Its the same case here in Germany, though I believe the services are free to most older Germans, but how much is decided by the Pflegegrad.. or Stage of care of a person. As a nursing student when I have to write a case study on a patient I realize that most of the diseases are exaggerated to maintain the #Stage# of care, so the insurance company will not withdraw a paid service. Many in the home and also in their homes recieving private care just get #nursed# to maintain the #Pflegegrad# for emergency.