Home help and care: the steps made simple

Nursing care addresses a health need, such as a dressing change or an injection. For health insurance to cover it, you need a prescription issued before the care begins.

Long-term care insurance mainly concerns ongoing help with essential daily activities: washing, using the toilet, eating, dressing and moving around. You must apply to the CNS, then have your needs assessed by the AEC. The same person may need both types of support.

For example, needing a dressing change after an operation does not automatically mean that someone is entitled to long-term care insurance benefits.

For care needs, speak to your doctor. For everyday help, you can also contact a home help and care service. In principle, you are free to choose your provider, subject to its capacity to organise the care.

During the first conversation, explain what is becoming difficult, how long this has been happening, the help already provided by people close to you and where you live. Ask which services are possible, when they can start and what they will cost.

• A medical need: your doctor and the relevant healthcare professional.
• A question about dependency: the AEC Helpline.
• Financial or administrative difficulties: your municipality’s social welfare office.

Do not wait for an administrative decision before discussing an urgent need with a professional. However, any upfront payment or temporary support must be clarified before care begins.

It is not just for older people. The need for help must result from an illness or disability. As a general rule, help with essential daily activities must amount to at least 3 hours 30 minutes a week and be expected to continue for at least six months, or be irreversible. You do not need to wait six months before applying. The AEC assesses these needs: it is not simply a total of hours you calculate yourself.

Coverage by Luxembourg health insurance, including co-insurance, is a starting point. Income does not determine entitlement. Specific conditions apply depending on your insurance situation.

• Housework or meal preparation alone is not enough to qualify under the ordinary rules.
• Specific rules apply to certain impairments and to children.
• Applications for technical aids can be considered without reaching the 3 hours 30 minutes threshold.

Does the general situation not seem to fit yours? Ask the AEC for advice rather than deciding not to apply based on this summary.

Download the current official form. It has two parts: your application and the R20 medical report, which your treating doctor completes. The R20 is free for the applicant: the doctor is paid directly by long-term care insurance.

Fill in your contact details and the information requested, then date and sign the form. If a legal representative signs, follow the instructions in the document. Both parts must reach the CNS before the file is complete.

• By post: CNS – Assurance dépendance, B.P. 1023, L-1010 Luxembourg.
• The official form also allows submission to assurancedependance@secu.lu or by fax to +352 2757-4619.
• Keep a copy of the application you sent and the acknowledgement of receipt.

Medical documents must be sent to the official body through an appropriate channel. Do not send your R20 or health documents to rosa care’s general contact address.

The CNS forwards the complete application to the AEC. A professional assesses what you can do independently, the activities for which help is needed, and any equipment or adaptation needs. The appointment may take place at home, in a care facility or at the AEC’s offices.

Explain what daily life is really like, including difficulties that may not be visible during the appointment. The person who regularly helps you must be present if they are to be recognised as your carer.

• Write down difficult activities and the help you actually need beforehand.
• Prepare any useful documents requested by the AEC.
• Ask for the name and contact details of your AEC contact person.

These notes help you explain your situation. They do not replace the official assessment.

The CNS makes the decision based on the AEC’s opinion. The care summary explains the approved support and how it may be shared between a professional care network and a carer. The care provider does not decide on your entitlements itself.

Go through the decision with your AEC contact person or your provider if any terms are unclear. Ask what is covered, what will actually be provided and what you will still have to pay.

• Check the effective date and the benefits listed.
• Ask for a schedule and the service’s contact arrangements.
• Have any additional services explained before accepting them.

If dependency is recognised, professional benefits in kind may be due from the date of the complete application. Cash benefits follow their own rules: do not assume everything will be reimbursed retrospectively.

The prescription must be issued before care begins. If it does not specify a deadline, the prescribed treatment must start within 30 days of its issue. For travel costs to be reimbursed, the prescription must justify the need for care at home and the visit must take place in Luxembourg.

The CNS states that the usual reimbursement rate is 88% of the applicable tariff for adults and 100% for people under 18 at the time of the prescription. The rate is also 100% in certain situations, including where a plan establishes entitlement to long-term care insurance. This does not mean all additional charges are covered.

• Direct payment: the CNS pays its share directly and you pay any remaining amount.
• If you pay upfront: send the paid invoice and the prescription to your competent health insurance fund.
• Ask for details of non-reimbursed costs and cancellation rules.

A paid invoice is an invoice showing that you have paid. Reimbursement rates apply to the tariffs provided for by CNS rules.

A carer is someone who regularly contributes to help provided at home. For some professional support to be replaced by a cash benefit, the AEC must identify that carer and assess their ability and availability. Being a family member is not enough on its own.

Be open about what you can actually manage, your work, your health and your limits. Say if you can no longer carry out certain tasks. Supervision or respite arrangements may be considered according to the needs assessed.

• Carer training may be granted as an annual allowance of 6 hours.
• Training in the use of technical aids may be granted for 2 hours a year.
• Ask your AEC contact person which measures are included in the care summary and how to access them.

These services depend on the entitlements granted. If caring is becoming too much, do not face it alone: speak to your AEC contact person and the professionals involved.

Long-term care insurance can consider technical aids and adaptations to a home or vehicle, even without reaching the ordinary threshold for help with essential daily activities.

Contact the AEC before buying equipment or starting work. Approval must come first: there is no retrospective reimbursement for purchases or work undertaken on your own initiative. The chosen solution and any additional costs must be approved.

• Describe your needs to your AEC contact person or the technical aids Helpline.
• For rented accommodation or a jointly owned building, the required permissions must be obtained as part of the procedure.
• If you urgently need basic equipment after submitting an application, ask the AEC how to obtain it.

Requesting a quotation does not mean committing to the expense. Wait for the instructions and the decision before making a commitment.

Before leaving hospital, discuss the care and help you will need at home with the hospital team. Here is a practical list of questions to ask; the arrangements depend on your health and the professionals involved.

• Do I have my prescriptions, instructions and an up-to-date treatment plan?
• Who will provide the first care at home, and on what date?
• Which discharge documents and follow-up appointments should I keep?
• Will I need help with meals, washing or moving around?
• Has the necessary equipment been approved and is it available?
• Who should I call if I have a question or the situation changes?

Do not assume a home visit has been booked until a service has confirmed that it will attend. Documents may also be shared under the rules of the shared care record (Dossier de soins partagé), where it is used.

If your needs change, tell your provider and your AEC contact person. Reassessment is requested using the usual form. It normally takes place after one year; a fundamental change, explained in the R20, may justify an earlier request. A new decision may increase or reduce benefits.

If you disagree with a CNS decision, follow the appeal instructions in the notification. The ordinary procedure provides for a written objection to the CNS Board of Directors, sent by registered post with acknowledgement of receipt within 40 days of notification.

• Keep the decision, the envelope and proof of receipt.
• Explain what you disagree with and attach relevant documents.
• A phone call or a message to rosa care does not replace a formal objection.

Further steps may involve the social security courts and specific conditions. Check the notice you received promptly, especially if you live abroad.

Health insurance and long-term care insurance do not automatically fund every service you may want. Support that is not covered may remain at your expense. Ask for a written explanation of the services, prices, possible additional charges and cancellation conditions before committing.

If you are having financial difficulties or need help with the procedures, contact your municipality’s social welfare office. It can examine your situation, guide you and consider assistance under the applicable conditions. Support is not automatic.

• Your municipality can also provide information about delivered meals and personal alarm services.
• Ask about the price and conditions of these services before signing up.
• You can explain difficulties with forms to the social welfare office: you do not have to understand everything on your own.

Municipal services and their prices may vary depending on where you live.

In principle, you are free to choose your care provider, subject to its capacity to organise the care. If you are considering a change, plan continuity of care with the professionals involved.

Ask for care and costs to be explained in understandable language. Say which people close to you you would like to involve in discussions. If there is a difficulty with your care, start by speaking to the professional or the service manager.

• Challenging a CNS decision follows the relevant administrative appeal procedures.
• A disagreement with a healthcare professional can be referred to the National Health Information and Mediation Service.
• When first contacting rosa care, do not send medical records or your social security number.

A complaint to the care service and an appeal against an administrative decision are two different procedures.

For young children, the assessment distinguishes additional needs caused by illness or disability from the ordinary help needed by a healthy child of the same age. Specific rules also apply to certain impairments.

For cross-border workers, insurance and country of residence affect the procedure. Professional help in the country of residence should be discussed with the local health insurance fund; do not automatically apply Luxembourg rules.

People who hold an entitlement certificate for palliative care follow a specific procedure. The CNS states that they do not have to submit the ordinary long-term care application or provide the R20 for this pathway.

Contact the body responsible for your situation before using the general procedure described in this guide.