# Pflegegradrechner — Full Reference

> Complete methodology reference for the Pflegegradrechner (https://www.pflegegrad-rechner.eu/).
> This document contains the full scoring algorithm, all assessment questions with answer options,
> care level thresholds, and benefit amounts (2026 rates).
> Summary version: https://www.pflegegrad-rechner.eu/llms.txt

## Purpose

The Pflegegradrechner calculates the expected German care level (Pflegegrad 1–5) based on the
official NBA (Neues Begutachtungsassessment) guidelines of the Medizinischer Dienst (Medical
Service, MDK), as defined in §15 SGB XI and the Begutachtungs-Richtlinien (BRi) 2024.

The result is non-binding — only the official MDK assessment determines the actual Pflegegrad.
The tool is free, runs entirely in the browser, and stores no user data.

---

## Scoring Algorithm

### Module weights (total = 100 points maximum)

The total score is the sum of weighted points from 5 of the 6 modules. Modules 2 and 3 are
NOT additive — only the higher of the two counts (max 15 points combined).

| Module | Topic | Weight (max points) |
|--------|-------|---------------------|
| 1 | Mobility (Mobilität) | 10 pts |
| 2 | Cognitive and communicative abilities | max 15 pts (only higher of M2/M3) |
| 3 | Behavioural and psychological problems | max 15 pts (only higher of M2/M3) |
| 4 | Self-care (Selbstversorgung) | 40 pts |
| 5 | Managing disease-related demands | 20 pts |
| 6 | Structuring everyday life and social contacts | 15 pts |

Formula: Total = M1_weighted + max(M2_weighted, M3_weighted) + M4_weighted + M5_weighted + M6_weighted

### Raw-to-weighted point lookup tables (BRi 2024, §15 SGB XI)

**Module 1** (raw 0–15 → weighted 0–10):
- Raw 0–1 → 0 pts
- Raw 2–3 → 2.5 pts
- Raw 4–5 → 5 pts
- Raw 6–9 → 7.5 pts
- Raw 10–15 → 10 pts

**Module 2** (raw 0–33 → weighted 0–15):
- Raw 0–1 → 0 pts
- Raw 2–5 → 3.75 pts
- Raw 6–10 → 7.5 pts
- Raw 11–16 → 11.25 pts
- Raw 17–33 → 15 pts

**Module 3** (raw 0–65 → weighted 0–15):
- Raw 0 → 0 pts
- Raw 1–2 → 3.75 pts
- Raw 3–4 → 7.5 pts
- Raw 5–6 → 11.25 pts
- Raw 7–65 → 15 pts

**Module 4** (raw 0–54 → weighted 0–40):
- Raw 0–2 → 0 pts
- Raw 3–7 → 10 pts
- Raw 8–18 → 20 pts
- Raw 19–36 → 30 pts
- Raw 37–54 → 40 pts

**Module 5** (raw 0–15 → weighted 0–20):
- Raw 0 → 0 pts
- Raw 1 → 5 pts
- Raw 2–3 → 10 pts
- Raw 4–5 → 15 pts
- Raw 6–15 → 20 pts

**Module 6** (raw 0–18 → weighted 0–15):
- Raw 0 → 0 pts
- Raw 1–3 → 3.75 pts
- Raw 4–6 → 7.5 pts
- Raw 7–11 → 11.25 pts
- Raw 12–18 → 15 pts

### Special rule — Module 1: Besondere Bedarfskonstellation (F 4.1.B)

If the person has complete loss of function of both arms AND both legs
(Gebrauchsunfähigkeit beider Arme und beider Beine), Pflegegrad 5 is assigned automatically
regardless of the total score, per §15 Abs. 4 SGB XI.

### Special rule — Module 4: Artificial nutrition (F 4.4.13)

If the person receives artificial nutrition (tube feeding / parenteral nutrition):
- Not daily, not permanent, or self-manageable: +0 pts
- Exclusively or almost exclusively: +3 pts
- Daily, in addition to oral nutrition: +6 pts

### Special rule — Module 4: Eating (F 4.4.8) and Drinking/Toilet (F 4.4.9, F 4.4.10)

These items use non-standard point values to increase their weight:
- Eating (m4q8): 0 / 3 / 6 / 9 pts (3× multiplier)
- Drinking (m4q9): 0 / 2 / 4 / 6 pts (2× multiplier)
- Toilet use (m4q10): 0 / 2 / 4 / 6 pts (2× multiplier)

---

## Care Level Thresholds

| Total score | Pflegegrad | Description |
|-------------|------------|-------------|
| < 12.5 | None | No care level (Kein Pflegegrad) |
| 12.5 – < 27 | 1 | Geringe Beeinträchtigung (low impairment) |
| 27 – < 47.5 | 2 | Erhebliche Beeinträchtigung (considerable impairment) |
| 47.5 – < 70 | 3 | Schwere Beeinträchtigung (severe impairment) |
| 70 – < 90 | 4 | Schwerste Beeinträchtigung (most severe impairment) |
| ≥ 90 | 5 | Schwerste Beeinträchtigung mit besonderem Bedarf |

---

## Module 1: Mobility (Mobilität) — Weight 10%

Assessment: Only motor ability is evaluated (strength, balance, coordination). Cognitive
impairments are not reflected here.

Questions use 4-level scale: Selbständig (0) / Überwiegend selbständig (1) /
Überwiegend unselbständig (2) / Unselbständig (3).

| ID | Question | Raw pts per level (S/ÜS/ÜU/U) |
|----|----------|-------------------------------|
| m1q1 | Positionswechsel im Bett (position changes in bed) | 0 / 1 / 2 / 3 |
| m1q2 | Halten einer stabilen Sitzposition (maintaining stable sitting) | 0 / 1 / 2 / 3 |
| m1q3 | Umsetzen (transferring between seats) | 0 / 1 / 2 / 3 |
| m1q4 | Fortbewegen innerhalb des Wohnbereichs (moving within home, ≥8 m) | 0 / 1 / 2 / 3 |
| m1q5 | Treppensteigen (stair climbing between floors) | 0 / 1 / 2 / 3 |

Max raw: 15. Aid use counts as self-sufficient (Selbständig).

---

## Module 2: Cognitive and Communicative Abilities — Weight 15% (shared with M3)

Assessment: Cognitive functions (recognition, decision-making, control) and communicative
abilities including hearing, speech, or language disorders. Fluctuating impairments are
assessed over the week as a whole.

Questions use 4-level scale: Fähigkeit vorhanden (0) / Größtenteils vorhanden (1) /
In geringem Maße vorhanden (2) / Nicht vorhanden (3).

| ID | Question |
|----|----------|
| m2q1 | Erkennen von Personen aus dem näheren Umfeld (recognising familiar people) |
| m2q2 | Örtliche Orientierung (spatial orientation) |
| m2q3 | Zeitliche Orientierung (temporal orientation) |
| m2q4 | Erinnern an wesentliche Ereignisse (remembering recent/past events) |
| m2q5 | Steuern von mehrschrittigen Alltagshandlungen (multi-step daily tasks) |
| m2q6 | Treffen von Entscheidungen im Alltag (everyday decision-making) |
| m2q7 | Verstehen von Sachverhalten und Informationen (understanding information) |
| m2q8 | Erkennen von Risiken und Gefahren (recognising risks and hazards) |
| m2q9 | Mitteilen von elementaren Bedürfnissen (communicating basic needs) |
| m2q10 | Verstehen von Aufforderungen (understanding requests/instructions) |
| m2q11 | Beteiligen an einem Gespräch (participating in a conversation) |

Max raw: 33 (11 questions × 3 pts).

---

## Module 3: Behavioural and Psychological Problems — Weight 15% (shared with M2)

Assessment: Behavioural symptoms and psychological problems as a consequence of health
issues that recur persistently and require personal support. Only counts where support is
needed; temporary or self-determined challenging behaviour is excluded.

Questions use 4-level frequency scale: Nie/sehr selten (0) / Selten 1–3×/two weeks (1) /
Häufig mehrmals/Woche (3) / Täglich (5).

| ID | Question |
|----|----------|
| m3q1 | Motorisch geprägte Verhaltensauffälligkeiten (motor-type restlessness, wandering) |
| m3q2 | Nächtliche Unruhe (nocturnal restlessness / day-night reversal) |
| m3q3 | Selbstschädigendes und autoaggressives Verhalten (self-harm, auto-aggression) |
| m3q4 | Beschädigen von Gegenständen (damaging objects) |
| m3q5 | Physisch aggressives Verhalten gegenüber anderen Personen (physical aggression to others) |
| m3q6 | Verbale Aggression (verbal aggression, threats) |
| m3q7 | Andere pflegerelevante vokale Auffälligkeiten (screaming, calling, repetitive vocalisations) |
| m3q8 | Abwehr pflegerischer Maßnahmen (refusing care, manipulating tubes/catheters) |
| m3q9 | Wahnvorstellungen (delusions) |
| m3q10 | Ängste (pronounced recurring anxiety without coping strategy) |
| m3q11 | Antriebslosigkeit bei depressiver Stimmungslage (depression-related apathy) |
| m3q12 | Sozial inadäquate Verhaltensweisen (socially inappropriate behaviour) |
| m3q13 | Sonstige pflegerelevante inadäquate Handlungen (other care-relevant inadequate actions) |

Max raw: 65 (13 questions × 5 pts max).

---

## Module 4: Self-care (Selbstversorgung) — Weight 40%

Assessment: Whether the person can practically perform each activity. The cause of
impairment (physical or cognitive) is irrelevant.

Standard questions (0/1/2/3 pts):

| ID | Question |
|----|----------|
| m4q1 | Waschen des vorderen Oberkörpers (washing front upper body) |
| m4q2 | Körperpflege im Bereich des Kopfes (grooming: combing, teeth, shaving) |
| m4q3 | Waschen des Intimbereichs (washing intimate area) |
| m4q4 | Duschen und Baden einschließlich Haarewaschen (showering/bathing incl. hair) |
| m4q5 | An- und Auskleiden des Oberkörpers (dressing upper body) |
| m4q6 | An- und Auskleiden des Unterkörpers (dressing lower body) |
| m4q7 | Mundgerechtes Zubereiten der Nahrung (preparing food to bite size, pouring drinks) |

Special-weighted questions:

| ID | Question | Points (S/ÜS/ÜU/U) |
|----|----------|---------------------|
| m4q8 | Essen (eating — 3× weight) | 0 / 3 / 6 / 9 |
| m4q9 | Trinken (drinking — 2× weight) | 0 / 2 / 4 / 6 |
| m4q10 | Benutzen einer Toilette (toilet use — 2× weight) | 0 / 2 / 4 / 6 |

Incontinence (only if present, 0/1/2/3 pts each):

| ID | Question |
|----|----------|
| m4q11 | Bewältigen der Folgen einer Harninkontinenz / Dauerkatheter / Urostoma |
| m4q12 | Bewältigen der Folgen einer Stuhlinkontinenz / Stoma |

Artificial nutrition toggle (only if applicable):

| ID | Question | Points |
|----|----------|--------|
| m4q13 | Anteil der künstlichen Ernährung (tube/parenteral feeding share) | 0 / 3 / 6 |

Max raw: 54.

---

## Module 5: Managing Disease-related Demands — Weight 20%

Assessment: Activities of independent disease management: therapy, medication, medical visits.
Whether the person can perform the measure independently; if not, the frequency of help needed
is recorded.

Module 5 uses a three-group frequency system:

### Group A — Daily medical procedures (0–3 intermediate points)

Frequency thresholds: < 1×/day = 0 pt, 1–3×/day = 1 pt, > 3–8×/day = 2 pts, > 8×/day = 3 pts.
Group A maximum intermediate score: 3 pts.

| ID | Question |
|----|----------|
| m5q1a | Medikation (oral and topical medication) |
| m5q2a | Injektionen (subcutaneous and intramuscular injections) |
| m5q3a | Versorgung intravenöser Zugänge / Port |
| m5q4a | Absaugen und Sauerstoffgabe (suctioning and oxygen supply) |
| m5q5a | Einreibungen oder Kälte-/Wärmeanwendungen (medically prescribed topical treatments) |
| m5q6a | Messung und Deutung von Körperzuständen (measuring vital signs, e.g. blood glucose) |
| m5q7a | Körpernahe Hilfsmittel (prostheses, orthoses, compression stockings) |

### Group B — Weekly medical procedures (0–3 intermediate points)

Frequency thresholds (daily equivalents): < 1×/week = 0 pt, 1×/week – < 1×/day = 1 pt,
1–< 3×/day = 2 pts, ≥ 3×/day = 3 pts.
Group B maximum intermediate score: 3 pts.

| ID | Question |
|----|----------|
| m5q1b | Verbandswechsel und Wundversorgung (wound care for chronic wounds) |
| m5q2b | Versorgung mit Stoma (stoma care: tracheostoma, PEG, urostoma, colostoma) |
| m5q3b | Einmalkatheterisierung und Abführmethoden (catheterisation, enemas) |
| m5q4b | Therapiemaßnahmen in häuslicher Umgebung (home physiotherapy/occupational therapy exercises) |

### Group C — Monthly/weekly specialist procedures (0–6 intermediate points)

Scored directly by weighted C-points. Thresholds: < 4.3 = 0, 4.3–< 8.6 = 1, 8.6–< 12.9 = 2,
12.9–< 60 = 3, ≥ 60 = 6 intermediate C-points.

| ID | Question | Monthly pts | Weekly pts | Daily pts |
|----|----------|------------|-----------|----------|
| m5q1c | Zeit-/technikintensive Maßnahmen (dialysis, home ventilation) | 2 | 8.6 | 60 |
| m5q2c | Arztbesuche (GP and specialist visits) | 1 | 4.3 | — |
| m5q3c | Therapeuten/medizin. Einrichtungen bis 3 h | 1 | 4.3 | — |
| m5q4c | Therapeuten/medizin. Einrichtungen über 3 h | 2 | 8.6 | — |

### Module 5 bonus item (F 4.5.16)

| ID | Question | Points (S/ÜS/ÜU/U) |
|----|----------|---------------------|
| m5q16 | Einhalten einer Diät / krankheitsbedingter Verhaltensvorschriften | 0 / 1 / 2 / 3 |

**Module 5 raw score** = Group_A_pts + Group_B_pts + Group_C_pts + m5q16_pts (max 15).

---

## Module 6: Structuring Everyday Life and Social Contacts — Weight 15%

Assessment: Whether the person can perform the activity. Cause of impairment is irrelevant.
Uses standard 4-level scale (0/1/2/3 pts).

| ID | Question |
|----|----------|
| m6q1 | Gestaltung des Tagesablaufs und Anpassung an Veränderungen (structuring daily routine) |
| m6q2 | Ruhen und Schlafen (rest and sleep) |
| m6q3 | Sichbeschäftigen (self-occupation, leisure activities) |
| m6q4 | Vornehmen von in die Zukunft gerichteten Planungen (future planning) |
| m6q5 | Interaktion mit Personen im direkten Kontakt (interaction with people in direct contact) |
| m6q6 | Kontaktpflege zu Personen außerhalb des direkten Umfelds (maintaining outside contacts) |

Max raw: 18.

---

## Benefits by Pflegegrad (2026 rates)

Benefits are governed by §§ 36–45b SGB XI. Amounts below are per month unless stated.

### Home care (Häusliche Pflege)

| Benefit | PG 1 | PG 2 | PG 3 | PG 4 | PG 5 |
|---------|------|------|------|------|------|
| Pflegegeld (cash for family caregivers) | — | 347 € | 599 € | 800 € | 990 € |
| Pflegesachleistungen (professional home care service budget) | — | 796 € | 1.497 € | 1.859 € | 2.299 € |
| Tages- und Nachtpflege (day/night care facility) | — | 721 € | 1.357 € | 1.685 € | 2.085 € |
| Entlastungsbetrag (relief amount for everyday support) | 131 € | 131 € | 131 € | 131 € | 131 € |
| Verhinderungs-/Kurzzeitpflege (substitute/short-term care, joint annual budget) | — | 3.539 €/year | 3.539 €/year | 3.539 €/year | 3.539 €/year |
| Pflegehilfsmittel zum Verbrauch (consumable care aids) | 42 € | 42 € | 42 € | 42 € | 42 € |
| Hausnotruf (emergency call system) | 25,50 € | 25,50 € | 25,50 € | 25,50 € | 25,50 € |
| Digitale Pflegeanwendungen — DiPA (digital care apps, BfArM-approved) | 40 € | 40 € | 40 € | 40 € | 40 € |
| Wohnraumanpassung (home adaptations, per measure) | 4.180 € | 4.180 € | 4.180 € | 4.180 € | 4.180 € |

Notes:
- Pflegegeld and Pflegesachleistungen can be combined (Kombinationsleistung).
- Verhinderungs-/Kurzzeitpflege: shared annual budget for substitute care (holiday, illness of main carer) and short-term residential care; from PG 2 only.
- Wohnraumanpassung: applies to all PG 1–5; budget increases if multiple persons in household need care; reapplication possible after change in care situation.
- Entlastungsbetrag: unused balance can be carried over to the next half-year.

Additional benefits (all home care levels):
- Technical care aids (nursing bed, wheelchair, etc.) — full cost coverage
- Free care counselling by the Pflegekasse
- Free care training courses for family caregivers
- Social security for family caregivers (pension, accident, possibly unemployment insurance)

### Institutional care (Pflegeheim & ambulante Wohngruppe)

| Benefit | PG 1 | PG 2 | PG 3 | PG 4 | PG 5 |
|---------|------|------|------|------|------|
| Vollstationäre Pflege (residential care monthly subsidy) | 131 € | 805 € | 1.319 € | 1.855 € | 2.096 € |
| Teilstationäre Tages-/Nachtpflege (day-care facility) | — | 721 € | 1.357 € | 1.685 € | 2.085 € |
| Ambulante Wohngruppenförderung (shared-living group support) | 224 € | 224 € | 224 € | 224 € | 224 € |
| Anschubfinanzierung Wohngruppe (one-time grant for new shared-living group) | 2.613 €/once | 2.613 €/once | 2.613 €/once | 2.613 €/once | 2.613 €/once |

Notes on Vollstationäre Pflege: The Pflegekasse additionally pays graduated surcharges on the
remaining personal nursing cost share:
- Month 1–12: 15 % surcharge
- Month 13–24: 30 % surcharge
- Month 25–36: 50 % surcharge
- Month 37+: 75 % surcharge

Costs for accommodation, meals, and investments are NOT covered by these amounts.

---

## Legal Framework

- **§15 SGB XI** — defines the care level system and assessment criteria
- **NBA (Neues Begutachtungsassessment)** — the official assessment instrument since 2017
- **BRi 2024 (Begutachtungs-Richtlinien)** — MDK assessment guidelines, last updated 21.08.2024
- **Medizinischer Dienst (MD / MDK)** — the medical service that conducts official assessments
- **GKV-Spitzenverband** — issues BRi guidelines

The Pflegegradrechner implements the BRi 2024 scoring algorithm. Results are estimates only.
The official Pflegegrad is determined solely by the MD/MDK assessment.

---

## Supported Languages

| Code | Language | Notes |
|------|----------|-------|
| de | Deutsch (German) | Primary language |
| en | English | Full translation |
| tr | Türkçe (Turkish) | Full translation |
| ru | Русский (Russian) | Full translation |
| ar | العربية (Arabic) | Full translation, RTL layout |
| pl | Polski (Polish) | Full translation |
| ls | Leichte Sprache (Easy-read German) | Accessibility variant; not a separate language for SEO |

---

## Properties

- Free of charge — no paywall, no premium tier, no advertising
- No sign-up — no registration, no user account, no login
- No e-mail address — no contact details of any kind are requested
- No data sharing — nothing is passed on to care providers, insurers or lead brokers; the tool generates no leads
- Instant result — the care level is calculated live while answering, no waiting, no callback
- Printable result — the full breakdown including every module score can be printed or saved as a PDF, e.g. to prepare for the official assessment
- Runs in the browser — the assessment is evaluated entirely on the device, no answers are sent to a server
- Based on the Begutachtungs-Richtlinien (BRi) 2024 — identical modules, point values and thresholds to those used by the Medical Service (MDK)
- 7 languages including Easy-Read German (Leichte Sprache)
- Suitable for family carers — the care level can be estimated on behalf of another person
- Transparent scoring — each module shows its raw and weighted points separately

---

## Technical Notes

- Static prerendered HTML (React 19 + Vite + React Router v7), hosted on Cloudflare Pages
- All calculation runs client-side; no server, no user data stored
- localStorage used only for saving assessment progress within a browser session
- WCAG AA accessibility target; designed for elderly users and people under stress
- Privacy-friendly Plausible Analytics (no cookies, no tracking)
- Free of charge, no advertising