# Germany care sector gaps and proposed nursing reform > Live situation record from CLSTR: https://clstr.news/situations/germany-selfemployed-benefit-gaps > Updated: 2026-08-20T03:58:45.000Z. Sources: 38. Developments: 4. Germany’s care sector continues to face intertwined staffing, funding, and benefit gaps. Recent data confirm the projected shortfall of 280,000–690,000 care workers by 2049 and ongoing unpaid care-assistance claims exceeding €500 million. The sector-specific minimum wage introduced on 1 July 2026 remains in force, while the 4.5% rise in care-insurance benefits from 1 January 2025 remains in effect. Legislative efforts to address systemic issues have led to the proposed Nursing Reorganization Act (PNOG). While the Federal Ministry of Health anticipates savings of more than €20 billion by 2030, the draft has drawn intense criticism. Burkhard Jung, President of the German Association of Cities, has advocated for a transition to full long-term care insurance to prevent citizens from falling into social assistance and to relieve municipalities of an estimated €30 billion annual deficit. Industry groups have raised specific alarms regarding benefit reductions. The Bundesverband Ambulante Dienste (bad) warned that the PNOG could lead to annual benefit reductions of up to €1,684 for some, potentially jeopardizing outpatient care. Critics also note that replacing the current combined annual amount for respite and short-term care with a new budget could limit flexibility. Financial pressures are intensifying. Jens Baas, head of Techniker Krankenkasse, has warned that rising long-term care insurance contributions are a “realistic prospect” due to an aging society. Baas has called on the federal government to repay €6 billion withdrawn from care insurance during the COVID-19 pandemic and suggested savings could be found by adjusting monthly flat rates for consumer aids. He noted the chance of maintaining stable rates is only “50:50.” ## Claims - Following a 4.5 percent increase on January 1, 2025, the next scheduled increase in care benefits is in 2028. (disputed) - The amount of care benefits for 2026 will remain unchanged compared to 2025. (disputed) - The German Association of Cities (Deutscher Städtetag) is calling for a transition to full long-term care insurance. (corroborated by 5 sources) - The draft Nursing Emergency Act (PNOG) proposes replacing the current relief amount with a new social space budget. (corroborated by 3 sources) - In Lower Saxony, the average monthly out-of-pocket cost for nursing care was approximately 2,900 euros in January 2026. (corroborated by 3 sources) - Care insurance benefits in Germany will increase by 4.5 % on 1 January 2025. (corroborated by 2 sources) - Municipalities face an annual deficit of approximately 30 billion euros. (corroborated by 2 sources) - The Federal Statistical Office forecasts a shortage of 280,000 to 690,000 care workers in Germany by 2049. (single source) - From 1 July 2026 the minimum wage for care workers in Germany will be €16.52, €17.80 or €21.03 per hour depending on qualification. (single source) - German courts ruled that a care insurance provider cannot downgrade a care level when a patient switches insurers without a substantial change in health condition. (single source) - Unpaid care assistance claims in Germany exceed €500 million, with many facilities awaiting over €100 000. (single source) ## Timeline ### 2026-08-20: Germany's Association of Cities calls for full long-term care insurance reform The German Association of Cities is calling for a full long-term care insurance model to relieve municipal budgets and prevent citizens from relying on social assistance due to rising nursing costs. 18 sources. https://clstr.news/cluster/germany-proposes-nursing-care-reform-to-reduce-insurance-costs ### 2026-08-08: Germany's proposed nursing care reform faces criticism Germany's proposed Nursing Reorganization Act (PNOG) aims to stabilize care insurance but faces criticism over potential benefit reductions and increased contributions. 4 sources. https://clstr.news/cluster/germanys-care-sector-grapples-with-funding-limits-and-staff-shortages ### 2026-07-28: Germany's Care Sector Confronts Workforce Shortage, Funding Gaps and Reform Germany's care sector battles a projected 280‑690k worker shortage, €500 m in unpaid claims, new wage hikes and a 2027 reform that could tighten Pflegegrad eligibility; SoVD urges early applications. 19 sources. https://clstr.news/cluster/germanys-self-employed-caregivers-lack-access-to-care-support-benefits ### 2026-07-25: German employer and public pensions highlighted as many miss benefits German workers miss out on employer‑pension contributions, hand‑craftspeople face limited statutory coverage, and ex‑CDU leader Friedrich Merz will draw about €6,150 monthly from his parliamentary pension. 11 sources. https://clstr.news/cluster/paraguays-low-pension-coverage-spurs-calls-for-private-retirement-planning --- Cite as: Germany care sector gaps and proposed nursing reform. CLSTR, https://clstr.news/situations/germany-selfemployed-benefit-gaps