Care | Reorganize and save

The Care Reorganization Act could lead to an obstacle course for people in need of care. Photo: dpa/Uli Deck A nursing reform has been pending for years. Now the first law is coming to the Bundestag for its first reading this Thursday, called the Care Reorganization Act (PNOG). On the one hand, the foundations for more stable financing of social long-term care insurance should be laid here. On the other hand, from the Federal Government's point of view, services should be subject to an examination on the grounds that the number of people in need of care is increasing, parallel to the growth in the proportion of the population of retirement age. However, the upcoming changes are only the beginning.

A care structure commission was just set up in mid-October and will probably go even further into the substance of the current care insurance and design. Results are expected to be presented by the end of January 2027.

Higher point limits will make it more difficult to obtain one of the lower levels of care in the future.

The PNOG, meanwhile, if it goes through the parliamentary process without changes, will, among other things, reorganize the home care framework. Instead of many individual services in home care, there should be four budgets: each with a focus on relief, benefits in kind, social space and bridging. Here the previous order is being thrown into disarray. As a result, there will be reductions in benefits, including the complete loss of all benefits for care level 1. In contrast to other constellations, there will be no grandfathering here.

Anyone who has not yet made full use of the possible care benefits provided by a care service has been able to convert up to 40 percent into everyday support offers - this will also no longer be possible in the future. The relief amount will also be eliminated - the social space budget will be introduced for this. However, the latter must be used monthly, while the relief amount could be saved and carried over to the following year.

Certain outpatient care services are no longer allowed to access the social space budget directly. It is reserved exclusively for everyday support recognized by state law.

This point shows that not only those in need of care have to reorganize themselves, but also the service providers with different orientations and focuses. Since not all those in need of care have so far made use of all possible services from the care insurance funds because they could not find any services for them, the local offer will now be restricted again, at least in the medium term.

Also noteworthy is the elimination of traditional preventive care, which could be provided hourly by neighbors or acquaintances while the relatives actually caring for them went on vacation. You can continue to do this, but no longer on the basis of the flexible common annual amount (up to 3,559 euros). Instead, there is a stricter bridging budget - and this should primarily be used for fully inpatient short-term care.

Another small example of savings at the expense of those in need of care: The new relief budget for care level 2 will include the previous care allowance, but also a flat rate for aids for use. At this point alone, those entitled lose a real sum of seven euros per month.

Contrary to the announcement of her predecessor Nina Warken (CDU), pension insurance contributions for caring relatives will not be reduced after the intervention of the new Health Minister Carsten Linnemann (CDU). However, there is a catch here: As soon as the person caring for them has reached the normal age limit and receives an old-age pension, the current pension can no longer be topped up this way. The savings effect should be around 1.8 billion euros in total. Caring relatives with little pension entitlement are particularly disadvantaged here.

In this area, reorganization means that existing elements have primarily been rearranged - although it is not so quickly clear what changes this means for those in need of care and their relatives. In any case, a different organizational effort is likely to arise for new applications, especially since the criteria are becoming stricter: Higher point limits will make it more difficult to obtain a lower care level (1, 2 or 3) in the future. There are also plans to increase the time limits on classifications and to make concrete recommendations for rehabilitation measures more frequently.

In the area of ​​financing and contributions, the childless allowance should initially increase from January 1st by 0.3 contribution points to 0.9 percentage points. From 2028, companies will also have to pay an insurance contribution of 3.6 percent for mini-jobs.

The end of completely non-contributory co-insurance for partners also affects care and will result in a premium surcharge of 0.52 percent from 2028 (together with health insurance, that will be 3.02 percent more). However, the stipulation that the care benefit amounts will be regularly increased annually from 2029 could lead to higher costs. First of all, the postponement of loan repayment to the years 2035 to 2039 provides relief. In total, federal loans of up to 4.4 billion euros were granted or planned in 2025 and 2026.

Also included in the PNOG draft are reforms in care and advice, which are not due to come into force until 2028 and 2029. Among other things, there will be a so-called care cockpit through which all applications and budgets will be processed completely digitally in the medium term. A new service could then be created from 2029 in the form of care support, which is, among other things, oriented towards prevention - i.e. to avoid care or more care. This can definitely make sense if it's not just about saving goals, but actually maintaining quality of life and independence.

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