Care homes in Germany

The 16 Federal States are responsible for specific legislation on care homes. Therefore, there are 16 different legal bases, which all differ.

No specific requirements.

No.

The care laws of the Federal States provide for different requirements. In general, the institution and the management must be able to provide proper quality of care, guarantee a certain minimum ratio of skilled personnel and are reliable to operate a care home.

No formal concession is required. However, the commencement of operation requires prior notification (at least three months in advance), clearance from the local care home regulatory body (Heimaufsicht) and a care agreement (Versorgungsvertrag) with the competent regional association of the public healthcare insurance (Pflegekasse).

No.

No.

There is a comprehensive care subsidy system by which – considering the degree of care care dependency – the public healthcare insurance pays fixed amounts directly to the care home operators. As far as the residents cannot afford the co-payments, the public welfare assumed the payment.

The competent care home regulatory body monitors the activities of care homes and can perform on-site inspections as part of the monitoring process. In addition, the Medical Review Board of the Statutory Health Insurance Funds (MDK) carries out site visits in order to monitor the quality of care.

83,132,799 (source: World Bank)

21.562% (source: World Bank)

15,380 (source: Statistisches Bundesamt)

There is no reliable statistic because Germany has both private and communal care homes. The waiting time therefore varies greatly and also depends on the location.

a. Care home supervisory authority (Heimaufsicht)

Each federal state has established a care home supervisory authority which supervises and advises care homes (including housing for senior citizens, short term care, hospices, nursing homes, assisted living (in some federal states)) with a main focus on protecting the interests and needs of the occupants. The responsibilities of the care home supervisory authorities are:

• monitoring that statutory duties are observed (in general annual reviews are carried out by way of on-site inspections)
• remediation of defects by imposing administrative acts 
• ensuring an adequate quality of care services in the care home
• providing comprehensive advice to the occupants, their relatives, employees and institutions responsible for management (Träger) of the care homes
• setting up working groups with other care industry institutions to coordinate the activities
• participating in the professional advancement of the work with the elderly and the handicapped. 

b. Medical service (Medizinischer Dienst, MD (formerly: MDK))

There are 15 regional medical services (“MD”) in Germany which have various responsibilities in the health sector. MD assists the health and nursing care insurance companies with medical and nursing care-specific matters. MD ensures that the health and nursing care insurance services are provided to the occupants in accordance with objective medical criteria and that the level of quality is high. With regard to care homes the main responsibility of the MD is to carry out quality inspections in the care homes as follows:

• basis for the review is the indicator-based guidelines for quality inspections of stationary and outpatient care
• main focus is the care quality from the perspective of the occupants who are visited for the purpose of conducting physical inspections (random samples) but the structure and the organisation of the care homes are also reviewed
• the care home operator receives a comprehensive report setting out proposals for specific measures to remedy any defects
• repeat inspections to review whether the proposed measures have been implemented can be conducted.