Increasing co-payments have been causing problems for many people in need of care in the home for years. And the burdens are not only increasing because of the high inflation. Will there soon be a stronger brake on costs?
Home care is getting more and more expensive. The proportion of those in need of care and their families that have to be paid has risen significantly despite the new relief surcharges, according to an evaluation by the Association of Substitute Health Insurance Funds. On January 1, 2023, in the first year in the home, a nationwide average of 2411 euros per month was due out of pocket, 278 euros more than at the beginning of 2022. Higher food costs and better wages for nursing staff now also had an impact. Patient representatives and the opposition are putting pressure on quick relief, including for home care.
On the one hand, the sums include the personal contribution for pure care and support. Unlike health insurance, long-term care insurance only bears part of the costs. For residents of the home, there are also costs for accommodation, food and also for investments in the facilities. Since January 1, 2022, there has been a relief surcharge in addition to the payments from the care insurance fund, which increases with the length of care. The personal contribution only for pure care is reduced by 5 percent in the first year in the home, by 25 percent in the second, by 45 percent in the third, and by 70 percent from the fourth year.
Even with the highest surcharge, the out-of-pocket co-payments rose to an average of 1671 euros per month. That was 130 euros more than on January 1, 2022, according to the data presented this Thursday. A total of almost 700,000 people in need of care will receive supplements, as the Federal Ministry of Health announced for the average of the first three quarters of 2022. Of these, 41.8 percent received the highest supplement from the fourth year in the home - and 25.4 percent the lowest because they were still in the first year in the home.
Without subsidies, everyone would now even have to pay 2468 euros themselves, 289 euros more than at the beginning of 2022. The cause is further additional costs that end up with those in need of care. For example, the personal contribution for pure care on January 1, 2023 was an average of 1139 euros after 912 euros at the beginning of 2022. The background to this is often higher personnel costs. Because since September 1, 2022, all facilities have had to pay nursing staff according to collective agreements or similar in order to be able to settle accounts with the nursing care insurance funds. The old black-red federal government had initiated the legal requirement - also in order to keep and attract urgently needed nurses in the profession.
In addition, the high inflation with more expensive groceries in the homes is noticeable. The additional payments for accommodation and food went up from 801 to 857 euros within a year. Overall, there are still large regional differences in the proportions to be paid by oneself. According to the evaluation on January 1, places in homes – without subsidies – were the most expensive in Baden-Württemberg with 2845 euros per month. They cost the least in Saxony-Anhalt with an average of 1868 euros. For the analysis, remuneration agreements between the long-term care insurance funds and homes in all federal states were evaluated. The data refer to residents with care grades 2 to 5.
The German Foundation for Patient Protection complained that the Federal Government and Minister of Health Karl Lauterbach were idly watching the cost explosion. "The previously empty promises of the traffic light coalition must finally be followed by action," said board member Eugen Brysch. "Each affected person needs 300 euros more per month from now on." In addition, inflation compensation should be introduced immediately. In general, those in need of care should pay a fixed personal contribution in the future. "The rest has to be taken over by the long-term care insurance. That creates predictability and generational equity for people."
The left-wing politician Ates Gürpinar said it was becoming clear that the percentage surcharges on the own shares did not relieve the burden because they did not break through the system of rapidly rising prices. "In addition to the financial burden, there is also an emotional burden." Instead of a reform with only individual adjustment screws, a "caregiver revolution" is needed so that all care-related costs can be covered by the care insurance.
Lauterbach has already announced a major care law for 2023. The focus is also on making many services more dynamic, as the ministry said. Inflation is currently eating up the care rates. The head of the substitute health insurance association, Ulrike Elsner, pointed out additional burdens due to further increases in wages and a new, nationwide uniform personnel assessment tool from July 1st. That is important, like the collective bargaining agreement, but the contributors alone cannot finance it. Elsner called for a "one-stop care reform" with dynamic tax subsidies.
One thing is clear: it will be even more expensive. Even the relief surcharges for home residents cost the nursing care funds 3.4 billion euros last year, as explained by the substitute fund association. This year it should be "well over four billion euros".
Also to be implemented is a ruling by the Federal Constitutional Court, according to which parents with several children must be better off than smaller families and those without children when it comes to long-term care insurance. The contributions must be adjusted by the end of July. Irrespective of this, the SPD, FDP and Greens have agreed in the coalition agreement to raise the care contribution “moderately”. It is now 3.05 percent of gross wages, or 3.4 percent for people without children. Patient representatives also draw attention to care at home. The social association VdK warned that the costs would have increased just as drastically due to higher nursing wages. A long-promised care allowance increase must now come.
