Complex needs one-to-one care — when nothing else fits

Who we care for

There is no typical client — but there are recurring constellations. A few anonymised examples from our work:

Co-occurring psychiatric illness and addiction:

A young adult with severe psychotic episodes alongside cannabis and alcohol misuse. Inpatient addiction treatment founders on the psychiatric illness, psychiatric admissions founder on the substance use. We provide support at home — with a clear framework, regular contact and a settled key worker.

Acute risk of self-harm at home:

A woman in her mid-50s with severe depression, discharged from hospital after several suicide attempts. Her family cannot be there around the clock, and she does not want another admission. We provide 24-hour care on a rotating shift model — until outpatient therapy takes hold.

Supported shared housing breaks down:

A person with borderline personality disorder who escalates in every supported flat-share, but who can be stabilised at home — with a designated key worker and a constant team.

Dementia with severe aggression:

A person with advanced dementia, still physically strong, whom no care home will keep — but who is manageable in their own flat with calm, experienced support.

What makes our support different in such cases

A small, settled team:

We do not work with a constantly changing roster of freelancers. Each client has two to four key workers who alternate. Trust grows because the same faces come back.

A clear stance, not pity:

We are friendly but consistent. Provocation is not met with counter-provocation. Someone who tests us finds reliable limits. That is — paradoxically — often what our clients need most.

Experience in crisis management:

Our team knows aggression, suicidality, psychotic episodes, self-harm. We do not panic; we de-escalate, document, and stay in contact with the treating doctor or the court-appointed guardian.

Connected to the wider support system:

We work closely with hospitals, community psychiatrists, court-appointed guardians and social psychiatric services. We are not a substitute for a professional treatment team — we are its extended arm in everyday life at home.

Who pays for this

Care of this kind is expensive — and it is rarely funded through ordinary channels. The possible routes:

• Private payment by the family — where means allow, often the quickest route.
• Integration assistance under SGB IX — where a psychological disability is formally recognised, applied for at the responsible district office.
• Social assistance under SGB XII — in cases of hardship, once other means have been exhausted.
• Private insurance — where entitlements to cover exist.

What we do not do

We are honest: we cannot do everything.

Compulsory measures:

are not our remit — where someone poses an acute danger to others and will not accept care voluntarily, that belongs in a hospital with a secure ward.

Detoxification:

is not something we do — that belongs in a qualified addiction clinic.

Extended acute psychotherapy:

is not our role — we support therapy, we do not replace it.

Frequently asked questions

• Do you also take on people other care services have turned down?

  Yes — these are often exactly the enquiries that reach us. We assess each case individually in the first talk.
• Can you take on clients under court-appointed guardianship?

  Yes. We work regularly with court-appointed guardians, both professional guardians and family members. The contract is then concluded with the guardian as the authorised representative.
• How quickly can you take over?

  For acute handovers from hospital, usually within three to seven days, depending on the complexity of the setting. Faster handover is possible in emergencies.
• Roughly what does 24-hour one-to-one care of this kind cost per month?

  It varies considerably, depending on the qualification required, the setting and the complexity. Continuous one-to-one care on a rotating shift model lies well above conventional home nursing — you will receive the precise calculation in the first talk, once needs have been established.
• What happens if a client becomes violent?

  We have clear escalation protocols. Where there is acute danger we call the emergency doctor and, if necessary, the police. This is part of our experience — such situations are demanding, but not unusual.
• Do clients have to consent to being cared for?

  Yes — we never provide care against someone’s will. If a person does not want us in their home, we are not the right people. In such cases we can, however, advise the family on how a court-appointed guardianship might be applied for.