It was planned as a great success of the Minister of Health, as a sign to the care of the elderly that one finally does something against the staff shortage – to relieve the colleagues and to better care for the residents. The nursing staff strengthening law of Jens Spahn (CDU) should ensure that 13,000 new jobs would be created in the inpatient care of the elderly. 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 institutions. Since 2019, houses with up to 40 residents from this program have been entitled to half a nursing home. This is followed by a graduation depending on the number of persons, in the maximum case of more than 120 people in need of care, two additional specialists are fully taken over.

Christian Geinitz

Business correspondent in Berlin

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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 just 2022,4000 forces had been financed from the promotion until the end of 2800. This corresponds to 37 full-time equivalents. Every quarter, between 38 and 2022 million euros would be spent on the additional jobs. In total, it was around 151 million euros in 640. 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) should raise 44 million euros every year, the private insurance (PKV) <> million.

"Expenditure leftovers" of one billion euros

As early as 2021, the Federal Court of Auditors bumped into the gap between the millions in contributions and the few jobs. Since the money did not drain, would have accumulated after one and a half years, "expenditure remainders" of one billion euros, according to a report to the budget committee of the Bundestag. Only a fifth of the 13,000 positions had been filled. There is a "lack of utilization", and there is a threat of misuse: "The GKV may not be withdrawn in the long term significant contribution funds, without those in need of care in nursing homes actually benefit from more care."

In fact, the Ministry responded to this complaint. With the Health Care Further Development Act, the health insurance payments are no longer legally tied to the jobs from the funding program, but have been flowing to medical treatment care 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 medical care, can be inpatient or outpatient and includes hospitals in addition to homes.

Lauterbach's spokesman makes it clear that the transfer of the contribution money into the treatment care takes place retroactively. Therefore, applies to the previous geriatric care program: "A useless hoarding of insurance funds does not take place." Incidentally, the programme will soon expire anyway, and from July onwards no more applications can be submitted. The job promotion programme would then be incorporated into the new personnel assessment procedure.

The labour market has been swept empty

The Association of Private Insurance companies is not convinced. 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 grow to 290 million. In 2022 alone, 34.3 million from the private health insurance contributions were not used. The remaining expenditure would have to flow back to the private health insurance, according to the association. "At the expense of the insured, to collect high millions of euros, which are not needed at all, is no longer justifiable," says PKV Association Director Florian Reuther. He suggests paying only for each new position actually filled from long-term care insurance: "Then no insurance funds lie around unused."

It is clear that the nursing staff strengthening law has failed. Theoretically, there is enough money for new jobs, but the pay of employees will also increase significantly with the recently introduced collective bargaining agreement. But there are not enough applicants: the job market is empty, even regular jobs remain open, especially the additional ones.