehabilitation the assessment must take place within five working days if it is needed for further care. The same applies if relatives have given notice of Pflegezeit (care leave) or if the care is palliative. (As at July 2026)

The most common mistake

Many people want to show themselves at their best during the visit: they get up especially early, dress carefully and say “I can manage”. Relatives play things down out of consideration. The result is a Pflegegrad that is too low. So describe an average, honest day – and explicitly include the bad days and the nights.

What to do?

1. Keep a Pflegetagebuch (care diary). For one to two weeks, note down for every day: what was help needed with? How much time did it take? What happened at night? What was no longer possible alone at all? Forms are available free of charge from the Pflegekasse and the Pflegestützpunkt (care support point).
2. Have your documents ready. Medication plan, reports from doctors and hospitals, rehabilitation discharge report, list of aids, severely disabled person’s pass, contact details of the treating doctors, evidence of services provided by a care service.
3. Ask someone you trust to be there. Relatives may and should be present and add information – particularly where memory or insight into the illness is limited. The care service can take part as well.
4. Do not play things down and do not exaggerate. Answer the question “Can you still do that?” concretely: “I can get up on my own, but I need two attempts and hold on to the cupboard.” Describe the effort, not the goal.
5. Show the home. Thresholds, a bath with no way of getting in, narrow doorways, missing grab rails – that is part of the assessment and at the same time the basis for a home adaptation grant of up to 4.180 Euro per measure (as at July 2026).
6. Ask for the assessment report. Tick the box on the application to say that you want to receive the full Pflegegutachten (assessment report), or request it in writing. Only then can you check whether the points awarded match your everyday life.
7. Check the decision and appeal if necessary. You can appeal against the decision within one month – informally at first, to meet the deadline, and submit the reasons afterwards. More on this in the category Pflegegrad & applications.

Where can you get help?

• Pflegestützpunkte will prepare for the assessment appointment with you free of charge, go through the Pflegetagebuch and then check the report afterwards. Addresses and opening hours under Directory (filter “Beratungsstelle / Pflegestützpunkt”).
• Care services and advice centres near you, including ones offering other languages or specialising in dementia, can also be found under Directory.
• Courses and information evenings preparing you for the assessment, as well as care courses under § 45 SGB XI, are in the calendar under Events.
• Unfamiliar technical terms in the report? Look them up in the care glossary.

All deadlines and amounts: as at July 2026 (§§ 18, 40 SGB XI).