Schleswig-Holstein's Social Minister Touré Calls Warken's Care Reform a Missed Opportunity

The Greens politician spoke of a squandered opportunity. «Die Ministerin verpasst damit eine große Chance», said Touré. What was needed was «eine echte Pflegereform, die den demografischen Wandel, einen akuten Fachkräftemangel und die großen Finanzierungslücken berücksichtigt». Instead, the draft felt like a mere stabilization program that ignored the lived reality of those affected.

Family Caregivers at the Center of Criticism

Specifically, Touré objected that the pension contributions that the care insurance fund has so far paid for family caregivers are to be cut by 30 percent. Even now, it is «meist von Ehefrauen, Töchtern oder Schwiegertöchtern, die dafür ihre Arbeitszeit reduzieren». «Dass pflegende Angehörige mit der Reform nicht unterstützt, sondern eher noch zur Kasse gebeten werden, ist ein Schlag ins Gesicht der Betroffenen», said the minister. This weakens a central building block against later old-age poverty among caregiving women.

According to the federal government's presentation, the reform provides for a package of spending brakes and additional revenues to financially stabilize the care insurance system. These include, among other things, raising the income threshold above which contributions become due, in line with the health reform. In 2027, the care insurance system is estimated to be relieved by 2.6 billion euros. However, according to federal calculations, this also creates an additional financial requirement of one billion euros that would have to be distributed among the states and municipalities.

Additional Burdens for States and Municipalities

For Schleswig-Holstein, Touré put the additional financial requirement at around 35 to 40 million euros per year – «fatal und nicht akzeptabel angesichts der Haushaltslage». The additional funds should, in the minister's view, be borne entirely by the federal government, which had already burdened the care insurance funds during the COVID-19 pandemic. During that time alone, the federal government had caused «fast 6 Milliarden Euro Mehrkosten», which it had not yet repaid. «Seit Jahren fordern die Pflegekassen das Geld ein.»

At its core, the criticism from the Schleswig-Holstein minister takes up a broader debate about the financing of care. «Es ist bedauerlich, dass der Bund nicht den Mut hat, diejenigen stärker in die Verantwortung zu nehmen, die wirklich einen Beitrag zur Finanzierung der Pflege leisten könnten», said Touré. She explicitly named a citizens' insurance scheme as well as the inclusion of income from capital gains and rental as options that were missing from the current draft.

Personal Contributions, Length of Stay, Care Grade One

Warken's reform is also causing annoyance because it intervenes at a politically sensitive point: personal contributions. In residential care in Germany, those affected pay a personal contribution not covered by care insurance. Warken had repeatedly emphasized in the public debate that adult children should continue to be called upon to finance their parents' care costs. Touré counters that a social gradation of personal contributions would have achieved much more – «denn die demografische Entwicklung war absehbar».

The draft also delays improvements in benefits for residential care: surcharges tied to length of stay are to take effect six months later than before. «Viele Pflegebedürftige werden damit noch länger auf Entlastungen durch die Pflegeversicherung warten müssen», criticized Touré. «Dies ist niemandem zu vermitteln.» The adjustment apparently aims to smooth the reform's bottom line, but hits precisely those who depend on every additional form of relief.

Care Housing Allowance and Investment Costs

According to the Social Ministry, Schleswig-Holstein is already engaged disproportionately in care financing. The state and its municipalities provide around 44 million euros annually for the care housing allowance (Pflegewohngeld), which benefits residential facilities whose residents cannot cover investment costs out of their own pockets. By forgoing an income- and asset-based individual assessment, the state thus accommodates operators – and indirectly also relieves those in need of care.

According to figures from the report, in Germany «rund 85 Prozent der Pflegebedürftigen zu Hause versorgt» are. Around seven million relatives provide informal care, often alongside reduced employment. «Die Zahl der Pflegebedürftigen in Deutschland von derzeit knapp 6 Millionen» will, «mit dem Renteneintritt der geburtenstarken Jahrgänge», rise by «um etwa 1,8 Millionen» by 2055. The pressure on the care insurance system will thus continue to grow over the coming decades – regardless of the stabilization measures under discussion.

Demographics and Social Contributions

The reform package also questions care grade one. Under discussion is «den Pflegegrad eins von insgesamt fünf gänzlich zu streichen». This would eliminate or restrict benefits for people with low care needs. Critics see this as a further step that would primarily affect the lower middle of those in need of care.

The Schleswig-Holstein minister also points to the fundamental architecture of care financing. In Germany, the federal states are obliged to finance maintenance for hospitals. «Während die Bundesländer bei Hospitälern verpflichtet sind, die Instandhaltung zu zahlen, verweigern sie dies bei Pflegeheimen», said Touré. If this obligation were extended to care homes, the personal contribution for a care home place that those in need of care must pay could be reduced by about 500 euros per month.

Residential Care and Maintenance

The fact that the care insurance system itself does not generate any pay-as-you-go returns and is increasingly dependent on federal loans further aggravates the situation. «Da auch in der Pflegeversicherung die Beiträge in der Regel zur Hälfte von den Arbeitgebern bezahlt werden», contribution increases needed for refinancing would also be a business-location issue. Germany already has «Deutschland … innerhalb Europas jetzt schon eine Spitzenposition bei den Sozialabgaben».

In political Berlin, however, the plans do meet with approval within the coalition, which wants to stabilize the finances of the care insurance funds in the short term with the draft. Criticism from the states nonetheless carries weight, because some of the measures would have to be implemented at the state and municipal level – for example, the question of how the additional funds are to be raised and who ultimately shoulders the higher personal contribution.

Outlook: Reform in the Bundesrat

On the substance, the conflict therefore remains unresolved for now. Touré announced that she would critically accompany the reform in the Bundesrat. She called on the federal government to launch a «echte Pflegereform» that distributes the burdens more fairly. «Es hätte aber einer echten Pflegereform bedurft, die den demografischen Wandel, einen akuten Fachkräftemangel und die großen Finanzierungslücken berücksichtigt», she said. Without such a step, the minister warned, care in Germany will become a burden for ever more families.

This text is an excerpt from the newsletter «Der andere Blick am Morgen» published by the Neue Zürcher Zeitung, written by Susann Kreutzmann, editor at NZZ Deutschland. The assessment is based on documented statements from those involved and verified key figures from care statistics and the architecture of Germany's care insurance system.