Germany - Anyone know the system?

[Newsjunkie]

My brother-in-law has a c4-c5 injury since January 2008. He lives in Stuttgart in Germany and is in a nursing home since October. He was in a spinal injuries unit in Tubingen until August and regained some movement in his left arm. He then spent two months in a general hospital while waiting for the nursing home place (no hoists available, a series of UTIs while he was there). Since leaving Tubingen, he has actually lost some function in his arm. He is only able to move to his wheelchair when the physiotherapist is there. He spends most of his days lying down in his room and has only two physio sessions per week. As you can imagine, my sister is very concerned and would like to know what kind of therapies and care others have been able to access in Germany. Might it be possible for him to live at home? Is there public funding for caregivers? We feel that there must be more that can be done but are finding it hard to work through the system. My sister is from Ireland originally.
Thank you so much for any help you can give us.

[carbar]

I'm very sorry to hear about your brother in law and I can't offer any advice about the system in Germany I'm afraid. It does seem that he is not getting the best option for him - why they put him a hospital and then a nursing home instead of rehab so that he could go home is a mystery. The only thing I can suggest is to submit a similar post on a German forum called Startrampe - but you'd need it to be in german (does your sister or brother in law speak the language?). Here is the link for the forum pages:

http://www.startrampe.net/arge/community/


But there are german members here at CC and hopefully they will see this thread and give you the information you need.
Good luck.

[SCI-Nurse]

Do you want to leave this post here or move it to the New SCI forum?

I have asked Mike C to respond to this post since he is one of our moderators and lives in Germany.

(KLD)

[Newsjunkie]

Thanks so much fr your responses. We've looked up Startrampe and that looks very useful. I would love to hear from Mike C - we really would love to find out more about supports for people with SCI in Germany.
Yes, it would be great if you could move to New SCI.

[Chester80]

Hello,

in Germany it is important to differentiate between an accident which happend on work or in leisure time.
Industrial accidents are covered by the "Berufsgenossenschaft", (pays better)
Accidents in leisure time are covered completely by the "Krankenkasse " (health insurance)

After rehab the patients were divided in 3 different categories dependend on the extent of the disability and the dependency on caregiving.

The worth it is you ( or the nursing service) were given more money.

[Newsjunkie]

Thanks Chester80. My brother-in-law and sister also live in Stuttgart and he is currently in a Pflegeheim. His accident happened during his leisure time, unfortunately. He is categorised as C4 now and has no use of his arms, although he was able to life his left hand to his face following intensive physiotherapy last summer.
Thanks again for any guidance you can give us.

[Mike C]

News, I just got my internet service back today after two weeks being down. I´ll get back to you ASAP...I gotta go to a meeting tonight.

[Mike C]

My brother-in-law has a c4-c5 injury since January 2008. He lives in Stuttgart in Germany and is in a nursing home since October. He was in a spinal injuries unit in Tubingen until August and regained some movement in his left arm. He then spent two months in a general hospital while waiting for the nursing home place (no hoists available, a series of UTIs while he was there). Since leaving Tubingen, he has actually lost some function in his arm. He is only able to move to his wheelchair when the physiotherapist is there. He spends most of his days lying down in his room and has only two physio sessions per week. As you can imagine, my sister is very concerned and would like to know what kind of therapies and care others have been able to access in Germany. Might it be possible for him to live at home? Is there public funding for caregivers? We feel that there must be more that can be done but are finding it hard to work through the system. My sister is from Ireland originally.
Thank you so much for any help you can give us.

Hi Newsjunkie,

It is important to know your brother in law´s exact legal status and work history so I can give you a better explanation about what is currently, as well as what can be made available to him and his family here in Germany. By this I mean, what is his nationality, current relationship status, was he employed before his accident in Germany (including in other EU countries), how long did he work. What healthcare insurance company is he currently a member of (AOK, BKK or another company), and is his accident going to be perhaps legally challenged in court? The latter is important to know because the German legal system judges civil cases by fault percentages and bases compensation awards on the judged amount. Statue of Limitations is generally three years. What is his current financial status? Is his former flat or place of residence partially or totally inaccessable? Can it be converted? There are lots of questions, but we will start with these for now.

Some backround info about me: I am an American with permanent residency status who had an accident here in Germany at the end of 1996 and have a SCI at the C6/7 level. My wife, who is a German national, and I, previously moved back to Bavaria at the beginning of 1994 and we both were working for German companies up until the time of my accident. We were thrown into the world of SCI just like most of us here, out of the blue, with almost no information and no real battle plan as to what, when, who, how and why. We hacked our way through the system and got what we needed, but it took time and a lot of energy.

Some backround information about the German healthcare system:
Unless your making a substantial monthly salary of €4050 or more per month or are self employed, you are required by law to register with a public health insurance company. Once you have done that, you foward that information to your employer and he or she deducts the premiums from your pay. Once you start working, you are protected by three different insurance plans. The main program is, of course, your primary health and medical insurance plan. This plan pays for the drugs, the docs, the hospital bills and, most importantly, most of the equipment needed to aid your brother in law...things like wheelchairs and lifts, transfer boards, pressure sore resistant seat cushions and matresses, ect.

The next mandatory insurance plan is called the Pflegeversicherung (flee-gee-ver-sic-er-ung). This can best be translated into english by calling it a long term care/nursing care insurance program. It provides primarily financial funding and educational services for those insured who, because of injury or illness, are incapacitated and in need of dependent care. The levels of funding (called a "pflegestufe"...literally care-level, which goes from zero to three) provided by the program is based on the severity of the injury or condition, and the patient is awarded a specific level based upon a complicated and beurocratic decision making process made by a designated medical examiner. This insurance program is very important, and I´ll talk more about this later after I get some more information from you.

The third insurance program covers work related accidents and/or caused sicknesses, and, as stated in another post above, offers higher quality rehabilitation and other services, but only for work related situations. This is fully payed by the employer.

More later!

[Newsjunkie]

Hi Mike
Sorry for not responding earlier - I thought I'd be notified if there was a response here and I haven't been checking here as we've been distracted by other matters, mainly my mum's terminal illness.

Your response is really helpful an I'll try to give you the information you need here.
He is German, married to my sister who is Irish. He worked in Germany for about 11 years in total but had been unemployed for about three months at the time of his accident. He is with the AOK. His accident won't be legally challenged in court.
He isn't earning at the moment and is getting a small pension every month. They own an apartment which is on the first floor and inaccessible (no lift). My sister is living there on her own at the moment.

Your description of the Pflegeversicherung is really interesting because it explains why there is lack of clarity about what he is entitled to - it's a lot more straightforward here in Ireland. There is a suggestion that he will be able to access vocational training (PC based) and this would be great but there seems to be a lot of bureacracy involved in this. Meanwhile, he's still in the nursing home, only having two sessions of physio per week and losing the small amount of left arm function he gained in rehab last year. My sister would like for them to get an accessible apartment and live together again but would it be possible for them to get funding for the level of nursing care that he would need? The insurance company seems very happy to pay for him to be in a nursing home rather than at home.

I'm really sorry for not responding earlier - thank you SO much for your response.
Pauline

[Mike C]

OK. Is your sister currently working? Full or part time? Can she speak/read/write in German? This is important to know because she is going to have to slug it out with the insurance companies and beurocracies to get the ball rolling and get what they need. The appartment that they have now; do they fully own it or do they have a mortgage to pay? I take it they are in their 30´s or so? There are loans available with near zero interest rates for families in need. But more on that later.

A guy in his situation has probably been given a pflegeversicherung care level of 3, meaning he can´t do much, if anything, on his own. If he was to leave the nursing home, there are two financial possibilities you can pursue once he is at home. Either your sister takes care of him fulltime, or she hires a professional caregiver to help him at home. If she elects to take care of him, her husband will then receive €675 a month, and he then pays her. In addition, she also becomes a monthly payment into her retirement account. She is also insured under workmans compensation in case she is injured while doing her care work. If they elect for a professional care service to come in, he will then get €1,470 to pay for services rendered. It must be said that that amount of money will be burned away to the last cent. There is a possibility that he could qualify for more money (€1,918) if he is considered a special case, but his needs must meet certain criteria. If they choose to take the professional care service, she does not get any of the benefits she would if she did the work herself. He still gets his pension no matter what option is chosen. If your sister does not work currently, they can put in for welfare to help them through. They can still choose both care options (even change one to the other if need be), and this money is not considered as income by the state, so it doesn´t effect welfare compensation rates if needed.

More after a few answers from you.