The basic problem with long-term care insurance is quickly explained: There are more and more people in Germany who are dependent on care, but in proportion there are fewer and fewer people who pay contributions. In 1998 there were still 29 people per person in need of care - last year there were only ten.
At the same time, care is becoming more expensive. Costs have risen sharply: from 16.9 billion euros in 2005 to 70.4 billion euros last year. The federal government expects that nursing care insurance could be short of 7.5 billion euros as early as next year.
Linnemann relies on savings
Federal Health Minister Carsten Linnemann (CDU) initially wants to close this gap primarily through savings. His draft is based in many respects on the plans of his predecessor Nina Warken (CDU). Among other things, these provide for a closer examination of who receives a level of care and is therefore entitled to benefits from long-term care insurance. The hurdles for the recognition of nursing degrees would therefore be higher.
It's also about the costs in the nursing home: those in need of care pay part of it themselves. The nursing care insurance also covers a fixed amount. The following applies: the longer someone lives in the home, the larger this subsidy becomes. Linnemann wants to slow down this help. Anyone who accommodates relatives in the home would then have to pay the full share out of their own pocket for a longer period of time.
The minister describes the draft in the report from Berlin as “a first aid” to keep contributions stable. In a second step, he would like to set up a commission at the end of October that will make nursing care insurance "structurally fit for the 2030s."
The SPD wants a “care cost cap”
The SPD fears that the costs of the reform will fall primarily on those in need of care and their families. “We are not taking part in a pure cuts package,” says Matthias Miersch, the parliamentary group leader. The necessary structural reforms were missing. The SPD's proposal: a care cost cap.
In a first step, the share that those in need of care pay themselves for pure care and support, the so-called facility-wide own share, should be limited to 1,500 euros per month. In a further step, the state subsidies should be offset against this capped amount. This would mean that the costs for your own contribution would fall below 1,500 euros.
However, a place in a home would still cost significantly more overall because there would still be the costs for accommodation and food as well as the maintenance of the home. According to the Association of Substitute Insurance Funds (VdEK), the national average share that those in need of care have to pay out of their own pocket is currently 3,364 euros. Linnemann says that this doesn't even begin to solve the problem.
The SPD wants to finance its proposal, for example, by raising the contribution assessment limit or by having privately insured people participate more. Linnemann, on the other hand, expects such a financial equalization between private and social care insurance to raise “highest constitutional doubts”.
What's next?
Government spokesman Steffen Meyer said: "In these hours and days we are not discussing whether there are reforms or whether there will be a nursing care reform, but rather we are talking about how." Discussions take place “in very different constellations”. The responsible state secretaries are currently struggling to reach an agreement, and in the evening there will be a top meeting around Chancellor Friedrich Merz and Federal Finance Minister Lars Klingbeil.
If the Union and the SPD do not find a compromise, the care reform could be removed from the cabinet agenda on Wednesday. It wouldn't have ultimately failed, but it would be a setback for the black-red coalition.
