Germany's care system sees reforms and new payment rules for all Pflegegrade

The German long‑term care insurance defines Pflegegrad 3 as a severe restriction of independence. Estimates suggest a weekly care effort of 24–37 hours, distributed across body care (7‑10 h), nutrition (5‑7 h), mobility (4‑6 h), medical care (2‑4 h), cognitive/social support (3‑5 h) and household help (3‑5 h).

A Pflegegrad can be lowered when the cared‑for person shows a “substantial” improvement in daily abilities. The care insurance must commission a new assessment by the Medical Service, inform the insured and allow a response before issuing an amendment that reduces benefits.

The draft Pflegereform scheduled for 2026 proposes major changes to the financing and structure of care benefits, including new budget models, adjustments to the Entlastungsbetrag and revisions of preventive and respite‑care rules. Providers warn that the still‑uncertain legislation hampers planning and staffing.

From 2026, the Entlastungsbetrag rises to €131 per month (€1,572 annually) and is available to all care grades (1‑5). It must be used with recognised providers for services such as home help, day‑care or support for short‑term care and can be transferred until 30 June 2027 if not spent. Together with the Umwandlungsanspruch, it can substantially increase financing for everyday support.