Must the Pflegekasse give me an appointment within two weeks?
After the initial application, yes – or it must issue you a voucher. § 7b SGB XI obliges it, immediately after receipt of the first application, to either offer “a specific advice appointment … to be held at the latest within two weeks of receipt of the application” or issue an advice voucher, which you can redeem at named advice centres “at the expense of the Pflegekasse”. Note the difference from § 7a SGB XI: it establishes the entitlement to advice as such and requires that a care adviser be named without undue delay – it does not contain a two-week deadline. Anyone looking for the deadline in § 7a will not find it and may then take it for an invention.
What is an advice voucher?
The legally intended alternative, when the Pflegekasse cannot offer its own appointment – and the least known part of the process. The voucher names “advice centres … at which it can be redeemed at the expense of the Pflegekasse within two weeks of receipt of the application”. So you go to an independent body, and the fund pays. In practice this means: if you are told that no appointment happens to be available, that is not an acceptable answer – explicitly request the voucher, ideally in writing and citing § 7b SGB XI.
Does the advice come to me at home?
On request, yes. § 7a Abs. 2 SGB XI determines that the advice takes place “at the request of a person entitled to it … in the home environment or in the facility in which this person lives”. So you do not have to travel to an office – which would be difficult anyway in the situation most people are in when they need care advice. Professionally, the home visit is also the clearly better option: only in the home does the adviser see thresholds, bathroom access, lighting, pathways and trip hazards – and that is exactly what the concrete suggestions for medical aids and home environment improvement arise from.
Are there care support centres in my federal state?
Probably, but not certainly – and the often-read claim that they exist “in all federal states” is not correct. § 7c SGB XI provides for care support centres (Pflegestützpunkt) with institution-independent advice, and there are more than 540 nationwide. Saxony and Saxony-Anhalt, however, have opted for other advice models and do not take the classic route via care support centres; in the other federal states too, the density varies considerably, depending on how actively they have been built up. What matters is: your entitlement to advice under §§ 7a and 7b exists everywhere – only this one organisational form is not available nationwide.
When should I get advice?
Earlier than most people do – namely already with the application, and not only with the Bescheid. § 7a SGB XI also expressly grants the entitlement “if an application for benefits under this book has been submitted”. Advice before the assessment is particularly valuable: you learn which six modules the Medical Service evaluates, what a useful care diary looks like, and why you should not try to put a brave face on things at the appointment. After that, renewed advice is worthwhile after every significant change – after a hospital stay, in the event of deterioration, or when a carer becomes unavailable. The entitlement is not a one-off.
What happens during the advice session?
Care advice assesses the need for help and draws up an individual care plan together with you: which benefits come into consideration, in what order they make sense, and who can provide them. It also helps with applications and coordination between those involved – the care service, the doctor, the medical supply store, the Sozialamt (social welfare office). Have the plan given to you in writing; it is the working basis for the coming months and helps if someone else takes over later. Bring a list of questions: otherwise half of it routinely fails to come up in conversation, and it is precisely the benefits you do not yet know about that you do not ask about on your own.
What should I specifically ask about?
About what you are not yet using – general questions get you less than questions by name. The four most common unused benefits are the Entlastungsbetrag of €131 a month, respite care by the hour, home environment improvement, and – with Pflegegrad 1 – practically everything. Also ask about the two remaining balances: how much is still left of the combined annual budget of €3,539 and of the Entlastungsbetrag? These are the pots that quietly expire. And bring up the carer: pension insurance contributions, care leave, relief services. In the long run, these topics often matter more than the amount of the Pflegegeld.
Does the advice cost anything?
No, not in any form. Neither the advice from the Pflegekasse, nor redeeming an advice voucher – this is expressly redeemed “at the expense of the Pflegekasse” – nor advice at a care support centre. The advice visit (Beratungseinsatz) under § 37 Abs. 3 SGB XI, which Pflegegeld recipients must regularly call upon, is also free of charge for you and is billed directly to the fund. So there is no economic reason to forgo advice – but there is a very good one for taking it: most families use fewer benefits than they are entitled to, and this only becomes apparent once someone with an overview looks at it.
