It is broadly agreed that a long-term care reform is indispensable. Prof. Dr. Heinz Rothgang, Thomas Kalwitzki and Benedikt Preuß (all from SOCIUM at the University of Bremen) present a new concept for redesigning long-term care insurance by means of financial and structural reform.
Commissioned by the “Pro-Pflegereform” (pro-care reform) Initiative – an alliance supported by over 120 care companies and more than 60 associations and organisations – the Bremen scientists have drawn up a concept for an alternative model to the current long-term care insurance system (AAPV – “Alternative Ausgestaltung der Pflegeversicherung”). The aim of the reform is to address the most urgent problems, namely, the maintenance of individual living standards when the need for long-term care arises, the threat to the provision of services due to reduced care capacities, and the financial problems of long-term care insurance funding. The authors propose three reform stages, the first of which is an emergency programme that should take effect by 2026. The full redesign of the system should be completed by 2030.
Limiting Co-Payments of People in Need of Long-Term Care by Inverting the Costs
The first reform stage is primarily intended to limit the continually rising co-payments that people in need of care have to make in care homes. The costs of medical care must be covered by the statutory health insurance funds, and training must be funded by the community of insurees. A key aspect of this reform stage is the inversion of costs (“Sockel-Spitze-Tausch”), which Rothgang and Kalwitzki elaborated in an earlier assessment. The idea is to turn the insurance principle of long-term care upside-down, as it were, so that while at present payments covered by insurance are limited and there is no restriction on care patients’ co-payments, in future the co-payments should form a stable basis and the unlimited remaining costs should be covered by long-term care insurance.
People in need of care should be treated equitably, whether in residential or day care or at home
The proposed second stage of the reform would be to enable the provision of needs-based outpatient care, thus putting all care-dependents on an equal footing irrespective of whether they are cared for in residences, day care facilities, or their own homes. This means extending the provision of care to cover professional carers as well as private persons or civil society organisations, thereby enhancing individual choices in shaping the care setting. Among other things, measures in this stage also include upgrading carers’ allowances to carers’ remuneration, the establishment of a comprehensive, modular service catalogue to enable standardized billing and payment, as well as the inversion of costs described above (“Sockel-Spitze-Tausch”) in day care and domiciliary care as well. To safeguard the provision of long-term care for the future, this stage also comprises a training offensive, aimed to double training capacities, so that by the end of the 2030s around one million new skilled workers and qualified assistants will have completed their training in long-term care.
The final reform stage would make sector-free long-term care provision available, and thus facilitate innovative mixes of accommodation and long-term care, as well as allow individual lay care-giving irrespective of place of residence. The key question will then no longer be where care services are provided, but by whom. People in need of care can choose their living setting freely and finance it themselves, and care would be provided by both professional carers and lay carers, e.g. by relatives.
Comprehensive reform of refinancing system to prevent contribution increases
In order to address the cost increases arising from the measures taken in the second and third reform stages, a comprehensive refinancing reform is also required that allows expenditures to be shared justly and mitigates contribution increases. This refinancing reform makes provisions for changes to income assessments and a financial adjustment between social care insurance and private long-term care insurance, as well as a tax subsidy for long-term care insurance.
“There is a rare consensus that in the light of the current state of long-term care insurance there is a need for reform. Our concept proposes measures for an immediate, comprehensive restructuring of the system in a way that not only safeguards long-term care provision in Germany, but also ensures a more equitable means of financing it,” stated Professor Rothgang.
Link to the Report and press release of the Pro-Pflegereform Initiative (in German):
https://www.pro-pflegereform.de/presse-downloads/
Contact:
Prof. Dr. Heinz Rothgang
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58557
E-Mail: rothgang@uni-bremen.de
Thomas Kalwitzki
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58544
E-Mail: thomas.kalwitzki@uni-bremen.de
Benedikt Preuß
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 1
28359 Bremen
Phone: +49 421 218-58647
E-Mail: bpreuss@uni-bremen.de
