In the SHI system, you are entitled to benefits for home nursing care in addition to medical treatment. In this context, you will receive home nursing care in your household, your family or in another suitable place, in particular in assisted living facilities, schools and kindergartens, if hospital treatment is necessary but cannot be carried out or if it is avoided or shortened by home nursing care (hospital avoidance care).
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In addition, you will receive nursing care at home if this is necessary to secure the goal of the medical treatment (security care). The prerequisite for this is that you need medical treatment because of illness and that home nursing care is part of the medical treatment plan. Your health insurance fund can stipulate in its statutes whether this should only be treatment care or whether basic care and domestic services are also provided. However, you are only entitled to home nursing care if no one living in your household is able to care for you to the extent required.
When you are discharged from hospital, home nursing care can be prescribed by contracted doctors, but also by hospital doctors who, as the last people to treat you, are usually best informed about the patient’s situation. This prescription within the framework of discharge management can cover a transitional period of up to seven days.
In the case of care constellations due to serious illness or due to acute aggravation of an illness, especially after a hospital stay, there are extended entitlements to benefits within the framework of home nursing care and home help as well as the benefit of short-term care under health insurance law. With this short-term care entitlement, a completely new benefit entitlement was created in SHI for insured persons corresponding to the benefit of social long-term care insurance. This regulation closed the gap in care for insured persons who are not yet in need of assistance, but who are also unable to care for themselves at home. As a result of the Digital Care Act, care professionals from home care can exchange information with the responsible registered doctor via video if necessary for the treatment of a common patient (patient-oriented case discussion).
The statutory health insurance generally pays for household help under two conditions:
if it is not possible to continue running the household because of hospital treatment or certain other benefits such as rehabilitation benefits or home nursing care
if there is a child living in the household who has not yet reached the age of twelve when the household help starts, or who is disabled and dependent on help.
Here, too, the entitlement only exists if no person living in the household is able to continue the household. However, some insurance funds also pay if older children or no children at all live in the household. You can find out more about this directly from your health insurance fund.
Your co-payment for household help is ten per cent of the daily costs, but no more than ten euros and no less than five euros. The co-payments are waived for household help during pregnancy and childbirth.