Nursing care insurance | Nursing care: Still before reform

The assessment of many of the new federal government's projects fluctuates between skepticism and hope. This also applies to the handling of the precarious financial situation of the social long-term care insurance system. In the area of nursing, there is also a queue of legislative proposals, including the Nursing Competence Act, which aims to enhance the status of nursing activities. The law on the nationwide regulation of nursing assistants, a professional group that currently requires up to two years of training and is used in support activities, has been announced for this year.

Last week, a federal-state working group was also established for long-term care, which has already met once. It is expected to deliver key points for the necessary reforms by the end of the year. The focus will be on proposals for how to cover the care costs of an aging population . The goal is fundamental reform, according to Health Minister Nina Warken (CDU). The federal government's working group also includes Family Minister Karin Prien (CDU) and other ministries. The heads of the state departments responsible for long-term care are also involved. Also involved are the leading municipal associations and the parliamentary groups of the governing parties in the Bundestag.

Not included so far are the cost carriers, i.e., the social long-term care insurance or the statutory health insurance (GKV), nor the caregivers themselves, which would be possible for the professionals among them, for example, with the German Nursing Council. This is one of the reasons why a joint public event between these two actors last Friday was particularly important.

The new chairman of the GKV umbrella association, Oliver Blatt, is quite moderate in this regard. He also believes that long-term care insurance expenditures should be reviewed: "Where does the money go, where does it reach?" Existing resources must be used efficiently. And existing nursing staff should work where they are most urgently needed. Blatt did not want to broadly support demands from employers to establish a benefit-free period after the initial assignment of a care level.

The head of the statutory health insurance association, like scientists and opposition politicians, also expects the federal government to first be honest about coronavirus protection measures in nursing facilities and pension insurance for family caregivers. If the funds spent here for social purposes were repaid to the insurance company, these two times five billion euros would provide a cushion for the "thorough reform." Otherwise, Blatt predicts that the nursing care insurance system will be tight again as early as 2026. New contribution rate increases are foreseeable then.

Nursing Council President Christine Vogler initially had to defend the increase in nursing wages in recent years – not without criticizing that these increases should not simply be passed on to those in need of care. If this principle were applied to hospitals, patients would have to pay corresponding surcharges for their treatment, which is hardly conceivable. However, Vogler makes another calculation: "By 2035, there will be a shortage of 350,000 nursing professionals in outpatient care alone." While wages have improved in the meantime, nurses willing to change are now paying close attention to working conditions. "However, it still takes months to fill a vacant position," reports the nursing expert.

She has a whole series of suggestions for the future on how resources in nursing could be used more effectively . For example, by expanding the skills of specialists, which is a legislative proposal on the coalition's agenda in this legislative period. This should make the system less doctor-centric. Vogler also wants nursing staff to better manage the entire process by involving relatives or neighbors. For those being cared for and their relatives, the entire field needs to be significantly less bureaucratic. In order to plan nursing finances, it is necessary to first collect social data on nursing, and there is no basis for this. Accordingly, there are enough approaches that a nursing reform could incorporate - not to mention that the entire system would have to be made much more preventative. This includes nursing professionals working towards avoiding higher levels of care wherever possible, or for example making school nurses the norm and acting as permanent contacts for schoolchildren's needs.

A far-reaching reform is urgently needed. Private insurers, on the other hand, are already waiting for their political lobby to strengthen the role of care provision in a much more "independent" way. From their perspective, new benefits from social long-term care insurance are simply not financially viable. And privately funded supplementary insurance is the panacea for all long-term care problems.

"However, it still takes months to fill a vacant nursing position."

Christine Vogler President of the Nursing Council