Care level for autism

Legal status: 08.10.2026 (federal law, checked against the statutory text). The versions in force at the time of your application are decisive. Legal terms are translated here for understanding; the German wording of the law is what counts.

What “in need of care” means in the law

Under the law, people in need of care are those who have health-related impairments of independence or abilities and therefore need the help of others. They must be people who cannot independently compensate for or cope with physical, cognitive or mental impairments or health-related burdens or demands. The need for care must exist permanently, probably for at least six months, and with at least the severity of care level 1. ^[1] “Care” here therefore does not only mean physical care: cognitive and mental impairments count as well.

The six areas of assessment

Six areas are decisive, which the law names with their criteria: ^[1]

1. Mobility, for example changing position, moving around within the living area, climbing stairs.
2. Cognitive and communicative abilities, for example orientation, managing multi-step everyday actions, making everyday decisions, understanding facts and requests, recognising risks and dangers, communicating elementary needs, taking part in a conversation.
3. Behaviours and mental problem situations, for example restlessness at night, self-harming behaviour, verbal and physical aggression, resisting care and other supportive measures, anxieties, socially inappropriate behaviours.
4. Self-care, for example personal hygiene, dressing and undressing, eating and drinking, using the toilet.
5. Coping with and independently handling demands caused by illness or therapy, for example medication, doctor visits, visits to medical or therapeutic facilities and, for children, attending early intervention facilities, keeping to a diet.
6. Shaping everyday life and social contacts, for example organising the daily routine and adapting to changes, resting and sleeping, occupying oneself, planning for the future, interaction in direct contact, maintaining contact outside the immediate environment.

Impairments that mean housekeeping cannot be managed without help are taken into account in these areas. ^[1]

How points become a care level

The assessment instrument has six modules that correspond to the six areas. Individual points are awarded for the criteria; the modules are weighted: mobility at 10 per cent, cognitive and communicative abilities together with behaviours and mental problem situations at 15 per cent, self-care at 40 per cent, demands caused by illness or therapy at 20 per cent and everyday life and social contacts at 15 per cent. For modules 2 and 3, only the higher of the two weighted values counts. ^[2]

The care level results from the total points: ^[2]

Total points	Care level	Description in the law
from 12.5 to under 27	1	slight impairments of independence or abilities
from 27 to under 47.5	2	significant impairments
from 47.5 to under 70	3	severe impairments
from 70 to under 90	4	most severe impairments
from 90 to 100	5	most severe impairments with special demands on care provision

In special constellations of need with an exceptionally high need for help, care level 5 can also be assigned for reasons of care expertise with fewer than 90 points. ^[2]

Particularities for children

For children in need of care, the care level is determined by a comparison of the impairments of their independence and abilities with age-appropriately developed children. ^[2] So what matters is how much help the child needs beyond what is usual at their age. A different classification applies to children up to 18 months. ^[2]

Application and assessment

• Application. Insured people receive care insurance benefits on application. Benefits are granted from the time of application, at the earliest from the time the requirements are met. If the application is not made in the month in which the need for care arose but later, benefits are available from the start of the month of application. ^[4]
• Prior insurance period. There is an entitlement if the person was a member or insured as a family member for at least two years in the last ten years before the application; for insured children, this is regarded as met if a parent meets the period. ^[4]
• Assessment. The care insurance fund commissions the Medical Service or other independent assessors to examine whether there is a need for care and which care level. ^[3] If no assessment takes place within 20 working days of the application or if independent assessors are to be commissioned, the care insurance fund must send a list of at least three assessors to choose from. ^[3]
• Time limit. The assignment to a care level can be time-limited if, in the assessment of the Medical Service, a reduction of the impairments is to be expected; the time limit must not exceed three years in total. ^[4]

How to word an application and deal with decision notices is in the article Applying and filing an objection.

What this can mean for people with autism

The law does not link to the diagnosis of autism but to the effects in everyday life. What matters is therefore what actually needs support in everyday life, for example in understanding requests, in multi-step actions, in dealing with changes and anxieties or in organising the daily routine. These are criteria that the law names in areas 2, 3 and 6. ^[1] How many points result in the individual case and which care level is decided by the assessment; we cannot make a general statement on that here.

Practical tip from the editorial team (not derived from the law): Describe concretely and with examples what help is needed for and what does not work without that help. A care diary can help with this but is not required by the law.

Reform planned, but not yet law: The draft of a Care Reorganisation Act (Pflegeneuordnungsgesetz) adopted by the Federal Cabinet on 30.09.2026 provides, among other things, that concrete recommendations on rehabilitation are to be made significantly more often in care assessments in future. ^[5] This article describes the law in force (as of 08.10.2026). Context for the draft: Care insurance: cabinet adopts Care Reorganisation Act.

Sources and literature

1. § 14 SGB XI – Begriff der Pflegebedürftigkeit. Sozialgesetzbuch Elftes Buch (www.gesetze-im-internet.de/sgb_11/__14.html). – Statute (German federal law, in German)
2. § 15 SGB XI – Ermittlung des Grades der Pflegebedürftigkeit, Begutachtungsinstrument. Sozialgesetzbuch Elftes Buch (www.gesetze-im-internet.de/sgb_11/__15.html). – Statute (German federal law, in German)
3. § 18 SGB XI – Beauftragung der Begutachtung. Sozialgesetzbuch Elftes Buch (www.gesetze-im-internet.de/sgb_11/__18.html). – Statute (German federal law, in German)
4. § 33 SGB XI – Leistungsvoraussetzungen. Sozialgesetzbuch Elftes Buch (www.gesetze-im-internet.de/sgb_11/__33.html). – Statute (German federal law, in German)
5. Bundesregierung: Entwurf eines Gesetzes zur Neuordnung der Pflegeversicherung (PNOG), Kabinettsentwurf vom 30.09.2026. – Draft bill, not valid law (in German)