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.
As of January 1, 2023, the nationwide average of 2411 euros per month was due out of pocket in the first year in the home, 278 euros more than at the beginning of 2022. Higher food costs and better wages for nursing staff now also had an impact. The pressure for a major financial reform announced by Health Minister Karl Lauterbach (SPD) is growing.
On the one hand, the sums include the personal contribution for pure care and support. Unlike health insurance, long-term care insurance only pays part of the costs. For residents of the home, there are also costs for accommodation, meals 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.
Co-payments go up and up
Even with the highest surcharge, the out-of-pocket co-payments rose to an average of 1,671 euros per month. That was 130 euros more than on January 1, 2022, as can be seen from the data available to the German Press Agency. A total of almost 700,000 people in need of care received supplements, according to the Federal Ministry of Health 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.
Discussion of exemptions
For the analysis of the substitute health insurance association, which includes Techniker Krankenkasse, Barmer and DAK-Gesundheit, remuneration agreements between nursing care funds and homes in all federal states were evaluated. According to the information, the data refer to residents with care grades 2 to 5.
Relief for those in need of care and secure financing of care in general in aging Germany has been discussed for a long time. One thing is clear: it will be 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”. Lauterbach wants to tackle a major care law in 2023. The dynamization of many services should also be in view, as the ministry said. Because inflation is currently eating up the care rates.
The head of the substitute health insurance association, Ulrike Elsner, said that in view of the increasing burdens, those in need of care and their relatives often did not know how to bear the costs. And new burdens would come from 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. Because politics is also required to implement a judgment of the Federal Constitutional Court.
The Karlsruhe judges decided last year that parents with several children should be better off in the statutory long-term care insurance system than smaller families and those without children. They ordered the contribution rates to be adjusted to the specific number of children by the end of July. Irrespective of this, the SPD, FDP and Greens have already agreed in the coalition agreement to increase the contribution “moderately”. It is currently 3.05 percent of gross wages, and 3.4 percent for people without children. In addition to those in need of care in the home, patient advocates are also calling for more support for care at home.
