Care is becoming more expensive: Warken plans cuts and higher contributions for the childless

Federal Health Minister Nina Warken wants to stabilize long-term care insurance with a mix of later relief in nursing homes and higher contributions. A draft law from her ministry, which is said to be available to the ARD Hauptstadtstudio, focuses mainly on two levers: slower subsidies for those in need of care in residential facilities – and more revenue through contributions, especially from the childless and high earners.

Warken is thus targeting a financing problem that has been growing for years: According to the plans, long-term care insurance is to be restructured so that a "multi-billion gap" is closed. For those affected, this means that support in nursing homes would arrive later – while higher contributions threaten some insured persons.

Warken focuses on nursing home costs and contributions

At its core, it is about the supplements that relieve those in need of full inpatient care of their so-called personal contribution. This system has so far been deliberately designed so that the relief increases with the length of stay: The longer someone is in a nursing home, the more they should gradually benefit from subsidies. The logic behind this: Long-term care is financially particularly burdensome because personal savings are often depleted and relatives reach their limits.

According to the draft, these relief levels are to take effect later – specifically, each by six months. This shifts financial assistance further back. For those in need of care and their families, this means: In a phase when high nursing home costs often come as a shock at the beginning, relief would increase more slowly.

Which stages would be affected

So far, the supplements in the current system are staggered according to length of stay. They start from the first month and then increase after 12, 24, and 36 months. Under the Long-Term Care Support and Relief Act, this is represented in specific percentage values:

• 15 percent from the first month
• 30 percent after 12 months
• 50 percent after 24 months
• 75 percent after 36 months

If these thresholds are pushed back by half a year each in the future, not only does the timing of higher relief shift. In practice, this can also mean that some affected people reach these higher supplements later or – depending on the length of stay – not at all, for example if a nursing home stay is shorter. Politically, this is a classic savings lever: The rule basically remains, but takes effect later and thus, on average, less strongly.

Stricter access to the system

The draft also provides for raising the hurdles for classification into a care level. If this is confirmed and implemented politically, it would be a second, particularly far-reaching lever: Because care levels are the key to benefits – from outpatient support to claims in inpatient care. Higher requirements would change access to benefits and could mean that people receive benefits later or under stricter criteria.

Higher contributions for the childless and more contribution liability for higher incomes

On the revenue side, Warken plans higher care contributions for the childless. This would redistribute the burden within the insured community. The childless already pay a surcharge in social long-term care insurance; a further increase would additionally affect this group and is politically particularly sensitive, as it is quickly perceived as a distribution decision – and not just as a purely financial measure.

In addition, the income threshold up to which contributions are due is to be raised. This would mean that higher incomes would also be more involved in financing, as a larger portion of wages would be subject to contributions. For the care funds, this is a direct increase in revenue; for those affected with higher incomes, it is a noticeable additional burden that applies monthly.

Financial reform with noticeable consequences

Overall, the initiative is less a structural reorganization of care than a financial reform: later subsidies in nursing homes, higher contributions, and stricter access via care levels. It is precisely this combination that makes the debate explosive. Because it affects different groups at the same time – people in residential care facilities, relatives who share nursing home costs, as well as insured persons who would be more heavily burdened through contributions.

Whether and in what form the package will come now depends on the political process. What is clear is: If relief in nursing homes comes later and contributions rise, care will become not only an organizational but even more a financial risk for many – and the question of fair burden-sharing in the system will once again move to the center.