Guide · Dementia
Care level with dementia: assessment, the 2027 reform and help
This guide is about the German statutory long-term care insurance (Pflegeversicherung). German terms are given in brackets so you can recognise them in letters from your care insurance fund (Pflegekasse).
- With dementia, the assessment looks mainly at how much prompting, supervision and help is needed in everyday life, not at the diagnosis.
- Memory, orientation and behaviour are assessed in two areas; the higher of the two counts for 15%.
- From 2027, more points are to be needed for care levels 1 to 3. Cognition and behaviour are not named among the announced changes to the scoring.
- Anyone who already has a care level keeps it, according to the draft. For new applications, the day the application reaches the care fund counts.
- From 2027, care groups are to be paid from the local support budget and crises from the bridging budget.
How dementia is assessed
The Medical Service (Medizinischer Dienst) assesses six areas of life. For people with dementia, these are especially important:
| Area | What counts | Weight |
|---|---|---|
| Cognitive and communication skills | recognising people, orientation, making decisions, following a conversation | 15%* |
| Behaviour and psychological problems | restlessness at night, anxiety, wandering, resisting help | 15%* |
| Self-care | washing, dressing, eating, drinking, using the toilet | 40% |
| Daily life and social contacts | daily routine, activities, contacts | 15% |
* Of the first two areas, only the higher score counts. The other areas are mobility (10%) and coping with illness and treatment (20%).
Important for families: someone who can still wash on their own but has to be reminded, guided or supervised is not considered fully independent. This kind of help is often overlooked in the assessment.
What the 2027 reform changes
- Higher thresholds: care level 1 from 15 instead of 12.5 points, care level 2 from 30 instead of 27, care level 3 from 50 instead of 47.5. Care levels 4 and 5 stay unchanged.
- Scoring in individual areas: changes have been announced for mobility, self-care, and daily life and social contacts. Cognition and behaviour are not named. The details will only be known once the law is passed.
- Duration of the need for help: in future it is to last at least six months “with high probability”. With dementia, this is usually the case.
- Protected status and key date: an existing care level is not to be lost solely because of the new thresholds. For new applications, the date the application reaches the care fund counts. More on protected status
Dementia changes over time. You can apply for a higher care level at any time if the need for help grows. How to apply for a higher care level
Preparing well for the assessment
- Keep a care diary: note for two weeks where help, reminders or supervision are needed, including at night. Download the care diary
- Be there: people with dementia often present their best side to strangers. Describe the difficult days, ideally in writing beforehand.
- Have medical reports ready: diagnosis, medication and reports on falls or hospital stays. Assessment checklist
Help for families
- Care groups and everyday companions: paid from the relief amount today, from 2027 from the local support budget according to the draft. About the local support budget
- Day care: remains a separate entitlement in addition to the care allowance or a home care service.
- Crises and the carer's holiday: short-term care and acute help from 2027 through the bridging budget. About the bridging budget
- Care courses: care funds offer free courses for family carers, often specifically on dementia.
Sources
- German Federal Ministry of Health: cabinet adopts the care reform act (Pflegeneuordnungsgesetz), press release of 30 Sept 2026; Bundesrat document 587/26
- pflege-dschungel.de: what the cabinet draft means for care at home (30 Sept 2026)
- Deutscher Pflegebeistand: care reform 2027 (as of 9 Oct 2026)
- German Social Code Book XI (SGB XI), 2026 version: Sections 14 and 15 (assessment), 39 and 42 (respite and short-term care), 41 (day and night care), 45 (care courses), 45a and 45b (everyday support services, relief amount)
Frequently asked questions
Does dementia automatically lead to a care level?
No. What matters is how independent the person still is in everyday life. Many people with dementia do reach a care level, though, because prompting and supervision count.
Does the 2027 reform change how dementia is scored?
The thresholds for care levels 1 to 3 are to rise. Cognition and behaviour are not named among the announced changes to the scoring. The details will only be known once the law is passed.
Which rules apply to our application?
According to the draft, the day the application reaches the care fund counts. For applications from 1 January 2027, the new thresholds apply.
Who pays for the care group?
Today the relief amount, from 2027 the local support budget from care level 2 according to the draft, provided the service is approved.