Who assesses a Pflegegrad (care level) in Germany?

The Medizinischer Dienst (MD) assesses statutorily insured people; MEDICPROOF assesses those with private long-term care insurance. The application goes to the care insurance fund (Pflegekasse), and the assessment date, not the application date, is normally the effective start — so applying early matters.

Do adult children have to pay for their parents' care?

Since the Angehörigen-Entlastungsgesetz took effect on 1 January 2020, adult children are only liable for parental maintenance if their own gross annual income exceeds a set threshold — currently around the figure shown above. Below it, the social welfare office does not pursue the children at all.

What is the § 528 BGB gift trap?

If someone who gave away an asset later becomes unable to cover their own living or care costs, § 528 BGB lets them — or, in practice, the social welfare office stepping into their claim — reclaim the gift, within a set number of years of the transfer. Signing the house over to children and later needing care is the classic, expensive version of this mistake.

What's the difference between Pflegegeld and Pflegesachleistung?

Pflegegeld is paid directly to the care recipient when care is provided by relatives or other informal carers. Pflegesachleistung pays a professional care service instead. Both can be combined proportionally, alongside Verhinderungspflege (respite care), Kurzzeitpflege (short-term residential care) and a monthly Entlastungsbetrag (relief allowance).

What happens if the family carer themselves falls ill?

Almost always nothing has been prepared, because care usually rests on one person. Medication schedules, doctors' contacts, the Pflegekasse case number and daily routines typically exist only in that person's head. A written handover — the same kind of document a healthcare power of attorney supports — is the only reliable fix.

Is a healthcare power of attorney required for care decisions?

In practice, yes. Without one, care contracts and medical decisions require a court-appointed guardian (Betreuer) — even for a spouse. § 1358 BGB gives married partners only a limited stopgap in health matters, not a general substitute for a power of attorney.

Guide

Long-term care in Germany: costs, duties, and the gift trap

Most people preparing their affairs plan for a sudden death. What most people actually live through — as the one needing care, or the child organising it — is a long, gradual loss of independence. This guide covers care levels, who really pays, and the mistakes that turn out to be expensive.

By The Erbnis editorsPublished 1 September 2026Updated 1 September 20266 min read

Key takeaways

Pflegegrade 1–5 are assigned after an assessment by the Medizinischer Dienst (MD) or MEDICPROOF; the assessment date usually sets the effective start, so apply early.
Pflegegeld (paid to the family) and Pflegesachleistung (a professional service) can be combined, alongside Verhinderungspflege, Kurzzeitpflege and the Entlastungsbetrag.
Since 2020, adult children only owe parental maintenance above a gross annual income threshold — most people fear this far more than the law actually requires.
§ 528 BGB lets a gift be reclaimed if the giver later needs care within the statutory window — signing over the house is the classic trap.
A healthcare power of attorney is the precondition for care decisions; § 1358 BGB gives spouses only a short statutory stopgap.

Why care is the scenario that actually happens

Most estate planning is built around a sudden death. Statistically, the far more likely path is a long, gradual decline — years, not days — during which someone else has to step in, make decisions, and keep the paperwork moving. It is also the phase in which a family's planning is used by living people, repeatedly, rather than sitting unopened until a funeral.

Care levels and the MD assessment

Germany assigns one of five Pflegegrade (care levels) based on how independently someone can manage daily life. The assessment is carried out by the Medizinischer Dienst (MD) for people with statutory long-term care insurance, or by MEDICPROOF for those privately insured. The application itself goes to the person's care insurance fund (Pflegekasse); the level, once granted, normally takes effect from the assessment date rather than the eventual decision date — which is why applying as early as possible matters more than most families realise.

Pflegegeld, Pflegesachleistung, and the extras

Benefits fall broadly into two channels: Pflegegeld, paid directly to the person receiving care when family or other informal carers provide it, and Pflegesachleistung, which pays a professional care service instead. The two can be combined proportionally. On top of that sit Verhinderungspflege (respite care when the usual carer is unavailable), Kurzzeitpflege (short-term residential care), and a monthly Entlastungsbetrag of … for everyday relief services.

Elternunterhalt: the threshold since 2020

Since the Angehörigen-Entlastungsgesetz took effect on 1 January 2020, adult children are only liable to contribute towards their parents' care costs if their own gross annual income exceeds …. Below that threshold, the social welfare office (Sozialamt) does not pursue the children at all, even if it is covering a parent's care home shortfall. An enormous number of people still believe the opposite, which makes this single fact one of the most reassuring things a family can learn.

The gift trap: § 528 BGB and ten years

The opposite mistake is transferring assets away too early. Under § 528 BGB, if the person who made a gift later becomes unable to cover their own reasonable living or care costs, the gift can be reclaimed — in practice, the social welfare office often steps into that claim once it is covering care costs — within … of the transfer, on a sliding scale. Signing the family house over to the children and then needing residential care within that window is the classic and expensive version of this trap.

Pflegezeit and Familienpflegezeit

Employed carers have statutory job protection: short-term leave for an acute care situation, up to six months of Pflegezeit, and up to 24 months of part-time Familienpflegezeit — subject to thresholds on employer size. Family carers who provide a sufficient number of hours per week can also build pension credits for the time spent caring, which is easy to overlook in the middle of an already stretched routine.

Why a healthcare power of attorney comes first

Care contracts, decisions about a care home, and medical choices all require someone with legal authority to make them. Without a Vorsorgevollmacht (power of attorney), the Betreuungsgericht (guardianship court) appoints a court-supervised guardian — even for a spouse. § 1358 BGB gives married partners only a limited stopgap, allowing them to make certain health-related decisions for each other for up to …, not a general substitute for a properly drafted power of attorney.

The handover problem: when the carer falls ill

Care almost always rests on one person. When that person is unexpectedly hospitalised for a week, nobody else typically knows the medication schedule, which doctor to call, when the care service is due, or how the person likes their mornings arranged. That handover rarely exists in writing anywhere — a short, current, printable summary of medication, contacts, the Pflegekasse case number, and daily habits is the single most useful document most families never think to prepare, until they suddenly need it.