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https://senioren-checker.de/pflege/pflegegesetz-pflegerecht/pflegegrad-4 

As our loved ones age, they may require additional assistance and care. It is important to ensure that they are receiving the appropriate level of care, and one level that might be necessary is Care Level 4. This level of care is for those who need extensive assistance with the activities of daily living. In this comprehensive guide, we will delve further into what care level 4 (Pflegestufe 4) entails and provide you with more information about how to determine if this level of care is right for your loved one.