Nursing home in NRW costs 3,671 euros out of pocket in the first year – nationwide 3,364 euros

Bremen records the highest figure at an average of 3,761 euros in the first year, followed by Saarland at 3,695 euros. Saxony-Anhalt remains the least expensive federal state at 2,891 euros in the first year of residence, according to further vdek analysis. In the state comparison, care in the first year in a home was most expensive in Bremen, now averaging 3,761 euros.

As of July 1, the nationwide average out-of-pocket cost for the first year in a home was 3,364 euros per month. The personal contribution decreases with longer duration of stay, as the long-term care insurance fund pays graduated subsidies. Currently, there is a state subsidy of 15 percent on care costs in the first year. In the second year, it is 30 percent, and from three years of stay onward, 75 percent.

Why costs are rising

For North Rhine-Westphalia, this means: the out-of-pocket payment in NRW fell to 3,373 euros in the second year, to 2,977 euros in the third year, and to 2,481 euros from the fourth year onward. Those already living in a home in their fourth year currently pay an average of 2,481 euros, according to the latest vdek calculation.

The rise in costs is mainly attributable to higher personnel expenses. According to the association, "care-related expenses" in particular saw the steepest increase – due in part to higher personnel costs. A key reason why a place in a nursing home is becoming more expensive is the increased spending on staff.

Since 2022, homes can only sign contracts with long-term care insurance funds if they pay according to collective agreements or similar. The salaries of care workers have risen sharply in recent years and now lie above average compared to other sectors, explained association chairwoman Ulrike Elsner.

What the long-term care insurance fund pays

Elsner views the development with concern. There was a backlog, and it is right that care workers are paid well. But it cannot be that this leads to ever greater burdens on those in need of care, said the head of the substitute health insurance funds association, whose members include Techniker Krankenkasse, Barmer, and DAK-Gesundheit.

Nationwide, the calculated base figure for pure care also rose past the 2,000-euro mark, now reaching 2,088 euros per month. This corresponds to an increase of 226 euros compared to July 2025. Added to this are costs for accommodation and meals, which have also risen: an average of 1,086 euros per month is now due for these, 50 euros more than on July 1, 2025.

Those in need of care must bear the so-called uniform institutional personal contribution (EEE) themselves. Costs for accommodation, meals, and also for necessary investments of the nursing home – the so-called uniform institutional personal contribution (EEE) – must be borne by those affected themselves. Added to this are the costs for training care workers.

The long-term care insurance fund contributes to costs depending on the care grade. From care grade 2 onward, the long-term care insurance fund pays monthly benefits to the nursing home. The benefits are graduated: Care grade 2 = 805 euros, care grade 3 = 1,319 euros, care grade 4 = 1,855 euros, care grade 5 = 2,096 euros. Care grade 1, for example, means relatively little support. At care grade 5, those affected are no longer able to care for themselves in everyday life.

A prerequisite for benefits is that contributions were regularly paid into a statutory or private long-term care insurance during working life and that the need for care has been confirmed by an expert. The benefit subsidy is paid directly to the nursing home.

When children must pay

If those in need of care cannot bear the costs themselves, relatives step in under certain conditions. When a parent moves into a home, the spouse is initially responsible for the costs, followed by the children. If there are several children, all siblings are liable jointly and severally – proportionally, according to their income and asset situation. However, children are only obliged to provide maintenance if their own gross annual income exceeds 100,000 euros.

This limit was established in 2020 with the so-called Relatives Relief Act. Adult children who have a gross annual income of more than 100,000 euros must contribute to financing. All income is added together in this calculation. If there are several siblings, only those who earn more than 100,000 euros must pay – each with the share calculated for them. Those who simultaneously build up private old-age provision for themselves can deduct a further five percent of gross income from the obligation to pay parental maintenance. The amount of maintenance payments is limited by various guidelines, for example the "Düsseldorf Table," which is also used to calculate maintenance for children. Existing assets, such as a home, do not have to be used for parental maintenance if they serve one's own old-age security.

Planned reform and criticism

Federal Health Minister Nina Warken (CDU) presented a draft law at the beginning of June aimed at reorganizing long-term care insurance. At its core, the plan is to cover an expected deficit of the long-term care insurance fund of 7.6 billion euros in 2027 – with a risk buffer also due to the weak economic situation, a total financial need of 11.2 billion euros is to be covered in order to avoid general contribution increases.

To this end, the time periods until a higher subsidy kicks in are to be extended from 12 to 18 months each. Currently, the personal contribution for pure care in the first year in a home is reduced by 15 percent, in the second year by 30 percent, in the third year by 50 percent, and from the fourth year onward by 75 percent. In the future, these stages are to take effect only after 18 months – this is intended to relieve the long-term care insurance funds by 2.6 billion euros next year.

In addition, the relief amount for care grade 1 is to be eliminated. The amount of 131 euros per month is intended to support family caregivers in their work. Among other things, for care grades 2 and 3, care allowance is to be paid in full only after three months. Cuts to pension contributions for family caregivers are also planned. Restrictions are planned for the free co-insurance of spouses.

However, the contribution for childless individuals is to rise slightly to 4.3 percent. The reform is also to include suspending the general requirement for collective bargaining-based pay for care workers for four years from the beginning of 2027. The requirements for classification into a care grade are to be raised in tendency. From 2028, general long-term care insurance benefits are to be adjusted annually to inflation according to a new mechanism rather than through individual laws.

The plans are meeting with sharp criticism. Instead of taking the red pen, the pure care costs must finally be capped at 1,000 euros, demanded Eugen Brysch, board member of the German Patient Protection Foundation. The foundation criticized that the planned weakening of subsidies would affect the approximately 800,000 nursing home residents in Germany. A 'cap on care-related personal contributions' was also listed as a review mandate for a commission in the black-red coalition agreement.

BSW founder Sahra Wagenknecht called the costs "pure usury" and demanded a monthly cap of 1,000 euros. Luigi Pantisano, federal chairman of Die Linke, said the costs could hardly be managed with normal incomes and would eat up life savings within a few years. Ramona Pop, head of the Federation of German Consumer Organizations, criticized that the planned reform does not provide relief but threatens to increase the burden. Simone Fischer, policy expert for the Greens, warned that more and more people in need of care could no longer afford home costs and would be dependent on social welfare. The coalition is currently discussing the rule on relatives' contributions.

Federal Health Minister Nina Warken also wants to involve relatives with incomes under 100,000 euros in care costs and is furthermore planning for the long-term care insurance fund subsidies to take effect only half a year later. The coalition is currently working on a care reform. Due to the financial woes of the long-term care insurance funds, however, it aims to weaken relief measures on personal contributions.

In the home, residents must also make payments