Germany’s five care grades: the points behind them and the six modules

Last checked against the official sources: 29 August 2026

A care grade is not an assessor’s opinion but an arithmetic result: six assessment modules, each scored, combined into a total out of 100 that falls into one of five grades. At the centre of the calculation sits a rule that surprises everyone: modules two and three are not added together — only the higher of the two counts. People who do not know it expect a higher grade than they receive.

The six modules — and what they actually measure

§ 14(2) defines the six areas on which the assessment rests, and § 15 divides the assessment instrument into six matching modules:

1. Mobility. Changing position in bed, holding a stable sitting position, transferring, moving within the home, climbing stairs.
2. Cognitive and communicative abilities. Recognising people close by, orientation in place and time, remembering events, managing multi-step everyday actions, making everyday decisions, understanding information, recognising risks, communicating basic needs, understanding requests, taking part in conversation.
3. Behaviour and psychological problems. Motor disturbances, night-time restlessness, self-harming behaviour, damaging objects, physical or verbal aggression, resisting care measures.
4. Self-care.
5. Coping with illness- and treatment-related demands.
6. Organising everyday life and social contacts.

Within each module, individual points are awarded per criterion, and the sums are then sorted into point ranges from 0 (no impairment) to 4 (most severe impairment).

The rule that changes the result: modules 2 and 3

This is the heart of § 15(3), and it is persistently misunderstood.

The individual points in each module are added, then converted into weighted points according to their range. And then comes the decisive sentence: “modules 2 and 3 are assigned a common weighted point, consisting of the highest weighted points of either module 2 or module 3.”

So cognitive abilities and behaviour and psychological problems — two entirely separate areas — do not have their points added. The higher is taken and the other is disregarded.

The effect is heavy in practice: a person with dementia who has both severe cognitive impairment and difficult behaviour will not receive the sum of the two, only the higher. That is why the outcome so often falls well below what families expect.

The weighted points from all modules are then added to form the total, and the person is placed in a grade according to the thresholds above.

By way of exception, paragraph 4 provides that people with special need constellations — a specific, exceptionally high need for help with special nursing requirements — may be placed in grade 5 even without reaching 90 points.

Two conditions before the arithmetic: the application and the insurance period

The application comes first. § 33(1) is categorical: long-term care benefits are granted on application. They run from the date of the application, at the earliest from the moment the conditions are met. And here is the clause that costs people money: where the application is made not in the month in which the care need arose but later, benefits run from the beginning of the month of the application — not retrospectively.

A month’s delay therefore means a month lost with no compensation. File as soon as the need appears, even before the paperwork is complete.

And the qualifying period. Paragraph 2 requires the insured to have been insured for at least two years within the ten years before the application. That condition catches recent arrivals in particular.

The decision may be time-limited. The grade and the benefits may be granted for a fixed period where the Medical Service expects the impairments to lessen. The limit may be repeated, but the total of the limited periods may not exceed three years. And before a limit expires, the care fund must review in good time and tell both the person and the caring institution whether benefits continue and at which grade — so that provision is seamless.

The care allowance: the figures in the statute

§ 37 gives people in grades 2 to 5 — not grade 1 — the option of claiming a care allowance in place of in-kind home nursing help. The condition: that the recipient, to an extent matching the allowance, secures the necessary body-related care measures, nursing support measures and help with running the household in a suitable way themselves.

The monthly amounts are written into the statute itself:

Where the entitlement does not exist for a full calendar month, the amount is reduced proportionately — and the month is counted as thirty days.

Note that grade 1 is outside the care allowance entirely; its benefits are of a different kind. That is a point many people get wrong.

Frequently asked questions

How many points does each grade need?

Grade 1 from 12.5 to under 27 · grade 2 to under 47.5 · grade 3 to under 70 · grade 4 to under 90 · grade 5 from 90 to 100.

Why is the grade lower than we expected?

Usually because of the modules 2 and 3 rule: cognitive abilities and behaviour share one weighted point equal to the higher of the two, and are not added together.

Are benefits paid retrospectively?

No. They run from the date of application, and where the application follows the month in which the need arose, from the start of the application month. File immediately.

How long must I have been insured?

At least two years within the ten years preceding the application.

Does grade 1 receive the care allowance?

No. The care allowance under § 37 is limited to grades 2 to 5.