Recently Completed Nursing Care Reform: Is Nursing Care Insurance Fit for the Future?

At the beginning of 2017, the most comprehensive reform of statutory nursing care insurance was implemented with the second and third stages of the Nursing Care Enhancement Act that had been preceded by years of discussion. Stefan Greß and Klaus Stegmüller, Fulda University, regard the new version of the concept of the need for care as a milestone in the development of nursing care insurance. The reform also has its weaknesses: in particular, the current skilled personnel deficit in the nursing care sector and the inadequate remuneration of caregivers has not been or insufficiently addressed in the reforms. Sabine Strüder, Consumer Protection Agency of Rhineland-Palatinate, also believes that with the reforms of nursing care insurance the legislators have introduced comprehensive changes that will lead on the whole to major improvements in benefits for those in need of care and their families, especially for outpatient care. However, serious problems remain in the securing of skilled nursing staff employees and in the sustainable financing of nursing care insurance. The question arises as to whether the existing pay-as-you-go system should be replaced by a capital-funded procedure and whether the existing separation of statutory and private nursing care insurance should be maintained. According to Dörte Heger, RWI – Leibniz Institute for Economic Research, Essen, the biggest challenge for nursing care insurance is demographic change, especially when the baby boomers in Germany reach retirement age leading thereby not only to an increase in the number of people in need of care but also to a decline in the number of contributors. In order to reduce the need for care, prevention and the consistent implementation of the principle of “rehabilitation before long-term care” are important keywords. In addition, however, productivity in nursing care needs to be increased. Here innovations as well as the increased use of technology can contribute. For Thomas Gerlinger, University of Bielefeld, with the introduction of a new concept of the need for long-term care and the corresponding appraisal system, long overdue measures have been taken to expand the circle of recipients and to identify their nursing needs. This is an important step in adapting benefit entitlements to current and future needs. Unfortunately, the ruling Grand Coalition has refrained from structurally strengthening the income side, especially the introduction of a citizens’ insurance to dampen future increases in contribution rates. The newly established nursing-care provision fund is not a suitable instrument for this.