The care situation in Germany is disastrous.
In an interview, an expert from the long-term care protection association explains why this is the case and how long-term care insurance can be improved.
Berlin – Everyone agrees that something urgently needs to be changed in care.
Health Minister Karl Lauterbach (SPD) has therefore just brought a care reform to the Bundestag in order to at least stabilize the financing of care insurance somewhat.
There are considerable doubts among experts as to whether this will be sufficient.
Markus Sutorius works in the legal department of the BIVA Care Protection Association.
Among other things, he advises relatives of people in need of care on legal issues.
He spoke to
IPPEN.MEDIA
about the biggest problems in long-term care insurance, why the federal government's long-term care reform is not good enough and what better care in Germany could look like.
+
A nurse walks across the hall with an elderly woman in a nursing home in Stuttgart.
© Christoph Schmidt/dpa
Mr. Sutorius, what are the typical cases that come to your legal advice?
Most of the inquiries are related to the rate increases, which have recently been very high.
What also concerns us a lot are deficiencies in care.
But we also get a lot of inquiries about social assistance: How do I get it?
Do I also get housing benefit in the home?
These are questions that have been reaching us more and more lately.
The need for long-term care represents the greatest risk of poverty for older people. What are the main reasons for this?
The cost of care has exploded since the fall of last year.
On the one hand, this is due to the fact that nursing staff now have to be paid according to collective agreements.
Secondly, it is of course also due to the fact that the costs in the home have increased.
One thinks of energy prices and food costs - all of which the nursing homes have to pay for.
The facilities are allowed to simply pass these costs on to the residents – and they do so.
We are talking about a personal contribution here, which amounts to an average of 2400 euros per month.
The long-term care insurance fund only pays the statutory subsidy depending on the level of care and nothing more.
Statutory long-term care insurance is chronically underfunded. How could it be made better?
The long-term care insurance is currently only financed by those who are compulsorily insured - i.e. the employees - with an amount of 3.05 percent of the gross wage.
In the case of childless insured persons, the figure is 3.4 percent.
The amount should now increase with the care reform, to 3.4 percent.
But all this is not enough.
If you look at the neighboring countries, especially the Netherlands, people there pay around ten percent of their gross wages.
They also have citizen insurance, which means that the self-employed and civil servants also pay into the nursing care fund.
If we were to increase the contributions even more here, there would probably be massive resistance
.
That's why it's not done.
The question that politicians have to ask themselves is: How should care be financed?
Through insurance or through tax money?
At the moment we actually have mixed financing.
In addition to insurance contributions, it is financed by federal subsidies for long-term care insurance and by social assistance, on which those in need will sooner or later depend.
So, as the care protection association, do you advocate a significant increase in contributions? Or should the system be completely revamped?
There are of course different opinions on the subject, including ours.
Personally, I believe that insurance that pays for services of general interest is actually nonsense.
In the Scandinavian countries, services of general interest are financed through taxes, I think that makes much more sense.
As a long-term care protection association, however, we fundamentally demand citizen insurance, i.e. a long-term care insurance fund, into which everyone – including the self-employed and civil servants – pays.
Then a lot more money would come into the till.
It was also considered to introduce it, but now we have a care reform instead, which basically changes little, except for a slight increase in contributions.
So you don't think Health Minister Lauterbach's care reform makes much sense?
Yes, it is a reform.
This hardly cushions the increased costs.
What we need is a reform that puts insurance on a different footing.
Keyword base-tip exchange.
The person in need of care would then pay a fixed amount, and anything more than that would be covered by the care insurance.
This could also be graded according to income.
But right now it's the other way around.
How are the costs calculated in the facilities? Is anyone filling their pockets here?
We don't know that exactly.
We don't know exactly how the negotiations between the nursing care funds, the social welfare agencies and the facilities are going.
The payers are actually supposed to carry out a plausibility check, but to be honest I don't know if they are really so well positioned to do it in any case.
We hear again and again that these care rate negotiations take place like at the bazaar.
Some numbers are thrown around and then an agreement is reached somewhere in the middle, without that being in any way comprehensible.
Is there no transparency about this?
No.
This transparency only exists for home residents if the home advisory board takes part in the negotiations.
Home advisory councils are only allowed to do this in Bavaria and Baden-Württemberg.
And there, too, very few people do it, it is also a complicated process.
But if it happens that someone is sitting there who happens to be in our club - then that's the statement we hear: It's a bazaar.
And the long-term care insurance companies probably don't negotiate particularly hard because they only have to pay a fixed amount anyway.
Correct.
You should actually check how the costs come about.
But whether they really take on this task….
One can at least have doubts about it.
Does that mean that it cannot be ruled out that home managers will seize the opportunity here to make a profit?
It can't be ruled out, exactly.
If you also hear that some facilities are making higher returns, then you can already see that something is wrong with the nursing rate negotiations.
How can people protect themselves from falling into this poverty trap later on?
Actually not at all.
Protection from the poverty trap is: Don't be in need of care.
In order to reduce the risk of poverty, the state would have to initiate a comprehensive care reform.
List of rubrics: © Christoph Schmidt/dpa
