Arranging care for elderly grandparents - Germany

Hi everyone,
No idea if this is the right place to ask these questions, but I'm having trouble getting google to tell me the answers, so here goes! Hope someone can help.

Background next, then questions...

I have very old grandparents in Bavaria, who have no other family in the country (I live in NZ so am ages away).

They live in their own house. A recent visit showed that they are in desparate need of care, as they are obviously unable to look after themselves. My Opa, however, does not see this (he is quite a stubborn man).

We have been told that if things doing improve, the authorities will move in and force them into a home, god knows where and they would also take over their assets. I can NOT imagine my Opa letting anyone take him away.

We really need to sort things out before it gets to that stage, but I have grown up in NZ and never lived in Germany, and have NO idea how things work there.

Questions....

• How easy is it to get places in nursing homes? Is there normally a waiting list etc.
  
• How easy is it to get a couple into the same place? They would have to stay together of course.
  
• Who pays? Do Germans have to have insurance for this sort of thing, or do we pay? Or, would they be expected to sell their house etc and pay from that?
  
• How much does that sort of thing cost?
  
• Can the elderly be forced out of their homes against their will?
  

Any help / answers greatly appreciated - I really have no idea and am in a tight spot - as I'm on the other side of the world and there is no-one over there that can help.

Okay, so I am no expert, and I know relatively little about such things, but here´s my tuppence worth:

I´ve heard that the Hausarzt can arrange for daily care to come in and help with things such as getting washed and dressed, etc - depending upon which level of care the Doc thinks is appropriate.
There is also a similar system to the British "Meals-on-wheels", whereby pensioners can have a hot meal delivered to them at home on a daily basis.
As far as I know (and please see above here!), the care is covered by a mixture of healthcare insurance, and private input - the meals too have to be paid for by the recipient as far as I know.
Anyway, not really knowing how bad the situation at home is, maybe these options aren´t even appropriate in this case, but it´s the best I can do to help right now, and it bumps the post up so that somebody else who might have more knowledge in this direction might see it too :-)

Do your grandparents have medical conditions which require daily professional support or special equipment? Or are they fairly healthy and just not strong enough to keep up with all the various chores around the house and also need a bit of help with basic tasks like getting dressed or cooking and shopping? Are they still able to walk and get around on their own? Are they mentally still alert or is dementia part of the problem?

Is moving them to an institution necessary? Are there any financial assets which could be used to bring in a live-in housekeeper from Romania or other Eastern European countries? There are organizations which provide such housekeepers legally in Germany which is a particularly good option for older couples who just need a bit of extra general help. Less severe medical conditions can be taken care of by visiting nurses once or twice a week But in-home care won't work if there are any more advanced medical conditions present which require daily (all day or 24/7) professional nursing.

My old landlord had a lovely older woman from Romania taking care of his old father for two years after the man suffered a series of heart attacks and couldn't walk any more. My in-law's neighbour had a rotating series of young student nurses from Eastern Europe come to help with her advanced diabetes. I can ask about what organizations they used, and get more specific details for you if that might be a possible option.

Also German organizations like Caritas (English site) can help. (web site in German, basic explanation of what is Caritas in English).

Funny that you should choose the words 'against their will'. Now consider the potential consequences of such an action...

Did they explicitly mention the possibility of an Entmündigung or amtliche Betreuung? Relevant illnesses present - e.g. dementia, alzheimers?

Because in that case Can the elderly be forced out of their homes against their will? definitely applies. As well as taking over all their assets in order to organize care for them.

Information I found on the Internet:
In germany most people have to pay into a "Pflegeversicherung". This insurance takes care of a part of the costs of nurturing the elderly. The amount of money you get depends on your needs (defined by so called "Pflegestufen" by certain doctors of their health insurance), but it´s almost never enough to pay for everything. Being old and frail is unbelievably expensiv. I read about costs of up to 5000 € per month. The insurance pays at the moment for certain services for a month:

Pflegestufe 1 (needs help at least once a day for things like personal hygiene, eating or mobility) 420€
Pflegestufe 2 (needs help at least three times a day)) 980€
Pflegestufe 3 (needs help all the time) 1470€ in special cases up to 1918€

Your grandparents will have to pay the rest and when all their money (and everything they owned) is gone, their kids will have to pay. If there is nothing to get from them, then the next generation (that would be you) is responsible. Im not 100% sure about this last part, but it seems to me that §1601 BGB says exactly that. If no relative can afford to help, welfare will step into the breach.

From my limited personal experience:
If no other option is applicable and your grandparents have to go into a nursing home, you should spend some time to find the right one. It is a big bonus, if the nursing home is close to someone trustworthy and trusted by your grandparents. Sooner or later there will be the need for someone from the outside to interfere and threaten with legal consequences to keep the nursing home management or other vultures from fleecing them.

It really depends on the region, and how much they are able to pay. Where exactly do they live?

How easy is it to get a couple into the same place? They would have to stay together of course.

See above. Normally, a nursing home will try to accommodate them together, maybe by rearranging other patients (standard rooms have 2 beds).

Who pays? Do Germans have to have insurance for this sort of thing, or do we pay? Or, would they be expected to sell their house etc and pay from that?

The health insurance of your parents should be able to tell you whether they qualify for "Pflegegeld" out of the Pflegeversicherung, and how much they can get.

How much does that sort of thing cost?

Depends on the location (more expensive in the city), the amount of care necessary, and of course what kind of comfort / service the house provides, whether it's private or subsidized by the city.
Where I live (near Munich), you can roughly count 2500-3000 a month. With some extras to be added, probably.

has been answered above.

There are many companies who organize live-in nurses from Poland or other Eastern European countries. They take care of the whole paperwork, visa etc. I can ask a friend if you want, how much this costs, and what organization he can recommend (his mother has Polish live-in nurses). But those are not qualified medical nurses, they are responsible for housework, and simple care. - for real medical purposes, you need additional nurses from a local service.

Yes, this is correct. We're dealing with this right now with my father-in-law and after January of next year we'll be paying part of his care in a senior's facility because my mother in law (still in her apartment) no longer has the funds to do so.

Thanks so much everyone for your help! Much better than google.

Will look into meals on wheels and try and convince Opa it's a good idea.

To answer the other questions...

Medical conditions - Oma has a carer come and shower her twice a week, as she has advanced osteoporosis and rheumatism, and can't do it for herself. Opa gets the results back from his dementia test this week. I don't expect good news - he can't remember who is wife is sometimes.

Entmündigung or amtliche Betreuung - definitely mentioned with the threat of forcing them out. Which is a worry, really.

The only really financial asset they have is the house they live in, so I assume if that was needed to pay for care then they would have to move out (into a home) and sell the house.

Finding a nursing home - we will definitely spent lots of time choosing the right one. There are two in the village they live in (Bruckmuehl) and one has a not-so-good reputation, so it won't be that one!

Who pays - I know they get some pflege-geld but I understand it's nowhere near enough to pay for a nursing home or live-in carer. It'd be a huge problem is we had to contribute, as here in NZ we don't earn as much and would be struggling with the exchange rate.

I will look at getting an in-home carer. They have a flat upstairs that is basically a spare apartment, so that is an option I suppose.

The biggest problem is my Opa's complete denial that there is a problem. He is very funny about people entering the house and it was a big step even letting nurses in to take care of Oma.

Thank you all sooo much for your help - this information has been invaluable and I can't thank you enough. I'm really grateful.

For the time being an in-home carer sounds like the best option since there is a flat available.
It will also give you the opportunity to check out the care homes in the area and see about financing them - you might also find that there is a waiting list for the better homes, so once again, an in-home carer seems a good idea.
Now you just have to find one and persuade the seniors that it´s a good idea!
Good luck!

Yep - and that will be a HUGE challenge! Especially from NZ, and I can't just pop over to Germany and sort it at short notice, as it's expensive to get there and I have a little baby to look after.

Yes, this is one of the scary parts. My in-laws, despite Pflegegeld (f-in-law is Pflegestufe 2 now) and two pensions are now having to use their savings to pay for Opa's home. And it's not a fancy one, just adequate. Once the savings are used up, they're bascially candidates for Harz IV. I have no idea how it would be if mother-in-law was also in care. We don't yet know how much we'll have to contribute, but we understand that after assessing your income and assets they take a percentage BUT they MUST leave enough for you and your family to maintain your standard of living. That means that spouse and children are first on the list as to who profits from income and they cannot touch assets like a house or other property.

Sound like it would be a great idea to start with live-in care and see how they get on. Good luck to you! I know how difficult it has been for us to make all these decisions and we only live a 20 min drive away from my husband's parents.

Hmmmm... wonder if they could force us to pay from the other side of the world? Hope not. Horrible situation, really. When we have it all sorted I will post our 'answer' on here.

I don't know for sure, but I assume they would contact the remaining next of kin no matter where they were. Yeah, keep us informed - whatever happens I hope it works out in everyone's best interests!

EDIT: Just found this link that claims that, yes, it doesn't matter where you live, you'll still be contacted. The link deals with Elternunterhalt, though, and what you would be doing would be Großelternunterhalt - don't know if there's a difference there. They do stress that not everyone has to pay up - it really depends on how much disposable income you have for yourself and your family. If you're under a certain level, the Sozialamt would have to pick up the tab for your grandparents.

Elternunterhalt auch aus dem Ausland?

My MIL in now resident in a Seniorenheim run by the Bayrisches Rotes Kreuz (Red Cross). It is subsidised by the Bavarian Govt. and prices are very reasonable, much lower than elsewhere. As I understand it, the Red Cross are not running it as a profit making business, but as a service. There are rooms/apartments according to ability to pay, and then when and if the resident needs it, there is a care section where they can go to where they can have more care.

It is attractive, basically a retirement apartment complex with the added care section, plus meals provided (if wanted), a library, laundry, activities. My MIL has one of the most basic apartments - there is a small kitchenette as you come in with two ring cooker, sink, fridge and cupboards, then a largish bathroom with wet room style shower etc, you go through a door to her room which has a bed niche, fairly large living area and also a balcony. Included in her rent is her phone rental, home insurances, electricity, water, breakfast, lunch, rooms are cleaned once a week. The laundry is coin operated but there are ironing boards and irons without charge. Plenty of space to hang stuff up. There is also a lock up area in the cellar where she can store extra things. There are two and (I think) three rooms apartments too. There is a small pool, cafe, hairdresser and beauty salon, and the reception is manned til 5.30pm. Automatic doors, everything is planned for people with possibly restricted movement, though I have seen much "younger" people living there. It is a three storey complex built in a sort of horse-shoe shape with lots of balconies and attractive gardens.

I think there are various seniorenheims throughout Bavaria run by the Red Cross. Worth looking into. There's a waiting list, dependant on what sort of accommodation you want. I do know that people have come to this one from as far away as Hamburg and Berlin.

I'm not sure exactly how it works, but MIL has "Pflege Stufe 1", that's Care level 1. There's a whole packet of care that she can take advantage of paid (I think) by her insurance (not private) in her apartment. I know that she is brought her medications (she forgets them), and has some other things done for her. Once the resident reaches Plege Stufe 3, then they usually live in the care section, which is run a bit more hospital style.