Care reform and finances: assessments are becoming stricter

When the expert comes next year to assess the care application of frail people, those affected will have to be prepared for a stricter verdict. Because then more restrictions are needed in everyday life in order to even achieve a level of care or a higher level of care than before. The assessor awards a certain number of points for each restriction. The higher the point value, the higher the level of care. The thresholds for achieving the next level of care will be raised in the upcoming law to reorganize nursing care insurance (PNOG), which was passed by the Federal Cabinet on Wednesday.

“We will have to make savings,” said Federal Health Minister Carsten Linnemann (CDU) on Wednesday after the federal cabinet approved his draft. “The system is under massive financial pressure.” He described the reform as the “first important step” towards stabilizing care. According to the ministry, there is a risk of a deficit of 7.6 billion in the so-called social care insurance (SPV) in the statutory health insurance companies next year.

According to the draft law, changing the classification into care levels one to three alone should bring about 4.2 billion euros in savings in 2030. The so-called relief contribution of 131 euros per month in care level one, which can be used to finance household help, is to be canceled; according to the draft law, this will result in reduced spending of 800 million euros in the coming year. However, the reduction in pension insurance contributions for caring relatives planned in an earlier draft does not occur.

In order to generate more income, the contribution assessment limit in statutory nursing care insurance is to increase by 300 euros per month from 2027; this is already planned for statutory health insurance. In addition, the contribution-free co-insurance of spouses without significant income of their own should be restricted. According to the ministry, for this group a contribution of 0.52 percent is usually due on the partner's contributory income.

In addition, the surcharge that childless people have to pay on the general contribution rate for long-term care insurance is to increase from 0.6 to 0.9 percentage points. This point alone is expected to bring in additional revenue of 3.3 billion euros next year.

Preventive care, which allowed people to bill up to 3,540 euros per year for replacement care during vacation periods, for example, is to be canceled. In return, other monthly budgets will be increased and new ones introduced, but social associations have protested against this restructuring.

In advance of the cabinet discussion, the SPD had called for greater capping of personal contributions to nursing home care using nursing care insurance funds. This was not taken into account in the new draft. However, the new draft no longer includes the proposal to reduce the previous subsidies from the nursing care funds for the personal contributions for stays at home. This was provided for in the earlier draft under Federal Health Minister Warken.

Most recently, the SPD wanted financial equalization between private and statutory nursing care insurance. This would have meant that the private nursing care funds (which are part of the private health insurance companies) would pay financial compensation to the statutory health insurance funds. On average, private funds have fewer members in need of care and therefore less expenditure.

Linnemann said this topic, along with many others, should be discussed in a specialist commission. The cabinet should decide on the commission for the committee next week. As early as the end of January, he expected recommendations from the commission to “make the care system fit for the 1930s,” said Linnemann. These should then be decided in the cabinet before Easter.

The AOK health insurance company complained that the care reform was “only a minimal compromise”. Only those paying contributions and those in need of care would be used to “fill financial holes in the short term”. The Greens declared that the government lacked the “strength and vision” for “real structural reform”.

In Germany, 5.7 million people receive benefits from long-term care insurance, including 4.9 million who are cared for at home. Of the 800,000 people in need of care in homes, more than 40 percent have to receive help from the social welfare office for the care costs.