Law against staff shortages in old people’s homes has failed

Es was planned as a great step forward by the Minister of Health, as a sign to geriatric care that something was finally being done about the shortage of staff – to relieve colleagues and to provide better care for residents. The Nursing Staff Strengthening Act Jens Spahn (CDU) should ensure that 13,000 new jobs are created in inpatient geriatric care. The highlight: they should be approved in an uncomplicated manner and paid for in full by the health insurance companies, without the involvement of those in need of care or the facilities. Since 2019, houses with up to 40 residents from this program have been entitled to half a nursing position. This is followed by a scale depending on the number of people, in the maximum case of more than 120 people in need of care, two additional specialists are taken over in full.

Today, four years and a pandemic later, which has increased the workload in the homes, there is not much left of it. The ministry of Spahn’s successor Karl Lauterbach (SPD) confirms that by the end of 2022, just 4,000 workers had been financed from the funding. This corresponds to 2800 full-time equivalents. Between 37 and 38 million euros are spent on additional jobs every quarter. In total, it was around 151 million euros in 2022. This is only a fraction of what the insurance companies have to pay into the pot according to the law: the statutory health insurance (GKV) is to raise 640 million euros every year, private insurance (PKV) 44 million.

“Residual expenditure” of one billion euros

As early as 2021, the Federal Court of Auditors encountered the gap between the millions in contributions and the few jobs. Since the money did not flow out, “residual expenditure” of one billion euros had accumulated after just one and a half years, according to a report to the budget committee of the Bundestag. Only a fifth of the 13,000 positions have been filled. There is a “lack of use” and there is a risk of misappropriation: “The GKV must not be deprived of significant contribution funds in the long term without those in need of care in nursing homes actually benefiting from more care.”

In fact, the Ministry responded to this complaint. With the Health Care Further Development Act, health insurance payments are no longer legally linked to the jobs from the support program, but have been allocated to medical treatment care as a flat rate since 2022. Although this can also benefit old people in nursing homes, the core is somewhat different: treatment care must be prescribed by a doctor, serves to provide medical care, can be inpatient or outpatient and includes not only homes but also hospitals.

Lauterbach’s spokesman makes it clear that the transfer of the contribution money to treatment care takes place retrospectively. Therefore, the following applies to the previous geriatric care support program: “There is no useless hoarding of insurance funds.” Incidentally, the program will soon expire anyway, from July no more applications could be made. The job promotion program will then be integrated into the new personnel assessment process.

The labor market has been swept empty

That doesn’t convince the association of private insurance companies. In his statement on Lauterbach’s draft of a new care support and relief law, he complains that a large part of the private health insurance money paid for the old strengthening law “lies unused at the Federal Office for Social Security (BAS)”. There is talk of 147 million euros, which could increase to 290 million. In 2022 alone, 34.3 million from private health insurance contributions were not used. The remainder of the expenditure would have to flow back to the private health insurance, according to the association. “Collecting millions of euros that are not needed at the expense of the insured is no longer justifiable,” says PKV Association Director Florian Reuther. He suggests only paying for every new position that is actually filled from the long-term care insurance: “Then there are no insured persons’ funds lying around unused.”

It is clear that the Nursing Staff Strengthening Act has failed. Theoretically, there is enough money for new jobs, but the wages paid to employees have also risen significantly with the recently introduced collective bargaining agreement. But there are not enough applicants: the job market has been swept empty, even regular positions remain open, especially the additional ones.