Live-in care at home in Germany — the complete guide

1. What live-in care covers — and what it does not

The German term "24-hour care" is misleading: it means a carer who lives in the household and is available during the day, not a registered nurse awake around the clock. Working time and rest periods apply here too. If continuous medical care is needed, a nursing service or a residential facility is the better answer.

2. What it costs and what drives the price

The cost consists of the carer's fee, the placement fee and your own expenses for board and lodging. Three factors set the range:

• Care level and workload: the higher the need for support, the higher the fee.
• German language skills: carers with good German (B1 and above) are in much higher demand and cost accordingly. In dementia care, good communication is a requirement rather than a luxury.
• Night duty: regular night-time work exceeds the live-in model and requires a second carer.

Achtung: Be wary of offers well below the market rate. A price that cannot cover social security contributions in the carer's home country is a warning sign — the liability ultimately falls on you as the household.

3. German long-term care insurance benefits

A recognised care level (Pflegegrad) reduces your own contribution considerably. These benefits apply to care at home:

• The care allowance is paid directly to the person in need of care and can be used freely for the placement.
• Respite care (§ 39 SGB XI) combined with short-term care (§ 42 SGB XI): up to €2,418 per calendar year can be claimed for live-in respite care — reducing monthly net costs by up to €201.
• The relief amount (§ 45b SGB XI, €125/month) is earmarked for recognized local support services; unused amounts roll over until mid-year.
• If there is no care level yet, apply first: it takes effect from the month of application, not from the decision.

4. Care fund assessment: 10 golden rules for a realistic care grade

The Medical Service of health funds (MD) evaluates independence across 6 key modules. Family members often inadvertently downplay difficulties out of pride or embarrassment, leading to an unfairly low care level. Follow these 10 practical guidelines:

5. Tax deductibility (§ 35a EStG)

Care in your own household counts as a household-related service. You can claim 20 % of the expenses up to a tax reduction of 4.000 € per year.

Two caveats that marketing tends to omit: this is a reduction of your tax liability after the fact, not a monthly discount — and it only helps to the extent that income tax is actually due.

• An invoice and proof of non-cash payment are mandatory — cash payments are not recognised.
• The amount applies per household, not per person.

6. Legal certainty: posting, the A1 certificate — and the risk of undeclared work

This is where sound offers separate from dubious ones. A carer from another EU country may work in Germany if they are employed and insured with an employer in their home country and are posted for the assignment.

The proof of this is the official A1 certificate under EU Regulation (EC) 883/2004. It confirms that social insurance continues in the posting state. Reputable agencies strictly align with DIN SPEC 33454, the German standard for quality-assured live-in care arrangements.

Always demand to see the A1 certificate before the carer arrives — never accept delays of weeks.

• The A1 certificate exists and covers the assignment period.
• Compliance with DIN SPEC 33454 quality benchmarks and statutory working time laws (ArbZG).
• There is a written contract with a named counterparty, not just a placement promise.
• The employer in the posting state is named and reachable.
• Working and rest periods are set out in writing.
• Payment is made without cash and against an invoice.

Achtung: Without these documents you are effectively running an unregistered employment relationship. As the household you are then liable for unpaid social security contributions, back payments and fines — and in the event of an accident there is no insurance cover.

7. What the family must provide

Accommodation is part of the model, not an extra. Without it the placement cannot go ahead.

• A separate, lockable room with daylight — not a walk-through room or the living room.
• Board, or an equivalent meal allowance.
• Access to bathroom and kitchen.
• Internet access (Wi-Fi) — the connection home matters greatly to most carers.
• Free time: usually two hours a day plus one day off per week, during which care must be covered otherwise.

8. Process and timeline

• Day 1 — Needs assessment: care situation, mobility, dementia, required language skills, start date.
• Days 1–3 — Selection: you receive matching profiles with experience, German level and availability.
• Days 3–5 — Contract: after your confirmation, the contract and posting documents are prepared.
• Days 5–7 — Arrival: the carer travels and the handover takes place in the household.
• After that — Rotation: live-in care runs in cycles of roughly 2.5 to 3 months, then the carer changes. Clarify early how that change is organised.

9. Checklist