Health Minister Nina Warken’s new nursing care reform proposal signals major changes in Germany’s social care system. The plan aims to reduce costs but raises concerns about tougher rules and higher costs for wealthier citizens.
The government faces growing financial pressure on social insurance. To ease the burden, Warken’s proposal lowers payments to nursing homes and increases the financial obligations of high earners. According to a draft law, support for nursing home costs will remain but payments to residents will increase with a six-month delay. Wealthy individuals would face higher contributions, similar to a raised cap on medical insurance payments. This could bring in an extra 1.6 billion euros next year and 1.7 billion annually afterward to care funds.
The reform also cuts back on pension contributions paid by care funds for relatives who provide home care. Non-parents would pay a slightly higher care contribution rate, rising by 0.1 percentage points to 0.7. Warken expects the nursing care insurance to face a 22.5 billion euro shortfall over two years and hopes the reform will help close the gap.
Seen in a leaked government draft, the reform introduces some of the deepest cuts since the creation of nursing care insurance. It aims to keep more patients cared for at home and includes new emergency funding and digital upgrades. Key savings include:
- Stricter care assessments to slow the growth of those classified as needing care, saving 2.5 billion euros by 2028 and over 4 billion by 2030. Critics say this will make it harder to qualify for care.
- Longer waits before nursing home support increases, saving 2.7 billion euros.
- Smaller cost-of-living increases for benefits starting 2028, saving 4.05 billion euros.
- Reduced pension contributions for relatives providing care at home, saving 1.9 billion euros.
- Cutbacks in support budgets for those with low care levels, saving about 1 billion euros.
- New rules requiring regular visits from trained care consultants for users of support budgets; missing appointments could lead to cuts in support.
- New contribution requirements for part-time workers, expected to raise 1.2 billion euros a year.
- Reduced free insurance coverage for spouses starting 2028, adding 350 million yearly.
The reform may also tighten eligibility for care levels, causing protests from affected families. The German Care Employers’ Association criticized the focus on prevention and support rather than creating new care services. The association’s president said preventing care needs and supporting families is good but does not solve immediate care shortages. He called for more flexibility and fewer rigid rules for care providers to increase available places.
The SPD’s general secretary, Tim Klüssendorf, opposed calls to ask people to tap into private savings such as home equity to cover care costs. He said this approach risks placing too much burden on patients and their families. Klüssendorf also urged changes to the health insurance savings plan to protect patients and the insured from bearing the main financial load.
On the other hand, statutory health insurers defended the reforms against state-level criticism. Barmer’s CEO, Christoph Straub, said states underestimate the seriousness of the financial situation. Straub emphasized the need for spending limits tied to income growth, requiring contributions from all parties. He also criticized states for failing their responsibility to fund hospital investments and ease the burden on nursing home residents.
The proposed changes represent a tough balancing act between cutting costs and maintaining care standards. They ignite debates about fairness, the role of private funds, and how to secure care quality in an aging society. The government must now negotiate the details within the coalition while managing public concern over the impact on patients and providers.
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