Elderly Care Levels in Germany (Pflegegrade): Assessment and Long-Term Care Insurance Support

What are Pflegegrade? A system of 5 levels (1 to 5) that defines how much daily care a person needs – physically, mentally, or psychologically.

Levels and examples:

• Level 1: minor need – elderly people mostly independent but require some support

• Level 2: moderate need – daily help with hygiene or mobility

• Level 3: high need – intensive and regular care required

• Level 4: severe need – almost complete dependence on assistance

• Level 5: very severe need + cognitive limitations – dementia or complex disabilities

How is the assessment done?

• By MDK (Medizinischer Dienst) for statutory insurance (GKV) or MEDICPROOF for private insurance (PKV)

• Six categories are evaluated with points:

  • Mobility (10%)

  • Cognitive and communication skills (15%)

  • Psychological and social behavior (15%)

  • Self-care (40%)

  • Medication and therapy management (20%)

  • Daily life management (15%)

Points required:

• 12.5 – <27 → Level 1

• 27 – <47.5 → Level 2

• 47.5 – <70 → Level 3

• 70 – <90 → Level 4

• ≥90 → Level 5

Examples:

• Elderly woman living alone, slow walking, needs help with cooking and bathing → Level 2

• Man with dementia, forgets medication, cannot bathe or dress alone → Level 4 or 5

Process:

• Submit application to health insurance

• Schedule assessment visit

• Prepare medical documents and daily activity list

• Family member should attend assessment

Appeal: Possible within one month, preferably with new medical reports.

Change over time: Reassessment possible if health worsens or daily care needs increase.