Germany's care insurance rules on lowering and raising care levels

The German long‑term care insurance (Pflegekasse) may lower a care level (Pflegegrad) only when the insured person's need for assistance has changed significantly. The insurer must show concrete improvements, such as the ability to eat or wash independently, and must order a new assessment by the Medical Service (MD) or another qualified examiner. A single lower assessment result is insufficient; the reduction must be justified by a clear difference in daily living needs.

Applicants seeking a higher Pflegegrad should document all assistance required before the MD evaluation. Incomplete or down‑played information can lead to an under‑estimation of need. The process involves a personal questionnaire, submission of supporting documents, and optionally the presence of a trusted person at the assessment. The Pflegekasse decides within 25 working days, with possible fees for delays.