S Susanne Broth, 73 years old, is not permitted to shower after a larynx operation. And due to her rheumatoid arthritis, she can no longer wring out a washcloth. Peeling potatoes is also out of the question. The single woman uses wet wipes for personal hygiene and lives on ready-made meals.
Only the lowest level, care grade 1, was approved for the woman, who in reality uses a different name. She herself does not receive money, but can, with the so-called “relief allowance,” seek paid help for four to five hours a month for her household and bill 131 euros to the long-term care insurance.
The relief allowance, which one receives in care grade 1 to pay for external help, and also the assessment of higher care grades, are now up for debate. For the finances of the long-term care insurance must be stabilized urgently. Expenditures for the social long-term care insurance rose from 31 billion euros in 2016 to 68 billion euros in 2024. In the coming years, billions of gaps will yawn in the care funds.
The federal–state working group “Future Pact for Care” presented on Monday initial proposals also regarding spending containment. Federal Health Minister Nina Warken announced that, in order to achieve “efficiency gains,” the “potentials in care provision” must be “increasingly exploited” and the “impact of existing benefits under review.”
What stands out in the interim report of the federal–state working group on care is that no benefits from long-term care insurance are to be scrapped abruptly from one day to the next. Rather, the report conceals structural changes that, in the medium term, would worsen the finances of care households, in other words, a kind of saving by the back door.
Prevention instead of direct assistance
According to the report presented on Monday by the expert working groups in the federal–state working group, care grade 1 should not be abolished, as had been reported in the meantime. The relief allowance, i.e., the indirect monetary benefit in care grade 1, will instead be “called into question” regarding its provisioning effects, the report states. The expert groups recommend to the ministers of the federal–state working group to use the funds allocated for the relief allowance wholly or partly for an early “professional, prevention-oriented support for those in need of care.”
Susanne Broth might therefore no longer be able to afford domestic help or washing her hair, but she would receive more advice. The question is whether focusing on more prevention through counseling truly helps those affected and their relatives, who struggle with frailty in a demanding daily life. With the relief allowance, one can currently also pay for help from trained neighbors, a flexibility that was hailed as progress when the care grades were introduced in 2017.
In 2017, the new concept of care dependency was established; instead of the previously applicable three care levels, five new “care grades” were introduced. Cognitive impairments are now also taken into account. In the assessment by the Medical Service of the Health Insurance, points are awarded for lack of independence, and depending on the point value, the care grade is assigned. The entry threshold for care grade 1 is lower than the threshold for the former care level 1, which is also partly responsible for the rising number of “people in need of care.” But this easier access to long-term care insurance since 2017 is now under debate.
Higher thresholds for classifications
The expert groups, according to the paper, recommend examining “what consequences a lowering of the thresholds in care grades 1, 2 and 3” would have on the distribution of those in need of care and thus on the “benefit expenditures.” In other words: the barrier to be classified as care grade 2 or 3 would be markedly higher than today, which could save the care funds substantial costs. A “grandfather clause” is supposed to apply.
The new care households would receive less money if classified at a lower level than today. Thus, under care grade 1 there would be no direct care allowance, under care grade 2 347 euros, and under care grade 3 599 euros per month, which could be spent as one wishes.
The expert groups also propose in one variant to grant the care allowance for new applicants for a “certain period” to be paid only at a reduced rate. Only after the expiry of a waiting period would the full previous care allowance be paid.
In roughly 3.1 million cases, relatives take on the main caregiving duties and receive care money, according to a Diakonie survey. Three quarters of relatives experience high emotional strain, half also physical strain. Many give up earnings. Reducing the care money for such households in the future, in one way or another, would lead to resentment.
However, increasing the revenue for the care fund is also difficult. The federal–state working group suggests discussing the introduction of a compulsory long-term care insurance, whose contributions would have to be borne by employees alone. The unions protest. In the federal–state group there is little talk of redistribution, such as a financial equalization between public and private long-term care insurance, or more fiscal resources for the care fund. Yet a 2024 IGES Institute study identified several levers to raise revenue, such as raising the contribution assessment ceilings for long-term care insurance, collecting contributions on capital gains, and other measures.
Saving by the back door will have consequences. The share of people over 80 is rising, even in 30 years, according to statistics. When things get tough, neglect of the very elderly increases. Family caregiving pushes households into poverty, and the burdens within families lead to lasting aggression. Those who are single, in need of care, and poor face the harshest fate. That is not a direction we should head in.
