In home care, an outpatient care service is often a great relief for family carers. However, there is often a great deal of uncertainty about the costs and services of a nursing service. First however times the question is clarified, what a mobile care service is and what it does:
What is an outpatient nursing service?
An outpatient care service is a service company that supports those in need of care and their relatives in home care. For a nursing service to be used, it must be commissioned. On the basis of a care contract, the nursing service now comes to the person in need of care at the agreed times in order to carry out the specified activities.
The frequency of the assignments is also regulated in the care contract. This can range from once or twice a week to several times a day. This is also strongly dependent on the need for care of the person in need.
What services do the nursing services provide?
Not every nursing service offers the same range of services. Some nursing services, for example, have additionally specialised in extra-clinical intensive care, while other nursing services have specialised in palliative care/heir-health care.
Therefore, before you commission an outpatient nursing service, it must be ensured that it can also provide the services that you or your relative require. The best thing to do is to have the catalogue of services provided by the mobile nursing service handed over to you.
If your nursing service cannot provide certain services and then assigns them to a cooperation partner, it must inform you of this. The services provided by nursing services are also stored in the remuneration agreements. Ask your nursing insurance fund about the agreements.
How high are the benefits in kind?
Anyone in need of care who has a degree of care of 2-5 can claim the following maximum benefits in kind from a nursing service without having to pay for them themselves. Alternatively, I have also listed the care allowance for you.
How does the nursing service bill the costs?
The nursing service settles the costs that have to be covered by the nursing insurance directly with the nursing insurance fund. You do not have to pay in advance.
If you receive combination benefits, the nursing allowance is not settled until the nursing service has settled the benefits with the nursing insurance fund. This can therefore take some time. For combination care, the nursing allowance is paid retroactively. If you were to claim ONLY care allowance, you would receive the care allowance at the beginning of the month. All other costs that exceed the benefits in kind will be charged directly to you.
Who pays the costs for the nursing service?
Who has to pay the nursing service costs depends on who the service provider is. These can be:
The health insurance
The health insurance fund pays for the nursing service when it comes to home nursing services. Domestic nursing care is prescribed by the doctor. People without a nursing degree also receive home nursing care, for example for aftercare after an operation or hospital stay or simply for putting on and taking off compression stockings.
Nursing care insurance
The nursing care insurance is responsible for people with a nursing care level of 2-5. It then assumes the costs for the nursing care service in the amount of the maximum benefit per nursing care level.
The social welfare office
The social welfare office is responsible for people who receive “help with care”.
Self-payers
A further possibility is that the costs for the nursing service are paid by the patient. This can happen if more benefits are claimed than are covered by the benefits in kind. Then the rest has to be paid by yourself. Or there are services of the nursing service used, for which there is no reason that the three above-mentioned service providers pay for it. So if you order a nursing service to be washed in the morning and evening, for example, without a nursing degree of 2-5 or a corresponding medical prescription, you will have to pay for the costs yourself.
Who has to pay the investment costs?
In some federal states, the nursing services can also calculate investment costs. Investment costs are costs for e.g. rent, lease, ground rent, use or shared use of buildings, etc., which the nursing service may partially include in your calculation. You can find more on this in § 82 paragraph 3 SGB XI.
Care benefits in kind and pension contribution payments
Those who care for their relatives will continue to receive pension contributions under certain conditions. Unfortunately, however, this payment of pension insurance contributions is linked to the extent to which a nursing service is used. In plain language, this means that the more care benefits in kind are claimed, the lower the pension contribution payments. You can read more about this in my article Pension for the care of relatives.
What is the difference between outpatient care and domestic nursing care?
Home nursing care is also provided by the nursing service. However, these services are not billed via the nursing care insurance but via the health insurance. Home nursing care is provided on prescription. This includes, for example, putting on and taking off compression stockings, adjusting medication and much more. Outpatient nursing care is paid for by the nursing care insurance fund up to the maximum limit of benefits in kind.
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