Module 1: Mobility

This covers all aspects of mobility within a person’s living space. This assessment focuses on strength, mobility, and coordination. Examples include climbing stairs or changing position in bed on one’s own. The assessment is based on a four-point scale ranging from “independent,” “mostly independent,” “mostly dependent,” to “dependent.” Mobility accounts for 10% of the overall score.

Module 2: Cognitive and Communicative Skills

This module assesses aspects such as recognition, decision-making, and control. Examples include orienting oneself in space and time, recalling important observations, and recognizing risks in everyday life. The assessment is based on a four-point scale: ranging from “present ability” to “mostly present ability,” “present to a limited extent,” and “absent ability.” Two criteria are also used here to assess the effects of hearing, speech, or language disorders.

Module 3: Pathological Behaviors and Mental Health Issues

This module focuses on behaviors and mental health issues resulting from recurring health problems that require support. Examples include self-harming or aggressive behavior, resistance to care interventions, lack of motivation associated with a depressed mood, or inappropriate social behavior. The assessment focuses on how often a caregiver must intervene or provide support. This section evaluates the frequency of occurrence. For the overall grade, Modules 2 and 3 are weighted together at 15%.

Module 4: Self-Care

In this module, independence is assessed in the following areas: washing, dressing and undressing, eating, and toileting. For example, this assessment also evaluates how a person copes with the consequences of urinary or fecal incontinence. The assessment is based on a four-point scale ranging from “independent,” “mostly independent,” “mostly dependent,” to “dependent.” Due to the particular importance of this module for nursing care, there are a few special considerations regarding assessment. The “eating” criterion is weighted three times, and the “drinking” and “use of the toilet/toilet chair” criteria are each weighted twice. Self-sufficiency accounts for 40% of the overall score.

Module 5: Requirements and Stresses Related to Illness and Treatment

This refers to how independently a person can manage therapies and other requirements related to their illness, and how often these measures are carried out. For example, this section records whether a person can take their medication on their own or whether they can administer insulin to themselves. But also whether one can visit a doctor’s office or a therapy center on one’s own. This accounts for 20% of the overall grade.

Module 6: Organizing Daily Life and Social Interactions

This assessment determines whether the person can organize their daily routine independently and according to their own preferences, keep themselves occupied, and is able to interact with people in their immediate surroundings. The assessment is based on a four-point scale ranging from “independent,” “mostly independent,” “mostly dependent,” to “dependent.” The organization of daily life and social interactions accounts for 15% of the overall score.

Classification of Care Levels

In addition, Module 7 covers activities outside the home, and Module 8 covers household management. However, these two modules are not taken into account in the evaluation.

The so-called care level is determined based on the results of the assessment across all modules. To do this, the individual points are first added together. Everything is then converted into a weighted score according to a predetermined calculation formula. The result is the total score, which can range from 0 to 100 points. A score of 0 indicates that the person being assessed is completely independent, while a score of 100 indicates the greatest possible impairment of independence.

A total score of 12.5 points or more indicates a need for long-term care. The requirements for Care Level 1 are then met. Care Level 2 is assigned for 27 points or more, Care Level 3 for 47.5 points or more, Care Level 4 for 70 points or more, and Care Level 5 for 90 points or more. The requirements for Care Level 5 are also met if a person has completely lost the ability to grasp, stand, and walk, regardless of the number of points scored.

There are a total of five care levels, abbreviated as PG:

• Care Level 1
  Minor impairment of independence or abilities
• Care Level 2
  Significant impairment of independence or abilities
• Care Level 3
  Severe impairment of independence or functional abilities
• Care Level
  : Severe impairment of independence or functional abilities
• Care Level 5
  : Severe impairment of independence or functional abilities, along with special requirements for nursing care

The Federal Medical Service provides good and comprehensive information on the guidelines for long-term care assessments here. In addition, the Federal Ministry of Health provides a free brochure here covering all long-term care insurance benefits.