Long-term care reform plans spark widespread backlash in Germany

Health minister Nina Warken is attempting a balancing act with these plans – she wants to stabilise the long-term care system and prevent a looming multi-billion euro shortfall while at the same time not unduly burdening those affected.

But her plans involve severe cuts for those in need of care, as well as their families and carers.

Here’s a look at some of the details:

Lowest-need care allowance scrapped

According to the draft proposal, the €131 allowance for the lowest of the five care levels (level 1 – minor impairment to independence) will be scrapped, while it will be halved for those placed in care levels 2 and 3.

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Relief allowances for nursing home residents deferred

Under the new plans, tiered subsidies for those requiring care will remain.

But those needing care will only be able to be reclassified into the next care level after a six-month delay, potentially putting many people significantly out of pocket.

The government estimates this will save around €2.6 billion in 2027.

If individuals are being cared for as full-time inpatients, their benefit supplements will be tiered according to how long they stay. In future, it will also take four and half years to reach the highest level of support, compared with three years currently.

Pension contributions for caregivers cut

Caregivers, too, will be negatively impacted: they’ll receive lower pension contributions from long-term care insurance funds and they’ll only be covered at 70 percent.

This will also reduce their individual pension entitlements. But they will be entitled to professional support, although the details of this have not been outlined.

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Contributions hiked for people without children and high earners

Those without children are also set to pay more as the reform specifies their long-term care contributions will rise to 4.3 percent.

Higher earners, too, will be negatively impacted as the proposed reforms include plans to raise the contribution assessment ceiling.

This is expected to generate additional revenue of around €1.6 billion for long-term care insurance funds in 2027 and €1.7 billion in each of the following two years.

Those in mini-jobs must contribute

For the first time, people in mini-jobs (where earnings are capped at €603 per month) will also have to make standard contributions to statutory long-term care insurance.

Free co-insurance of spouses restricted

From 2028, insured individuals will have to pay a surcharge of 0.52 percentage points for long-term care insurance for their spouses or registered partners who were previously covered free of charge.

€100,000 earnings threshold for children of care recipients scrapped

Currently, children cannot be held liable for their parents’ long-term care costs up to the level of €100,000. But a new, separate regulation plans to scrap this.

The idea behind this is to relieve municipalities of the costs of long-term care assistance by allowing them to charge the relatives of those who need care.

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Better long-term illnes prevention

The draft also states there will be better support for long-term illness prevention. Insured individuals over 60 are to receive regular supplementary entitlement to medical services for the early detection and prevention of age-related health risks, burdens and illnesses.

What have critics said?

Many critics, from politicians to social organisations, have slammed the increased burden that the reform threatens to place on those in need of care and their families.

Mecklenburg-Western Pomerania’s Minister-President Manuela Schwesig said the plans are “not a reform, but a burden package”.

Speaking to Politico, she said the plans would “place a greater burden on those in need of care and their families and put care workers in a worse position.”

Patient advocate groups also criticised the lack of a future-oriented concept and the penalisation of caregivers who looked after relatives at home.

“We’re talking about a reform that isn’t really a reform, because a reform means further development. But nothing is being further developed here. Instead, there are fundamental cuts, and mandatory contributions are being increased,” Eugen Brysch of the German Patient Protection Foundation told ARD.

Municipalities to foot the bill

Others were quick to point out how cutting support for care recipients would increase the burden on municipalities, who could be hit if rising out-of-pocket costs push more people into the social welfare system.

Leipzig mayor and president of the German Association of Cities Burkhard Jung described the plans as “a slap in the face”. He told Funke Media Group journalists they would lead to an additional burden of billions for municipalities rather than providing relief in the coming years.

“This draft must never pass the Bundestag in its current form,” he added.

Similar criticism came from within the CDU. Talking to the Augsburger Allgemeine, former Bavarian Health Minister Klaus Holetschek said, “This is not a genuine reform, but rather a shifting of costs towards social assistance.”

Others criticised the reform for doing nothing to address the issue of waiting lists for places in nursing homes.

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“This raid on contributors, those in need of care and municipalities won’t create a single nursing home place,” Employers’ Association for Care President Thomas Greiner told the Rheinische Post.

But CDU/CSU parliamentary group leader Jens Spahn stood up for the “difficult but necessary step” Warken had taken, calling the plans “a balanced package”.

“Long-term care insurance, like health insurance, is simply bankrupt,” he told ARD.

What happens now?

The draft legislation will now undergo consultation with government ministries, states and associations before being discussed – and potentially approved – by the cabinet before the summer break.

Given the degree of criticism, further amendments appear likely.

In their current forms, the plans are expected to save Germany’s structurally underfunded healthcare system €11 billion in the first year alone.

The Ministry of Health expects a deficit of around €7.6 billion in long-term care insurance for 2027. Without reform, the annual funding gap is expected to grow to around €15.4 billion by 2028.

Germany’s situation is exacerbated by the rising average age of the population with a growing number of people needing care and a shrinking pool of contributors to pay for it.

With reporting by AFP and DPA