Charlotte G., 74 years old, is severely rheumatic and, after a cancer operation, also speech-impaired. She can no longer peel potatoes, she often eats frozen foods. In the morning she slips into a pair of sweatpants; zipping up a zipper is hardly possible for G. A neighbor makes phone calls for her because G. is difficult to understand on the phone. Another helper buys heavy groceries for her; G. can only walk with great difficulty.
G. has a care level 2, she receives €347 per month in care allowance. From this, G. can give a neighbor a little money for their help. She can afford ready-made meals, a mail-order purchase, perhaps a taxi ride. All of this would not be possible otherwise. G. is a recipient of basic security benefits. The care allowance is not deducted from the social benefit.
Cases like G. exist in the thousands. They are people with health limitations who are not bedridden, who can go to the toilet alone, who are not confused – but who can hardly wash themselves properly, can hardly go shopping, can no longer peel vegetables, can barely go outside.
In the long-term care insurance there are for these cases the first two of five care levels. And these “lighter cases” in care are now coming under the scrutiny of the savings debate.
Rapid rise in applicants
The social research institute IGES, commissioned by the National Association of Statutory Health Insurance Funds—including the care funds—produced a study examining the rapid rise in the number of people in need of care since 2017. At that time, a new concept of care dependency was introduced; instead of the former care levels there are now five care grades.
From 2017 to 2024, the number of people in need of care roughly doubled from 3 million to almost 6 million, the health insurance association concluded. In a solidaristic system, one must ensure that those who really depend on help receive it, while the system remains financially sustainable, said Oliver Blatt, chair of the GKV.
According to the IGES report, the main cause of the sharply increased number of benefit recipients is an increased application for care benefits by, on average, younger people—i.e., under 65—and “less severely impaired” individuals. More than three-quarters of first-time applicants receive only the low care grade 1 or 2 in the outpatient sector.
Climbing stairs, cooking are assessed
In the assessment, six areas of limitations are queried, including mobility, cognitive and communicative abilities, behaviors and psychological problems, self-care, coping with illness-related burdens, daily living and social contacts.
So for example, one is asked whether one can still move around independently in the apartment, whether one can climb stairs, whether one can prepare food for oneself, whether one can still shower oneself and wash one’s hair, whether one can maintain contact with people outside one’s immediate environment. Even if this is only “predominantly independent,” but not completely “independent,” points are awarded for the impairments. These point values are weighted. From this the care grade is calculated.
According to the IGES report, rather small impairments, especially in mobility and self-care, account for a relatively large share of initial assessments. The IGES scientists also questioned assessors themselves. They explained in the study that the thresholds for the care grades are “very low.” It is also stated that often many small deficits together lead to a care grade, “even though the overall picture of the situation does not indicate a pronounced need for help,” as the paper says.
Threshold values should rise
The researchers noted that the point values in the assessments often concentrated on the “interval of up to two points above the threshold.” In other words, the assessments often barely reach the threshold needed for the next higher care grade.
Exactly at these thresholds, the upcoming reform of the long-term care insurance could possibly adjust. The experts are considering raising the thresholds for the next higher care grade. This would save billions of euros for the care funds.
The president of Diakonie Germany, Rüdiger Schuch, has already protested: The rising numbers of people in need of care surely cannot be addressed by simply not classifying them as in need of care. Federal Health Minister Nina Warken (CDU) announced that a concept for the care reform would be presented by mid-May. Savings are also planned for subsidies for the co-payments of residents in care homes. In 2027 alone, the care fund was short of 6 billion euros. The shortfall is as dramatic as with the health insurance funds.
If the thresholds are lowered, Charlotte G.’s points might not even reach the second care grade anymore, but only the first grade. This one provides no direct monetary benefits to those in need of care. “A bad joke,” says the pain-stricken Berlin resident.
But the savings are intended only for new applicants. If the care reform comes with these changes from 2027, there will likely be a rush of applicants, still this year.
