Germany's long-term care reform draft draws sharp criticism from municipalities, opposition, and care industry

A central element of the draft is a tightening of access to long-term care benefits. The proposal raises the hurdles for classification into care grades 1, 2, and 3, a change the ministry says is needed because the criteria originally adopted in the 2017 reform deviated from scientific recommendations. People already classified into a care grade before the new law takes effect would retain that grade, but the new rules are designed to make entry into the system more demanding. Green party health expert Janosch Dahmen described the change as the largest savings item in the package, amounting to restrictions on care services for those in need.

Tightening access to benefits

For nursing home residents, the draft alters the schedule of relief supplements that increase with length of stay. Under current rules, care insurance funds pay subsidies toward the personal contribution of 15 percent in the first year, 30 percent after twelve months, 50 percent after twenty-four months, and 75 percent after thirty-six months. The reform extends each tier deadline by six months, so the maximum 75-percent subsidy would only be reached after four and a half years. The ministry said the change is a necessary measure to stabilise the social care insurance, estimating the move alone would save roughly two billion euros a year. The average monthly personal contribution for full inpatient care in the first year recently exceeded 3,200 euros nationwide.

The draft also restructures support for outpatient care. The current monthly relief allowance of up to 131 euros for care grade 1 would be eliminated, while the allowance for care grades 2 and 3 would be halved during the first three months. The savings are earmarked to establish a new 'Pflegebegleitung' service for early professional advice, as well as a 'Überbrückungsbudget', a bridging budget that can be used for outpatient care services or a short-term nursing home stay during health crises or unplanned absence of the main caregiver. Various individual home-care benefits would be consolidated into budgets, and from 2028, care insurance benefits for both outpatient and inpatient care are to be adjusted annually to inflation.

Impact on family caregivers

Family caregivers would be affected by a cut to pension contributions paid by the care insurance fund on their behalf. The draft reduces these contributions to 70 percent of the current level, which will translate into lower future pension entitlements for those who care for relatives at home. Combined with the elimination and reduction of relief allowances, the measures have drawn particular concern from advocacy groups, who warn they will push more people into old-age poverty.

On the revenue side, the draft raises the contribution rate for childless individuals by 0.1 percentage points, from the current 0.6-percent surcharge to 0.7 percent. Combined with the general employee contribution rate of 1.8 percent, the total care insurance contribution for childless adults would rise to 4.3 percent. The contribution assessment ceiling for care insurance is also to be raised, affecting employees earning more than 5,812.50 euros per month. According to Health Ministry calculations, those affected would face a maximum additional burden of 17 euros per month.

Revenue measures and higher contributions

For the first time, care insurance contributions of 3.6 percent would be levied on mini-job wages up to 603 euros, payable exclusively by employers. From 2028, contribution-free co-insurance of spouses would also be restricted, similar to plans already in train for health insurance. Under the new rules, only partners with children under seven, children with disabilities, caregiving relatives, and retired partners could remain co-insured without contributions. Other spouses without significant own income would pay 0.52 percent on their contributable income. The draft also states an intention to make supplementary long-term care insurance premiums tax-deductible, although this is not yet a formal part of the reform. Additionally, the proposal aims to abolish a 2020 rule under which only adult children earning over 100,000 euros per year can be called upon by the social welfare office to pay for parents' care costs.

The political reaction has been swift and largely hostile. Burkhard Jung, president of the German Association of Cities (Deutscher Städtetag) and SPD mayor of Leipzig, called the plans a 'Schlag ins Gesicht der Kommunen' — a slap in the face of municipalities. Speaking to the newspapers of the Funke Mediengruppe, Jung said the draft would lead to additional billions in burdens for municipalities in the coming years rather than relief, warning: 'Dieser Entwurf darf so niemals den Bundestag passieren.' Municipalities bear costs when care-dependent people fall into social welfare, and Jung argued the proposed cuts would shift those costs onto local authorities.

Janosch Dahmen, health expert for the Greens, went further, characterising the reform as 'keine Strukturreform, sondern eine Kürzungsreform' — not a structural reform but a cuts reform. In remarks to the Deutsche Presse-Agentur (dpa), Dahmen said Germany spends less on care as a share of its economic output than many comparable European neighbours, despite having a significantly older population. He accused the federal government of continuing to refuse financing of non-insurance benefits, adding: 'Die Kosten der Pflege verschwinden dadurch nicht – sie tauchen nur an anderer Stelle wieder auf.' The National Association of Statutory Health Insurance Funds, which also represents care funds, considers the package unbalanced, while the Patient Protection Foundation and the Social Association Germany have also criticised the plan.

Municipalities warn of higher social welfare costs

The care industry has echoed those concerns. Thomas Greiner, president of the Arbeitgeberverband Pflege, which represents private care companies, told the Rheinische Post that there are already long waiting times for nursing home places. He denounced the draft as 'Dieser Raubzug bei Beitragszahlern, Pflegebedürftigen und Kommunen schafft nicht einen Pflegeplatz.' Sören Pellmann, parliamentary group leader of Die Linke in the Bundestag, said the cuts threaten more old-age poverty for people needing care and their family caregivers. Reports also indicate discontent with the proposal within the governing coalition itself, including from the SPD and CSU, complicating the government's stated aim of passing the law before the summer break in July.

Defence of the package has come from within the CDU. Jens Spahn, the party's parliamentary group leader and a former federal health minister, told the ARD programme 'Interview der Woche' that Warken is taking a 'difficult but necessary step' and presenting a 'balanced package'. Spahn stressed the underlying fiscal reality: 'Aber die Pflegeversicherung - wie übrigens auch die Krankenversicherung - die sind schlicht und ergreifend pleite.' Warken has framed the package in similar terms, telling the Bundestag that without reform the long-term care insurance will not be financially sustainable, though she has yet to secure broad backing for the bill.

Industry and opposition push back

The draft now heads into a contentious legislative process. After passage by the Bundestag, the Bundesrat will also deal with the plans. Whether the reform clears both chambers in its current form before the summer recess will depend on negotiations not only with the opposition but with the coalition's own restive members, who have made clear that further changes are likely if the law is to win the required majorities.

Whatever the final shape of the legislation, the draft marks a significant shift in how Germany finances the growing cost of long-term care. By raising contributions on childless adults, restricting spousal co-insurance, and adjusting the schedules under which nursing home residents receive subsidies, the ministry is seeking to spread the burden more broadly while keeping a lid on headline contribution rates. Critics counter that the measures amount to a transfer of costs onto care-dependent people, their families, and municipalities, and that without broader structural reform the underlying gap will return in years to come.