Nursing Development Act

Basic data
Title:	Law on the structural development of long-term care insurance
Short title:	Nursing Development Act
Abbreviation:	PfWG
Type:	Federal law
Scope:	Federal Republic of Germany
Legal matter:	Social law
Issued on:	May 28, 2008 ( BGBl. I p. 874 )
Entry into force on:	July 1, 2008
GESTA :	M023
Please note the note on the applicable legal version.

The Long-Term Care Development Act is a German article law that aims to better align long-term care insurance with the needs of those in need of care and their relatives.

The Nursing Development Act consists of fourteen articles . Articles 1 and 2 change the Eleventh Book of the Social Code (SGB XI). Article 3 contains the new Law on Care Leave (Care Leave Act) , which aims to introduce care leave.

Care-specific regulations

Among other things, the law provides for the creation of care support points and the introduction of care leave . Outpatient and inpatient services are to be increased gradually. People with so-called care level 0 should also be able to receive benefits in the future. To finance these measures, the contribution rate is to be increased by 0.25 percentage points.

The care support points are to be set up by the care funds . The proposal of the German Association for Public and Private Welfare to transfer this task to the municipalities was not taken up by the legislature.

In addition, the Care Development Act is intended to inform those in need of care and their relatives about the quality of each care facility. The first round of the examinations of the care facility had to be completed by the end of 2010. Now they are done annually. Assessments are based on the school grade principle, ranging from “very good” to “poor”.

The Medical Service of the Health Insurance (MDK) checks care facilities and creates its own quality reports . However, these are not published. Instead, the MDK must adhere to the “Transparency Agreement for Nursing Homes” that has been in force since the beginning of the year when assessing the system. It is binding for all care funds and their associations as well as for the approved care facilities.

Inpatient care facilities are assessed on the basis of 82 criteria, which in turn are classified into five subject areas (outpatient care facilities are basically assessed according to the same system; however, there are only four subject areas and 49 criteria):

• Nursing and medical care (35 criteria)
• Dealing with residents with dementia and other people with geriatric psychiatric changes (10 criteria)
• social care and everyday life (10 criteria)
• Housing, meals, housekeeping and hygiene (9 criteria)
• Survey of residents (18 criteria)

An overall grade is calculated from the results of the first four subject areas; there is a separate note for the resident survey.

Critics complain that the overall grade for a nursing home is hardly meaningful, since all 82 criteria and subject areas are offset against each other. By forming mean values, individual and structural deficiencies would be lost in the overall grade. A “deficiency” in the case of serious deficiencies in maintenance (such as an incorrectly treated pressure ulcer ) could be compensated for by “regular training of employees in first aid” or “garden areas secured with a fence”.

"According to this grading system, there will be no 'inadequate' facilities on paper in Germany - even if they are inadequate," criticized the social association VdK Rhineland-Palatinate , the Medical Service of the Health Insurance (MDK) Rhineland-Palatinate and the AOK Rhineland-Palatinate in a joint press conference on April 28, 2009.

In politics, Christine Haderthauer , Bavarian State Minister for Labor and Social Affairs, Family and Women, has spoken out against the grading system.

Communication of causes of illness

Article 6 No. 15 of the PfWG adds the following paragraph to Section 294a of Book V of the Social Security Code (SGB V) , which regulates the notification of causes of illness and third-party damage to health:

(2) If there are indications that the prerequisites of Section 52 (2) have been met, the doctors and facilities participating in statutory health care as well as the hospitals are obliged under Section 108 to provide the health insurance companies with the necessary data. The insured must be informed of the reason for the report according to sentence 1 and the reported data.

With this addition, the health insurance companies should be able to reclaim medical costs from the insured, if they are responsible for the illness themselves or at least are responsible. The health insurance companies are already authorized to take recourse to those who cause illness under current law. Compared to the draft version, which would have required reporting in all cases of Section 52 of the Book V of the Social Code, the scope of the reporting obligation was limited to Section 52 (2).

The President of the German Medical Association , Jörg-Dietrich Hoppe , described the amendment to Section 294a of Book Five of the Social Security Code as a “general attack on medical confidentiality and the constitutionally protected patient confidentiality”.

Dynamization of insurance benefits (planned)

After the introduction of statutory long-term care insurance in 1995, no benefit adjustments were made until 2008 that could adequately compensate for the creeping loss of real value due to inflation and cost increases in the care sector. The benefit rates for the main types of benefits were already set in 1993 (!) And had not been adjusted until the PfWG came into force, which led to massive losses in real value. Statutory long-term care insurance paid - for example, in the case of inpatient care in a home - exclusively for the care costs (i.e. for the care expenses, medical treatment care and social care) (partial benefits insurance) and it only paid lump-sum, limited amounts that were actually incurred - and continuously rising - covered care costs to an ever lesser extent. At the same time, the self-contribution of those in need of care increased continuously. In this way a gradual privatization of costs was brought about.

In 2001 this (average) co-payment was already there

for care level I - 163 euros

for care level II - 303 euros and

for care level III - 576 euros.

Until 2007, this contribution increased rapidly. The (average) monthly pure care costs (i.e. without the additional costs for accommodation and meals as well as investment costs for inpatient care) were in Germany in 2007:

for care level I - 1307 euros

for care level II - 1733 euros and

for care level III - 2158 euros.

In 2007, however, the statutory insurance only paid lump-sum amounts:

for care level I - 1023 euros

for care level II - 1279 euros and

for care level III - 1432 euros.

This meant that in 2007 the person in need of care had to pay considerable contributions themselves:

for care level I - 284 euros

for care level II - 454 euros and

for care level III - 726 euros.

With regard to the total costs of care (i.e.: care costs + costs for accommodation and meals + investment costs = home fees ), the contributions made by the person in need of care themselves (or their close relatives or from the social welfare office / war victims' welfare - in this order) were considerably higher. In 2007 these were:

for care level I - 1277 euros

for care level II - 1447 euros

for care level III - 1719 euros.

Against the background / and foresight of this development was already in the coalition agreement of November 11, 2005 (Grand Coalition CDU / CSU + SPD) under P. 8.2. ( “Improvements on the benefits side” ) a dynamization of the insurance benefits was announced: “The benefits of the long-term care insurance have remained unchanged since 1995 and are therefore subject to a gradual decline in value. Increasingly, people in need of care must therefore be supported by social assistance. The care services should therefore be made more dynamic. ” But it was not until the middle of 2008 that the so-called Care Further Development Act was passed (a) gradual minor adjustments until 2012 and (b) regular service dynamizations from 2015 onwards in Section 30 of Book XI of the Social Code. However, this dynamic performance should first be checked in 2014 and then be carried out from 2015 (and from then on every 3 years): “Every three years, for the first time in 2014, the federal government checks the necessity and amount of an adjustment of the benefits of the long-term care insurance. The cumulative price development in the last three complete calendar years serves as an orientation value for the need for adjustment; It must be ensured that the increase in the benefit amounts is not higher than the gross wage development over the same period. The general economic conditions can also be taken into account in the examination. "

One could have expected that with a "further development" of long-term care insurance, the dynamization of insurance benefits would have been brought about more quickly, but for fear of the additional costs that would arise, 2015 was retained. In addition, it is certain that if the dynamization is then actually carried out, it is by no means intended to compensate for the previous loss in value, but only to adjust the then (2015) lump-sum benefits of the long-term care insurance. The care costs would then still not be fully covered by the insurance, the co-payments would continue to exist or increase further.

literature

• Gerhard Igl : The law on the structural development of long-term care insurance. In: New legal weekly. 31/2008, pp. 2214-2219.
• Sonja Reimer, Andreas Merold: Changes to the social long-term care insurance through the Long-Term Care Development Act. In: The social justice. 7/2008, pp. 381-388.

Web links

• Text and synopsis of the Care Development Act
• Summary of the main points of the law
• Nursing reform at a glance

swell

1. ↑ Statement of the German Association for Public and Private Welfare from December 12, 2007 ( Memento of the original from March 25, 2008 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. 
2. ↑ Press release of the German Medical Association from October 1, 2007. ( Memento of the original from December 15, 2007 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. 
3. ↑ Barmer GEK: Care Report 2009, pp. 33–38. ( Memento of the original from February 22, 2014 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. 
4. ↑ Barmer GEK: Barmer GEK care report 2013. November 2013, p. 122 / Tab. 23 ( Memento of the original from December 24, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. 
5. ↑ Barmer GEK: Barmer GEK care report 2013. November 2013, p. 122 / Tab. 23 ( Memento of the original from December 24, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. 
6. ↑ Barmer GEK: Barmer GEK care report 2013. November 2013, p. 122 / table 23; The table also shows the increase from 1999 to 2011 ( memento of the original from December 24, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. 
7. ↑ Federal Court of Justice (BGH) - press release no.27/2014: No forfeiture of the right to parental maintenance in the event of unilateral loss of contact between the dependent and his adult son (decision of February 12, 2014 - XII ZB 607/12) (judgment not yet published on the Internet)
8. ↑ Barmer GEK: Barmer GEK care report 2013. November 2013, p. 122 / Table 23 ( Memento of the original from December 24, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. 
9. ↑ Together for Germany. With courage and humanity. Coalition agreement between CDU / CSU and SPD, p. 108.
10. ↑ Barmer GEK: Care Report 2009, p. 35ff. (In particular Table 3 / overview of the planned performance adjustments) ( Memento of the original from February 22, 2014 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. 
11. ↑ German Bundestag - 16th electoral term - printed matter 16/7439 - 7 December 2007 - draft law of the federal government: draft of a law for the structural further development of long-term care insurance (long-term care development law) - s. here § 30 SGB XI: Dynamization
12. ^ Federal Ministry of Health: Long-term care insurance benefits
13. ↑ Barmer GEK: Barmer GEK care report 2013. November 2013, pp. 51–53. ( Memento of the original from December 24, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. 
14. ↑ s. to the structural design of a law - German Bundestag - 16th electoral term - Printed Matter 16/8525 - 12 March 2008 - resolution recommendation and report of the Committee on Health (14th Committee) to the bill of the Federal Government - Printed matter 16/7439, 16/7486 Further development of long-term care insurance (Long-term Care Further Development Act) and amendments, p. 4: D: Financial impact

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