Understanding the MDK Assessment
The assessment by the Medical Service (Medizinischer Dienst, formerly MDK) is the pivotal event in the care level application process. The outcome of this single visit determines the care level and therefore all future benefits. Because so much depends on this assessment, thorough preparation is essential.
The assessor is typically a trained nurse or physician with experience in geriatric care and the NBA assessment system. They visit the care recipient at home and evaluate independence across six standardized modules. The entire visit usually lasts between 60 and 90 minutes, during which the assessor observes, asks questions, and documents their findings.
It is important to understand that the assessor is not an adversary. Their job is to objectively evaluate the care situation and assign the appropriate care level. However, the assessment captures only a snapshot of one day, which may not represent the typical care needs. This is why preparation is so crucial: it ensures that the assessor has the full picture.
The Care Diary: Your Most Important Tool
A care diary (Pflegetagebuch) is a detailed daily record of all care activities, the time required for each, and any difficulties encountered. It should be kept for at least two weeks before the scheduled assessment, ideally longer. The diary serves two purposes: it provides objective documentation that the assessor can review, and it helps the care recipient and family articulate their needs clearly during the interview.
For each entry in the care diary, record the following: the date and time, the specific activity (for example, assistance with showering, meal preparation, medication administration), the duration of the activity, the level of assistance required (prompting, partial assistance, or full assistance), and any special circumstances or difficulties.
Pay particular attention to nighttime care needs, which are easy to forget but carry significant weight in the NBA assessment. If the care recipient requires assistance during the night for toileting, repositioning, or because of confusion or anxiety, these episodes should be documented with times and durations.
Many care counseling services and insurance funds provide template care diaries that can be downloaded and printed. These templates are organized by NBA module, which makes it easy to ensure all relevant areas are covered.
Gathering Medical Documentation
Compile all relevant medical documentation well before the assessment date. This includes current medication lists, doctor's reports from all treating physicians, hospital discharge summaries from any recent stays, rehabilitation reports, specialist assessments (for example, neurological or psychiatric evaluations), and any previous care assessments or objection decisions.
Organize the documents chronologically and prepare a brief summary of the care recipient's medical history, including diagnoses, surgeries, and significant health events. This saves time during the assessment and demonstrates that the care needs are well-documented and substantiated.
If the care recipient has cognitive impairments such as dementia, bring documentation of the diagnosis and any cognitive testing results. Cognitive and behavioral issues (NBA Modules 2 and 3) are important components of the assessment and are sometimes underestimated if not properly documented.
Behavior During the Assessment
The single most important behavioral guideline is to be honest and realistic about the care situation. This means showing the actual level of difficulty and dependence, not the best possible day. Many care recipients instinctively try to appear more independent than they typically are, out of pride, embarrassment, or a desire to seem strong. This well-meaning behavior directly undermines the assessment outcome.
Do not clean the house to perfection before the assessment or dress the care recipient in their finest clothes if they normally need assistance with these activities. The assessor needs to see the everyday reality, not a staged best-case scenario. If the care recipient normally struggles with buttons, let them demonstrate that struggle rather than dressing them beforehand.
When the assessor asks questions, answer thoroughly and honestly. If the care recipient has good days and bad days, describe both and emphasize that the assessment should reflect the typical or slightly worse-than-typical day. Quantify difficulties wherever possible: instead of saying the care recipient sometimes needs help with eating, specify how often and what kind of help is needed.
Allow the care recipient to attempt tasks themselves during the assessment rather than jumping in to help. The assessor needs to observe the actual level of independence. If the care recipient cannot complete a task or completes it only with great difficulty, this is valuable information that supports an accurate assessment.
The Role of the Accompanying Person
Having a trusted person present during the assessment is not just recommended but can make a significant difference in the outcome. The accompanying person can be a family caregiver, a friend who is familiar with the care situation, a professional care counselor, or an advocate from a patient support organization.
The accompanying person serves several functions: they can provide additional observations that the care recipient may forget to mention, they can offer a second perspective on the level of assistance needed, they can ensure that the assessment covers all relevant areas, and they can take notes during the assessment for future reference.
Before the assessment, discuss with the accompanying person which aspects of care are most important to highlight. Review the care diary together and identify any points that might be overlooked. During the assessment, the accompanying person should participate actively but allow the assessor to lead the conversation.
Module-by-Module Preparation Tips
Module 1 (Mobility): Demonstrate any difficulties with changing position in bed, maintaining a stable sitting position, transferring from bed to chair, moving within the home, and climbing stairs. If assistive devices are used, show them and explain why they are necessary.
Modules 2 and 3 (Cognitive abilities and behavioral issues): If the care recipient has dementia or other cognitive impairments, document specific examples of disorientation, inability to make decisions, anxiety, aggression, or nighttime restlessness. These modules share a combined weight, with only the higher score counting, so it is important to be thorough in both areas.
Module 4 (Self-care): This is the most heavily weighted module at 40 percent. Cover all aspects of personal hygiene, eating, drinking, and toileting. If the care recipient needs assistance with any of these activities, even partial assistance or prompting, this should be clearly demonstrated and documented.
Module 5 (Managing disease-related demands): Document the complexity of medication management, the frequency of doctor visits, and any therapies that require coordination. If the care recipient needs daily medication administration, wound care, or blood sugar monitoring, these all contribute to the score.
Module 6 (Organizing daily life): Describe the care recipient's ability to structure their day, maintain social contacts, and engage in meaningful activities. Isolation, inability to plan the day, or dependence on others for structuring activities all increase the score in this module.
After the Assessment
After the assessor leaves, write down your impressions while they are fresh. Note which topics were discussed, whether you feel all relevant aspects were covered, and any areas where you think the assessment may not have captured the full extent of care needs. These notes will be invaluable if you need to file an objection later.
The assessor produces a report that is sent to the care insurance fund, which then makes the formal decision. When you receive the decision, compare the module scores in the assessor's report with your own observations and care diary. If significant discrepancies exist, this is grounds for an objection.
Remember that the care level can be reassessed at any time if the care situation changes. If the initial assessment does not result in the expected care level, a well-prepared objection or a new application after the care situation has been documented more thoroughly can lead to a different outcome.