What is the purpose of long-term care (LTC) insurance?
The main purpose of long-term care insurance is to cover benefits in kind, assistance and care for the dependent person provided in full or in part within the framework of home care or an assistance and care establishment, as well as assistive technologies and home adaptations.
For dependent persons cared for entirely or partially at home, the coverage may include cash benefits to replace benefits in kind.
Long-term care insurance does not replace health insurance. It covers care and assistance that are not covered by health insurance.
How do you know if you are dependent?
You are considered dependent if, as a result of a physical, mental or psychological illness or a similar deficiency, you have a significant and regular need for assistance from a third party for the activities of daily living (ADL). The activities of daily living concern: personal hygiene, toileting, nutrition, clothing and mobility.
You may also have recourse to the assistance of a third party who carries out all or part of the activities of daily living for you or supervises or supports you in order to enable you to carry out these acts.
For children up to the age of eight, determining the state of dependence is based on the additional need for assistance from a third party compared to a child of the same age who is sound in body and mind.
Long-term care benefits are granted if a dependent person requires assistance and care in the areas of the activities of daily living for at least 3.5 hours per week and if, in all probability, the dependent person’s state of dependence exceeds six months or is irreversible.
However, in the event of significant and regular need duly established by the State Office for Assessment and Monitoring (State Office for Assessment and Monitoring – Administration d’évaluation et de contrôle) of long-term care insurance, adaptations to the home, assistive technologies and related training may be granted regardless of the threshold defined above if, in all probability, the illness or impairment exceeds six months or is irreversible.
The benefits paid by the long-term care insurance scheme provide assistance and care for the dependent person in accordance with good nursing care practice.
The benefits paid by the long-term care insurance are granted with a view to saving money while respecting the needs of the beneficiary.
Long-term care insurance benefits are still available to you if you seek hospice care.
What are the steps to take in order to receive benefits?
If you are dependent and want to receive benefits, you must apply to the National Health Fund (CNS).
Being dependent means needing the help of someone, a professional or a relative, to perform activities of daily living. These acts concern personal hygiene (washing, brushing teeth), elimination of body waste (going to the toilet), nutrition (eating, drinking), dressing and undressing as well as mobility (getting up, lying down, moving around). Not being able to go to the toilet or get out of bed or eat without help is being dependent. However, persons are not dependent in the sense of the law if their limitations consist in no longer being able to carry out domestic tasks without help.
The application, or an objection to a decision of the president of the CNS or his representative, can also be submitted by your spouse or another family member. If the legal representative is not a lawyer, he or she must be able to provide a written power of attorney.
Delegates from professional or trade union organizations can also represent you, if they have a mandate.
This application must be made with a LTC insurance claim form.
All useful information and the form can be foundHERE.
Who assesses dependency?
The National Health Fund (CNS) forwards the file to the State Office for Assessment and Monitoring (State Office for Assessment and Monitoring) of the dependency insurance, which is the body responsible for determining dependency. The State Office for Assessment and Monitoring is a state administration under the authority of the minister responsible for social security.
Its staff includes doctors, psychologists, social workers, physiotherapists, occupational therapists, psychiatric nurses and nurses. The State Office for Assessment and Monitoring will contact you or the person you have indicated on the application form to assess your state of dependency.
You will be requested to come to one of the consultation rooms of the State Office for Assessment and Monitoring in Luxembourg-Hollerich. If your state of health does not allow you to travel, the assessment will take place at your home or in the care facility where you are staying.
How is dependency assessed?
The dependency assessment is conducted by a State Office for Assessment and Monitoring health professional in the applicant’s home, at the State Office for Assessment and Monitoring facility or in another facility. The applicant will be notified of the assessment appointment.
In principle, this health professional is the advisor for the file and makes sure that it is followed up. This person’s contact details are given to the applicant at the time of the assessment.
During the assessment, the dependent person’s ability to perform the activities of daily living is examined. The person requesting the services and, if necessary, a member of his or her family are interviewed.
After the assessment, the advisor will keep a record of the care and assistance required by the dependent person for one week. This standard statement will also determine whether the person has reached the entry threshold of 3.5hrs/week of assistance and care in the activities of daily living (ADL)
What to do in case of direct need for help and care if a person lives at home?
The person concerned can contact a provider of his choice directly (a help and care network), which will inform him of the terms of his care.
If the person is found to be dependent after the assessment by the State Office for Assessment and Monitoring (State Office for Assessment and Monitoring) of the long-term care insurance, the care and assistance provided by the professional service (benefits in kind) are due from the date of the application.
What to do in case of direct need for assistive technologies or home adaptation?
For any information related to assistive technologies, adapting housing or vehicles, please contact the Administration d’évaluation et de contrôle (AEC) de l’assurance dépendance
Helpline « Aides techniques et adaptations logement » de l’AEC HERE.
ATTENTION: It is absolutely necessary to avoid buying assistive technologies (e.g. wheelchair, hospital bed, walking aids) on your own initiative or starting adapting your home. It is essential to wait for State Office for Assessment and Monitoring approval. The law does not provide for retroactive payment.
For children up to the age of eight, determining the state of dependence is based on the additional need for assistance from a third party compared to a child of the same age who is sound in body and mind. The procedures for determining dependence in children are laid down by Grand Ducal regulation.
Based on State Office for Assessment and Monitoring’s determination of care and support in the activities of daily living (ADL), you are assigned one of the following 15 levels of weekly care and support needs:
What are the avenues of appeal against a CNS decision?
If you do not agree with the decision of the National Health Fund (CNS), you can submit a challenge with the CNS Board of Directors. To do so, you must send a letter to the president of the CNS within 40 days of being notified of the decision. The letter must be signed by the person who applied for the benefits.
You will then receive a new decision. If you still disagree with the decision, you can appeal to the Social Security Arbitration Board.
This new step must be taken within 40 days of the date of notification of the decision. The Social Security Arbitration Board has the final say up to the value of €1,250.
If you still disagree with the decision of the Social Security Arbitration Board, you can appeal to the Higher Social Security Council.
You again have 40 days from the date of notification of the decision to submit this appeal.
Like health insurance, LTC insurance is a mandatory insurance.
The group of beneficiaries is the same as for health insurance.
If you work in Luxembourg, either as a salaried employee or as a self-employed person, you are insured. You are also insured if you work in Luxembourg but do not reside there (e.g. cross-border commuters).
The insurance also extends to your spouse or partner and your children.
You can also get LTC benefits if you are receiving a pension, Social Inclusion Income (REVIS) or unemployment benefit.
You do not need to complete a probationary period, unless you have taken out optional insurance. In this case, the insurance probationary period is one year.
It is also important to remember that not only elderly people are entitled to the benefits of long-term care insurance. These benefits are granted regardless of the age of the person concerned; the only thing that counts is the state of dependence that has been determined.
What in-home benefits are you entitled to?
Si vous désirez rester chez vous et être soigné à domicile, vous pouvez vous adresser à un réseau d’aides et de soins.
Des informations très utiles peuvent être trouvées sur le site www.luxsenior.lu.
Un contrat sera conclu entre vous et le réseau d’aides et de soins qui s’engage à exécuter la synthèse de prise en charge établie par l’Administration d’évaluation et de contrôle (AEC).
Les prestations décrites ci-après fournies par le réseau, sont directement prises en charge par l’assurance dépendance. Vous n’avez donc pas besoin de payer le réseau d’aides et de soins. Celui-ci reçoit l’argent de la part de l’assurance dépendance. Ces prestations sont principalement des prestations en nature et accessoirement des prestations en espèces dans l’hypothèse où une partie des actes essentiels de la vie (AEV) en faveur de la personne dépendante est assurée par l’aidant.
L’aidant est une tierce personne qui fournit intégralement ou partiellement les aides et soins à la personne dépendante à son domicile en dehors des réseaux d’aides et de soins.
Des actes supplémentaires de la part des infirmiers du réseau d’aides et de soins (pansements, piqûres…) restent à charge de l’assurance maladie.
Aids and care for the activities of daily living life (ADL)
The ADLs concern care and assistance in the following areas:
Hygiene: help with body and oral hygiene, shaving and facial waxing, menstrual hygiene.
Toileting: help with elimination of waste, help with changing the ostomy bag or emptying the urine drainage bag.
Nutrition: help with eating and hydration, help with enteral nutrition.
Dressing: help with putting on or taking off clothes, help with donning and removing off corrective and compensatory equipment.
Mobility: help with transfers, travel, getting in and out of housing, getting up and down stairs.
For more details on the different services, please consult the “reference system of care and assistance” which is Appendix II of the amended Grand-Ducal regulation of 18 December 1998 setting procedures for determining dependence.
Aid in the field of independence support activities (ISAs)
The purpose of the ISA is to learn or maintain the motor, cognitive or psychological abilities required to enable you to perform the activities of daily living or to limit the worsening of dependence for these same acts.
ISAs complement the care and assistance for ADL and cannot be separated from it. There must therefore be a direct link between the activities supporting independence and the activities of daily living. This direct link is to be understood as an intervention that arises from the intensity of the risk of deterioration of physical or psychological functions essential for performing activities of daily living or for the maintenance of these functions.
These activities are generally not likely to substantially reduce your dependence regarding ADL and are not intended to be rehabilitative. They are intended to prevent your ADL dependency from worsening or becoming more chronic.
The ISA are awarded to you if the following two conditions are met:
you are able to participate actively, mentally or physically, in the activities proposed;
you have the minimum comprehension and assimilation skills necessary for learning.
ISAs can be combined with home support activities.
ISAs can be provided individually or in groups, depending on your needs and regardless of where you live. The conditions for providing independence support activities do not prescribe the details of the area of intervention covered by the service, to allow for the necessary flexibility to meet the varying objectives and needs of the different ADL over time.
Independence support activities provided on an individual basis are covered up to a maximum of five hours per week. These activities can be carried out in groups for a maximum of 20 hours per week.
Home care
For home care, State Office for Assessment and Monitoring assesses and determines requirements for either individual or group care activities. These activities are covered when you are assigned one of the weekly caregiving levels of need if an ongoing need for supervision and support is identified.
These on-call activities are intended to ensure your safety, avoid harmful social isolation, and provide respite for the caregiver.
Assistive technology devices
Dependency insurance can cover assistive technology “to enable persons to maintain or increase their independence in the areas of personal hygiene, nutrition and meal preparation, mobility inside and outside the home, dressing, housekeeping activities and verbal or written communication”. They can address safety, prevention, and pain relief needs. They are also intended to facilitate the work of those providing care and support. Examples include a wheelchair, a medical bed, a lift, or other assistive devices such as a video enlarging system for a visually impaired person, communication aids etc.
Assistive technologies are made available free of charge to the person who needs them. However, the amount paid may not exceed €28,000 per device.
Long-term care insurance can also cover adaptations to cars for private use.
With respect to adaptations required for the driver’s seat and position, only those adaptations mentioned on the driving licence can be covered by long-term care insurance.
To make these entries on a driver’s license, please make an appointment at:
Ministère de la Mobilité et des Travauxpublics Département de la mobilité et des transports – Commission médicale
Tel. : +352 247-84466
If you would like to know which firms carry out car adaptations, you can contact:
Info-handicap Coordinateur en accessibilité 65, avenue de la Gare
L-1611 Luxembourg
Tel. : +352 366 466-1 Fax : +352 360 885
E-mail : info@iha.lu
Caisse nationale de santé (CNS) Assurance dépendance B.P. 1023
L-1010 Luxembourg
Your application is not considered complete until both the application form and the medical report are received by CNS.
Your living circumstances must be compatible with keeping a dog.
The school for guide dogs for the blind
If the conditions for receiving a financial subsidy from long-term care insurance for the acquisition of a guide dog are met, your file will be sent to the guide dog school in Woippy/Metz in France (Association des Chiens Guides du Grand Est).
The guide dog school will contact you and carry out an assessment. You will have to go to their premises to undergo a locomotion test using a tactile cane in an unfamiliar place and have an initial interview with the educators. Following this test, based on the file of the dependency insurance, the school will judge if you are physically able to move with a dog and if you master the locomotion techniques.
The school will study your habitual routes to ensure that they are safe. The school will visit you at home to get to know the environment in which the future guide dog will have to act. You will be invited to the school for a “dog trial” to validate the choice of dog recommended by the educators.
The training course and the handover of a guide dog
Un stage de 2 à 3 semaines, dont la date sera fixée avec vous, sera prévu afin de vous former, ainsi que votre entourage, à l’utilisation du chien. Il se tiendra en partie à l’école et en partie à votre domicile. À la fin du stage vous signerez le contrat avec l’école de chiens guides d’aveugles (Association des Chiens Guides du Grand Est) et la remise officielle du chien aura lieu. Il faudra s’attendre à un délai supérieur à 1 an pour le déroulement de la procédure jusqu’à la remise du chien guide d’aveugle.
La subvention de l’assurance dépendance comprend le prix d’acquisition du chien, les frais d’élevage auprès d’une famille d’accueil, les frais de formation du chien guide et les frais d’acquisition du harnais. Il comprend en outre les frais d’initiation à la technique de guidance au harnais à l’école et au domicile du bénéficiaire, ainsi que le suivi du chien par l’école. Les frais de déplacement et de séjour à l’école sont à la charge du demandeur.
Follow-up and support
You will be followed and accompanied by the guide dog school (Association des Chiens Guides du Grand Est) throughout the dog’s guide career, which is seven to nine years.
The costs of maintenance, food, veterinary fees and liability for damage caused by animals are to be borne by the beneficiary.
The beneficiary must undertake to respect the needs of the dog and to take care of the dog in accordance with the legislation on animal protection.
Contacts and usefuladdresses
Association des Chiens Guides du Grand Est École de Woippy 10, avenue de Thionville
F-57140 Woippy/Metz
Tel. : +33 3 87 33 14 36 www.chiens-guides-est.org
Adaptations to your home can be paid for to enable you to maintain or increase your independence in the areas of personal hygiene, meal preparation and mobility inside and outside the home.
Some examples of housing adaptation:
installation of a shower instead of a bathtub;
widening of a door to allow the passage of a wheelchair;
installation of a stairlift;
installation of a concrete access ramp;
installation of anti-slip materials on the floor etc.
Adaptations to residences are covered upon recommendation from the State Office for Assessment and Monitoring of Long-Term Care Insurance.
If an applicant is living in rented accommodation that is not suitable for their needs, the long-term care insurance may help to pay the extra cost of renting accommodation that is suitable or adaptable. The maximum amount that can be paid is €350 per month. The monthly contribution to the rent ends when the ceiling of €28,000 has been reached.
You must apply for LTC insurance in advance.
For persons desiring to remain at their home: you must occupy your adapted residence during the period that will be notified to you in the official decision. If you move without any compelling reason before the end of the period, you will have to reimburse the outstanding balance. (see amended Grand-Ducal regulation of 22 December 2006 determining (…) 2. the terms and limits of the coverage of housing adaptations by the long-term care insurance).
You must be:
the owner of your home;
a tenant or co-owner: after the State Office for Assessment and Monitoring (State Office for Assessment and Monitoring) of long-term care insurance has given its approval in principle for an adaptation of the dwelling, you must obtain a written agreement from the owner and the co-owner, based on a letter that you will receive from the State Office for Assessment and Monitoring.
Roll-out of the project
A State Office for Assessment and Monitoring expert will visit your home. This person will be your State Office for Assessment and Monitoring advisor and will follow up on your file, seeking the solutions that best suit you. If there is no assistive technology to mitigate your difficulties and if your life plan is to remain at home, the State Office for Assessment and Monitoring can recommend an adaptation for your home. The State Office for Assessment and Monitoring works in collaboration with ADAPTH asbl (Association for the Development and Distribution of Technical Aids for the Disabled) to adapt the home.
The ADAPTH expert comes to your home to analyse the different possibilities of adaptation. Their partner engineers or architects check the technical feasibility of recommended solutions and draw up an estimate of the cost of the work to be done.
If ADAPTH offers several solutions, your State Office for Assessment and Monitoring advisor will contact you to decide by mutual agreement which project to implement. This project is detailed by ADAPTH in a “functional specifications” document.
You must read the functional specifications carefully. You indicate your agreement or remarks regarding this solution to your State Office for Assessment and Monitoring advisor. After your initial agreement, any subsequent modification that you make to these specifications will result in additional expertise costs that will be invoiced to you.
On the basis of this agreement, a “technical specification” is drawn up by the ADAPTH partners, in which the technical details for the companies are transcribed.
Two copies of this technical specification document are sent to you for obtaining estimates. Two different companies of your choice must submit estimates. If you need assistance in finding a quote, you can contact ADAPTH.
Send these two estimates to your State Office for Assessment and Monitoring advisor who will analyse them and have them checked by ADAPTH if necessary.
Project construction
You will receive an official decision from the National Health Fund (CNS) indicating the amount of coverage as well as the names of the companies whose bids meet the specifications.
You must inform ADAPTH of your choice of contractor prior to awarding the job to one of the selected companies.
ADAPTH will monitor the site throughout construction.
Invoices for completed work should be submitted to ADAPTH for review. After verification, they will be forwarded to the CNS for payment to the companies.
You should be aware that the renovation work may cause some inconvenience. The places to be adapted will not be accessible throughout the duration of construction, on average between one and three weeks. In addition, unforeseen items may result in increasing the scope of the work and thus prolong it. Also, construction work involves the presence of workers and may cause dust, dirt, noise, etc.
The total duration of the procedure can vary from six to 24 months, depending on the scope of the final project.
The official handover of the work site will take place in the presence of your State Office for Assessment and Monitoring or ADAPTH advisor.
It is important to note that any adaptations to the home may result in a review of your ‘care and assistance’ plan.
Contact and useful address
ADAPTH asbl – Association pour le développement et la propagation d’aides techniques pour handicapé(e)s Centre de compétence national pour l’accessibilité́ des bâtiments (CCNAB)
36, rue de Longwy
L-8080 Bertrange
Tel. : +352 43 95 58-1
Fax : +352 43 95 58-99 www.adapth.lu
Incontinence equipment aid
A lump sum of €14.32 per month is granted for the use of incontinence equipment. The amount corresponding to one hundredth of the weighted cost of living index as at 1January 1948 is adjusted in accordance with the rules applicable to the salaries and pensions of civil servants.
Housekeeping assistance activities
LTC insurance may award housekeeping assistance activities if the dependent person is assigned one of the weekly caregiving needs levels (minimum 3.5 hours per week).
The activities of assistance in the maintenance of the dependent person’s household are covered on a flat-rate basis up to three hours per week.
Presence and supervision of a caregiver
These long-term care insurance benefits are granted if you remain at home without assistance and care, and if you are fully or partially cared for by one or more people around you. These people are called “caregivers“.
The State Office for Assessment and Monitoring (State Office for Assessment and Monitoring) assesses a caregiver ‘s abilities and availability to provide help and care in the areas of activities of daily living (ADL) at least once a week, as well as requirements for their supervision and training. This assessment is done via an assessment and determination tool and the reference base, an information sheet duly completed and signed by caregivers and an individual interview with the caregiver.
The assessment is used to evaluate the availability of caregivers, taking into account their professional situation, family responsibilities, and the geographical proximity of their home to you, to assess their psychological and physical abilities, and to evaluate the possibilities for time off available to him or her outside of long-term care insurance. A third party cannot be considered as a caregiver if he/she is assigned one of the weekly levels of personal assistance and care needs.
Following the assessment of the claimant and the caregiver, if applicable, they will draw up a summary of care detailing the benefits.
If State Office for Assessment and Monitoring determines that the assistance and care for the activities of daily living or the activities of assistance with housekeeping are provided entirely or partially by a caregiver as home care, it states how the required services will be implemented between this caregiver and the providers of the assistance and care networks in the coverage summary file. This allocation remains valid until a new summary is drawn up following a reassessment.
Allocation of the required services ends when a caregiver is unavailable to provide the required care and assistance, as determined by the ACS. If the caregiver is temporarily unavailable, the required care and assistance are provided by the care and assistance providers, without the coverage summary being changed.
A grand-ducal regulation defines the tool for evaluating and determining the benefits of long-term care insurance, a standardised form and the reference system for care and assistance used within the framework of the missions of the State Office for Assessment and Monitoring of long-term care insurance and establishes a standard form for the coverage summary. The same grand-ducal regulation may also define the time required for different pathologies and clinical situations in a fixed manner.
Considering the required services provided by the caregiver, the cost of assistance and care in the areas of the activities of daily living (ADL) by the providers of the assistance and care networks corresponds to one of the following packages:
Coverage of care and assistance in the activities of daily living (ADL) by providers of care and assistance networks
Package 0
125 minutes when the provider provides less than 210 minutes per week
Package 1
280 minutes when the provider provides between 210 and 350 minutes per week
Package 2
420 minutes when the provider provides between 351 and 490 minutes per week
Package 3
560 minutes when the provider provides between 491 and 630 minutes per week
Package 4
700 minutes when the provider provides between 631 and 770 minutes per week
Package 5
840 minutes when the provider provides between 771 and 910 minutes per week
Package 6
980 minutes when the provider provides between 911 and 1050 minutes per week
Package 7
1,120 minutes when the provider provides between 1,051 and 1,190 minutes per week
Package 8
1,260 minutes when the provider provides between 1,191 and 1,330 minutes per week
Package 9
1,400 minutes when the provider provides between 1,331 and 1,470 minutes per week
Package 10
1,540 minutes when the provider provides between 1,471 and 1,610 minutes per week
Package 11
1,680 minutes when the provider provides between 1,611 and 1,750 minutes per week
Package 12
1,820 minutes when the provider provides between 1,751 and 1,890 minutes per week
Package 13
1,960 minutes when the provider provides between 1,891 and 2,030 minutes per week
Package 14
2100 minutes when the provider provides between 2031 and 2170 minutes per week
Package 15
2,230 minutes where the provider provides between 2,271 minutes per week or more
There is also the option of requesting a cash benefit in lieu of the Activities of Daily living (ADL) and Housekeeping Assistance provided by caregivers.
On the basis of the summary coverage prepared by State Office for Assessment and Monitoring, the benefits in kind for the activities of daily living and for activities to assist with the upkeep of the household provided by the caregiver may be replaced by a cash benefit corresponding to one of the following packages:
Cash payments that can partially replace the assistance and care for activities of daily living (ADL) provided by assistance and care networks
Package 1
€12.50 per week when the caregiver provides less than 61 minutes per week
Package 2
€37.50 per week when the caregiver provides between 61 and 120 minutes per week
Package 3
€62.50 per week when the caregiver provides between 121 and 180 minutes per week
Package 4
€87.50 per week when the caregiver provides between 181 and 240 minutes per week
Package 5
€112.50 per week when the caregiver provides between 241 and 300 minutes per week
Package 6
€137.50 per week when the caregiver provides between 301 and 360 minutes per week
Package 7
€162.50 per week when the caregiver provides between 36 and 420 minutes per week
Package 8
€187.50 per week when the caregiver provides between 421 and 480 minutes per week
Package 9
€212.50 per week when the caregiver provides between 481 and 540 minutes per week
Package 10
€262.50 per week where the caregiver provides 540 minutes per week or more
This benefit ends if the caregiver is unavailable to provide the care and assistance according to summary coverage outlined by the State Office for Assessment and Monitoring.
For children up to the age of eight who are in a state of dependence, the duration of the services provided by the caregiver is also impacted by an adjustment coefficient taking into account the additional needs compared to a child of the same age who is sound in body and mind. The adjustment coefficients and the procedures for applying this provision shall be determined by Grand Ducal regulation.
Cash benefits are not subject to social security contributions or taxes.
A dependent person receiving a cash benefit is entitled to continued benefits at the time of entitlement to palliative care.
COMMENTS:
Two people may have the same level of dependency but different packages for benefits in kind and cash benefits, as these packages vary according to the sharing of tasks between a care network and caregiver.
Some explanations may be useful for better comprehension.
Levels of weekly care and support needs or “Dependency Level”
Depending on the needs for assistance and care in the activities of daily living (ADL), a dependent person is assigned one of 15 levels of weekly requirements in terms of assistance and care.
Each of these 15 levels corresponds to an interval of minutes of care to which a dependent person is entitled during a week.
Allocation of services
In the case of home care, we speak of a distribution of benefits if a care and assistance network (RAS) and a caregiver are involved in providing assistance and care to the dependent person. Allocation of the assistance and care to be provided between the RAS and the caregiver is established by the advisor of the State Office for Assessment and Monitoring of long-term care insurance ‘State Office for Assessment and Monitoring) during the assessment.
Allocating the procedures will make it possible to set the fixed rates of payment:
the in-kind benefit package to be paid to the network for its care
the cash benefit package to be paid to a dependent person to compensate the caregiver for their care.
Cash benefit
If a dependent person lives at home and has a State Office for Assessment and Monitoring-approved caregiver, part of the benefit in kind (help from a care network – RAS) can be converted into a cash benefit.
Only benefits in kind for the activities of daily living and for housekeeping assistance activities may be replaced by a cash benefit.
There are ten different cash benefit packages, depending on the amount of care provided by the caregiver. This package is allocated to a dependent person. It is intended to compensate caregivers who provide the help and care.
Cash benefits are payable from the date of notification of the decision if a claimant is recognised as dependent and if a private person providing the assistance and care is recognised as a caregiver.
Benefit in kind
In the context of long-term care insurance, assistance provided by a professional service (care network, semi-stationary centre or institution) is referred to as a benefit in kind.
There are 16 different packages depending on the amount of help and care required in activities of daily living. This package is paid directly by the CNS to the institutions. Where applicable, the costs of the various activities are also paid directly to the establishment.
The benefit in kind is due from the date of application if the applicant is recognised as dependent.
Assistance with housekeeping
This assistance consists in helping you to maintain the sanitation of the living areas of your home (bathroom, kitchen, bedroom, living room, dining room) and to ensure that basic supplies are available, i.e.:
cleaning and tidying up the living areas;
washing dishes and cleaning kitchen equipment;
ensure that food is edible;
purchase food and basic necessities;
change bedding;
washing and ironing clothes.
The act “ household assistance activities” can be combined with “independence support activities (ISA)” and with all forms of home support activities.
Assistance with housekeeping is covered on a flat-rate basis for up to three hours per week.
Palliative care services
If you require admission to hospice care, you do not have to file a “hospice insurance” claim and go through a State Office for Assessment and Monitoring assessment process, just have your doctor submit a “statement for hospice care” to the Social Security Medical Inspection unit.
In addition to the medical procedures provided for by the health insurance scheme, which are covered in accordance with the rules laid down in the statutes of the National Health Fund, you are entitled to the benefits of the long-term care insurance scheme, with the exception of adaptations to your home.
Aids and care in ADL areas provided by providers in the care and assistance networks are covered at a flat rate of 780 minutes of care and assistance needs. The other benefits to which you are entitled are covered within the limits provided. The Grand-Ducal regulation defines the conditions and processes according to which assistive technology costs are reimbursed for people receiving palliative care.
People who are already receiving LTC insurance and a cash benefit continue to be entitled to that benefit when they become eligible for hospice care.
What inpatient benefits are you entitled to?
If you live in a nursing home (nursing homes provide day and night accommodation and all the assistance and care you need, e.g. nursing homes or integrated centres for the elderly) and you receive assistance and care in this facility, the long-term care insurance will pay for the following benefits.
Aid and care in the activities of daily living (ADL)
When you receive assistance and care for the activities of daily living in an establishment with a continuous stay, the cost of the required services approved in the coverage summary is paid in full by applying the following fixed amounts:
Coverage of EYL-related care and assistance provided by network providers
Package 1
280 minutes when a provider allots between 210 and 350 minutes per week
Package 2
420 minutes when a provider allots between 351 and 490 minutes per week
Package 3
560 minutes when a provider allots between 491 and 630 minutes per week
Package 4
700 minutes when a provider allots between 631 and 770 minutes per week
Package 5
840 minutes when a provider allots between 771 and 910 minutes per week
Package 6
980 minutes when a provider allots between 911 and 1050 minutes per week
Package 7
1,120 minutes when a provider allots between 1,051 and 1,190 minutes per week
Package 8
1,260 minutes when a provider allots between 1,191 and 1,330 minutes per week
Package 9
1,400 minutes when a provider allots between 1,331 and 1,470 minutes per week
Package 10
1,540 minutes when a provider allots between 1,471 and 1,610 minutes per week
Package 11
1,680 minutes when a provider allots between 1,611 and 1,750 minutes per week
Package 12
1,820 minutes when a provider allots between 1,751 and 1,890 minutes per week
Package 13
1,960 minutes when a provider allots between 1,891 and 2,030 minutes per week
Package 14
2,100 minutes when a provider allots between 2,031 and 2,170 minutes per week
Package 15
2,230 minutes when a provider allots 2,171 minutes per week or more
The ADLs decided on in the coverage summary cannot be billed, even if they have been refused by the dependant or exceed the planned package. This rule does not apply if the dependent person requests care and assistance in an ADL area not provided for in the coverage summary.
Independence Support Activities (ISAs)
The purpose of these activities is to learn or maintain the motor, cognitive or psychological skills required to perform the activities of daily living or to limit the worsening of dependence for these same acts.
ISAs are awarded if the following two conditions are met:
the dependent person can participate actively, mentally or physically, in the proposed activities;
the dependent person has minimal comprehension and assimilation skills with the activities of accompaniment in the institution.
ISAs can be combined with institutional support activities.
ISAs provided on an individual basis are covered for a maximum of five hours per week. These activities can be carried out in groups for a maximum of 20 hours per week.
The long-term care insurance can pay for support activities when you stay in a long-term care facility (AAE)
AEs consist of daytime supervision of a dependent person. The aim is to ensure the safety of the dependent person who cannot be left alone for a long time or to avoid harmful social isolation. They help to structure the daily routine of a dependent person and enable participation in occupational or social activities. They are provided in the community.
AAEs are awarded to dependent persons in care and support facilities.
The “support activities in LTC facilities (AAE)” act can be combined with independence support activities.
The accompanying activity you need in a continuous stay establishment is covered according to a fixed rate of four hours per week. This package can be increased to ten hours per week if you need specific and personalized supervision requiring sustained monitoring.
Long-term care insurance can provide you with assistive technologies
The granting of assistive technologies differs according to where a beneficiary is staying. Assistive technologies may be covered by long-term care insurance for persons staying in a long-term care facility or in supervised accommodation, but the coverage is more restrictive (see list of assistive technologies covered by the long-term care insurance appended to the amended Grand Ducal Regulation dated 22 December 2006). Long-term care facilities and supervised housing must have a range of assistive technologies, in accordance with the approvals required under the legislation governing relations between the State and entities working in the social, family, and therapeutic fields.
Examples of assistive technologies: walkers, wheelchair etc.
What benefits are you entitled to during an intermittent stay in a care facility?
When dependent persons receive care and assistance during an intermittent stay in a facility, they are entitled to the benefits referred to in the text above for the periods of stay in this establishment and to the benefits referred to in the text above for the periods they stay at home.
If dependent persons are in an institution financed by the State budget, they are entitled to the benefits referred to in the above text for the periods they stay at home.
Under what conditions are your services covered?
Long-term care insurance benefits are payable at the earliest from the date an application is submitted, which includes the application form, accompanied by the Caregiver Information Sheet, where appropriate, and the duly completed report of an attending physician.
Benefits may be granted for a fixed or an indefinite period.
There are two types of benefits: benefits in kind and cash benefits.
Benefits in kind at home and in care facilities
If a dependent person lives at home
If only a care and assistance network (RAS) is involved, the fees for benefits in kind in the area of the activities of daily living (ADL) are paid directly by the National Health Fund (CNS) to the RAS. Where applicable, the costs of the various activities are also paid directly to the RAS.
If an RAS and a caregiver are involved in the care, distribution of the required care and assistance, i.e. allocation to what is carried out by the RAS and what is carried out by the caregiver, is used in the coverage summary. Depending on the distribution chosen, the respective fees for benefits in kind and cash benefits will be paid directly by the CNS to the RAS for benefits in kind and directly by the CNS to the dependent person for cash benefits.
If a dependent person lives in a facility for the elderly or disabled
Long-term care insurance covers the costs of the assistance and care required for the activities of daily living by dependent persons: the lump sum for benefits in kind for the activities of daily living is paid directly by the CNS to the institutions. There are 15 different packages depending on the amount of care and assistance required. If necessary, the costs of the various activities granted are also paid directly to the establishment.
The cost of board and lodging (which includes the cost of renting a room, food and supervision) – the amount of which varies according to the different facilities – is always paid by the persons living in an establishment, whether or not they are dependent.
Cash benefits
If a dependent person lives at home, the law provides that a person who participates in the assistance and care on a regular basis, and at least once a week, can be hired as a caregiver under certain conditions.
This caregiver may be a relative or a private person you have hired. In order for a replacement of benefits in kind (assistance from a care and assistance network) with a cash benefit to be possible, this caregiver must be identified and assessed by the State Office of Assessment and Monitoring.
Only benefits in kind for the activities of daily living and for activities to assist with housekeeping can be replaced by a cash benefit. There are ten different cash benefit packages, depending on the extent of care provided by caregivers.
Cash benefits are paid after the due date.
Payment may be contingent upon producing a life certificate.
The payment of the cash benefit ends on the day a managing body for long-term care insurance determines that the caregiver is unavailable. If this ascertained unavailability is temporary, the payment of the cash benefit is suspended during the periods when the required assistance and care are provided by the assistance and care providers.
Payment shall be made by postal or bank transfer to the account of the beneficiary or, in the case of a minor child or a person under guardianship, to the account of the legally authorized person. The costs are borne by the beneficiary.
Certain groups of people are eligible for LTC insurance and receive a flat-rate cash benefit under other conditions.
These include:
people with reduced visual acuity;
people with communication difficulties due to severe hearing problems, aphasia, dysarthria, and those who have had a laryngectomy;
people with a symptomatic form of spina bifida.
Once the criteria for a hearing or vision impairment have been assessed by an ENT or ophthalmic specialist, approved by the LTC Insurance State Office for Assessment and Monitoring (State Office for Assessment and Monitoring), the person is eligible for a lump sum cash benefit.
When and how can your care and support needs be reassessed?
At the initiative of the State Office of Assessment and Monitoring (State Office for Assessment and Monitoring), a reassessment of your needs may take place under the following conditions and procedures:
when the services required in the areas of the activities of daily living (ADL) set out in the coverage summary are fully completed by a service provider, the reassessment shall be carried out at the earliest two years after the notification of the final decision on the care;
when the required services agreed upon in the coverage summary are fully or partially provided in your home by a caregiver, the reassessment is carried out at the earliest one year after the notification of the final decision of care
when you leave home to be cared for in a care and assistance facility, the reassessment is carried out within six months of your admission;
When you apply for assistive technologies or housing adaptation, the State Office for Assessment and Monitoring can reassess all your needs;
when the State Office for Assessment and Monitoring identifies a fundamental change in circumstances, it may reassess your needs.
Upon receipt of a substantiated request by you, your family members, the caregiver or a provider, or at the initiative of the managing body of LTC insurance, the State Office for Assessment and Monitoring assesses whether a re-evaluation of your requirements is appropriate. A request for a reassessment of benefits is only admissible after one year has elapsed since the notification of the final decision to cover you, unless a doctor’s medical report attached to the request shows that there has been a fundamental change in circumstances in the meantime.
The reassessment of need and the determination of the benefits required is done using the same criteria as at the time of the initial application for LTC insurance benefits.
When the required services outlined in the coverage summary is fully or partially performed by a provider, the provider may be tasked to reassess needs and determine required benefits upon request by the State Office for Assessment and Monitoring. The State Office reviews and supplements the data collected by the LTC assessment and benefit determination tool, if applicable.
Based on the reassessment of needs and the determination of the required services, the State Office prepares a new coverage summary.
A decision to increase benefits shall take effect on the first day of the week in which the claim is submitted. A decision to reduce benefits shall not take effect until the first day of the week immediately following the week in which it was notified.
Under what circumstances can your benefits be withdrawn?
Any LTC benefit is discontinued if the conditions for which it was provided fail.
If the basis for calculation changes or if it is found that the benefit was granted as a result of a material error, the benefit shall be increased, reduced or withdrawn.
All persons who cause benefits to be awarded by alleging false facts or concealing material facts or failing to report such facts after an award of benefits must be returned.
The decision to return benefits can only be made after you have been heard either orally or in writing. Cash benefits will be withdrawn or reduced if it appears from a notice by the State Office for Assessment and Monitoring that they are not being used for the specified purpose, without prejudice to a corresponding increase in benefits in kind.
For all decisions to withdraw, reduce or terminate LTC benefits, the State Office for Assessment and Monitoring shall be consulted.
What is the statute of limitations for benefits?
Legal action of care and assistance providers for their services against insured persons or against the entity responsible for managing the dependency insurance is time-barred after two years from the date that services were provided.
Insured persons’ legal action against an insurance institution shall be barred within the same period from the date of entitlement.
When can benefits be suspended or terminated?
Benefits in kind are suspended during a hospital stay. The entitlement to cash benefits received in the week preceding the hospitalisation is maintained for the three weeks following admission. However, in the event of successive stays, entitlement to cash benefits may not be retained over 21 days per year.
By way of derogation from paragraph 1 above, a dependent person under the care of a functional re-education and rehabilitation centre may receive the benefits in kind necessary to remain at home for the time spent outside this centre at the expense of LTC insurance. Benefits are awarded following a review by the State Office for Assessment and Monitoring.
To what extent can LTC insurance benefits be combined with other benefits?
Long-term care insurance benefits are not due when you are entitled to the same type of benefits under the public health insurance scheme. However, if you are entitled to the cost of assistive technologies under the long-term care insurance scheme, this entitlement takes priority.
Long-term care insurance benefits are not payable if you are entitled to benefits of the same kind under accident insurance, war damage legislation, disability legislation and differentiated education legislation.
The aid provided for housing assistance is suspended until the cost of adaptations to the home provided by the long-term care insurance is covered.
To what extent can LTC insurance benefits be combined with assistance?
The provisions concerning long-term care insurance do not alter the legal obligations of the State, the municipalities and the social offices to assist needy persons, nor do they alter legal, statutory, contractual or testamentary obligations concerning the assistance of insured persons or their survivors.
However, the State, the municipality or the social office which has assisted a needy person for a period during which he was entitled to dependency insurance benefits, may be reimbursed for their expenses within the limits of the benefits provided for by law.
The organisation responsible for managing dependency insurance is obliged to inform, on request, the assistance organisations whether and to what extent the persons they have assisted are entitled to the benefits provided for by law.
To what extent is the long-term care insurance subrogated to your rights in the event of the recurrence of damage caused by a third party and covered by the insurance?
If insured persons or their dependants are entitled to claim compensation for damage caused to them by a third party under a legal provision, the right shall pass to the organisation responsible for administering the long-term care insurance up to the amount of the benefits and insofar as it concerns the elements of damage covered by the long-term care insurance.
Paragraph 1 shall not apply to compensation for damage caused by harmful events occurring before 1January 1999.
How is LTC insurance financed?
In order to meet the costs it incurs, the long-term care insurance scheme applies the system of burden sharing by provisioning a reserve which may not be less than 10% of the annual amount of current expenditure.
Apart from investment income and other miscellaneous resources, the resources needed to finance the insurance are made up of:
a contribution of 40% of total expenditure by the State, including the allocation to the reserve;
by a special contribution consisting of the proceeds of the “electricity” tax chargeable to any final customer, including self-generation, with an annual consumption of more than 25,000 kWh, charged to the electrical energy sector, which is allocated to the financing of the dependency insurance;
the remainder is financed through a dependency contribution of 1.4% deducted from professional income and replacement income by insured persons.
Who pays the dependency contribution and how is it calculated?
The basis for the dependency contribution is professional income and replacement income as well as income from assets. There is no ceiling, and the contribution is not tax deductible.
If you are an employee, civil servant, recipient of a pension, REVIS inclusion allowance or unemployment benefit, the dependency contribution is calculated on your professional or replacement income, after deducting one quarter of the minimum social wage (see Social parameters).
In case of part-time work, this deduction is prorated according to the number of hours declared in relation to 173 hours. The same applies to the deduction on replacement income subject to the dependency contribution and on sick pay.
If you are a pensioner and you work as an employee or in a similar capacity, the deduction is applied to your professional income and prorated as described above. Any remaining deduction is deducted from your pension.
The dependency contribution is established and collected by the Joint Social Security Centre (CCSS). It is deducted by the employer or the institution paying the replacement income.
If you receive income from assets (rent, dividends, profit shares, etc.), the contribution is also levied on this income. However, the allowance of one quarter of the minimum social wage (see Social parameters) does not apply. In addition, the dependency contribution is not to be considered as income tax and does not fall under the operating expenses, procurement costs or special expenses provided for under income tax.
The establishment and collection of the dependency contribution on income from assets on behalf of the managing body of the dependency insurance scheme is the responsibility of the Direct Tax Administration.
Who is responsible for managing LTC insurance?
The National Health Fund (CNS) is responsible for the management of long-term care insurance.
The task of the CNS Board of Directors is to:
decide on the annual budget and the annual statement of income and expenditure of the long-term care insurance, to be approved by the Minister responsible for Social Security on the advice of the supervisory authority;
prepare the negotiations to be conducted by the President or his representative with the care and assistance providers and to decide on the outcome of these negotiations;
make individual benefit decisions.
Decisions of the Board of Directors are taken by majority vote.
What are the avenues of appeal against a decision of the CNS regarding LTC insurance?
At the request of an insured person, any matter of individual concern may be subjected to a decision by the President of the National Health Fund or his representative. This decision is taken in the absence of a written objection from the person concerned within 40 days of notification. The objection shall be disposed of by the Board of Directors.
Applications for benefits and objections filed following a decision of the President of the National Health Fund or his representative are properly filed if they are filed by the applicant himself, his legal representative, his partner or one of the persons entitled to represent the applicant at a court hearing. If the representative is not a lawyer, he or she must provide proof of a written power of attorney.
The prerogatives referred to in the preceding paragraph may also be exercised by duly mandated representatives of professional organizations or trade unions.
Applications for benefits are still routinely made if the applicant’s treating physician certifies on the completed application form that the applicant is incapable of acting and if the physician certifies that he or she has made the declaration requiring the applicant to be placed under court protection.
Decisions on benefits taken by the Board of Directors may be appealed to the Social Security Arbitration Board.
The Conseil arbitral de la sécurité sociale (Social Security Arbitration Board) gives a final decision up to the value of €1,250 and may appeal if the value of the dispute exceeds this sum. The appeal is brought before the High Council of Social Security.
Le Conseil arbitral de la sécurité sociale statue en dernier ressort jusqu’à la valeur de 1 250 euros et à charge d’appel, lorsque la valeur du litige dépasse cette somme. L’appel est porté devant le Conseil supérieur de la sécurité sociale.
What is the role of the State Office for Assessment and Monitoring of LTC insurance (AEC)?
The State Office for Assessment and Monitoring (AEC) is a state administration under the authority of the minister responsible for social security and has the tasks of evaluation, monitoring and advice regarding dependency insurance benefits.
The State Office for Assessment and Monitoring issues opinions, determines the assistance and care of dependent persons and prepares coverage summaries.
Every two years, the State Office for Assessment and Monitoring:
checks and measures the adequacy of the services actually provided and the required services set out in the coverage summary by reviewing the care documentation provided by the care providers and, if necessary, making a visit to dependent persons;
monitors the quality of the services provided to dependent persons by means of indicators, the documentation of the care provided by the care providers and, if necessary, by visits to dependent persons.
The State Office for Assessment and Monitoring prepares a biennial report on the controls it carries out, which it forwards to the Board of Directors of the National Health Fund (CNS), to the Ministers responsible for Social Security and Health, and to the Ministers responsible under the legislation regulating relations between the State and institutions working in the social, family and therapeutic fields.
The State Office for Assessment and Monitoring informs and advises the protected persons, and the people close to a dependent person, including the caregiver, doctors and assistance and care professionals working in the field of dependent persons.
It advises the managing body of the LTC insurance and the ministerial departments responsible for financing and approving services and care and assistance facilities with a view to adapting the structures to the needs of the dependent population.
It provides expertise at the request of other public services.
The opinions of the State Office for Assessment and Monitoring having individual scope are binding on the entity responsible for managing dependency insurance. Without prejudice to the foregoing provisions, the Arbitration Board and the High Council of Social Security may in any event appoint independent experts. If the opinion of the State Office for Assessment and Monitoring has been contradicted by the expert appointed by the Arbitration Board, the entity itself shall decide whether or not to appeal.
The State Office for Assessment and Monitoring carries out its duties by obtaining information and conducting an assessment at the usual place of living of the persons applying for LTC insurance benefits, and their caregiver if applicable. Considering the condition of a dependent person, the assessment may take place in the examination rooms available to the LTC Insurance State Office of Assessment and Monitoring.
The staff of the State Office for Assessment and Monitoring may, in the performance of their duties and provided with the supporting documents for their functions, visit the homes of persons who have requested the care and assistance, assistive technologies and adaptations to the dwelling provided for in this booklet or the establishment which accommodates them, in order to make the observations required for granting, maintaining or withdrawing benefits. Visits to the home or to the facility may only take place between 6:30 a.m. and 8:00 p.m.
State Office for Assessment and Monitoring staff may receive care and support documentation for dependent persons from the care and support providers.
State Office for Assessment and Monitoring staff cannot benefit from inter vivos or testamentary dispositions made in their favour by a person during the period in which he or she was in receipt of LTC benefits, except in the case of relatives up to and including the fourth degree.
By way of derogation from the provisions requiring them to maintain professional secrecy, the employees of the administrations and social security bodies are required to provide State Office for Assessment and Monitoring with the information in their possession that is necessary for the performance of the tasks entrusted to it.
The State Office for Assessment and Monitoring may conclude partnership agreements with specialised services for the performance of its tasks, provided that these services have not concluded a care and assistance contract with the managing entity of the dependency insurance.
Le personnel de l’AEC ne peut profiter des dispositions entre vifs ou testamentaires faites en sa faveur par une personne pendant la période où elle a touché des prestations de l’assurance dépendance, sauf dans le cas de parenté jusqu’au quatrième degré inclusivement.
Par dérogation aux dispositions qui les assujettissent au secret professionnel, les agents des administrations et organismes de sécurité sociale sont tenus de fournir à l’AEC les renseignements qu’ils détiennent et qui sont nécessaires à l’exercice des missions lui confiées.
L’AEC peut conclure des accords de partenariat avec les services spécialisés en vue de la réalisation de ses missions pour autant que ces services n’ont pas conclu un contrat d’aides et de soins avec l’organisme gestionnaire de l’assurance dépendance.
What is the role of the advisory commission?
An advisory commission has been established, consisting of the following members:
one representative of the Minister responsible for Social Security;
two members representing the State Office of Assessment and Monitoring (AEC);
two members appointed respectively by the ministers responsible for health and the family;
the president of the organization responsible for managing the long-term care insurance or his representative
two members appointed by and from among employee representatives;
two members appointed by the professional group(s) representing the care and assistance providers;
two members appointed by the High Council for the Disabled and the High Council for the Elderly.
The representative of the Minister responsible for Social Security shall act as chairman of the commission.
For each full member there shall be an alternate member. The committee may consult with experts.
The Advisory Commission may refer to itself any matter relating to its terms of reference in order to:
give its opinion on the Grand-Ducal regulation which determines the tool for evaluating and determining the benefits of the dependency insurance, the standard statement and the reference system for care and assistance used within the framework of the State Office for Assessment and Monitoring’s missions and which establishes a standard form for the coverage summary;
recommend a list of assistive technologies covered by the dependency insurance scheme, to be drawn up by grand-ducal regulation;
give its opinion on the standards concerning the qualification and staffing of personnel as well as on the coefficients of qualification of the personnel and management of the group.
The Commission may also be referred to the ministers responsible for social security, health or family affairs, the State Office for Assessment and Monitoring, the entity responsible for managing dependency insurance, or the professional group(s) representing care and assistance providers.
In the event of a tie vote in the committee or sub-committee, the Chairman’s vote shall prevail.
The operating costs of the Commission are borne entirely by the State.
What are the quality standards and indicators for LTC insurance benefits?
The services to be paid for by the nursing care insurance are provided by the assistance and care providers in compliance with the standards concerning the qualification and staffing of the personnel, and in accordance with the coefficients for the qualification of the personnel and the management of the group, laid down by Grand-Ducal regulation (see legal basis below) and the Advisory Commission requested in its opinion.
This grand-ducal regulation also determines how quality control of the services is carried out, as well as the content of the quality indicators of the care. The indicators are used by the State Office for Assessment and Monitoring to measure the quality of the care of dependent persons and correspond to a census of the number of dependent persons with a bedsore, of dependent persons for whom pain assessment is carried out, of the prevalence of falls and their recurrence among dependent persons, of the nutritional follow-up of dependent persons, of the formalised system of complaint management and of the content of the documentation.
How is the relationship between LTC insurance and the different categories of care providers regulated?
The relationship between the long-term care insurance and the various categories of care and assistance providers referred to in the following articles is defined by framework agreements. These agreements are concluded between the managing entity of the long-term care insurance and the professional group(s) representing the care and assistance providers.
The agreements shall include the following requirements:
the commitment to provide dependent persons with the necessary care and assistance in accordance with the services required in the coverage summary and to provide these services in accordance with the quality provisions
procedures and arrangements for documenting staffing and qualification standards
the commitment to provide continuous care and assistance every day of the year
the procedures for assembling documentation for invoicing and payment of services provided, as well as for their verification
the terms and conditions under which dependent persons and the service provider enter into the care contract and may terminate it
an undertaking to keep accounts in accordance with a uniform chart of accounts supplemented by an analytical section. The chart of accounts as well as the modalities and rules for cost accounting are set by the managing body of the dependency insurance
the procedures for coordinating assistance and care and all the services concerning dependent persons, as well as the procedures for cooperation amongst the various participants.
When care providers are not able to meet the conditions set out in points 1 and 3 above, they must prepare a in a written contract stating that they have secured the assistance of another provider to provide the assistance and care required by the dependent person in their care under the conditions set out therein.
Framework agreements shall be concluded for an indefinite period and shall be effective only for the future. They may be amended at any time by mutual agreement of the signatory parties and may be terminated in whole or in part by either party giving 12 months’ notice. Negotiations for their total or partial renewal shall be initiated within two months of termination, on a date published in the Mémorial at the initiative of the CNS.
The service providers adhere to the framework agreement by means of a care and assistance contract concluded with the managing entity of the dependency insurance. The care and assistance contract specifies the circle of persons cared for by the provider and, in the case of home care providers, the geographical scope of its activities, which may not be inferior than that corresponding to the territory of an electoral district.
The framework agreements shall be published in the Mémorial, where appropriate, in the form of a coordinated text.
What is meant by "care and assistance providers"?
These are the care and assistance networks, which mainly provide home help and the care and assistance facilities that are integrated centres for the elderly, nursing homes, intermittent stay care, assistance facilities and specialised day centres.
What is meant by "care and support networks"?
A care and assistance network is a validly constituted group of one or more natural or legal persons providing dependent persons maintained at home with the care and assistance required depending on their state of dependence.
All assistance and care provided within the framework of an assistance and care network must be provided by persons carrying out their activities through an authorisation issued by the competent minister pursuant to the legislation regulating relations between the State and entities working in the social, family and therapeutic field and having concluded an assistance and care contract with the entity responsible for managing the dependency insurance.
Care and support networks can use semi-stationary centres.
The following are considered to be semi-stationary centres: institutions that receive dependent persons either during the day or at night, in the event of home care, and provide them with the assistance and care required depending on their state of dependence during their stay in the centre, having concluded a contract with the managing entity of the dependence insurance for this purpose.
What is a "long-term care facility"?
There are two types of care facilities: continuous stay and intermittent stay long-term care facilities.
Continuous stay facilities
Continuous stay care facilities are facilities where the person resides on a permanent basis. They are either integrated centres for the elderly which accommodate both able-bodied and dependent persons, or care homes which only accommodate dependent persons.
If you want a room in a facility, you can apply directly to the facility of your choice, as facilities are responsible for deciding who to place in beds that become vacant.
A public or private long-term care facility carries out its operations either by virtue of an approval issued by the competent minister pursuant to the legislation governing relations between the State and entities working in the social, family and therapeutic fields, or by virtue of another legal provision, and must have concluded a care and assistance contract with the entity managing the dependency insurance scheme for this purpose.
Intermittent stay facilities
Intermittent stay facilities are facilities where a person alternates between staying in a facility and staying at home. These facilities are only for people with disabilities.
The establishment must provide all the care and assistance required by the dependent person during the period of stay in the facility in accordance with the terms and conditions laid down in the framework agreement.