Federal Health Minister Karl Lauterbach (SPD) sees the nursing care insurance system under increasing pressure and is calling for controversial countermeasures in an interview with the Redaktionsnetzwerk Deutschland (RND). Demographic change and the large shortage of skilled workers are increasingly pushing the system to its limits, he says.
Lauterbach is therefore calling for a different financing approach. Much of the German care system is already stretched to the limit: “It cannot stay like this.” Thomas Fischer, professor of nursing science with a focus on geriatric care at the Evangelical University in Dresden, agrees with Lauterbach: “The resources we currently have in the system are not enough for good care,” says Fischer. However, he questions the alarming figures that the minister mentioned in the RND interview.
“Explosive increase” questionable
Lauterbach speaks of an “almost explosive” increase in the number of people in need of care. For demographic reasons, fifty thousand new people in need of care were expected in 2023. However, figures from private and state nursing care funds show an increase of more than 360,000 people in need of care, he told the RND. Fischer cannot understand why Lauterbach’s ministry only expected so few new people in need of care. “We haven’t seen the number of people in need of care increase by just 50,000 for ten years,” says the expert.
A look at the nursing statistics of the Federal Statistical Office, which publishes figures every two years, shows that the increase is really not that unusual. From 2019 to 2021 alone, the number of people in need of care in Germany rose by more than 800,000 to 4.96 millionAn increase of 360,000 people in need of care in 2023 is more like a continuation of this trend than an explosion. In fact, the Federal Statistical Office, whose internal calculations Lauterbach relies on, has also predicted an increase of 200,000 people in need of care by 2023.
For Dresden professor Fischer, the development of the number of people in need of care is hardly surprising, but the situation is no less dramatic. “The care system has long been at its limits, if not beyond them,” he says. It is long overdue that reforms are now being considered. In the past, the problem has always been pushed from one legislative session to the next.
Citizens’ insurance should become a topic again
Lauterbach therefore wants to discuss a citizen’s long-term care insurance scheme again. “We are entering a phase in which demographics will cause costs to rise more than ever before. For the first time, the question is how long long-term care insurance will remain affordable,” he says. In view of this situation, it is unjustified “that high earners and civil servants do not participate in the solidarity-based financing of long-term care because they can insure themselves privately.”
In a conversation with the RND, Lauterbach also called for higher tax subsidies for the pension contributions of caring relatives and indicated that there are disagreements within the coalition about financial reform of care. A working group from several ministries wants to soon “put their different proposed solutions side by side in a neutral and fair manner”.
More money alone cannot solve the problems of the ailing care system, says Thomas Fischer. “We need more qualified staff. But that is not available. Despite all our efforts, we have not yet solved this problem,” criticizes the expert. In addition, the issue of care in Germany is being handled with too much focus on the acute care phase at the end of life. Care prevention is not an issue.
“We could start much earlier to enable people to remain self-determined for as long as possible,” says Fischer. Dementia, loneliness, cardiovascular disease and diabetes are drivers of the need for care. If society as a whole invested more in the prevention of these factors, the burden on the care system could be massively reduced, explains Fischer. “We are currently not tapping into this potential at all,” he says.