“Without investment, care will become less fair”: Informal carers react to Germany’s Future Pact

At a joint press conference on 11 December 2025, Germany’s Health Minister Nina Warken, presented the most important findings of a federal-state working group ‘Future Pact for Care’, which will start a process of legislative measures in 2026.

wir pflegen e.V. welcomed the direction of many recommendations, but issued a highly critical position statement and press release highlighting in particular …

“The report published on 11 December 2025 by the Federal-State Working Group on the Future Care Pact is causing considerable concern at the Federal Association of Unpaid Carers (wir pflegen e.V.). The association recognises the political aspiration to secure sustainable care and relieve the burden on families. However, an initial assessment reveals, that the key points presented fall short of this ambition and threaten to exacerbate fundamental injustices in the care system.

The federal association primarily criticises the dictate of wanting to achieve far-reaching improvements in care financing and provision without additional investment, but purely from currently financed services.

Sebastian Fischer, convenor of the association, says: ‘If more resources are to be diverted from the already inadequate care system to improved preventive measures, rehabilitation and the capping of care home costs, this will logically lead to significant cuts in other, presumably outpatient and home-based, service areas under the “dictates of austerity measures”.’

This threatens to systematically exacerbate care triage: “Without targeted investment, improvements in services and more intensive specialist nursing care for people with lower care needs will inevitably lead to cuts for people with higher care needs. Specialist nursing support would be withdrawn from those who need it most, and existing injustices in the already inadequate care system would be further exacerbated.”

As a result, even more working relatives – predominantly women – would have to reduce their working hours or leave their jobs altogether to compensate for the loss of services. This ‘care exodus’ would exacerbate the labour shortage, reduce tax revenues and increase the risk of poverty in old age.

The association criticises the planned limitation of personal contributions to inpatient care alone as particularly unfair. This measure would lead to a systematic redistribution at the expense of those who provide care at home.

“The working group has not presented a viable concept for capping personal contributions for home care, even though over 86 per cent of people are cared for and looked after at home. The working group is thus consciously accepting that the financial relief in the care home sector will have to come at the expense of  care at home, people in need of care and their relatives due to the necessary redistribution of benefit entitlements. This means a deepening of the systemic injustices of the care system,” Fischer continued.

The association welcomes the planned strengthening of carer advice structures, initial ideas for making benefit entitlements more flexible in personal budgets and the introduction of case management practices. However, this requires solid financing and consistent focus on the needs of family carers.

‘Care can only be made fair and sustainable if the Future Pact is accompanied by genuine investment in improved care provision and relief for family carers providing home care,’ emphasised Fischer.

The government introduced the findings of the Advisory on its website as follows:

• Prevention and sustainability in long-term care: Regular health check-ups to identify individual risk factors for care-related illnesses are supplemented by a reorientation of health insurance benefits towards the specific preventive and rehabilitative needs of people requiring care.
• Staying active and independent – avoiding the need for care: Home care is sustainably supported with targeted professional support, preventive and rehabilitative measures, and an emergency budget for off-peak hours.
• Short distances to care – facilitating accessibility: By bundling benefits in kind and relief budgets, outpatient services for people in need of care are to become more flexible and easier to access. At the same time, benefit amounts can be focused compared to the amounts previously available for outpatient benefits in kind and cash benefits.
• Ensuring care provision across the board: To ensure citizen-oriented care provision in rural areas, care insurance funds and local authorities are to be given more opportunities to sponsor care facilities, whereby they may deviate from contractual requirements in order to provide targeted care services.
• More freedom, fewer regulations: By simplifying and reducing duplicate regulations at federal and state level, core areas such as personnel deployment and quality assurance are to be sustainably de-bureaucratised in order to improve the working conditions of carers and increase the attractiveness of nursing professions.
• Courage to innovate: With unbureaucratic support for innovations in care, especially in the areas of digitalisation and artificial intelligence, the aim is to increase the efficiency of work processes and drive forward the digital transformation.
• Sustainable financing and affordability of nursing care insurance: The principles of the partial benefit system and the care levels are to be retained. However, in order to slow down the growth in nursing care insurance expenditure, both options for limiting care-related co-payments and the access effect of existing thresholds in the assessment system are being examined.