Nursing Care Fund must pay for replacement care abroad

BSG facilitates foreign leave for people in need of care and relatives
In the future, dependents and caregivers can more easily spend their holidays together abroad. The long-term care funds have to pay for a so-called substitute or preventive care there, too, on Wednesday, 20 April 2016, ruled the Federal Social Court (BSG) in Kassel (ref .: B 3 P 4/14 R). Unequal treatment of holiday at home and abroad was not objectively justified.

The prevention or replacement care should promote the care readiness of relatives and also give them the possibility of a vacation. The right to substitute care also exists if the care of the family member is temporarily impossible due to illness or other personal reasons.

Nursing care must also pay for replacement care abroad. Image: Photographee.eu - fotolia

The Nursing Fund will then pay for the necessary replacement caregiver for up to six weeks per calendar year. The amount of benefits per day depends on the level of care, a maximum of 1,612 euros per year. For a maximum of four weeks, the regular care allowance will be paid in addition to half.

In this specific case, a mother from the Reutlingen area regularly took care of her disabled son at home. The child received care allowance after the care level II. Despite the necessary care should also be a joint holiday in it. Together with other family members, they traveled in January 2009 for five days to Switzerland for a skiing holiday.

While the mother was skiing, however, she was prevented from nursing. Instead, the replacement of the grandfather, who had traveled extra for this.

The care insurance of the Techniker Krankenkasse should be paid for this preventive care. Overall, the family claimed for incurred travel and accommodation costs of the grandfather € 279.

The Nursing Fund refused this. A claim for benefits of preventive care abroad is excluded.

The Landessozialgericht (LSG) Baden-Wuerttemberg was still right in its ruling of 18 July 2014 (Ref .: L 4 P 5119/11, JurAgentur report dated 16 October 2014). The coveted reimbursement for preventive care should be regarded as a "contribution in kind". If these were provided abroad, the nursing care fund would not have to pay for it.

The plaintiff, represented by VdK, considered the rejection to be an unjustified difference in treatment. When spending a holiday in Germany, the expenses for the replacement care would be taken over without any problems, but not during holidays abroad.

The SPA also saw this as a difference in treatment for which there was no objective reason. The long-term care fund had only failed the benefits of preventive care because the holiday took place with the child in need of care abroad. In Germany, on the other hand, there would have been no problems. In principle, although the benefits of the care fund rest during a stay abroad, the care allowance, there is an exception. Of these, "preventive care" is also included as an ancillary benefit.

There is no reason to worry that families could abuse the reimbursement of the replacement care by taking the grandfather at a cash cost, for example, to a luxury hotel in the Maldives on vacation. First, the reimbursement is capped anyway only to a maximum of 1,612 euros. On the other hand, only "necessary expenses in connection with the replacement care" would have to be paid. The Nursing Fund must decide at its discretion, what is needed for the replacement care. (Fle / mwo)