Cuts to nursing home costs, higher financial burdens on top earners, and stricter criteria for determining care dependency, Germany's Federal Health Minister Nina Warken (CDU) wants to tackle the funding crisis in the country's long-term care insurance system with a drastic savings package, according to a draft law published in Berlin on Thursday. The proposals have met with sharp criticism from social welfare organisations and trade unions, who are particularly condemning what they describe as a one-sided burden placed on those in need of care and their families.
Germany's long-term care insurance system is heading towards a financial crisis of significant proportions. According to the Federal Health Ministry, the sector is projected to run a deficit of around €7.6 billion in 2027. Without reform, that annual shortfall is expected to balloon to approximately €15.4 billion by 2028.
Health Minister Nina Warken (CDU) has made clear that she intends to address the crisis without raising contribution rates, instead presenting a wide-ranging package of savings measures and structural adjustments.
Those in need of long-term care will receive higher subsidies from long-term care insurance toward their nursing home costs six months later than before.The highest benefit supplement, currently reached after three years, would only be attained after four and a half years under the new rules.
Warken wants to tighten the criteria used to assess the degree of a person's care dependency. The draft law also includes provisions to strengthen prevention measures, with the aim of reducing the number of people who become dependent on care in the first place.
The government is proposing to raise the contribution assessment ceiling for long-term care insurance, bringing it in line with the approach used in statutory health insurance, meaning higher earners would pay more into the system.
The additional contribution rate for childless individuals is set to rise by 0.1 percentage points, bringing the total surcharge to 0.7 percentage points above the standard rate.
Workers in so-called mini-jobs, who are currently exempt from long-term care insurance contributions, would be required to pay into the statutory system under the new proposals.
Under current rules, the care insurance funds cover pension contributions of unpaid family caregivers in full. Warken's plan would reduce this coverage to 70 per cent. As a partial offset, caregivers would be entitled to professional guidance and support. An emergency bridging budget is also envisaged for situations where a family caregiver is suddenly unable to continue.
An existing provision shielding adult children from being required to contribute to their parents' care costs, until their annual income exceeds €100,000, is set to be scrapped entirely. Adult children on lower incomes could once again be called upon to contribute to nursing home costs.
Voluntary supplementary insurance policies and occupational care provision schemes could become eligible for tax incentives, as the government seeks to encourage greater private long-term care provision.
A dedicated allocation of €1.7 billion from the special infrastructure fund is earmarked for the digitalisation of the care sector.
The reaction from welfare organisations, trade unions, and opposition politicians has been overwhelmingly hostile. Martin Fichtmüller, chief executive of the Arbeiter-Samariter-Bund, described the proposals as a "bankruptcy declaration of social policy" and warned that the government was charting a course that would cause lasting damage to solidarity in Germany. He also criticised a planned suspension of the requirement to pay care workers at collectively agreed wage rates.
Verena Bentele, president of the VdK social welfare association, called the planned reduction in pension contributions for family caregivers "a slap in the face" for those providing unpaid care. She also opposed the removal of the €100,000 income threshold protecting adult children from liability for parental care costs. The Paritätische Gesamtverband welfare organisation raised concerns about the absence of transitional protections for people already in the care system.
Michaela Engelmeier of the SoVD welfare organisation and Kathrin Sonnenholzner, president of the Arbeiterwohlfahrt, both described the package as a burden placed squarely on those who need care, their caregivers, and their families. Sonnenholzner specifically objected to the reintroduction of income-based liability for adult children.
DGB trade union federation chair Yasmin Fahimi was among the most outspoken critics, branding Warken's reform plans as "pure cynicism" and a "destructive reform" of the care insurance system. She urged the government to withdraw the draft and return with a proposal that would strengthen, rather than hollow out, the welfare state. Caritas, for its part, criticised the reduction in pension contributions for family caregivers as a decision that was hostile to families and to women.
Within the parliamentary sphere, reactions were mixed. SPD health expert Christos Pantazis welcomed the reform's greater focus on prevention and rehabilitation, but called for a structural financial equalisation between the statutory and private long-term care insurance streams.
The Greens' care policy spokesperson Simone Fischer argued in the Welt newspaper that the government was attempting to stabilise care insurance primarily by making those in need of care, their relatives, and contributors bear more of the burden, describing this as little more than a redistribution of costs.
Left Party parliamentary group leader Sören Pellmann accused SPD party chair Lars Klingbeil of having already quietly approved the socially regressive cuts list. Oliver Blatt, head of the GKV statutory health insurance umbrella body, said the overall package was "unbalanced".
Eugen Brysch of the Patient Protection Foundation called it a "hard blow" for family caregivers, and municipal umbrella organisations warned of increased pressure on towns and cities to provide social assistance for those unable to meet care costs.
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