German Health Minister Nina Warken has announced a sweeping reform of the care insurance system (Pflegeversicherung). The reason is mounting financial problems — the projected deficit for 2027–2028 reaches 22.5 billion euros. The planned changes will affect elderly people receiving benefits as well as their families. This is a topic of concern for anyone planning care for loved ones in Central Europe.
One of the key elements of the reform is changing the qualification rules for care levels (Pflegegrade). The government is not eliminating the levels themselves but plans to return to stricter scientific criteria when assessing levels 1 through 3. Minister Warken considered the existing regulations too lenient. In practice, this means that some people who previously received benefits may lose their entitlement or be classified at a lower care level. For seniors and their families, this is a significant change requiring advance preparation.
The reform also provides for increased financial burdens. Contributions for higher-income individuals will rise through raising the contribution assessment ceiling. Additionally, subsidies for stays in care homes will be spread over time, which in practice means higher out-of-pocket costs for care recipients and their families. The minister emphasized that care insurance was never designed as full coverage of care costs — it has always been only partial support. Seniors should therefore consider additional financial protection in case of long-term care needs.
The number of people receiving care benefits in Germany has doubled since 2017 and now exceeds 6 million. In addition to demographic changes — an aging society — this growth was influenced by expanding the definition of care to include new groups, including children and adolescents with conditions such as ADHD. This dynamic growth is one of the main causes of the system’s financial crisis and the government’s argument for the necessity of reforms.
The reform has met with sharp criticism from patient organizations and the care industry. The Patient Protection Foundation accused the government of blaming children for the deficit, emphasizing that this group represents only about 2 percent of all those in need. The German Association for Assistance to the Elderly and Disabled (VDAB) is demanding a genuine structural reform that will fairly secure the system’s financing for the future and address the chronic shortage of medical and care personnel.
Reforms in the German care system are significant not only for residents of Germany. Many Polish, Slovak, and Czech families use the German care system — both as care recipients and as caregivers. Changes to Pflegeversicherung may affect working conditions for Central European caregivers employed in Germany and the availability and costs of care. It is worth monitoring these changes and planning care arrangements for loved ones well in advance.
May 19, 2026
