(de-news.net) – Germany’s proposed long-term care reform has come under criticism from opposition parties, patient organizations, insurers and caregiver representatives, who warn that planned savings and stricter eligibility requirements could increase pressure on care recipients and their families. While the government seeks to stabilize the insurance system through higher contributions, benefit restructuring and greater emphasis on prevention, calls are growing for amendments to protect home-based care, maintain flexible respite arrangements and distribute financial burdens more equitably.

The Bundestag has begun debating a proposed overhaul of the long-term care insurance system, amid concerns that planned savings could disproportionately affect care recipients and family caregivers. Government representatives have acknowledged the need for further amendments. Health Minister Carsten Linnemann (CDU) pledged to strengthen home-based care, expand prevention and ensure continued support for people requiring assistance, while attributing the system’s financial pressures to demographic developments and previous political decisions.

Linnemann emphasized that the transition to the proposed arrangements for relief payments and substitute care must not cause significant disruptions at the beginning of the year. Acknowledging concerns about the restructuring of benefits, he promised further adjustments to the legislation while stressing the need to prevent abuse. Drawing on his family’s experience, the Minister argued that home-based care differed considerably between households and could not be adequately assessed through financial indicators alone. Greater investment in prevention, counseling and rehabilitation should help prevent or delay dependency, extend healthy life expectancy and improve quality of life.

The governing coalition’s Social Democratic Party (SPD) also acknowledged the need for amendments. Dagmar Schmidt, the party’s deputy parliamentary group leader, described the legislation as one of the most consequential reforms of the current parliamentary term. She identified the restructuring of benefits and the proposed elimination of flexible substitute care arrangements as areas requiring further consideration.

Opposition parties raised additional concerns about the distribution of costs and access to support. Simone Fischer, the Greens’ spokeswoman for care policy, criticized plans to introduce stricter eligibility requirements for care grades one through three, while Left Party leader Luigi Pantisano called for greater financial assistance for family caregivers. Claudia Weiss, the AfD’s health policy representative, argued that the proposals would impose additional financial burdens on citizens.

The draft legislation includes a 0.3-percentage-point increase in the contribution surcharge for people without children and a 300-euro increase in the income ceiling subject to social insurance contributions. Prevention and early rehabilitation are also intended to play a greater role, while an initially proposed reduction in pension entitlements for family caregivers has been abandoned. Under the proposed benefit restructuring, the existing relief allowance would be eliminated for care grade one and transferred into a new community-based budget (Sozialraumbudget) for all other care grades. The funds would be restricted to everyday assistance and could no longer be used to pay for services provided by outpatient nursing care providers.

Government commissioner warns against additional burdens on family caregivers

Government Care Commissioner Katrin Staffler (CSU) has called for substantial amendments, arguing that the reform must remain reliable and practical for care recipients and their relatives despite financial constraints. She warned that additional bureaucracy and more complicated procedures could undermine its objectives, particularly for family caregivers already facing considerable organizational and emotional pressures.

Staffler singled out the proposed changes to flexible substitute care, which currently allow relatives to arrange temporary assistance when they cannot provide care themselves. Removing this flexibility could deprive caregivers of essential opportunities for respite, she argued, citing discussions with practitioners who had identified shortcomings in the draft. She therefore expects parliamentarians to address these concerns before the legislation advances.

At the same time, Staffler acknowledged the need to secure the insurance system’s financial stability. However, she maintained that efforts to strengthen its finances must not result in additional burdens for those providing unpaid care or undermine support for people who depend on assistance.

Patient and caregiver organizations criticize proposed restrictions

Representatives of patient and caregiver organizations voiced further opposition to the planned changes. Daniela Eckstein, chairwoman of the national association Wir pflegen, warned against modifying the eligibility criteria for care grades, arguing that obtaining benefits was already difficult in many cases. She called for greater confidence in information supplied by care recipients and their relatives, rather than routinely suspecting them of abusing the system.

The German Foundation for Patient Protection also criticized the draft, arguing that the government was effectively reducing support for home-based care, particularly through restrictions affecting short-term and substitute care. It questioned the proposed restructuring of care grade one and urged parliament to make corrections before adopting the legislation.

Health insurance association calls for fairer distribution of costs

Oliver Blatt, chairman of the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband), called for a more equitable allocation of the financial costs associated with reform. While acknowledging that stabilizing the insurance system would inevitably require adjustments, he argued that the current proposals placed disproportionate pressure on care recipients and contributors without adequately addressing the Federal Government’s financial responsibilities.

Blatt specifically criticized the continued failure to reimburse pandemic-related expenditures and assume responsibility for pension contributions made on behalf of family caregivers. He maintained that broad acceptance of the reform would depend on distributing its financial consequences more fairly, even as he welcomed the government’s decision to address the system’s structural problems.

Michaela Engelmeier, chairwoman of the Social Association of Germany (SoVD), similarly characterized the legislation as predominantly an austerity measure. She warned that stricter care assessments and the suspension of federal subsidies would shift additional costs onto care recipients and contributors. Engelmeier urged the planned Care Structure Commission to develop a comprehensive alternative based on a universal, solidarity-based insurance system funded by all citizens, a substantial increase in the contribution assessment ceiling and the inclusion of additional income sources.

ASB proposes greater use of private assets to finance long-term care

Knut Fleckenstein, federal chairman of the Workers’ Samaritan Federation (ASB), argued that private assets, particularly real estate, should play a greater role in financing long-term care. He maintained that the insurance system should not primarily protect inherited wealth and proposed reconsidering tax-exempt property transfers to children when such arrangements subsequently leave public authorities responsible for financing care. Fleckenstein nevertheless supported retaining the existing income threshold under which children must contribute to their parents’ care costs only when their annual gross income exceeds 100,000 euros. He argued that requiring children to contribute earlier, irrespective of their parents’ assets, would be difficult to justify.

The ASB chairman also called for limits on nursing home residents’ out-of-pocket payments, warning that people who had worked throughout their lives and raised families should not face poverty in old age. To strengthen the insurance system’s finances, he proposed that the federal government repay the outstanding five billion euros in pandemic assistance, substantially increase contribution assessment ceilings and require broader participation in the insurance scheme.

Fleckenstein welcomed the government’s decision to retain pension credits for family caregivers, reversing an earlier proposal to reduce these entitlements. He also cautioned that cuts to prevention and outpatient care could ultimately increase overall expenditure because institutional care was considerably more expensive. Maintaining adequate support for home-based care would therefore be essential to containing long-term costs and ensuring the financial sustainability of the wider care system.