Care assistant under sections 43b and 53b SGB XI

People in need of care who live in inpatient care facilities (nursing homes, short-term care, day and night care) are entitled to additional support and activation under section 43b SGB XI. This means attention that goes beyond the care that is strictly necessary. SGB XI is the eleventh book of the German Social Code, the law on statutory long-term care insurance. People who take on this task are called additional care assistants (zusätzliche Betreuungskräfte).

The qualification these staff need and their duties are set out in the Betreuungskräfte-Richtlinie of the GKV-Spitzenverband (the national association of the statutory health insurance funds). The legal basis is section 53b SGB XI. The guideline only takes effect once the Federal Ministry of Health has approved it. The current version was adopted on 21 October 2022. Older texts and course offers still refer to section 87b SGB XI (until 2016) or section 53c SGB XI (2017 to 2019). The guideline was amended several times in that period and the section number changed.

According to the guideline, care assistants look after and activate people in need of care. This includes motivating them to take part in everyday activities and accompanying them, for example painting and crafts, cooking and baking, listening to music and singing, board and card games, walks and outings, reading and reading aloud, or looking at photo albums. They are also available for conversations about everyday matters and worries.

Under the guideline, additional care assistants are not nursing staff. They may not be involved regularly or as a planned part of their work in personal care tasks or housekeeping. Medical nursing measures (for example wound care on a doctor's orders) remain reserved for qualified nursing staff. Help that is urgently and directly needed during a care activity is part of the role when no nurse is available at that moment.

The guideline provides for three building blocks. First, an orientation internship of 40 hours in a care facility. Then the qualification itself, with at least 160 teaching hours and a two-week care internship, divided into a basic course (100 teaching hours), the care internship and an advanced course (60 teaching hours). Care assistants who are employed also complete further training of at least 16 teaching hours every year. A therapeutic or nursing degree is not required for the work. People who already have a suitable training, for example as a registered nurse or with a state-regulated nursing assistant training of at least one year, are in principle treated as already meeting the requirements.

The guideline does not name specific course providers. Courses are offered by aid organisations and training providers, among others. The Malteser describe on their website a compact course of 160 teaching units of 45 minutes each plus an 80-hour care internship. Participants receive a certificate as proof there.