ZDH: "Nursing care reform does not bring stability"

The German Federal Cabinet has approved the Long-Term Care Reform Act. The draft legislation primarily contains cost-cutting measures. From the perspective of the skilled trades sector, these measures are insufficient to ensure the long-term viability of the statutory long-term care insurance system.

The center-right/center-left coalition government has agreed on a draft law for the reform of long-term care. After lengthy negotiations, structural changes will initially be largely omitted. A structural reform is to follow later. What remains are cost-saving measures which, according to the Federal Ministry of Health, are intended to put long-term care insurance on a more stable financial footing in order to safeguard long-term care provision.

Health Minister Carsten Linnemann (CDU) says that the measures on the expenditure and revenue sides are a first step toward stabilizing the financing of long-term care insurance. "We need further efforts to make long-term care sustainable for the 2030s. Therefore, a structural commission will begin developing fundamental reforms in October. It is important to note that our long-term care system is a partial benefit system. In light of the sharply rising costs for nursing homes, we must provide even stronger support for home care."

This is what the government is planning:

Stabilization of finances

• Implementation of the regulations of the Contribution Rate Stabilization Act: Increase of the contribution assessment ceiling of the social long-term care insurance (SPV) by 300 euros per month analogous to statutory health insurance (GKV).
• Effective January 1, 2028, a surcharge of 0,52 percent will be levied for the co-insurance of spouses or registered partners, analogous to the statutory health insurance reform. The same exceptions apply as in statutory health insurance, for example, for parents of children with disabilities or family members providing care at home.
• From January 1, 2027, the contribution surcharge for childless SPV members will be increased by 0,3 points to 0,9 percent.
• The long-term care insurance continues to fully cover the pension insurance contributions for family members and relatives providing care.
• From 2029 onwards, an annual, regular, and therefore reliable adjustment of long-term care insurance benefit contributions based on the core inflation rate will be introduced. This will prevent price increases from disproportionately burdening those requiring care.

Strengthening prevention

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• Insured individuals aged 60 and over will henceforth be entitled to a preventive health check-up, the "Check-up 60+". This addition to the standard check-up for those aged 60 and over allows for the early detection and assessment of health risks and burdens, thus helping to better prevent loss of independence or the need for long-term care. Health insurance companies will also be able to recommend more suitable preventive care options to their members in the future, utilizing existing data for this purpose.
• "Rehabilitation before care": In the future, the assessment of care will more consistently examine whether rehabilitation can noticeably reduce the need for care.
• Through preventative, professional care support, families caring for loved ones at home will receive early and ongoing assistance. In addition to establishing a stable and sustainable care arrangement, the goal of this support is to improve the health and well-being of those receiving care and to relieve the burden on family members and caregivers. The support also includes facilitating access to preventative and rehabilitative care services.

Less bureaucracy, better supply structures

• The digital "care cockpit" will simplify the organization of care in the future. With the introduction of a central online portal, all the information and tools that those requiring care and their relatives need to manage daily care and navigate the long-term care insurance system will be bundled in one digital location. Instead of having to search extensively for information, a single login will be all that's required to submit applications, find providers, obtain information about care, or get an overview of the benefits received.
• By combining previously separate benefits, it will be possible to increase the core benefits for home care – the care allowance and the entitlements to in-kind benefits from outpatient care and support services – in care levels 2 to 5. For low-threshold support in everyday life, a social area budget will be available from care level 2 onwards, replacing the previous relief allowance. This will make the benefit system more transparent, and those requiring care and their relatives can decide for themselves, within the framework of the new benefit budgets, which care needs they wish to prioritize using the funds for.
• Special attention is paid to the needs of families with children requiring care: For those requiring care up to the age of 25, the social services budget amounts to up to €300 per month, or up to €3.600 per year. This can be used to finance recognized support services for daily living. These include, among other things, individual caregivers recognized by the long-term care insurance funds, who are organized as neighborhood support services.
• Furthermore, the provision of care in acute nursing situations is to be improved in the future. A bridging budget is available for care in acute and transitional situations, which can be used for emergency services in outpatient care as well as inpatient short-term care. From 2028 onwards, there will also be dedicated short-term acute care beds.
• The assessment system will be adapted in line with the original scientifically recommended values, enabling more precise allocation of care levels 1 to 3. Furthermore, a scientific advisory board will be established to continuously review the assessment instrument and procedures and develop expert recommendations and proposals to adapt them to societal changes as well as developments in medicine, technology, and nursing science. All individuals already assigned a care level will retain their existing level of care.

Better use of technology and digitalization

• Long-term care insurance law is being modernized: Contract and reimbursement regulations are being opened up to give care facilities more scope for innovation and to create greater incentives for the use of technology and digitalization. Outpatient and inpatient care facilities will gain more freedom to implement innovations through an innovation rule, which they can coordinate with the long-term care insurance funds, provided that the protection of those requiring care is not compromised. Furthermore, inpatient care facilities will be able to claim the costs of implementing technology and digitalization in their care rates to a certain extent and within a specific timeframe through so-called transformation staffing allocations, if these measures are expected to reduce staffing needs.
• The Competence Center for Digitalization and Care will be made permanent and given additional responsibilities. This will enable it to better and more sustainably support digitalization in long-term care and contribute to ensuring that innovations are implemented in the care sector.
• The federal government's special fund for infrastructure and climate neutrality will provide €1,6 billion for the digitalization of long-term care facilities. The states are expected to contribute a total of €400 million to this project.

From the perspective of the German Confederation of Skilled Crafts (ZDH), the planned measures are insufficient to stabilize the statutory long-term care insurance system. While the draft legislation addresses important issues, it falls short of what is necessary. "Anyone who wants to permanently limit social security contributions and safeguard the competitiveness of Germany as a business location must go beyond this law," explains ZDH President Jörg Dittrich.

It is right to examine spending policies and focus more on available revenues. However, the difficult financial situation necessitates further measures. Dittrich: "Without further reforms, the deficit of the statutory long-term care insurance would rise to €7,5 billion in 2027 and even to €15 billion in 2028. Therefore, further savings are needed to permanently stabilize the statutory long-term care insurance system and relieve the burden on businesses and employees."

Make structures more efficient

The president of the German Confederation of Skilled Crafts welcomes the adjustments to the assessment system for determining care levels, the elimination of the relief allowance for household-related services, and the restriction of free co-insurance for spouses. "It is unacceptable that the repayment of the federal loans is being postponed to the years 2035 to 2039, thus merely delaying the financing problems." Instead of shifting the financial burden onto those paying contributions, the state must "finally finance non-insurance-related benefits from tax revenue." 

The planned increase in the contribution assessment ceiling and additional long-term care insurance contributions for marginally employed individuals also place a burden on employers and employees – especially on labor-intensive craft businesses. "New benefits such as a social area budget set the wrong priorities during a period of necessary consolidation. The priority must be to make existing structures more efficient and to ensure the long-term financial sustainability of long-term care insurance."

Dittrich calls for a comprehensive concept

The Long-Term Care Reform Act must be followed by further changes. "What's needed is a comprehensive concept for pensions, health, and long-term care with the goal of reducing social security contributions back below 40 percent. This also includes strengthening private pension provision, for example, through mandatory private long-term care insurance with government subsidies. Only with sustainable financing and a fair distribution of the burden can the social security systems be secured in the long term and the competitiveness of businesses maintained."

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