LTCcovid Country Profile – Germany

This country profile brings together information on the experience of the long-term care sector (focussing on people who use and provide care) during the COVID-19 pandemic in Germany from a living international report on COVID-19 Long-Term Care. It also provides links to research projects on COVID-19 and long-term care, to key reports, and lists key experts on the impacts of COVID-19 on the long-term care sector in Germany.

Responses to the International Living Report Questions on COVID-19 and Long-Term care:

This is the section for Germany from a “living report” that aims to provide an overview of how Long-Term Care systems around the world have been affected by the COVID-19 pandemic, how they have responded and what lessons are being learnt. This report does not seek to provide detailed or comprehensive information for each country, but instead aims to summarize key reports and articles and point the reader towards those sources. It builds largely on the reports previously published in this website. It is being developed collaboratively, by answering a list of questions for as many countries as possible. 

This page shows the answers currently available for Germany and is automatically updated as new information is added.

This report has been initially developed by the team working on the Social Care COVID Recovery and Resilience project and questions will be added to and validated by LTCCovid contributors who are experts on Long-Term Care in their respective countries. This study is funded by the National Institute for Health Research (NIHR) Policy Research Programme (NIHR202333). The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

Please cite as:

Comas-Herrera A., Marczak J., Byrd W., Lorenz-Dant K., (editors) and LTCcovid contributors.  International living report on COVID-19 and Long-Term Care users and providers: context, impacts, measures and lessons learnt. LTCcovid, Care Policy and Evaluation Centre, London School of Economics and Political Science. Available at: https://ltccovid.org/country-questions/


PART 1 – Long-Term Care System characteristics and preparedness
PART 2 – Impacts of the COVID-19 pandemic on people who use and provide Long Term Care
PART 3 – Long-Term Care system characteristics and preparedness that may have affected the response to the pandemic
PART 4 – Reforms to strengthen Long-Term Care systems and to improve preparedness for future pandemics and other emergencies
  • 4.04. Reforms to improve care coordination

    An EU report (2021) notes that care-support bases offering advice and support are being set up in Germany, providing relevant information, application forms, and practical assistance.

  • 4.02. Reforms to the Long-term care financing system

    From 2017 the legal entitlement to LTC benefits and the categories of beneficiaries have been extended (particularly to people with dementia) by recognising cognitive and mental capacity as part of the instrument used to assess people’s care level. The assessment encompasses the six areas: mobility, cognitive and communication abilities, behavioural and mental difficulties, self-care, ability to cope and independently manage health or therapy related needs and burden, organising everyday life and social contacts; in addition, the amount of benefits have increased substantially for most through the reorganisation of support entitlements into five care grades. No person already receiving support should have been worse off following the reform.

    Co-payments for people living in residential care settings no longer depend on a person’s care grade. All people in living in a nursing now pay the same care-related co-payment (the amount differs between residential homes). In addition, people in full- or part residential care settings receive a legal entitlement for additional offers of care.

    As part of this ‘second care strengthening bill’ (zweites Pflegestärkungsgesetz) contribution rates to the mandatory long-term care insurance increased by 0.2 percentage points (to 2.55 per cent for people with children and 2.8 per cent for people without children).

    Advice on available care and support through the long-term care insurance has been strengthened through an initiative to expand the network of advice centres as part of the third care strengthening law’ (drittes Pflegestärkungsgesetz) (Source: Bundesministerium fuer Gesundheit; Bundesministerium fuer Gesundheit – die Pflegestaerkungsgesetze

    Since 2019, Germany exempts children of people in need of care with an annual gross income of less than EUR 100,000 Euro from the obligation to cover care costs not covered by the care beneficiary, regardless of the care setting. Moreover, numerous reforms,  adopted between 2008 and 2019, have extended benefits to facilitate and provide incentives for informal care as a measure targeting affordability (source: Publications catalogue – Employment, Social Affairs & Inclusion – European Commission (europa.eu).

    In June 2021 a new care reform was passed. The reform seeks to relieve people living in residential care settings for longer periods of time from some of the co-payments. For example, the reform seeks to reduce co-payments of people living in residential care for more than 12 months by 25 per cent (on average €228 per month based on average contributions of €911). This reduction increases with time spent in residential care. For people living in residential care settings for more than 36 months, the reduction will amount to 70 per cent (on average €638 per month based on average contributions of €911).

    The reform is planned to be financed by a federal grant (1 billion per year) and an increase in the long-term care insurance of 0.1 per cent for childless people. (Source: Bundesministerium fuer Gesundheit)

  • 4.05. Reforms to address Long-Term Care workforce recruitment, training, pay and conditions

    From 1 January 2019 residential care settings with up to 40 occupants can apply to receive funding care positions. The amount of additional care resources financing through the sickness funds depends on the number of occupants in the care home (e.g. a 50% position for homes with up to 40 ocuptions,  1 full-time and one 50% position for homes with 81-120 occupants, 2 full time positions for homes with more than 120 occupants). This initiative should finance about 13,000 positions (Source: Bundesministerium fuer Gesundheit).

    In June 2021 a new care reform was passed. This reform also seeks to improve staffing levels in residential care settings by implementing a bundeseinheitlichen Personalschlüssel (a formula determining the level of staff needed in care homes across the country). Care workers will also be allowed to prescribe tools to support people with LTC needs and to make more independent decisions when providing domiciliary care. (Source: Bundesministerium fuer Gesundheit – Pflegerefom)

  • 4.05. Reforms to address Long-Term Care workforce recruitment, training, pay and conditions

    The care profession bill (Pflegeberufegesetz) led to a revision of the training curriculum and examination procedures. In addition to apprenticeships a degree in care has been introduced. School fees are no longer allowed, and apprentices are entitled to an appropriate compensation. The bill has been fully enacted since January 2020. (Source: Bundesministerium fuer Gesundheit – Pflegeberufegesetz)

    In 2019 comprehensive measures were introduced to increase workforce training; improve working conditions and pay; relieve the administrative burden on professional carers; and promote recruitment of care professionals in third countries.  Consequently, up to 13,000 additional posts for qualified long-term care workers were created in nursing homes. The funding of 20,000 additional positions for nursing assistants was secured. Germany also increased salaries in the long-term care sector, The Care Wages Improvement Act in 2019 created a legal basis to improve wage conditions for care workers. As a result, minimum wages for qualified care workers have been introduced and the minimum wages for nursing assistance staff were increased (and previously disparate regional rates were aligned). (source: Publications catalogue – Employment, Social Affairs & Inclusion – European Commission (europa.eu).

    In June 2021 a new care reform was passed. From 1 September 2022 care settings will need to pay their care staff according to tariff. (Source: Bundesministerium fuer Gesundheit  – Pflegereform)

    In addition, homecare providers and residential care facilities can receive partial funding (up to €12,000 ) through the LTC insurance funds for the purchase of digital and technical innovations to improve the working conditions of staff over the period 2019 to 2021 and reduce time care staff is spending on bureaucratic tasks. (Source: Bundesministerium fuer Gesundheitl; Publications catalogue – Employment, Social Affairs & Inclusion – European Commission (europa.eu)

    Another programme makes grants available up to 2024 for measures to improve the work-life balance of professional carers. The country has made efforts to co-operate with third countries to improve vocational training and recruitment of LTC professionals, especially with Mexico, the Philippines, and Kosovo- this will be funded from health insurance funds (source: Publications catalogue – Employment, Social Affairs & Inclusion – European Commission (europa.eu).

  • 4.06. Reforms to improve support for unpaid carers

    The care strengthening bills ensure that when unpaid carers are temporarily unable to provide care (e.g. holidays, illness) for people with care level 2 or higher, the long-term care insurance covers the costs of up to six weeks replacement (up to €1,612) care per calendar year. This can also support other household members/unpaid carers taking on the replacement care. This replacement care can also be taken up on an hourly basis. (erste pflegestarkungsgesetz). In addition, replacement care can be combined with 50per cent of the support for short-term care (Kurzzeitpflege) (Source: Bundesministerium fuer Gesundheit – Verhinderungspflege; Bundesministerium fuer Gesundheit – die Pflegestaerkungsgesetze)

    Following the care strengthening bills, unpaid carers in Germany providing community care for people at care level 2 or higher, providing 10 or more hours per of care and do not work more than 30 hours per week are entitled to retirement contributions through the long-term care insurance. In addition, protection through the unemployment insurance has been expanded for carers. This also remains when unpaid carers take holidays. (Source: Deutsche Rentenversicherung; Bundesministerium fuer Gesundheit – Verhinderungspflege)

    The care strengthening bills also provided an entitlement to qualified advice from their care fund. This can help unpaid carers to organise and coordinate care arrangements. (Source: (Source: https://www.bundesgesundheitsministerium.de/fileadmin/Dateien/5_Publikationen/Pflege/Broschueren/PSG_Das_Wichtigste_im_Ueberblick.pdf).

    A bill to improve the compatibility of family, care and work enables employees to leave their job for up to six months to care for a close relative at home. In addition, employees can reduce their work hours for up to two year to up to 15 hours per week. To mitigate the loss of income, employees taking up this possibility can apply for an interest-free loan from a government agency ((Source: Bundesministerium fuer Gesundheit – die Pflegestaerkungsgesetze).

    In addition, working unpaid carers can take up to 10 days paid leave (paid by long-term care insurance – care support money) if they need to temporarily organise care for a close relative (Source: Bundesministerium fuer Gesundheit – die Pflegestaerkungsgesetze).

    From 2019 unpaid carers receive improved access to rehabilitation. The changes include that unpaid carers can now access residential rehabilitation even if from a medical perspective ambulatory treatment would be sufficient. Unpaid carers are also entitled to have the person they care for looked after in the same residential setting where they receive medical rehabilitation. (Source: Bundesministerium fuer Gesundheit)

  • 4.08. Reforms to strengthen community-based care

    People with LTC needs can receive up to €4,000 for changes to their home (for example, to widen doors) to enable people to remain in the community for longer. (Source: Bundesministerium fuer Gesundheit – die Pflegestaerkungsgesetze; Bundesministerium fuer Gesundheit – erstes Pflegestaerkungsgesetz)

    The care strengthening bills support people wishing to set up shared accommodation for people with LTC needs by providing financial support to set this up. People with care needs living in shared accommodations can also receive monthly financial support (Source: Bundesministerium fuer Gesundheit – die Pflegestaerkungsgesetze; Bundesministerium fuer Gesundheit – erstes Pflegestaerkungsgesetz)

    The first care strengthening bill expanded day and night care services. These services can be used without reducing people’s care allowance or entitlement to domiciliary care. (source: Bundesministerium fuer Gesundheit – die Pflegestaerkungsgesetze)


Ongoing research projects on COVID-19 and Long-Term Care in Germany:

https://ltccovid.org/completed-or-ongoing-research-projects-on-covid-19-and-long-term-care/?_country=germany

Most recent LTCcovid report:

https://ltccovid.org/wp-content/uploads/2020/05/Germany_LTC_COVID-19-26-May-2020.pdf

Experts on COVID-19 and long-term care in Germany:

Klara Lorenz-Dant, Thomas Fischer, Kerstin Hämel