The Pflegeversicherung was set up in the early 1990s to meet the needs of long term care patients. Past experiences of Krankenversicherung were used to shape the new compulsory insurance system, which is financed by a deduction from the monthly pay cheque, shared between employers and employees. In most parts of Germany a bank holiday (Buss- und Bettag, mid November) was axed to meet employer's demands.
By the way: 2006 the German Ministry of Health published statistics about the risk of needing long term care:
"people under 60 - app. 0,6 percent ,
between 60 and 80 years - app. 3,9 percent,
above 80 years - app. 31,8 percent" do get support from Pflegeversicherung.
Maybe this is a surprise to you?
The German Pflegeversicherung is part of the pretty segmented German system of social security. Pflegeversicherung was set up to give material support to people who regularly and persistently need assistance with daily tasks (1). The Pflegeversicherung focusses on physical care, dressing and undressing, the intake of food and drink and the use of the toilet. These are named Grundpflege or basic care tasks.
To illustrate the consequences of segmentation in the German system, we take someone as example who suffers from nausea, kidney failure and chronic fatigue.
The 'health care branch' (Krankenversicherung of the German social security system, aims at the cure of diseases, medical treatment and drugs. Liver dialysis, in this example, is financed by Krankenversicherung.
Rentenversicherung (state pension system) takes responsibility for the material needs of people who ended their working life, which is likely with patients that need dialysis.
If the patient not only suffers from nausea, but vomits, bodily care might be needed. Pflegeversicherung contributes to this.
So, following the kidney failure, one is coming into contact with all three branches of the system, but even this is not enough. Common sense is not able to understand, that travelling three times a week to get liver dialysis in a clinic is not covered by any of these three. One needs to get in touch with yet a fourth organisation, the Sozialamt (Department of Social Security), which pays for the travelling expenses, but only if one has a low income.
When the Pflegeversicherung was set up in 1993 politicians decided that for the Pflegestufe (a certain level of support) a small segment of daily-life-assistance only would be taken into account. Furthermore, the payments by Pflegeversicherung are fixed for each Pflegestufe. There is no room for manoeuvre. There are the Pflegestufen 0, 1, 2 and 3, offering different levels of material support.
In assessing the needs of a patient (Einstufung) it is not the medical or care diagnosis that is focussed on, but the time a lay person would need to assist with the tasks of Grundpflege (paragraph 15 SGB XI).
Since 1993 the regulations about Einstufung in eine Pflegestufe are fixed by law and remain unchanged at core. However, in 2017, a new terminology was implemented. Instead of Pflegestufen, 5 Pflegegrade have been established. Pflegegrad 1, Pflegegrad 2, Pflegegrad 3, Pflegegrad 4 and Pflegegrad 5. If someone is hardly able to do the shopping, to cook decent meals, to clean the cloth, to scrub the floor is of marginal relevance for the Pflegestufe because it is not counted as Grundpflege. That it not only serves ones well-being but general health as well that one gets out into fresh air ... is not relevant for Einstufung.
Changes made in 2006 and 2012 allocate some more support with people suffering from dementia, but these additions did not change the logic of the needs assessment. The Needs Assessment has been changed significantly, though with the implementation of the Pflegegrad concept.
As far as I understand the German system of social security, Sozialhilfe is the only branch that is bound to a rather holistic understanding of the needs of clients - but it checks about income and assets first. Furthermore: there is a strict ruling that Sozialhilfe is the last institution giving support. All other possibilities of support need to be claimed first.
1) The German word Pflege does not translate well neither with care nor with nursing but aims mainly at bodily, physical care.