Five months had elapsed for the federal government and the states to work out the key points for a reform of the heavily strained Social Long-Term Care Insurance (SPV). On Thursday they presented a closing paper that leaves the central question of financing the care system still unanswered. Care insurance funds, associations and the opposition criticized the paper sharply.
The closing report of the Bund-Länder-AG “Future Pact Care” on the “sustainable structural and financing reform in the care insurance” spans 47 pages. It was described as only a “good basis for a further process” and as a “substantive proposals” by, besides Federal Health Minister Nina Warken (CDU), Hamburg’s Health Senator Melanie Schlotzhauer (SPD) and NRW Health Minister Karl-Josef Laumann (CDU) at the presentation. “The sticking point remains a sustainable financing,” said Warken.
Agreeing on anything else was possible only to strengthen prevention and to promote counseling and training of those affected and their relatives in the early stage of care dependency. Home care plays a central role in the care system, Laumann said: “Without home care, the system would be unmanageable in terms of volume and the skilled workforce and not financially viable at all.”
Higher Hurdles for Care Levels
Regarding how rising care needs and care costs are to be financed, the working group remained noncommittal. Fundamentally, they want to keep the partial-benefit system of the SPV; thus, there will continue to be an own contribution to care. The five care levels introduced in 2017 should remain. For new assessments, however, it will be harder to obtain a higher care level in the future, because the so-called “threshold values” are to be raised. Contrary to earlier statements, care level 1 should be retained, but the so-called relief amount of 131 euros to relieve family caregivers or to promote independence will be abolished.
The presented “Roadmap remains vague on the decisive questions and creates more confusion than guidance”
Carola Reimann, Chairwoman of the AOK Federal Association
To stabilize the SPV on the revenue side, Schlotzhauer pointed to possibilities to broaden the financing base. It is conceivable, the Hamburg health senator argued, to strike a balance between private care insurances and the SPV or to include other forms of income such as capital or rental income. Her ministerial colleague Laumann from NRW was more cautious: discussions about income types as well as an increase in the contribution assessment ceiling would have to be viewed in the broader context of other social security systems.
With regard to the heavily burdened social security systems, there are currently several reform efforts underway: in addition to the “Future Pact Care” working group, there is a commission for the reform of the welfare state and a commission for financing the statutory health insurance. Further questions about financing the care insurance – for example in the context of the social benefit “Hilfe zur Pflege” – will therefore be clarified jointly, it was stated on Thursday. “The questions are bigger and more complex than the hospital reform,” said Schlotzhauer.
Criticism: “Roadmap to Nowhere”
Massive criticism is voiced by the health insurance funds, associations and the opposition. From announced key points, non-binding options had become, said Oliver Blatt of the Spitzenverband der gesetzlichen Krankenversicherungen, which also represents the care funds. “The presented ‘Roadmap’ remains vague on the decisive questions and creates more confusion than guidance,” said Carola Reimann, chairwoman of the AOK Federal Association.
“The stalemate in care continues,” said Green party care policy spokesperson Simone Fischer. There is still no clarity, no priorities and no real commitment to effectively limit the personal contributions and fair financing. Evelyn Schötz of the Left also spoke of a “cowardly paper.”
The Association of Statutory Health Insurance Funds (VdEk) called for the “long overdue” relief of the care insurance from state tasks. “Contributions from insured persons must not be used for pension and unemployment insurance contributions of caregiving relatives or for immediate aid during the Corona pandemic,” said association chair Ulrike Elsner. The states would have to bear the investment costs for care homes, Elsner added. Currently, these costs are borne by the residents of care homes — more than 500 euros per person per month.
There will be further consultations in January. According to the Roadmap, the reform of care financing is to take effect by the end of 2026. This is questionable given the current lack of concrete ideas for implementation.
