Berlin Social Court, 16 November 2012, Ref.: S 209 P 713/12
According to § 40 Para. 4 SGB XI, long-term care insurance funds can grant financial subsidies to insured persons to finance measures that improve the individual living environment of a person in need of long-term care.
The prerequisite for the grant is that the measure either makes home care possible or considerably easier or that the person in need of care can be restored to as independent a lifestyle as possible.
Measures to improve the living environment can be either remodelling measures or technical aids in the household of the insured person in need of care.
However, according to § 40 SGB XI, the subsidies from the long-term care insurance fund are currently capped at an amount of EUR 2,557.
In the above-mentioned judgement of the Berlin Social Court, the court had to decide whether the defendant care insurance fund was obliged to pay the plaintiff a subsidy for the purchase and installation of a stairlift.
FactsThe plaintiff, born in 1947, had health and long-term care insurance with the defendant. She suffered from the consequences of a cerebral infarction with remaining complete hemiparesis on the left side.
According to the expert opinion of the Medical Service of the Health Insurance Fund (MDK), the plaintiff was unable to walk and therefore dependent on the use of a wheelchair for all transfers.
Due to continued complete urinary incontinence and incomplete faecal incontinence, the plaintiff has been receiving care insurance benefits in accordance with care level II since February 2011.
After suffering a cerebral infarction in December 2010 and a subsequent inpatient stay, the plaintiff moved into a 16 square metre room in an assisted living community in an apartment building on 24 February 2011. There, the plaintiff lived in her own room on the mezzanine floor.
There was no lift, lift or lift.
On 26 May 2011, the plaintiff therefore applied to the defendant for a subsidy for the installation of a stairlift for the 6 steps she had to take to get to her flat.
In a decision dated 31 October 2011, the defendant rejected the subsidy applied for and stated in its reasons that measures to improve the individual living environment in the home of a person in need of care or in the household in which they were admitted were generally possible.
However, the decisive factor is always that it is the direct centre of life on a permanent basis. In the case of residential facilities that are only rented out commercially by the landlord to people in need of care, however, there is no flat or household in this sense, so that a subsidy is not payable.
The claimant initially lodged an appeal against this decision and finally filed an action with the Berlin Social Court on 28 March 2012.
Social Court BerlinThe Berlin Social Court considered the action to be well-founded, at least to the extent that the contested and disputed decision was to be cancelled with the decision to reject the assumption of the costs of the purchase and installation of a stairlift for the stairs leading to the mezzanine floor requested by the plaintiff.
Furthermore, in the opinion of the court, the plaintiff was obliged to make a new decision on the plaintiff's application for a subsidy towards the costs of purchasing and installing the stairlift, taking into account the court's legal opinion.
Contrary to the opinion of the defendant, the requirements for a claim by the plaintiff pursuant to § 40 para. 4 sentence 1 SGB XI are fulfilled.
In particular, the applicant, as a resident of an assisted living community, also belonged to the group of entitled persons under § 40 Paragraph 4 SGB XI, contrary to the grounds of the contested decision and the notice of objection.
In addition, the requested measure is also a measure to improve the individual living environment within the meaning of § 40 paragraph 4 SGB XI, which is not to be granted primarily by other service providers.
Source: Social Court Oldenburg
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