Major nursing reform: Federal and state governments have not (yet) made a decision

Berlin. The press release from the Federal Ministry of Health came late Monday evening: The federal-state working group "Future Pact for Care" discussed initial interim results from the specialist level for a reform of the social long-term care insurance (SPV) in a digital meeting, it stated.

One conclusion from this: The abolition of care level 1 – recently controversially discussed – is likely off the table. The Federal Ministry of Health stated that the distinction between care levels should be retained in principle, but that the structures of the benefit law should be simplified and focused as much as possible.

Five care levels have existed since 2017. They are graded according to the severity of the impairment to independence in everyday life. Care level 1 aims to prevent or delay the need for care. Around 860,000 people receive care level 1.

The interim report states that the specialist working group recommends that the ministers and senators use the funds allocated for the relief amount for care level 1, in whole or in part, to provide early, specialist, preventative-oriented support for those in need of care, which does not currently exist in this form, in this care level (in the sense of a "repurposing"...). The relief amount is currently €131 per month.

Construction site non-insurance services

How non-insurance benefits in statutory long-term care insurance should be handled remains unclear. Long-term care insurance funds and social associations are demanding that the federal government reimburse the funds for the approximately €5.6 billion in coronavirus costs . The funds were withdrawn from the long-term care insurance funds' compensation fund during the pandemic.

On Monday, it was stated that the states considered a short-term stabilization of the financial situation to be achievable only if non-insurance benefits were consistently financed from tax revenue.

The coalition agreement between the CDU/CSU and the SPD does not contain any mention of this. The coalition was recently only able to agree on a loan totaling two billion euros for 2025 and 2026. This was sharply criticized in health insurance circles: the federal government was lending money to the nursing care funds even though it owed them billions.

Access to the pension fund!?

The wording of the long-term care fund introduced in 2015 is also vague. A share of 0.1 percentage points of the annual care contributions is invested in this fund. A good ten billion euros have now been "parked" for when the approximately 20 million baby boomers reach the age where they require care.

The Federal Ministry of Health stated that the fund should make a greater contribution to stabilizing the contribution rate for long-term care. This could result in fewer funds flowing into the fund—or funds being withdrawn.

Such an intervention would not be new: in 2023, the allocation of contributions to the long-term care fund for the years 2024 to 2027 was already reduced by one billion euros each year, i.e. from 1.7 billion euros to 0.7 billion euros.

The SPD parliamentary group said on Tuesday that what the ministry had presented was not yet a comprehensive plan. A genuine reform of long-term care insurance requires "fairness in financing." Those who want solidarity must also bear it fairly – "in both statutory and private long-term care insurance." (hom)