Long-term care assessment and eligibility in Germany and AT

In Germany and Austria, discussions regarding the transparency and accessibility of medical assessments for care and disability benefits have emerged. The German Federal Cabinet approved a draft for the Care Reorganization Act, which would require the Medical Service to provide explicit reasons if it does not recommend rehabilitation during an assessment. Simultaneously, in Austria, patient advocates have criticized the Pensionsversicherungsanstalt (PVA) for redacting psychological tests and questionnaires from reports, arguing that such redactions hinder the ability of patients to protect their legal rights during appeals. In Germany, data from the Medical Service of Bavaria indicates that rejection rates for initial long-term care applications (Pflegegrad) have reached a new high, with more than one in four applications being denied due to strict legal definitions of dependency. Recent developments highlight growing systemic challenges and financial pressures. While support mechanisms like ‘Verhinderungspflege’ and short-term care coverage exist, family caregivers face extreme physical and mental exhaustion, with approximately 85 percent of care cases handled at home. Many caregivers work up to 49 hours per week without adequate support, a reality highlighted in a recent ARD documentary by Caren Miosga. Recent data indicates that approximately 86 percent of the 5.7 million people requiring care are supported at home, a reliance that poses risks to the labor market; studies suggest up to 229,000 full-time positions could be lost by 2045 due to caregiving demands. Financial burdens continue to rise. In North Rhine-Westphalia, monthly out-of-pocket costs for nursing home residents are projected to reach €4,080 by 2026. Long-term care insurance faces a projected deficit of 15 billion euros by 2028, prompting debates over a “care citizen insurance” model and increased inheritance taxes.