What is nursing policy


The Long-Term Care Insurance Act was passed 25 years ago - a good time to take stock. Until the introduction of long-term care insurance, the family (or the local social environment) was traditionally responsible for care for the elderly, in line with the principle of subsidiarity. Since then, "[t] he care for the population (...) is a task for society as a whole" (Section 8 (1) of the Social Code (SGB) XI). However, the fulfillment of this task poses more and more difficulties today, which on the one hand have to do with socio-demographic and cultural changes, such as demographic change, the pluralization of family forms and the change in gender norms. On the other hand, it is also the politico-economic design principles and structural features of the long-term care insurance itself, for example the restriction to basic care or the competitive orientation, which make reforms necessary in order to be able to adequately care for (more) people in need of care in the future and at the same time for the carers, regardless of whether they are professional or family, dignified working or care conditions and (material) recognition.

Review: The collective insurance against the risk of long-term care

In the mid-1990s, after a good 20 years of discussion, statutory long-term care insurance was introduced in Germany. Previously, the risk of being in need of care was considered a private matter. The "Nursing" policy area got on the political agenda for several reasons: first as a result of the overloading of the municipalities due to enormous care-related social assistance expenses, Secondly - related to this - by the degradation of the very old, mostly female inpatient care needs to social welfare and thus "pocket money" recipients, third due to the quantitative and qualitative supply deficits in the outpatient area and fourth due to the excessive demands and the resulting decrease in willingness to (sacrifice) of the mostly female caregivers. As a result of this socio-political problem pressure, several alternatives were discussed, such as private insurance, tax-financed welfare benefits or an insurance solution - with financing issues always playing an important role in the context of the prevailing market-liberal welfare state policy.

Federal Labor and Social Minister Norbert Blüm (CDU) advocated an independent long-term care insurance at the beginning of the 1990s, but had to make concessions to the FDP as a coalition partner (social and private long-term care insurance, compensation of the employer's contribution by canceling a public holiday, contribution rate stability through the budget principle) as well as to the SPD, which dominates the Federal Council (waiver of a waiting day regulation that encroaches on collective bargaining, granting higher care benefits). [1]

Structural principles of long-term care insurance

In the area of ​​tension between social (political) care needs and economic restrictions, a pay-as-you-go social insurance has emerged in which everyone - i.e. not only dependent employees, but also civil servants and self-employed - is compulsorily insured in the social or private branch. In contrast to health insurance, everyone receives the same nursing services, which, however, have been limited to the level of basic nursing care for reasons of stable contribution rates and cost limitation. In addition, the field was economized and a care market was established in which the non-profit organizations that had dominated up to that point now have to compete with the newly emerging private providers. Furthermore, since then all private and non-profit institutions have been approved by the long-term care insurance funds, provided they meet the legal requirements. At the beginning, a distinction was made between three levels of care. Since 2017 these have been replaced by the system of care levels. People in need of care (and their relatives) can choose between care allowance (between 125 and 901 euros), care benefits in kind (between 689 and 1,995 euros) and inpatient care (between 125 and 2,005 euros) according to the classification by the medical service of the health insurance (MDK). A combination of care allowance and outpatient benefits in kind is also possible. The care allowance is paid to the person in need of care, who forwards it to the carer (s). These are insured for pensions and accidents through long-term care insurance. In addition, benefits for preventive, short-term, day and night care can be used. Furthermore, the principle of the priority of home-outpatient care was enshrined in law. The care services are only of a supplementary nature and are intended to support family, neighborly and voluntary care. Care advice and care courses as well as care aids and measures to improve the living environment are also part of the long-term care insurance claim and benefit catalog.

Long-term care insurance is financed equally by contributions from employees and employers, whereby the costs are in fact borne by the employees alone, since a public holiday (the day of penance and prayer) has been canceled to compensate for the employer's contributions. The contribution rate was initially 1.7 percent; it is currently 3.05 or 3.3 percent for childless people. [2]

In 2018, 82 million people had long-term care insurance, of which almost 73 million were in social and 9 million in private long-term care insurance. The income and expenditure of social long-term care insurance have more than doubled since 2003 and are currently (2018) around 38 billion euros (income) and 39 billion euros (expenditure), respectively. There was a revenue surplus between 2008 and 2016, while the balance was negative in the past two years. At the end of 2018, funds were just under 3.4 billion euros. [3]