Is there a waiting period after the last notice?
No. An application for a higher care grade is possible at any time – even a few weeks after a notice – provided the condition has actually worsened. There is no statutory waiting period, and the Pflegekasse must not refuse an application solely because the last assessment was recent. What you should prepare, however, is the statement of reasons: if the last assessment was only a short time ago, what has changed since then is examined particularly closely. An up-to-date care diary and new medical findings – such as a discharge report after a hospital stay – are then decisive.
From when do I get the higher benefits?
From the month the application is submitted, so retroactively also for the period between the application and the notice. This is the same mechanism as with the first application, and the reason why you should call immediately rather than gather documents first: the application is informal, and every month you spend preparing is a month without the higher benefits. Have the application date confirmed. For a move from Pflegegrad 2 to 3, €252 a month is at stake on Pflegegeld alone – so two months of hesitation cost more than €500.
Higher care grade or objection — which is right?
It depends on the point in time, and confusing the two regularly costs people their entitlements. An application for a higher care grade is right if the condition has worsened since the assessment; it is possible at any time and takes effect from the month of the new application. An objection is right if you believe the condition was already wrongly assessed back then; it then takes effect retroactively from the original application, but must be lodged within one month of the notice. If you are unsure: secure the objection deadline first – one sentence is enough to meet the deadline – because that deadline runs out, while an application for a higher care grade remains possible at any time.
How do I make a convincing case for a higher care grade?
By showing the change, not just today’s condition. Get hold of the old assessment report – you are entitled to a copy – and go through it module by module: where does it contain an assessment that no longer holds true today? Set a specific, dated observation against it, supported by an up-to-date care diary covering one to two weeks. Add anything that has arisen since the last assessment: discharge reports, new diagnoses, a statement from the care service on individual modules. This comparison – how it was then, how it is now, and the evidence for it – is the strongest statement of reasons an application for a higher care grade can have.
Do the 25 working days and the €70 also apply here?
Yes. § 18c SGB XI does not distinguish between a first application and an application for a higher care grade: the Pflegekasse must “notify its decision in writing no later than 25 working days after receipt of the application”, and if it fails to do so, under subsection 5 it owes €70 for each week or part of a week by which the deadline is exceeded. The rule from § 18 SGB XI also applies: if no assessment has taken place after 20 working days, you must be given a list of independent assessors. So note the application date for an application for a higher care grade too – without it you cannot claim either right.
When is the application especially worthwhile?
Above all after events that document a change with a date: after a hospital stay, after a fall with consequences, with progressing dementia, after a stroke, or when a need for help at night increasingly arises. In all these cases there are documents – a discharge report, a new diagnosis, a change in medication – that show exactly what matters. The advisory visit is also a good occasion: the care professional who visits every six or three months sees changes from the outside and can assess whether an application has a chance. Ask them explicitly about it.
Can the Pflegegrad also be lowered?
In principle yes – if the condition improves substantially, for example after successful rehabilitation. In practice this is rare where the need for care is age-related, but it does occur after acute events from which someone makes a good recovery. This is no reason to forgo a justified application for a higher care grade: what is assessed is the actual need for help, and if it has increased, the assessment leads to a higher, not a lower, grade. Anyone who applies for nothing out of fear of being moved to a lower grade forgoes benefits to which they are entitled – and at the same time misses the chance to adjust care to the actual need.
What changes with a higher care grade?
More than most people expect – and much of it not automatically. Pflegegeld increases (€252 more from grade 2 to 3, then €201 and €190), as do the benefit in kind, day care and the grant for full-time residential care. On the other hand, the additional relief allowance (Entlastungsbetrag) of €131, care aids at €42 a month and the combined annual budget (Gemeinsamer Jahresbetrag) of €3,539 remain unchanged. Important: some benefits have to be applied for again or adjusted after moving to a higher grade – for example if you now want to use day care to a greater extent. Use the free care advice to find out what is now available to you.
