It’s less than a year before the general election, but Health Minister Jens Spahn wants to start a nursing reform beforehand. Over the weekend, the CDU politician outlined the first ideas he wants to discuss within the coalition. An important part of his concept: for people living at home who need care, the contribution to healthcare costs is maximized. He wants to “create a framework that makes healthcare more predictable,” says Spahn. The minister also wants to simplify home care. He also wants to enforce collective labor agreement wages across the board for those working in healthcare.
Capping of the personal contribution in the home
Minister of Health Spahn proposes that house residents pay a maximum of 700 euros per month in health care costs – and this for a maximum of three years. After that, this amount should drop to zero. However, this does not mean that people in need of care no longer have to pay anything out of their own pocket for their home. Because there are other costs besides the “personal contribution”.
According to statistics from the Association of Replacement Funds, residents of a home currently pay an average of 2015 euros per month, of which 774 euros is for room and board, 445 euros is intended for investment costs for nursing home operators – the own contribution towards healthcare costs is 786 euros per month.
Nursing expert Thomas Kalwitzki from the University of Bremen describes the proposed reduction in personal contribution as a big step in the right direction. “Anyone who needs care knows that it costs them a maximum of 25,000 euros to go home,” says the scientist. At the moment it is “difficult for many people to calculate” the financial burdens they may face. “A ceiling for the personal contribution would provide great certainty,” says the gerontologist. The amount of 700 euros per month is debatable, says Kalwitzki. He thinks it is advisable to set the amount lower so that the relief effect is greater. “There will certainly be discussions in the political process – especially as the coalition partner SPD is demanding full insurance,” Kalwitzki expects.
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Even the Federation of German Consumer Organizations does not consider the financial relief to be sufficient. Considering an average pension of 1500 euros, even with a ceiling for the care part of 700 euros, the total costs are still much too high for most people in need of care, Klaus Müller criticized. The leftist Bundestag member Pia Zimmermann also sees it: “The need for care remains a risk of poverty,” she says.
Since January 2017, it has been legally determined that residents with care level II to V, regardless of the care level, pay the same part of the care costs. However, the amount of this personal contribution differs from house to house. In some cases, the costs also differ between the federal states. The average self-care contribution is particularly high in North Rhine-Westphalia and Southern Germany, while residents in, for example, Saxony-Anhalt, Saxony or Mecklenburg-Vorpommern would currently not benefit from a ceiling for the self-care contribution of 700 euros.
But even if the average personal contribution in some East German states is less than 700 euros, healthcare costs in these countries would rise sharply, so that a ceiling ‘would apply’ by 2022 at the latest, predicts gerontologist Kalwitzki.
According to the Federal Bureau of Statistics, about a quarter of the 3.4 million people who need care in Germany are currently being cared for in a nursing home. In absolute numbers, that is about 818,000 people.
Care at home
For home care, Spahn wants to combine two services (preventive care and short-term care) into a budget that caring families can spend more flexibly. Both services are intended to represent informal carers for a short period of time. The amount of 3,330 euros per year, which the minister mentions, would be about 100 euros higher than the current benefits.
Collective pay for employees
Spahn wants to guarantee the collective labor agreement remuneration of nursing staff by only being allowed to contract with nursing funds that use collective agreements negotiated by employers and employees. According to the Federal Statistical Office, a total of more than 1.1 million people work in health care, just under 400,000 in outpatient care and more than 760,000 at home.
Although nurses are now lacking in many places, the pay is very different. There is no national collective labor agreement in nursing yet. This is also because there are very different organizations active in the industry. There are private, congregational, non-profit, and church sponsors. According to the Federal Department of Labor, collective bargaining agreements only apply to 20 percent of older workers.
Minister of Health Jens Spahn (CDU) presenting his health care reform Photo: Frank Rumpenhorst / dpa
The nursing researcher Kalwitzki thinks it makes sense to combine a national introduction of collective labor agreement wages with a ceiling for the personal contribution. “According to the previous regulations, it would be different that with better remuneration of the nursing staff, the costs for those in need of care also increase,” says the scientist from Bremen. Another positive side effect: The just-presented process of staff appraisal can be introduced without these costs being passed on to residents, he says. A recently published study by the Institute of Bremen shows that this procedure would require more staff in all healthcare facilities.
Cost of reform
Spahn estimates the cost of the nursing reform at six billion euros. He argues that the additional expenses should be largely paid for from tax revenues – and not from contributions to long-term health insurance. The CDU politician states that care is a “task for society as a whole”. The experience with the Corona crisis has increased acceptance for it.
Opportunities for implementation
Spahn’s proposals are in principle approved by SPD’s coalition partner. SPD general secretary Lars Klingbeil referred Monday to a decision by the SPD from 2019 in which the party voted in favor of a limit on its own shares.
At the same time he called for improvements to the concept. The minister made the mistake of making everyone pay the same, Klingbeil said, “That’s not possible.” The SPD politician spoke out for more attention to income in healthcare costs. Those with a high income and capital can also do more with healthcare costs. Spahn himself also made it clear that he did not expect it to be “a debate without controversy”.
What is missing?
The German Patient Protection Foundation complains that with the Spahn reform, caring family members are being neglected. “The more than three million people who need care should receive just $ 100 a year at home,” said Eugen Brysch, board member of the Foundation, referring to the planned changes. “The Federal Health Minister only has peanuts left for caring family members as the largest health service in Germany.”
According to Diakonie president Ulrich Lilie, the reform proposed by Spahn is just “a drop in the ocean”. Long-term care insurance needs a major overhaul. This mainly includes needs-based staffing in the facilities and a sensible concept to link itinerant and inpatient offerings. ‘The families of people in need of care must be noticeably relieved’, Lilie demands.