Germany does not decide how much care someone receives by diagnosis. It measures how much independence they have lost, converts that into a score, and assigns one of five Pflegegrade. The system has been in its present form since 1 January 2017, when the second Pflegestärkungsgesetz replaced the three old Pflegestufen with five levels and, crucially, widened the definition of care to include people with dementia.
For anyone working in German care, the Pflegegrad is the most quoted number in the building. It determines the budget, the visit frequency and the paperwork, so the vocabulary around it is worth learning properly rather than absorbing by accident.
What Replaced What
The change is worth understanding because older colleagues still use the old words.
| Older term, until 2016 | Current term |
|---|---|
| Pflegestufe I | Pflegegrad 2 |
| Pflegestufe II | Pflegegrad 3 |
| Pflegestufe III | Pflegegrad 4 or 5 |
| Pflegestufe 0 | Pflegegrad 1 |
| eingeschränkte Alltagskompetenz | kognitive Einschränkung |
| Pflegebedürftigkeit | same word, wider definition |
Under the old system a person with dementia and no physical limitation scored almost nothing. The reform fixed that by making everyday competence the basis of the assessment instead of minutes of physical help.
The Six Modules and the Score
The assessment instrument is the Neues Begutachtungsassessment, usually shortened to NBA. It measures six modules and weights them, producing a total between nought and one hundred.
| Module | What it measures |
|---|---|
| Mobilität | moving about, indoors and outdoors |
| Kognitive und kommunikative Fähigkeiten | memory, orientation, understanding |
| Verhaltensweisen und psychische Problemlagen | behaviour and psychological needs |
| Selbstversorgung | washing, dressing, eating, continence |
| Bewältigung krankheitsbezogener Anforderungen | managing illness, medication, appointments |
| Gestaltung des Alltagslebens und sozialer Kontakte | structuring the day, social contact |
Modules two and three are weighted more heavily than their raw scores suggest, and that is the technical reason dementia now produces a Pflegegrad. Selbstversorgung, by contrast, is the module most people assume dominates and it does not.
The Points That Map to Each Level
The thresholds are published and stable, and they are quoted in every disputed case.
| Total points | Pflegegrad |
|---|---|
| 12.5 to under 27 | Pflegegrad 1 |
| 27 to under 47.5 | Pflegegrad 2 |
| 47.5 to under 70 | Pflegegrad 3 |
| 70 to under 90 | Pflegegrad 4 |
| 90 to 100 | Pflegegrad 5 |
Pflegegrad 1 carries only advisory benefits and a small relief amount. From Pflegegrad 2 the person qualifies for Pflegegeld, the cash payment made to a family carer, or for Pflegesachleistungen, professional services provided in kind, and may combine the two.
What Each Level Unlocks
| Pflegegrad | Main entitlement |
|---|---|
| 1 | advice and the monthly Entlastungsbetrag |
| 2 | Pflegegeld or Pflegesachleistungen |
| 3 | higher amounts, plus care aids |
| 4 | higher amounts again, plus more respite |
| 5 | the highest amounts, with intensive support |
The amounts are indexed, so the figures you learn this year will change, but the structure does not. Pflegegeld rises with each level and Pflegesachleistungen rise faster, which is why a family weighing cash against professional help is really weighing a few hundred euros against a few thousand.
The Entlastungsbetrag is the exception in the table, because it is available from Pflegegrad 1. It stands at 131 euros a month and may be spent on day care, household help or a relief service, provided the provider is recognised by the fund.
Two Words That Decide the Money
| German term | English meaning |
|---|---|
| das Pflegegeld | the cash payment to the carer |
| die Pflegesachleistungen | professional services in kind |
| die Kombinationsleistung | mixing cash and services |
| der Entlastungsbetrag | the monthly relief amount |
| die Verhinderungspflege | substitute care when the carer is away |
| die Kurzzeitpflege | short-term residential care |
| die Pflegehilfsmittel | care aids such as pads and gloves |
| die Höherstufung | upgrading to a higher level |
The choice between cash and services is the one families discuss most, and German calls the mixture a Kombinationsleistung. The decision is revisited about twice a year in most households, because health rarely stands still.
Verhinderungspflege and Kurzzeitpflege are the two safety valves that keep family care sustainable. Both are named in the first conversation with a Pflegeberater, and a candidate who can explain them at an interview sounds like somebody who has met the system rather than somebody who has learned a word list.
The practical point is that a Pflegegrad is a budget as well as a clinical judgement. Being able to say which level a person holds, what it pays for and when the next review falls due is basic literacy in German care work.
Who Assesses, and the Words You Hear
The assessment is carried out in the person's home by the Medizinischer Dienst, the MD, which acts for the care insurance fund. The visit is a Begutachtung and the written result is a Gutachten.
| German term | English meaning |
|---|---|
| die Begutachtung | the assessment visit |
| das Gutachten | the written assessment report |
| der Medizinische Dienst | the medical service of the funds |
| die Pflegekasse | the care insurance fund |
| der Pflegebedürftige | the person in need of care |
| die Pflegeperson | the family carer |
| die Angehörigen | the relatives |
| der Widerspruch | the objection to a decision |
A rejected application or a lower grade than expected can be challenged by Widerspruch, normally within one month of the decision letter, and a substantial share of objections succeed. Understanding that process is part of the job, and it is a good reason to learn German with the care system rather than around it.
Why This Vocabulary Is Employable
Providers abroad routinely ask at interview what a Pflegegrad means, and a candidate who can explain Selbstversorgung, the Gutachten and the Widerspruch in German is immediately more useful than one who cannot.
Knowledge of the assessment also changes how you write. A good entry records lost independence in the terms the MD will look for, which is why experienced staff describe mobility and orientation in plain, specific language. If you want to learn German for a care career, the legal framework is the part that separates a worker from a colleague.
The bars show the minimum total on the 100-point NBA scale for each level, rounded to whole points.
The Pflegegrad is the number everyone in German care quotes. Learn German with the assessment, the Gutachten and the care plan built into the course.
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