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Explained: How Germany plans to fight its drastic shortage of care workers

Around 1.6 million people work in the care sector in Germany. But almost 40,000 jobs are unfilled — and demand is growing due to an ageing population. What happens now?

Published: 5 June 2019 12:39 CEST

Explained: How Germany plans to fight its drastic shortage of care workers

Employees in Germany's care sector are often overstretched. Photo: DPA

Better pay, lighter workloads and more trainees: that's how the government hopes to plug a huge vacancy gap in Germany's crisis-hit care sector.

There are almost 40,000 unfilled nursing care positions throughout the country. The issue is particularly urgent because the number of people who need care in Germany is expected to rise significantly in the coming decades: from the 3.3 million counted in 2017, to four million by 2030, and 5.3 million by 2050, according to estimates by authorities.

Why? Because German society is getting older and that means there's going to be a bigger burden on care services, which are already struggling to cope. At the other end of the scale, people are having less babies, although family friendly policies, like paid parental leave, do seem to be having a positive impact on the birth rate.

On Tuesday Labour Minister Hubertus Heil, Family Minister Franziska Giffey, both of the centre-left Social Democrats, and Health Minister Jens Spahn, of the centre right Christian Democrats, presented a package of measures that were agreed on with the help of key industry stakeholders.

However, the cost of the new measures is expected to be in the billions and funding decisions have still not been finalized.

Spahn said the care industry, which is known for having low pay and stressful conditions, must become more attractive to potential employees to help with the workload of care-givers. The government says this can only be addressed by getting more staff onboard – and looking abroad to recruit foreign workers.

“This not only relieves the burden on the individual carer, but also leaves more time for the care of those in need of it,” Spahn said.

Heil added that although hot topics in politics at the moment were major issues such as digitalization and climate change, the question of how to manage care should be given equal attention.

Jens Spahn, Franziska Giffey and Hubertus Heil on Tuesday. Photo: DPA

It comes after the government launched its “Konzertierte Aktion Pflege” (“Concerted Action Care,” or KAP) last summer, in an attempt to recruit more people to the industry.

This involved discussions with employers, trade unions, welfare associations, churches, health insurance firms and representatives of those affected.

The three ministers now say the new proposals will be implemented – but there is some resistance to the plans and questions remain unanswered. Here’s an overview:

More pay

One of the main aims is to secure higher wages for staff working in the elderly nursing care sector. However, the government alone cannot guarantee this.

Heil is launching a law that is to come into force on January 1st 2020, and should result in two possible paths to achieve this goal.

The first provides for employers' associations and the Verdi trade union to negotiate a collective agreement.

The government would then work to make their agreement binding for the entire industry. However, private nursing home operators in particular are opposed to this idea.

In the case that a collective agreement does not work, a second way of ensuring higher pay is for a commission to suggest higher care minimum wages by May 2020. This would apply to auxiliaries as well as specialists, and the aim would be for similar levels of pay across Germany. Typically, people in eastern states in Germany earn less than in western regions.

Heil stressed that the government hopes the first idea will work out but that a back-up plan was needed.

Photo: DPA

But what does ‘better pay’ mean?

Spahn made it clear that nursing staff caring for the elderly should be paid around €2,600 to €2,700 a month. And for many that would be a large wage increase.

Extra trainees and recruitment from abroad

Training to become a care worker needs to be more attractive, according to the government.

As of 2020, trainees nationwide will no longer have to pay education fees, but will receive remuneration of around €1,000 a month, Giffey said. It is hoped that by 2023, the average number of trainees and training institutions in Germany will have increased by 10 percent compared to this year.

Germany also hopes to attract more foreign workers and will look at ways of offering language training in their country of origin in a bid to attract them.

Better working conditions

To achieve better conditions, unions say there needs to be more reliable duty schedules and limits on the amount of people assigned to one member of care staff.

“Employees must know that their situation will improve step by step,” said Verdi board member Sylvia Bühler. “There must be an end to the constant overworking.”

There should also be more cooperation with other medical specialists, such as doctors, the plan says.

In addition, digital technology is to be used to relieve care employees of paperwork.

The cost

The ministers did not make any concrete announcements on the financing of the plan.

But it is clear there will be considerable additional costs. Depending on the pay scales to be determined, it could cost an extra two to five billion euros per year, Spahn explained with reference to an expert opinion.

Possible options would be higher nursing care contributions or a state subsidy such as is the case with pensions.

Spahn has already said that more contributions are needed to the country's social security system and has controversially said that people without children should pay more towards care and pension insurance.

Currently, relatives of people in care – usually children – have to contribute to long term nursing insurance if the person receiving care can't afford it. However, in future the government wants to ensure that this burden will no longer be the case for people who earn less than €100,000 per year.

That means the gaps would have to be filled with taxpayers' money, and individual federal states would have to agree to this.

Eurgen Brysh, of the Patient Protection Foundation, said the government now had to lay out how this can all be achieved.

“They must finally present a concrete plan on how the care of the future will look and how it will be financed,” he said.

Member comments

Anonymous - 1 October 2019 at 00:14 CEST

Eastern Europeans, on the whole, make great, conscientious and sympathetic carers, and it shouldn’t be difficult to recruit them if the pay is right, plus many of them seem to learn to speak German quiter easily. My own mother had wonderful care from Poles and Rumanians.

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10 key things you need to know about healthcare in Germany

If you’re living in Germany or thinking of making it your home, you’re in luck. Germany’s healthcare system is widely regarded as one of the best in the world, and ranks above the OECD average on most key indicators as of 2023.

Navigating a foreign healthcare system can be a little tricky for any foreign resident, especially new arrivals. So we’ve created a guide to some of the most important aspects of Germany’s healthcare system.

Do I need health insurance?

Yes. Health insurance is mandatory for all German residents, so you’ll need to take out a form of insurance even if your current policy from your home country covers you whilst in Germany.

The German health insurance system operates through two co-existing insurance types; private and public.

If you’re working in Germany, you’ll need to be covered by one of the two. Some visas allow for a special expat insurance instead, however, there are specific requirements for this.

How does public insurance work?

Public health insurance, or Gesetzliche Krankenversicherung (GKV), is the most common form of health insurance in Germany. The German Bundesministerium für Gesundheit (Health Ministry) estimates around 90 percent of the population are signed up to GKV funds.

If you opt for public insurance, you’ll pay a monthly premium to your health insurance provider, which is calculated according to your income. Your employer will also pay mandatory contributions to your insurance.

You have free choice of your health insurance fund, with over 100 public health insurance funds to choose from. Each will provide you with different levels of benefits and coverage, so it’s wise to take a close look at the fine print for each option.

Public health insurance pays for healthcare that is „sufficient, appropriate and economic“. This includes medical treatments, prescribed medications, vaccinations, psychotherapy, and allied health care. Your health insurance will also pay the cost of hospital treatments, if the need arises.

While most treatment providers will charge the cost of your care directly to your health insurer, some healthcare costs require a co-payment. This includes prescriptions and hospital care, however, the co-payments are generally small and scaled to your annual income.

Your public health insurance will also pay you a sickness benefit, or Krankengeld, if you’re certified unfit for work for more than six weeks.

If you’re coming to Germany to work for a company, this is most likely going to be the best form of insurance for you. However, if you earn over a certain amount, or are self-employed, you may have to opt for private health insurance.

When you sign up to a public health insurer, you’ll be given the all-important Gesundheitskarte (health insurance card). It’s important to always bring this with you when accessing any healthcare services. It’s also helpful to carry it around all the time in case of an emergency.

A German health insurance card.

A German health insurance card. Photo: picture alliance/dpa | Jens Kalaene

What about private insurance?

Private health insurance, or Private Krankenversicherung (PKV), is the other form of health insurance in Germany.

If you’re self-employed, a small business owner, a freelancer, or work in the public service, you’ll most likely have to sign up for PKV, although there are still notable exceptions to this.

If you earn over the compulsory social insurance threshold – currently set at €69,300, according to the Verband der Privaten Krankenversichrung – you become eligible for private insurance.

Premiums for PKV are calculated based on a risk assessment done by the insurer, and generally vary based on your age and health. It’s important to note you can be rejected by a private insurer if you’re deemed too risky to cover. This isn’t the case with public health insurance.

If you’ve come to Germany with dependents, such as children or a spouse, they also aren’t automatically covered by your private health policy and will generally require separate premiums.

If you decide on private insurance, you’ll have to cover the upfront costs of seeing doctors, going to hospital and obtaining medication. You’ll be either fully or partially reimbursed afterwards by your insurer.

PKV might not be for you if you hate being bogged down with admin tasks, as claiming the payments from the insurer means filling in forms in German, although there are some providers that offer services in English.

If you’re a member of a public health insurance fund, you can take out additional cover with a private insurer to cover you for certain benefits, such as comprehensive dental treatment. You’ll bear the cost of any additional coverage yourself.

What about expat insurance?

Another option is expat insurance, also known as incoming insurance. It provides coverage for people newly arrived in Germany and is suitable for some visas without work contracts.

Temporary expat insurance could act as a good stopgap if you’ve just entered the country, but it doesn’t provide as comprehensive a coverage as PKV or GKV.

Coverage varies across providers, and you’ll generally have to pre-inform them of appointments and other medical care and be reimbursed.

However, if you’re planning on renewing or changing your visa soon, it’s worth mentioning that having expat health insurance isn’t sufficient. You’ll need to be covered by a public or private insurer for it to be approved.

Finding a doctor

If you don’t speak German, the prospect of finding a doctor might seem a little daunting. Fortunately, there are plenty of services to help you find a doctor who works in your native language.

A site like doctolib.de is a fantastic resource for finding and booking appointments with a variety of different health practitioners, from GPs to cardiologists.

How GPs work in Germany

General Practitioners, or Hausärtze, either operate by themselves as solo, practice-based physicians or within a medical centre. While registering with a local GP is encouraged, it isn’t compulsory.

GPs in Germany can provide prescriptions, offer vaccinations, perform minor medical procedures and conduct routine check-ups. You’ll need to book an appointment in advance, but some GPs offer open hours where you can wait in the practice to be seen (and expect long waits).

E-prescription service Germany

A patient inserts their health insurance card into a card reader at a German pharmacy. Photo: picture alliance/dpa/Reuters/Pool | Annegret Hilse

Unlike many other healthcare systems around the world, GPs in Germany don’t act as a gatekeeper to more specialised care. While you won’t need to see a GP for a referral to a specialist such as a dermatologist or gynaecologist, there are a few specialities (such as radiology and laboratory services) which are exceptions to this.

Seeing specialists

Free choice of medical practitioners is a core principle of the German healthcare system, so you’ll be able to pick and book appointments with specialists without a referral from your GP in many cases.

When searching for specialists, you’ll likely see some specialists are only available to those who are privately insured or self-paying. Finding a specialist who works with publicly insured patients is possible, however the wait times will likely be a little longer.

If you have any questions, your health insurer or your GP should let you know how you can access a specialist doctor.

What about the dentist?

Public health insurance doesn’t fully cover dental care. While basic dental is covered, such as a yearly checkup, many German residents rely on supplementary private insurance for more comprehensive dental treatments because care can be expensive.

However, you should check with your insurance to see what extra dental services are covered. For instance, some insurers contribute a one-off payment to supplement teeth cleaning, but they won’t explicitly tell you this information when you take out insurance.

Pharmacies and medicine

If you’ve been given a prescription by one of your physicians, your next stop should be at a pharmacy, or Apotheke to have it filled.

You’ll typically have to present your Gesundheitskarte to the pharmacist, and depending on your health insurance you might have to make a co-payment for the medication. This will be a maximum of 10 euros and a minimum of five euros.

If Sunday rolls around and you find yourself in need of a prescription, there are emergency pharmacies, known as Notdienst-Apotheke, which operate on a rotating schedule within one area or district. You’ll generally be able to find the schedule at your regular pharmacy or online.

If having prescriptions delivered to you works better, there’s a service called MAYD which will deliver anything you need from your local Apotheke to you.

Going to hospital

Germany has a comprehensive hospital network, with most people able to reach an acute care hospital within 30 minutes by car.

The quality of hospital will depend greatly on where you live. Federal states are responsible for hospital care, and some operate better hospitals than others.

When you arrive at a hospital, you’ll need to have your Gesundheitskarte on you for the registration process. The hospital will need to know about your health insurance status for the billing process.

It’s also important to note here that the disparity between public and private insurance is most apparent when it comes to hospital care. If you’re privately insured, you will generally have better access to more senior doctors, your own room, and be seen faster.

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