Entitlement to care allowance is suspended during inpatient treatment

September 29, 2021 – Entitlement to the payment of care allowance is interrupted if a person in need of care has to be treated as an inpatient in a clinic for more than four weeks. This was decided by the Osnabrück Social Court with a judgment published yesterday on September 7, 2021 (S 14 P 16/19).

The decision was based on the action brought by a girl represented by her parents. It not only suffers from trisomy 21 and an intestinal disease, but also from a congenital heart defect. Care level 4 is recognized for the child. They are cared for at home by their parents and receive care allowance.

From September 2017 to August 2018, the applicant was treated as an inpatient in a heart center. The care fund initially continued to pay the care allowance. After four weeks, however, she ordered with reference to § 34 Absatz 2 SGB XI the resting of the claim.

Parents must be present during the hospital stay?

The plaintiff considered this to be unjustified. In support of this, the parents who represented her asserted that due to the complexity of the disease and an expected donor heart operation, her constant presence was also necessary during the hospital stay. Because in fact they would have taken over the care actually incumbent on the hospital.

This was not disputed by the Osnabrück Social Court, which finally dealt with the case. The judges nonetheless rejected the lawsuit as unfounded.

Individual circumstances do not matter

With the regulation in the eleventh social code, the legislature wanted to prevent double benefits in the opinion of the court. Because with inpatient care in a clinic, there is objectively no need for home care.

“So if care allowance were paid – beyond the four weeks – during the hospital stay, there would be at least a double benefit, financially,” said the court.

The judges considered it understandable that in the case of the plaintiff the presence of her parents was necessary. However, the law would not take individual circumstances into account.

This also applies in cases where minors are in need of care. The plaintiff is therefore not entitled to care allowance after the statutory four-week period for the continued stay in the clinic has expired.

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