Nursing home care costs are rising: significant differences between countries

Berlin. Nursing home care is becoming even more expensive for residents. Out-of-pocket payments during the first year in the facility now exceed the €3,000 mark per month on average nationwide, according to an analysis by the Association of Statutory Health Insurance Funds. As of July 1, the average monthly cost was €3,108. This is €124 more than on January 1 and €237 more than on July 1, 2024. In ongoing consultations for a major nursing care reform, the pressure for relief continues to grow.

Compared to other federal states, care for the first year in a nursing home is most expensive in Bremen, averaging €3,449 per month, according to data available to the German Press Agency. North Rhine-Westphalia follows with €3,427. The lowest monthly costs as of July 1 were in Saxony-Anhalt, at €2,595, and Mecklenburg-Western Pomerania, at €2,752.

These amounts include, on the one hand, the co-payment for the care and support itself. Unlike health insurance, long-term care insurance only covers a portion of the costs. For residents in nursing homes, additional payments for room and board, investments in the facilities, and training costs are also included.

More and more people in Germany who require care wish to be cared for at home. However, this is often not feasible for their family members. For years, caregivers from Eastern Europe have provided assistance – this has both advantages and disadvantages.

The reason for the ever-increasing burden on those in need of care is rising personnel and living costs, explained the Association of Statutory Health Insurance Funds. The national average personal contribution for care alone has now risen to €1,862 per month—€184 more than in the middle of last year. Better pay for urgently needed nursing staff is having a significant impact on this.

But maintenance and food costs also increase, averaging €1,018 per month, an increase of €63 compared to July 2024. The Association of Statutory Health Insurance Funds (VHS) explained that the study evaluated reimbursement agreements between nursing care funds and nursing homes in all federal states. These include the Techniker Krankenkasse (TK), Barmer, and DAK-Gesundheit.

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To contain costs, since 2022, those in need of care have received relief supplements based on the length of stay in addition to the benefits provided by the nursing care insurance funds. The personal contribution for care alone will thus be reduced by 15 percent in the first year in the nursing home, by 30 percent in the second year, by 50 percent in the third year, and by 75 percent from the fourth year onwards. However, even with the highest supplement, the burden increased at a lower level – now averaging €1,991 per month. This was €126 more than in mid-2024.

Ulrike Elsner, CEO of the German Association of Statutory Health Insurance Funds, warned that co-payments have been rising steadily for years. "Residents of nursing homes can no longer be expected to bear burdens of this magnitude." To change this quickly, the states must fulfill their responsibility to cover the costs of investments and training.

A federal and state working group, which has just begun work, is seeking more comprehensive solutions. Results are expected by the end of the year. "Care must not be a risk of poverty," Health Minister Nina Warken (CDU) stated as one of the goals. This also includes stabilizing long-term care insurance, which is projected to be slightly negative this year. However, there is still a lack of funds to avert further premium increases in 2026.

In general, the problems run deeper. Last year, 30 percent of nursing insurance expenditures went toward full-time residential care, even though only 12.6 percent of those in need of care received this service, as the Federal Audit Office explained in a report for the Bundestag. Another driving force behind this increase is the relief supplements, which are expected to increase costs to €7.3 billion this year.

Various reform proposals have long been on the table: from more tax revenue and caps on co-payments to a restructuring of the model into a full insurance policy that covers all care costs. The long-term care insurance funds are demanding that the federal government reimburse billions in expenditures from the coronavirus pandemic and cover pension contributions for family caregivers. "There is no lack of knowledge," the Federal Audit Office also wrote, "but rather a lack of will to implement it."

RND/dpa