Card 01 · In force 1 Jan 2026
Pflegekompetenzgesetz
Wider independent powers for qualified nurses.
LawFormer office · nursing & long-term care
Who cares, and who pays
Two of Nina Warken's nursing laws became law; the third — the reform of long-term care insurance finances — was still a draft when she left the Ministry of Health in July 2026. The debate now continues under her successor.
Card 02 · Training from 2027
Nursing assistant training
One federal 18-month training instead of 27 state programmes.
LawCard 03 · Draft, June 2026
Care insurance reorganisation
Spending brakes and new revenue for a care insurance in deficit.
PendingFormer officeThis page covers Nina Warken's term as Federal Minister of Health (6 May 2025 – 29 July 2026). Long-term care reform is now the responsibility of Federal Health Minister Carsten Linnemann. It is not part of her current role at the Chancellery. Related: Ministerial record · Health policy · System reform.
The scale
Care in Germany is mostly provided at home
Long-term care is the part of the welfare state most directly exposed to demographic change. The figures below set the frame for every measure on this page.
5.7 mPeople in need of long-term care
86%Cared for at home
Two consequences follow. Professional nursing staff are scarce and expensive, so policy tries to use their qualifications more fully and to open more routes into the profession. And the financing of long-term care insurance (soziale Pflegeversicherung, SPV) — a partial-cover insurance that pays fixed benefits, leaving residents of care homes with substantial personal contributions — comes under pressure from both rising numbers and rising wages. Destatis attributes the growth of nursing services to 25.3 per cent of all health expenditure in 2024 partly to higher personnel costs.
Card 01
Expanded powers for nurses
- 6 August 2025
Cabinet
Government adopts the draft.
- 6 November 2025
Bundestag
Law passed.
- 19 December 2025
Bundesrat
Final approval by the Länder.
- 1 January 2026
In force
New powers apply.
The law on expanding competences and reducing bureaucracy in nursing — known as the Pflegekompetenzgesetz — allows qualified nursing professionals to carry out certain services independently that were previously reserved to doctors. The Federal Government cites the management of chronic conditions as an example: in areas such as diabetes, chronic wounds and dementia, nurses can now take more decisions without a medical order. Powers are graded by qualification, so that what a nurse may do depends on the training completed.
The second strand is administrative: the law removes or simplifies information and documentation requirements in long-term care, so that more working time goes to residents and patients.
Supporters see the law as overdue recognition of nursing expertise and a way to relieve doctors' practices. The central open questions are practical: how quickly the corresponding qualifications are available, how the new services are remunerated, and how responsibility is shared between nurses and doctors when tasks overlap.
Card 02
A federal nursing assistant training
On 9 October 2025 the Bundestag passed the law introducing a uniform federal nursing assistant training (Pflegefachassistenzausbildung); the Bundesrat approved it shortly afterwards. Until now each Land regulated its own assistant training — 27 different programmes in total. From 2027 a single training of usually 18 months full-time creates an independent professional profile that is recognised nationwide and usable across hospitals, care homes and home care.
The aims are to recruit more people into nursing, make trained assistants mobile between Länder and create a clear step towards the full nursing qualification. Amendments allow pilot projects to use other facilities, such as rehabilitation centres, for practical training, and let authorities recognise people with third-country nursing qualifications as nursing assistants during adaptation measures.
The welfare association Der Paritätische welcomed the law but criticised that it was not sufficiently synchronised with the full nursing training and that existing financing rules had not been evaluated first. A Greens proposal for up to six additional months for language support and general education was rejected.
Card 03
A care insurance in deficit
The financing of long-term care insurance was the largest unresolved nursing issue of her tenure — and the one handed on to her successor.
2024 spending€64.7bnSPV spending, +11.3% on 2023 (Destatis).
Bridge 2026+€1.7bnAdditional federal loan for 2026 (BMG, final 2026 budget debate, 27 Nov 2025).
Gap 2027>€7.5bnProjected deficit cited by the minister, May 2026 (dpa).
Gap 2028>€15bnProjected deficit without reform, same source.
The June 2026 draft
In early June 2026 her ministry circulated a draft Care Reorganisation Act (Pflegeneuordnungsgesetz) for consultation within government. It assumed a 2027 deficit of around €7.6 billion and combined spending brakes with new revenue. According to published summaries, it would:
- delay by six months each step of the rising subsidies towards care-home residents' personal costs, saving about €2.6 billion in 2027;
- raise contributions for childless members and lift the contribution assessment ceiling for higher earners;
- restrict free co-insurance of spouses along the lines of health insurance;
- introduce annual inflation indexing of benefits and stricter criteria for new care-grade assessments, with existing grades protected;
- add professional "care accompaniment" for people cared for at home, intended to prevent deterioration.
Reactions
GKV-Spitzenverband chief Oliver Blatt called the package necessary but far too unbalanced, arguing that the burden fell mainly on people in need of care and on contribution payers. Care providers welcomed parts of it but warned of risks in the suspension of collective-pay obligations without a sustainable refinancing of wages. Within the coalition, SPD health politician Christos Pantazis called for a fairer distribution of costs in the parliamentary process.
After the reshuffle, on 31 July 2026, the heads of government of Saxony, Saxony-Anhalt and Thuringia objected that stretching the personal-cost subsidies would hit hardest where pensions are lowest, and signalled resistance in the Bundesrat.
In September 2026 her successor Carsten Linnemann said he aimed to bring a reform based on the draft to cabinet that month, signalled that planned cuts to pension credits for family carers would be dropped, and announced an expert commission for a fundamental overhaul of the care system.
Continuing debate
The questions that remain
Contributions, taxes or personal costs?
Every care reform must decide how much of rising costs falls on contribution payers, on the federal budget and on people in need of care themselves. The June 2026 draft relied mainly on contributions and benefit adjustments; critics, including the eastern Länder, argued for more tax funding.
Can family care be sustained?
With most people cared for at home, often by relatives, measures affecting care allowances and carers' pension credits reach millions of households. This is why changes in this area are politically sensitive.
Will new powers and training attract staff?
The Pflegekompetenzgesetz and the assistant training address the workforce from the supply side. Whether they raise the attractiveness of the profession enough to offset demographic demand will only become measurable over several years.
Is a commission the right instrument?
Patient advocates criticised the commission announced in September 2026 as time-consuming, while providers called for more capacity rather than further studies. Supporters point to the FinanzKommission Gesundheit as a model for preparing difficult decisions.
Sources & further reading
- Federal Government — Qualifikationen von Pflegekräften besser nutzen
- Der Paritätische — Bundestag passes nursing assistant training law
- Federal family ministry — law as passed by the Bundestag (PDF)
- Destatis — 5.7 million people in need of care at the end of 2023
- Destatis — nursing services as a share of health expenditure
- Destatis — health expenditure 2024
- Federal Ministry of Health — speech in the final Bundestag debate on the 2026 health budget (27 Nov 2025)
- dpa via onvista — In der Pflegeversicherung fehlen Milliarden (8 May 2026)
- Haufe — Pflegeneuordnungsgesetz: what is planned (5 Jun 2026)
- apotheke adhoc — care reform draft (4 Jun 2026)
- Ärzte Zeitung — eastern heads of government oppose care reform (31 Jul 2026)
- Nordkurier/dpa — Linnemann plans commission for care reform (11 Sep 2026)