Nursing care insurance in the crisis: Current reform plans fall short
24.04.2023 14:18
The vast majority of Germans expect significantly greater efforts to bring nursing care insurance out of the crisis. This emerges from a Forsa survey commissioned by DAK-Gesundheit.
Together with the German District Association and Diakonie Deutschland, the third largest German health insurance company is calling for far-reaching changes to the draft of a care support and relief law presented by the Federal Ministry of Health (PUEG).
“Despite massive increases in costs for those in need of care and homes, the draft bill does not provide for any additional cents from federal funds. Nursing insurance is at a crossroads,” says DAK boss Andreas Storm. According to the Forsa survey, people want a fair distribution of burdens, but the federal government is relying unilaterally on increasing contributions. “If Minister Lauterbach does not use tax resources to stabilize long-term care insurance, the long-term care reform is doomed to failure,” said Storm.
German District Association: This isn't a big deal
The German District Association is also following the development with concern. “The bill only contains repair measures that are long overdue,” says Dr. Irene Vorholz, deputy to the general manager. “Although these are correct in themselves, they will only lead to short-term and selective relief. This is not the big hit that we actually need. A fundamental reform is needed to make care future-proof. This affects both the financing and the necessary staff and support for home care. If politicians don’t take decisive action to counteract this, we will have a nursing shortage in just a few years.”
Diakonie Germany: A fundamental care reform is needed
Diakonie Deutschland sees considerable need for improvement in the current draft law. Financing in particular is on a shaky foundation. Maria Loheide, head of social policy at Diakonie Deutschland: “The results of the Forsa survey must be taken seriously and a fundamental care reform must be initiated. The vast majority of the population would like to have strong, solidarity-based nursing care insurance that covers the essential nursing care costs. All nursing care insurance benefits must be adjusted in line with the cost increases in recent years. There must not be an even greater devaluation of care services.” Tax resources should also be used to finance this, particularly to finance non-insurance services. “This includes training costs in nursing and pension contributions for caring relatives who limit their employment. Time is of the essence: fundamental care reform is needed. Otherwise, long-term care is on the verge of collapse,” said Loheide.
The majority view nursing care provision critically
Nursing care insurance in Germany is in a major crisis. It is becoming increasingly difficult to cover enormous cost increases in both inpatient and outpatient care, so that the burden on those in need of care and on local social assistance continues to rise. At the same time, the financial gap in long-term care insurance is increasing. This leads to a further increase in contributions. The National Association of Statutory Health Insurance Funds has already warned: “Due to the conflicting priorities that obviously exist within the government coalition, a situation is emerging in which an entire social insurance branch is increasingly no longer able to adequately fulfill its mandate to insure against a central life risk (…) in terms of financial structure.”
Against this background, Forsa, on behalf of DAK-Gesundheit, asked how Germans assess the current care policy and their own insurance in the event of care. The study comes to clear results: citizens view nursing care insurance in Germany critically. Almost two thirds (65 percent) of those surveyed are of the opinion that long-term care insurance generally provides somewhat (52 percent) or very (13 percent) poor coverage for nursing care needs.
They are also concerned about their personal care provision: a majority of 54 percent of those surveyed are very or even very worried in the event that they themselves become in need of care. These personal concerns are particularly great in the East: Here they are almost two thirds (64 percent).
Home care needs to be more supported
96 percent of those surveyed consider it important or very important that caring relatives receive more financial support. Women in particular see it this way, as they are much more involved in caring for relatives in Germany than men. Against this background, those surveyed do not find the planned increase in care allowance by five percent in 2024 appropriate: the vast majority (79 percent) of citizens find the increase to be too low.
“Nursing relatives cannot go on strike”
The current reform plans for long-term care insurance ignore the realities, criticizes DAK CEO Storm against this background. “This shows the great criticism from all age groups. If Minister Lauterbach does not use tax resources to stabilize long-term care insurance, this long-term care reform is doomed to failure from the start,” said Storm. He warns: “Many people are in need of care themselves or are looking after their relatives; they see the problems every day. And everyone else is also worried about their own care provision,” says Storm. “Politics must make improvements, especially when it comes to increasing care allowances. In view of the massive price increases, wage increases are currently occurring in almost all other areas. But the care allowance, which has not been adjusted since 2017, is only to be increased by five percent - and only in 2024. The caring relatives, Germany's largest care service, find this completely inadequate, but can do nothing about it. Because caring relatives cannot strike for the interests of those in need of care.”
Diakonie Deutschland sees the five percent increase in care allowance, planned for the first time since 2017, as a lack of appreciation for the enormous care services provided by relatives. “If we continue to want relatives to take on care tasks to a large extent, a significant increase in care allowances and financial security for carers is necessary. “In addition, an accompanying and relieving care system must be further expanded,” says Loheide.
Social welfare dependency is growing
The slight increase in subsidies for personal contributions in inpatient care provided for in the nursing care reform (PUEG) is also clearly not enough. It doesn't even take price developments into account.
A very large majority (83 percent) of those surveyed are of the opinion that people who have paid contributions to long-term care insurance all their lives should not become social cases. The German District Association reminds: “Nursing care insurance was introduced to end the social welfare dependency of many people in need of care. Now more than a third of the residents are receiving social assistance again. The costs of municipal social assistance are increasing from year to year. “Here, too, we need to make significant improvements,” criticizes Vorholz.
Instead of higher contributions for childless people, relief from tax revenue
When it comes to contributions for long-term care insurance, the long-term care reform (PUEG) to implement a ruling by the Federal Constitutional Court on July 1, 2023 provides relief for insured persons who have several children. To this end, contributions for those without children are to increase significantly. A majority of 54 percent of those surveyed, on the other hand, believe that families should be relieved from tax revenue. Younger people in particular see it this way.
A large majority continues to rely on a pay-as-you-go solidarity system: 70 percent of those surveyed reject the statement “Everyone has their own responsibility here and should take care of themselves in the event of long-term care through private supplementary insurance.” “Private provision can make a contribution, but it is not the key to solving the financing problems of long-term care insurance,” says DAK boss Storm.
Reform must ensure the future of nursing care insurance
Against this background, three quarters (75 percent) of those surveyed are of the opinion that the additional costs should (also) be financed through tax subsidies in the future. The currently envisaged solution, according to which only the contributions should be increased, is supported by only a fifth (22 percent), and almost no one wants a reduction in benefits (4 percent). This clear positioning is evident across all party preferences. 85 percent of Germans believe that statutory nursing care insurance should continue to cover all essential nursing care costs.
As part of the study, Forsa surveyed 1,004 citizens aged 18 and over online. The survey was conducted from March 10 to 14, 2023.