INKOVEMA Podcast „Well through time“

#64 – Mediation as a relief offer in the care sector according to § 45 a, b SGB XI.

New fields of mediation in the health and care sector.

In conversation with Marja Költzsch

Well through time. The podcast about mediation, conflict coaching and organisational consulting.

Contents:

Caring for family members in need of care at home requires family carers to adapt a considerable part of their own lives to the needs of the sick person (including the illness). They put their own needs in the background, are always on stand-by and may even exceed their own resources to the point of falling ill and being unable to work.

Mediator Marja Költzsch would therefore like to empower family carers to integrate their own needs and wishes into their everyday care routine as well as possible and to create a health-promoting support system for themselves.

Health and quality of life should be protected and promoted by eliminating and avoiding stressful stumbling blocks in day-to-day care and conflicts between people as far as possible.

To this end, she successfully submitted an official application for the state of North Rhine-Westphalia to recognise mediation and mediation skills in accordance with § 45 a, b SGB XI. In the podcast, she talks about the circumstances, background and motivations behind this endeavour.

Social Security Code XI – Social long-term care insurance

§ Section 45a SGB XI Offers for support in everyday life, conversion of outpatient benefits in kind (conversion entitlement), authorisation to issue regulations

(1) Everyday support services help to relieve the burden on carers and help those in need of care to remain in their home environment for as long as possible, maintain social contacts and continue to manage their everyday lives as independently as possible. Offers for support in everyday life are

1.

Offers in which volunteers in particular provide care for people in need of care with general or special care needs in groups or in the home (care offers),

2.

Offers that provide targeted relief and counselling support for family carers and similarly close carers in their capacity as carers (offers to relieve carers),

3.

Services designed to support those in need of care in coping with the general or care-related demands of everyday life or in the household, in particular with household management, or with the independent organisation of individually required assistance (services to relieve the burden of everyday life).

The services require recognition by the competent authority in accordance with the state law issued pursuant to paragraph 3. Several of the areas mentioned in sentence 2 numbers 1 to 3 can also be covered by an offer of support in everyday life. In particular, care groups for people suffering from dementia, groups of helpers to relieve the burden on family carers or similarly close carers in the home on an hourly basis, day care in small groups or individual care by recognised helpers may be considered as offers of support in everyday life, Agencies for arranging care and respite services for people in need of care and family carers as well as carers with similar needs, family support services, everyday companions, care companions and services for household-related services.

(2) Offers for support in everyday life include the provision of care and general supervision, everyday support that strengthens or stabilises existing resources and abilities, support services for relatives and comparable relatives in their capacity as carers to help them cope better with everyday care, the provision of services, organisational assistance or other suitable measures. The services have a concept that contains information on the quality assurance of the service as well as an overview of the services that are to be offered and the amount of the costs charged to those in need of care. The concept also includes information on the target group and activity-appropriate qualifications of the helpers and on the availability of basic and emergency knowledge in dealing with people in need of care as well as on how appropriate training and further training of the helpers and continuous professional supervision and support, especially of volunteers, are ensured in their work. In the event of significant changes to the services offered, the concept must be updated accordingly; if the costs charged for these services change, the corresponding information must be updated.

(3) The state governments shall be authorised to determine by statutory order the details of the recognition of the services for support in everyday life within the meaning of subsections 1 and 2, including the requirements for regular quality assurance of the services and for the regular transmission of an overview of the services currently offered and the amount of the costs charged for them. When issuing the ordinance, they should take into account the recommendations adopted in accordance with Section 45c (7).

(4) Persons in need of care at home with at least care level 2 can receive a reimbursement of costs for the reimbursement of expenses for services for support in everyday life recognised under state law, taking into account their entitlement to outpatient care benefits in kind in accordance with § 36, insofar as no outpatient care benefits in kind were received for the corresponding benefit amount in accordance with § 36 in the respective calendar month. The amount used for this purpose may not exceed 40 per cent of the maximum benefit amount provided for the respective care degree in accordance with § 36 per calendar month. No prior application is required to utilise the conversion of the outpatient benefits in kind in accordance with sentence 1. Entitled persons shall receive the reimbursement of costs in accordance with sentence 1 upon application for the necessary financial resources from the responsible care insurance fund or the responsible private insurance company and, in the case of entitlement to benefits, on a pro rata basis from the benefit assessment office upon presentation of corresponding receipts for personal expenses incurred in connection with the use of the services of the offers for support in everyday life. The remuneration for outpatient care services in kind in accordance with § 36 must be settled as a priority. Within the scope of the combined benefit in accordance with § 38, the reimbursement of expenses in accordance with sentence 1 is deemed to be utilisation of the benefit in kind to which the beneficiary is entitled in accordance with § 36 paragraph 3. If more care allowance or pro rata care allowance has already been paid to the person in need of care for the respective calendar month before the reimbursement of costs pursuant to sentence 1 is paid out than he/she is entitled to after taking into account the amount of the expenses to be reimbursed, the reimbursement amount shall be offset against the amount of care allowance already paid out. If entitled persons receive the benefit in accordance with sentence 1, Section 37 (3) to (5) and (7) to (9) shall apply; Section 37 (6) shall apply accordingly with the proviso that a reduction or withdrawal is made with regard to the reimbursement of costs in accordance with sentence 1. The utilisation of the conversion of the outpatient benefit in kind pursuant to sentence 1 and the utilisation of the relief amount pursuant to Section 45b are independent of each other.

§ Section 45b SGB XI Respite allowance

(1) People in need of care at home are entitled to a relief amount of up to 125 euros per month. The amount is earmarked for quality-assured services to relieve the burden on family carers and other similarly close relatives in their capacity as carers and to promote the independence and self-determination of those in need of care in organising their everyday lives. It serves to reimburse expenses incurred by insured persons in connection with the utilisation of

1.

Day or night care services,

2.

Short-term care services,

3.

Services provided by outpatient care services within the meaning of § 36, but not services in the area of self-care in care grades 2 to 5,

4.

Services provided by offers recognised under state law for support in everyday life within the meaning of § 45a.

Reimbursement of expenses shall also be made if funds for respite care pursuant to § 39 are used to finance the benefits specified in sentence 3. The benefit in accordance with sentence 1 can be utilised within the respective calendar year; if the benefit is not utilised in a calendar year, the unused amount can be carried forward to the following calendar half-year.

(2) The entitlement to the relief amount arises as soon as the eligibility requirements specified in paragraph 1 sentence 1 are met, without the need for a prior application. The person in need of care shall receive the reimbursement of costs in the amount of the relief amount in accordance with paragraph 1 from the competent long-term care insurance fund or the competent private insurance company and, in the case of entitlement to benefits, on a pro rata basis from the benefit assessment office when applying for the necessary financial resources on presentation of corresponding receipts for personal expenses incurred in connection with the use of the benefits referred to in paragraph 1 sentence 3. For the purposes of statistical recording by the long-term care insurance funds and private insurance companies, the receipts must clearly and recognisably indicate in connection with which of the benefits referred to in paragraph 1 sentence 3 numbers 1 to 4 the expenses were incurred in each case.

(3) The relief amount in accordance with paragraph 1 sentence 1 is not taken into account in the care benefits in accordance with § 13 paragraph 3 sentence 1. § Section 63b (1) of the Twelfth Book does not apply to the relief amount. By way of derogation from sentences 1 and 2, the relief amount may be taken into account with regard to the benefits under Section 64i or Section 66 of the Twelfth Book in the case of assistance with care, insofar as benefits are to be granted under these provisions, the content of which corresponds to the benefits under paragraph 1 sentence 3.

(4) The remuneration demanded for the provision of services in accordance with paragraph 1 sentence 3 numbers 1 to 4 may not exceed the prices for comparable benefits in kind from authorised care facilities. The state governments may determine further details on the structure of a corresponding limitation of the remuneration that may be demanded for the provision of services in accordance with subsection (1) sentence 3 number 4 by services for support in everyday life recognised under state law in the statutory order in accordance with Section 45a (3).

Left:

• Website Marja Költzsch