Out-of-pocket costs for nursing homes rise again to a record level

The differences remain substantial in a state-by-state comparison. The most expensive inpatient care is in Bremen at 3,761 euros per month. Those in need of care in Saarland (3,695 euros per month) and in Baden-Württemberg (3,657 euros) also pay above-average amounts. North Rhine-Westphalia ranks third among the most expensive federal states at 3,671 euros in the first year in a nursing home; that is 244 euros more than in the previous year.

Regional differences: From Bremen to Saxony-Anhalt

Saxony-Anhalt remains the cheapest in the national comparison: "Despite the increase, Saxony-Anhalt remains the cheapest federal state in the national comparison at 2,891 euros in the first year of stay." In Thuringia, the burden also rose significantly, by around 250 euros in Thuringia. Lower Saxony (3,008 euros) and Mecklenburg-Western Pomerania (3,032 euros) are also comparatively affordable.

The out-of-pocket share is composed of the so-called uniform facility-specific out-of-pocket share (EEE), which includes costs for accommodation, meals, necessary investments by the facility, and training costs for care staff. Added to this are the pure care costs, which are only partially covered by the long-term care insurance fund. From care grade 2 onward, the long-term care insurance fund pays graduated amounts directly to the facility: 805 euros in care grade 2, 1,319 euros in care grade 3, 1,855 euros in care grade 4, and 2,096 euros in care grade 5.

Subsidies from long-term care insurance funds increase with length of stay

In addition, graduated subsidies from the long-term care insurance funds have applied since 2022, which increase with the length of stay: the out-of-pocket share for pure care is thus reduced by 15 percent in the first year in a nursing home, by 30 percent in the second, by 50 percent in the third, and by 75 percent from the fourth year onward. "The longer someone is in a nursing home, however, the more the long-term care insurance fund's subsidies for pure care kick in. This reduces the burden as the length of stay increases." In NRW, for example, the monthly burden drops to 3,373 euros in the second year, to 2,977 euros in the third, and to 2,481 euros from the fourth year onward.

Parallel to the rising costs, the federal government is planning a care reform. Federal Health Minister Nina Warken presented a corresponding draft law at the beginning of June. According to this, family members with a gross annual income below 100,000 euros are also to be required to contribute to care costs in the future. The limit set in the Family Relief Act of 2020 has applied until now: "Adult children who have a gross annual income of more than 100,000 euros must contribute to the financing." "Bundesgesundheitsministerin Nina Warken will auch Angehörige mit unter 100.000 Euro Einkommen an den Pflegekosten beteiligen." "Über die Regel diskutiert derzeit die Koalition."

Planned reform: Children earning under 100,000 euros should also pay

The draft also provides for the subsidies from the long-term care insurance funds to take effect only half a year later in the future: "Zudem plant sie, dass die Zuschüsse der Pflegekassen erst ein halbes Jahr später greifen." Specifically, the time intervals between the higher subsidy levels are to be extended from twelve to 18 months, so that the out-of-pocket share decreases only six months later. For care grades 2 and 3, the full care allowance is also to be paid only after three months, and the relief amount in care grade 1 (currently 131 euros per month) is to be eliminated.

According to the Health Ministry's calculations, this would generate 2.6 billion euros in savings next year. A prerequisite for receiving benefits from the long-term care insurance is regular contributions during working life as well as the determination of a need for care by an assessor; the amount is based on the assigned care grade.

For children who must support parents in a nursing home, the Federal Ministry of Consumer Protection states: The maintenance claim can be reduced by providing proof of a higher personal need, such as through one's own dependent children, loans, or private insurance. Individuals who simultaneously build up private old-age provision can additionally deduct five percent of their gross income, regardless of the form of investment. Existing assets such as a self-used property for retirement provision do not have to be used for parental maintenance. The amount of maintenance payments is limited by guidelines such as the Düsseldorf Table.

This news was broadcast on 14.07.2026 on Deutschlandfunk. Regarding the causes of the cost increase, Elsner pointed to the backlog in care wages – wages in care are now above the cross-sectoral average. At the same time, she warned that the growing burden on those affected must be politically contained.