Your grandmother arrived from Ukraine, she’s 78, barely walks after a stroke, and you have no idea how to get her proper care in Germany. You ask around - people say “apply for Pflegegrad” - but nobody explains how. What documents do you need, what needs to be translated, who assesses her condition? Let’s break it down step by step so you don’t spend months figuring out something that can be done in a week.
What’s a Pflegegrad and Why You Need One¶
Pflegegrad (care level) is Germany’s official assessment of how much a person can handle daily life on their own. There are 5 levels:
- Pflegegrad 1 - minor limitations in independence
- Pflegegrad 2 - significant limitations
- Pflegegrad 3 - severe limitations
- Pflegegrad 4 - very severe limitations
- Pflegegrad 5 - very severe limitations with special care requirements
Without a Pflegegrad, you won’t get any care benefits. No cash allowance, no professional caregiver services, no nursing home placement. Getting a Pflegegrad is the first step to making sure your elderly or sick relative gets real help.
Who’s Eligible: Ukrainians with §24¶
If your relative has a residence permit under §24 AufenthG (temporary protection), they’ve had full access to Germany’s social security system under SGB II or SGB XII since June 2022. That means access to the full range of statutory health insurance (GKV) benefits - including Pflegeversicherung (long-term care insurance).
Here’s how it works in practice:
- If your relative receives Bürgergeld from Jobcenter - they’re automatically insured through Pflegekasse (care insurance fund)
- If your relative receives Sozialhilfe from Sozialamt (e.g., due to age) - they’re entitled to “Hilfe zur Pflege” (help with care) under §61-66 SGB XII. In this case, you apply through Sozialamt
§24 residence permits have been extended until March 4, 2027. No additional steps needed.
More about Bürgergeld and documents for Jobcenter.
How Much You’ll Get in 2026¶
Amounts depend on the assigned Pflegegrad and who provides the care - you personally (then you get Pflegegeld) or a professional service (then Pflegesachleistungen go directly to the provider).
Pflegegeld (if you or family provide care)¶
| Pflegegrad | Monthly amount |
|---|---|
| Pflegegrad 1 | - (no payment) |
| Pflegegrad 2 | €347 |
| Pflegegrad 3 | €599 |
| Pflegegrad 4 | €800 |
| Pflegegrad 5 | €990 |
Pflegesachleistungen (if professional service provides care)¶
| Pflegegrad | Monthly amount |
|---|---|
| Pflegegrad 2 | €796 |
| Pflegegrad 3 | €1,497 |
| Pflegegrad 4 | €1,859 |
| Pflegegrad 5 | €2,299 |
You can combine both - partially care for your relative yourself and get Pflegegeld, while also using professional services. The two types of benefits are calculated proportionally.
Additional benefits for all levels¶
- Entlastungsbetrag - €131/month for household services (even for Pflegegrad 1)
- Verhinderungspflege + Kurzzeitpflege - combined annual budget of up to €3,539 for when the primary caregiver temporarily can’t provide care (vacation, illness)
- Pflegehilfsmittel - up to €40/month for care supplies (gloves, pads, disinfectant)
How to Get a Pflegegrad: Step by Step¶
Step 1: Apply to Pflegekasse or Sozialamt¶
The application can be informal - just call the Pflegekasse (listed on the health insurance card) and say you need a care level assessment. Or write a short letter and send it by mail.
If your relative receives Sozialhilfe from Sozialamt - apply there. Sozialamt is required to determine the Pflegegrad “unverzüglich” (without delay).
Tip: a family member can apply on behalf of the person needing care. Just list yourself as the contact person.
Step 2: Prepare for the MD Assessment¶
After your application, the Pflegekasse sends an expert from MD (Medizinischer Dienst) - a medical assessor who evaluates the person’s condition. This service used to be called MDK.
The assessment must take place within 25 working days of your application. It usually happens at home - the expert comes and evaluates how independent the person is.
What the MD assesses - 6 modules:
| Module | What they assess | Weight |
|---|---|---|
| 1. Mobility | Moving around, getting up, climbing stairs | 10% |
| 2. Cognitive abilities | Time/space orientation, memory, decisions | 15% |
| 3. Behavior | Aggression, restlessness, nighttime wandering | 15% |
| 4. Self-care | Eating, washing, dressing, toilet | 40% |
| 5. Treatment and therapy | Taking medication, bandages, doctor visits | 20% |
| 6. Daily routine | Shopping, cleaning, cooking | 15% |
Module 4 (self-care) carries the most weight - 40% of the total score. If your grandmother can’t wash, dress, or eat on her own - that’s the strongest argument.
Step 3: Go Through the Assessment¶
The assessment usually takes 60-90 minutes. The expert talks to both the person needing care and the person who provides it.
Critical for Ukrainians: the MD expert speaks only German. If your relative doesn’t speak German, you can (and should!) be present as an interpreter or bring a trusted person. This is completely legal and even recommended.
What to bring:
- All medical documents (hospital discharge papers, exam results, prescriptions)
- Pflegetagebuch (care diary) - for 2 weeks before the assessment, write down everything you do for your relative: what time you help them get up, how long bathing takes, how many times you wake up at night. This is your strongest evidence
- Translations of Ukrainian medical documents
Step 4: Get the Decision and Choose Your Benefits¶
After the assessment, the MD sends their report to the Pflegekasse. You’ll typically get the decision within 2-4 weeks. A letter arrives with the assigned Pflegegrad and available benefits.
If you disagree with the decision (say, they gave Pflegegrad 2 but you think it should be 3) - you have 4 weeks to file a Widerspruch (objection). It’s free and worth trying - statistically, about a third of objections lead to an upgrade.
What Documents You’ll Need¶
For the application¶
- Health insurance card (Versichertenkarte) - or insurance number
- §24 Aufenthaltserlaubnis of your relative - copy of both sides
- Passport or ID
- Anmeldebescheinigung - proof of address registration
For the MD assessment¶
- Medical documents from Ukraine: hospital discharge papers, diagnoses, surgery reports, test results
- Medical documents from Germany: if your relative has already seen doctors here - Arztbriefe (doctor’s letters), referrals, test results
- Pflegetagebuch (care diary) - keep it for at least 7-14 days before the assessment
- Medication list - current, with dosages
- Disability certificate from Ukraine (if available) - with translation
Additional¶
- Vollmacht (power of attorney) - if you’re applying on behalf of your relative. A simple written authorization, no notary needed
- Bescheid from Jobcenter or Sozialamt - proof that your relative receives social benefits
Which Documents Need Translation¶
The main rule: anything issued in Ukraine with medical or legal significance needs to be translated.
Must translate (beglaubigte Übersetzung)¶
- Hospital discharge papers - diagnoses, surgeries, treatments. The MD expert doesn’t read Ukrainian, and without translation they’ll simply ignore these documents
- Disability certificate (disability group from Ukraine) - if available, this is a strong argument for a higher Pflegegrad
- Medical summaries and reports - especially for chronic or progressive conditions
Recommended to translate¶
- Test results (MRI, CT, ultrasound) - if the conclusions are in Ukrainian. Numerical lab results are often understandable without translation, but written conclusions aren’t
- Prescriptions and doctor’s orders - medication list with dosages
Does NOT need translation¶
- German medical documents (Arztbriefe, Befunde) - already in German
- §24 Aufenthaltserlaubnis - already in German
- Bescheid from Jobcenter or Sozialamt
- Anmeldebescheinigung
More about which documents DON’T need translation for Germany.
Translation costs¶
| Document | Price (approximate) |
|---|---|
| Hospital discharge (1-2 pages) | €45-80 |
| Disability certificate | €35-55 |
| Medical report / summary | €40-70 |
Timeline: usually 2-5 working days depending on volume. Medical texts are more complex than standard documents, so both price and timeline are a bit higher.
On ChatsControl you can order a certified translation of medical documents from Ukrainian to German online.
More about the difference between notarial, sworn, and certified translation and document translation costs.
5 Tips for a Successful MD Assessment¶
1. Keep a Pflegetagebuch from day one¶
Write down every day: what time they get up, whether they need help getting up, how many times you wake up at night, whether they can get to the toilet alone, whether they eat independently. The more detail, the better. The MD expert comes for an hour, but you provide care 24/7 - the diary shows the real picture.
2. Don’t downplay the problems¶
The Ukrainian habit of “everything’s fine, I’m managing” works against you here. If your grandmother tells the expert “I’m doing great, I do everything myself” - but in reality you help her 10 times a day - the Pflegegrad will be lower than it should be. Talk to her beforehand and explain: here you need to honestly describe the difficulties. It’s not complaining - it’s providing facts to get help.
3. Show the “bad days”¶
The MD expert only sees one moment - their visit. But a person’s condition can vary day to day. Describe and show the worst days in the diary - when pain is worse, when they can’t get up, when they got lost in their own kitchen.
4. Prepare translations in advance¶
Don’t leave medical document translation to the last minute. The MD expert won’t be able to consider diagnoses from Ukrainian documents if they’re not translated. This is especially important for chronic conditions and disability certificates.
5. Be present at the assessment¶
Even if you’re not the official representative - come as a “Vertrauensperson” (trusted person). You know your relative’s daily life better than they do. You can add what they forget or are too embarrassed to mention. And if needed - interpret from Ukrainian to German during the assessment.
Common Mistakes When Applying for Pflegegrad¶
Didn’t apply because “it’s not bad enough yet” - many people wait, thinking the condition “isn’t that serious.” Pflegegrad 2 starts at significant limitations in independence - if the person needs help with washing, dressing, or moving around, that’s already grounds for an application.
Didn’t prepare medical documents - showed up to the assessment without discharge papers, without translations, without a care diary. The expert only evaluates what they can see and what’s documented. No documents means a lower Pflegegrad.
Didn’t appeal the decision - got Pflegegrad 1 instead of 2 or 3 and accepted it. Filing a Widerspruch is free, and it’s worth trying. There are even free consultations for this (Pflegestützpunkte, Verbraucherzentrale).
Didn’t know about Entlastungsbetrag - even with Pflegegrad 1 (which doesn’t qualify for Pflegegeld) you can get €131/month for household help. Many people don’t know about this and miss out.
Where to Get Help¶
- Pflegestützpunkte - free care consultation centers in every major city. Find your nearest: zqp.de/beratung-pflege
- Pflegekasse - your insurance is required to provide free consultation (Pflegeberatung) within 2 weeks of your application
- Germany4Ukraine - portal for Ukrainian refugees with info on senior care services
- Handbook Germany - information in English about social services
- Sozialverband VdK - the largest organization that helps with Pflegegrad appeals. Membership starts at €5/month, but they support you through the entire process
If you’re caring for an elderly relative while dealing with other admin tasks - check our guides on Bürgergeld and Jobcenter, opening a bank account, and Kindergeld.
FAQ¶
Are Ukrainians with §24 eligible for Pflegegrad?¶
Yes. Since June 2022, Ukrainians with temporary protection (§24 AufenthG) have access to the full statutory health insurance catalog, including Pflegeversicherung. If your relative receives Sozialhilfe from Sozialamt, they’re entitled to “Hilfe zur Pflege” under SGB XII.
How much is Pflegegeld in 2026?¶
Pflegegeld for home care: Pflegegrad 2 - €347, Pflegegrad 3 - €599, Pflegegrad 4 - €800, Pflegegrad 5 - €990 per month. Pflegegrad 1 doesn’t qualify for Pflegegeld but does get the €131 Entlastungsbetrag.
Do Ukrainian medical documents need to be translated for the MD assessment?¶
Yes, the MD expert doesn’t read Ukrainian. Hospital discharge papers, disability certificates, and medical reports need to be translated into German. For key documents, a certified translation (beglaubigte Übersetzung) is recommended. Cost: €35-80 per document.
How long does the Pflegegrad process take?¶
From application to decision, usually 5-7 weeks. The Pflegekasse must schedule an MD assessment within 25 working days. After the assessment, the decision arrives in 2-4 weeks. If documents are incomplete or additional examinations are needed, the timeline extends.
What if the assigned Pflegegrad is too low?¶
File a Widerspruch (objection) with the Pflegekasse within 4 weeks of receiving the decision. It’s free. About a third of all objections lead to an upgrade. Free help is available from Pflegestützpunkte, Verbraucherzentrale, or Sozialverband VdK (membership from €5/month).
Can a relative who doesn’t speak German go through the MD assessment?¶
Yes. You can (and should) bring a trusted person to the assessment - a relative, friend, or interpreter. This is officially permitted and recommended. The trusted person can interpret, supplement answers, and show the care diary.
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