With increased preventive measures, stronger support for home care, and relief from strict staffing regulations, Germany aims to put its struggling long-term care insurance on a more stable footing. The responsible federal-state commission presented its recommendations for a care reform on Thursday, which will now undergo a “practical review” and is expected to be transformed into legislation next year.
The employer association for care services described the proposals as offering “bright spots,” while health insurers and other associations criticized them, saying they represent only an assessment of the current situation without concrete financing options.
The long-term care insurance system has accumulated multibillion-euro deficits. The social insurance system faces significant challenges, with a growing number of people requiring care and a simultaneous shortage of caregivers. The newly presented “Future Pact on Care” maintains the concept of partial insurance and keeps the existing five care levels.
A strong emphasis, however, has been placed on prevention. “In short, we must avoid the need for care or delay its onset,” said Health Minister Nina Warken (CDU) during the presentation of the working group’s results. The commission recommends, among other measures, voluntary health checks in old age and closer support for care-dependent individuals at home, especially at the start of care level one, to prevent deterioration.
It will also be examined whether employees who reduce their working hours to provide care could receive partial financial compensation in the future. In regions with insufficient care services, health insurers and municipalities should, according to the proposals, have greater opportunities to operate care facilities themselves.
Reducing bureaucracy and regulation is intended to relieve care institutions and personnel. The paper also advocates for more flexibility in staffing, eliminating overlapping federal and state requirements on personnel and care quality. Finally, it emphasizes the expansion of digitalization and artificial intelligence in care. The employer association praised the suggestion to allow more flexibility in staffing and to abolish rigid staff-to-patient ratios to address the shortage of skilled workers. It also noted that “it was overdue” to open eldercare to greater innovation.
However, criticism was widespread. Employers’ association president Steffen Kampeter called the proposals “more than disappointing.” He added: “They remain vague and provide no answers on how contribution rates can remain stable and how long-term care insurance can be financed fairly across generations. It achieves nothing to avoid uncomfortable political decisions by convening commissions.”
Health insurers were also sharply critical. Oliver Blatt, CEO of the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband), said: “The announced key points have become non-binding options. It is disappointing that the federal-state working group has now presented no concrete reform measures, but rather a general description of the problem regarding the financing of long-term care insurance.”
The Paritätische Welfare Association called for a “system change” toward a fully solidaristic insurance model. The trade union Verdi advocated for a cap on out-of-pocket costs for care and demanded that additional income types be included in insurance calculations. Left Party politician Evelyn Schötz described the report as a “timid paper without political direction,” saying it further delayed important reform. She added that a fair reform must “distribute burdens fairly by drawing more on very high wages and unearned income.”
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