Limited everyday skills

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Limited everyday competence was a term from the law of the German social long-term care insurance . Because of their considerable need for general supervision and care, insured persons with limited everyday skills were entitled to special care services, additional care services and home care.

With the Second Act on the Strengthening of Long- term Care , the concept of restricted everyday skills has been dropped. Such activities are now immediately taken into account when determining the newly introduced care levels.

definition

There was limited everyday competence if the insured person was permanently impaired in performing daily activities due to dementia- related disabilities , a mental handicap or mental illness and therefore had to be regularly and permanently supervised and cared for. It did not matter whether the prerequisites for classification in a care level were met.

background

When determining the need for care , only the need for help that people in need of care need for the legally stipulated activities of daily life in the form of basic care and household care was taken into account . In contrast, no consideration was given to the need for assistance in the form of general supervision and care not related to activities in the course of daily life.

To correct this situation, was on 1 January 2002 in home care an entitlement for patients with a considerable need for general supervision and care on additional care benefits under § 45b SGB XI introduced.

On July 1, 2008, the entitlement to benefits was also extended to those in need of care whose need of care was not classified as significant (“care level 0”).

Since January 1, 2013, insured persons with limited everyday skills were also entitled to additional care services in accordance with Section 123 SGB ​​XI and home care in accordance with Section 124 SGB ​​XI.

According to Section 119b (1) SGB ​​V, since April 1, 2014, you have been entitled to take advantage of the special care of insured persons in need of care in the field of dental care in inpatient care facilities if they have entered into a cooperation agreement between the nursing home and the cooperating dentist under dental care law .

Procedure for determining the limited everyday skills

Like the need for care, the limited everyday skills were also determined during a home visit by experts from the Medical Services of the Health Insurance (MDK) or by other experts commissioned by the long-term care insurance . The Medicproof company was responsible for private patients ; the miners had their own appraisers. The review process was divided into two parts, a screening and an assessment .

Screening

The damage, impairment of activities and resources uncovered during the assessment were evaluated in the context of a screening with the aim of determining whether an assessment procedure should be carried out. The specific need for help in the areas

  • orientation
  • Drive / employment
  • Mood
  • memory
  • Day / night rhythm
  • Perception and thinking
  • Communication / language
  • Adapting to the situation
  • Perceiving social areas in life

recorded and assessed as conspicuous or normal.

A subsequent assessment was carried out if there was an abnormality in at least one area that could be traced back to functional disorders caused by dementia, intellectual disability or mental illness and this resulted in a regular and permanent need for supervision and care.

Assessment

The assessment was based on the 13 items of Section 45a (2) SGB XI a. F. the assessment of whether the impairment of everyday skills is significant in the long term, as there is a need for regular and permanent supervision and care. Cognitive disorders caused by illness or disabilities as well as affect and behavior disorders are recorded. The following items were given:

  1. Uncontrolled leaving of the living area (people walking away)
  2. Failure to recognize or cause dangerous situations
  3. Improper handling of dangerous objects or potentially hazardous substances
  4. Physical or verbal aggressive behavior in misunderstanding of the situation
  5. Inappropriate behavior in the situational context
  6. Inability to perceive one's own physical and emotional feelings or needs
  7. Inability to co-operate with therapeutic or protective measures as a result of therapy-resistant depression or anxiety disorder
  8. Disorders of the higher brain functions (impairment of memory, impaired judgment), which have led to problems in coping with everyday social activities
  9. Disturbance of the day / night rhythm
  10. Inability to plan and structure the daily routine independently
  11. Failure to recognize everyday situations and inappropriately reacting to everyday situations
  12. Pronounced unstable or uncontrolled emotional behavior
  13. Temporally predominantly depression, despondency, helplessness or hopelessness due to a therapy-resistant depression

"Significantly limited everyday skills"

A considerably limited everyday skills occurred when a "yes" is indicated in the assessment at least two items, including at least once in an item from one of the areas 1 to 9.

"Increasingly limited everyday skills"

An increased degree of restricted everyday skills existed if the relevant prerequisites for the "significantly restricted everyday skills" were met and a "Yes" was also given for at least one other item from one of the areas 1, 2, 3, 4, 5, 9 or 11 is specified.

Benefits for insured persons with significantly reduced everyday skills

Additional care services according to § 45b SGB XI

  • People in need of care of care levels I to III and insured persons who need help in the area of ​​basic care and domestic care who do not reach the extent of care level I (so-called care level 0) were entitled to
    • Reimbursement of costs when using additional care services in the amount of 104 euros per month (basic amount) or 208 euros per month (increased amount) depending on the extent of the need for help due to the damage and impaired ability (§ 45a SGB XI)

Additional care services according to § 123 SGB XI

  • This increased for those in need of care at care level I
    • Care allowance by 70 euros to 305 euros and the
    • Care benefits in kind by 215 euros to up to 665 euros.
  • For those in need of care in care level II, this increased
    • Care allowance after around 85 euros to 525 euros and the
    • Care benefits in kind by 150 euros to up to 1,250 euros.

Home care services according to § 124 SGB XI

People in need of care in care levels I to III as well as insured persons with significantly limited everyday skills received home care services in the form of support and other help in the home environment, in particular

  • Support of activities in the home environment that serve the purpose of communication and maintaining social contacts,
  • Support in the organization of everyday domestic life, in particular assistance in developing and maintaining a daily structure, in carrying out needs-based activities and in maintaining a needs-based day / night rhythm. ( § 124 )

Individual evidence

  1. ↑ Guideline for the identification of persons with significantly limited everyday skills and for the assessment of the need for help of March 22, 2002, changed by resolutions of May 11, 2006 and June 10, 2008
  2. ↑ Walhalla specialist editorial team: The entire patient and care law: Support and qualified advice for the sick, those in need of care and their relatives; With the home laws of the countries . Walhalla Fachverlag, May 6, 2013, ISBN 978-3-8029-0739-5 , p. 795–.
  3. ↑ See § 14 and § 15 SGB ​​XI
  4. ↑ Article 1 No. 6 Act to Supplement the Services for Home Care for People in Need of Care with Substantial General Care Needs (Pflegeleistungs-Zusatzgesetz - PflEg) of December 14, 2001, Federal Law Gazette I, page 3728, 3730 ff
  5. ↑ Article 1 No. 27 Act on the Structural Development of Long-Term Care Insurance (Long-term Care Development Act - PfWG) of May 28, 2008. Federal Law Gazette I, pages 874, 882 f
  6. ↑ Article 1 No. 48 Law on the realignment of long-term care insurance ( Care Reorientation Act - PNG) of October 23, 2012, Federal Law Gazette I, pages 2246, 2255
  7. ↑ Guideline for identifying people with significantly reduced everyday skills and for assessing the need for help, point 2.1
  8. ↑ Guideline for identifying people with significantly reduced everyday skills and for assessing the need for help, point 2.2