Long-Term Care Crisis in Germany: Why Cutting Care Level 1 is a Mistake and What Real Reform Looks Like

The need for long-term care strikes families unexpectedly, yet Germany's statutory long-term care insurance (Pflegeversicherung) system is reaching its breaking point. In an in-depth interview, Katharina Lorenz from the Social Association Germany (SoVD) outlines the profound structural deficits, the growing fear of financial collapse among families, and why a fundamental course correction is desperately needed. This conversation is critical for anyone concerned about retirement planning, elder care, and financial security.

The SoVD's Role: Advocacy and Direct Support for Families

The SoVD has advocated for social justice for over a century. In the complex realm of long-term care, its role is twofold: providing direct, expert support to members and campaigning for systemic political change.

Q: How does the SoVD support caregivers and those in need of care with daily challenges like applications and appeals?

Katharina Lorenz: "When someone becomes care-dependent, everyday life is turned upside down. The sheer volume of forms and bureaucracy overwhelms many. Our legal experts provide comprehensive advice on entitlements, prepare families for medical assessments, explain care reports, and guide them through appeals and even court proceedings if benefits are denied." The SoVD also informs the public through its magazine, social media, free webinars, and a detailed guide, "Suddenly in Need of Care – What You Need to Know Now."

The Flawed Debate: Why Abolishing Care Level 1 is a "Schnapsidee" (Fool's Errand)

Q: What is your assessment of the political debate about abolishing or changing Care Level 1?

Katharina Lorenz: "To put it bluntly: abolishing Care Level 1 is a fool's errand. It's a quick fix that saves money in the wrong place." She explains that while Care Level 1 does not entitle individuals to cash benefits for care, it does provide access to crucial support like respite care allowances, assistive devices, and home modifications. "These services are vital for maintaining independence, preventing further decline, and ultimately avoiding higher care costs later. They also provide essential relief for family caregivers who are often at their limit. Cutting this level makes vulnerable individuals pay for the government's failure to put long-term care insurance on a solid financial footing."

Instead of cuts, the SoVD advocates for a citizen's insurance model (Bürgerversicherung) for long-term care, where everyone—including civil servants, the self-employed, and politicians—contributes, creating a broader and fairer funding base.

Systemic Failures and the Path to Reform

The interview highlights several critical areas where the current system fails and proposes concrete solutions.

1. The Financial Burden and the Case for Comprehensive Insurance

Out-of-pocket costs for nursing home care have skyrocketed, pushing over 30% of residents to rely on social assistance. The SoVD's solution is a comprehensive long-term care insurance (Pflegevollversicherung) that covers all costs related to care, support, and social participation, eliminating crippling co-payments.

2. The Workforce Crisis and Bureaucratic Nightmares

The severe shortage of care professionals requires better pay, more attractive working hours, and clear career paths. Furthermore, the system is bogged down by excessive bureaucracy, which is a leading cause of unclaimed benefits. The SoVD calls for legal simplification, better data exchange, and a user-friendly digital infrastructure that doesn't replace but enhances local advisory services.

3. Supporting Family Caregivers and Modernizing Assessments

Family caregivers, including an estimated 480,000 children and adolescents, face high physical and psychological strain. The SoVD demands reliable counseling, respite options, and paid caregiver leave (Pflegezeit) to prevent caregiving from becoming a poverty risk.

The current assessment system, while improved for those with cognitive impairments, often fails those with purely physical needs or younger care recipients (e.g., needs related to postpartum care). The SoVD calls for age- and gender-specific differentiation in assessments.

4. The Role of Digital Tools

While supporting the use of digital care applications, Lorenz emphasizes they must be low-threshold, barrier-free, and serve to relieve both the care recipient and the family caregiver, not replace human support.

Conclusion: A Call for Dignity and Solidarity

The core message is clear: Long-term care is a societal risk that requires a societal solution. "Dignity, security, and solidarity must not depend on one's wallet," Lorenz states. The SoVD's central demands are a departure from the expectation of free family care, the legal anchoring of professional care standards, and the introduction of a comprehensive, solidarity-based insurance model.

For readers in systems like the United States, where long-term care is primarily a private financial burden—with costs potentially devastating savings and only limited coverage through Medicaid after asset depletion—Germany's debate highlights a universal challenge. Proactive planning with private long-term care insurance or hybrid life/LTC policies becomes even more critical in any system facing demographic pressure.

This interview is based on the SoVD's extensive position paper on long-term care reform, available on their website.