A guide to a place in a nursing institution: who determines the classification, how public funding through the Ministry of Health works, what the co-payment is, what part children play in the calculation, and how it fits with private long-term care insurance.
Two separate worlds: public and private
When a family reaches the point of a place in a nursing institution, it meets two entirely different routes, and sometimes confuses them.
The public route is Ministry of Health funding for a place in a nursing institution, subject to classification, entitlement tests and a co-payment.
The private route is a long-term care insurance policy, assessed according to its own definition and unconnected to the Ministry of Health's classification.
The two routes do not contradict each other, and it is worth checking both. Pele Yoetz focuses on the insurance side; for the public route you should approach the Ministry of Health or the health fund.
The classification — who determines it and why it matters
The health system uses classifications determining which setting a person is suited to and who is responsible for funding it. The accepted terms are frail, cognitively frail, nursing care and complex nursing care.
The classification is determined by an authorised body in the health system, in accordance with the rules. It is not determined by the family and not by the institution itself.
Its practical significance: the classification affects the type of setting, the funding body and the process. So it is a point worth understanding early rather than discovering halfway through.
The co-payment — the part that surprises people most
Public funding for a place in a nursing institution is not complete. There is a co-payment calculated according to rules, and the calculation takes into account the income and assets of the person admitted and of their spouse.
A point that surprises many families: under certain rules a contribution from children is also examined. This is a sensitive subject that causes a good deal of family tension, so it is better to establish it in advance rather than when the bill arrives.
The precise rules, amounts and tests are updated and published by the Ministry of Health. Do not rely on old information or on another family's experience.
Where private insurance comes in
A long-term care policy may pay a monthly benefit even while the insured person is in an institution — and sometimes at a different rate from the benefit at home.
That benefit can be used to fund the co-payment or to bridge the gap between the public funding and the actual cost. That is precisely the purpose the policy was intended for.
So the stage at which a nursing place is being considered is a critical moment to check whether a policy exists. Many families discover this too late, after paying out of their own pocket for many months.
What to do before the move
If the move is still ahead of you, there are a few things worth doing in advance. The effort is small and the benefit may be significant.
- Check whether a long-term care policy exists — including on the Insurance Mountain
- Read what the policy says about staying in an institution
- Establish whether the cover is a fixed benefit or indemnity
- Establish the classification process and the public funding with the health fund
- Check what co-payment is expected
- Start keeping invoices and confirmations from the first day
Frequently asked questions
Who funds a place in a nursing institution?
There is a public route with the Ministry of Health, subject to classification, entitlement tests and a co-payment. In parallel, a private long-term care policy may pay a monthly benefit. These are separate routes.
Who determines the nursing classification?
An authorised body in the health system, according to the rules. The classification is not determined by the family or by the institution, and it affects the type of setting and the funding body.
What is the co-payment in nursing institution care?
The share the family bears alongside the public funding. It is calculated according to rules taking income and assets into account, and under certain rules a contribution from children is also examined.
Does long-term care insurance pay while the insured person is in an institution?
It depends on the policy. Many policies distinguish between home and an institution and set different rates. The benefit may be used to fund the co-payment or to bridge the gap in cost.
What should we check before moving to a nursing institution?
Whether a policy exists, what it says about staying in an institution, whether the cover is a fixed benefit or indemnity, what co-payment is expected, and start keeping invoices from the first day.
Official sources for further checking
This is general information and does not replace personal medical, legal or insurance advice. Eligibility is determined by the documents and rules that apply to each case.
