Nursing reform | Protests against austerity policies at the expense of care

The Federal Association of Private Providers of Social Services (bpa) started its protest tour in Magdeburg at the end of last week against critical regulations in the planned Care Reorganization Act. Photo: dpa/Christopher Ratter This reform has not yet reached its goal: theoretically, the Care Reorganization Act (PNOG) could be controlled directly through the parliamentary procedure. The first parts would come into force from January. However, the planned changes are so drastic compared to the already precarious practice that they are driving associations and employees onto the streets. The nationwide demonstration this Wednesday in Berlin is only part of the actions. In terms of content, the nursing associations warn of service cuts, job cuts in outpatient care and higher burdens for those in need of care and relatives.

The restructuring of services into four new budgets, which ultimately results in less care, will not only place greater strain on caring and helping relatives. The structure of current outpatient services is also facing upheaval. The Federal Association of Private Providers of Social Services (BPA) warns of the loss of over 50,000 jobs. The Diakonisches Werk Rheinland-Westfalen-Lippe sees an average of six jobs at risk per nursing service.

The Federal Association of Private Providers of Social Services warns of the loss of over 50,000 jobs.

Domestic workers will be particularly affected because the financing basis will no longer be available - on the one hand by abolishing the nominally very low relief amount for care level one of 131 euros per month. In the future, this level of care will only have a symbolic character. For higher levels of care, the previous relief amount is converted into a social space budget, but nursing services are excluded there. Only everyday companions and non-nursing care services recognized by state law are allowed to work here.

Nursing services are also no longer allowed to advise and accompany their clients or patients. However, new care support should be provided by the care funds and municipalities. This will draw skilled workers into an area away from nursing practice, but is only expected to take effect from 2029. Until then, the current advisory visit will continue, but in perspective, jobs here are like an ejector seat.

Also criticized by associations such as Diakonie and the Verdi union are the future higher hurdles for care levels 1 to 3. If those in need receive support only later or to a lesser extent, this will only provide a short relief for the finances of the care funds. The loss of independence and mobility then occurs more quickly, the need then increases and even full-time inpatient care may otherwise be avoided.

The demand is not decreasing here, but the billing rules are changing. According to the Nursing Council, however, the effect of the current reform policy goes beyond just changing a few rules: the refinancing of collectively agreed remuneration is also at risk and the skills of nursing and midwives are not consistently used.

People in these professions don't want to be seen just as a cost factor. Through qualified work, you promote health and maintain independence. Accordingly, the Nursing Council has not only wanted nursing to be included in political decisions since yesterday - including through voting representation in the self-administration of the healthcare system, for example in the Federal Joint Committee. This decides which therapies and other services must be financed by the health insurance companies.

There have already been calls for comprehensive improvements to the PNOG and public protests in Düsseldorf, Magdeburg, Hamburg and Bremen in the past few days. Immediately following the Berlin demonstration on Wednesday, employees and industry representatives will meet in the capital on the next two days for the German Nursing Day 2026. This will be about the perspective of the different professions, but also about digitalization, regional supply, international colleagues and heat protection. The discussion of the controversial PNOG will be the subject of a hearing by experts in the Health Committee of the Bundestag on November 25th.

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