Four nursing care levels (0–3) are defined by the German social code XI (SGB XI). The nursing care level needs to be approved by the Medical Review Board of the statutory health insurances (MDK) in a standardised procedure. The definition for nursing care level is described in Table 4 . Elderly who do not reach the requirements for nursing care level I, but need help for daily living (SGB XI § 45a) receive care for their needs. This is referred to as nursing care level 0 .Table 4Definitions of the nursing care levels RequirementsNursing care leveltotal daily help(including help in household)personal help (included in total daily help) 1minimum 1,5 h>45 min 2minimum 3 h≥2 h, 3 times a day 3minimum 5 h≥4 h permanent help