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HEALTH

What foreigners need to know about old-age care in Germany

Whether you're thinking ahead to the future or wondering how to care for elderly relatives in Germany, here's what you need to know about the old-age care and the financial help that's available.

Elderly pensioners play cards in a care home.
Elderly pensioners play cards in a care home. Photo: picture alliance/dpa/Wort & Bild Verlag | Getty Images/South_agency

If you’re planning on living in Germany long-term, it’s a good idea to start thinking about how to provide for yourself in your old age – or for relatives who may live abroad and be unable to care for themselves.

Fortunately, Germany has quite a well-developed insurance system that offers support for people who require care at any point in their lives or for people with caring responsibilities.

Here’s a brief overview of the system and how much support you can get if you or a close relative requires care at home or in a nursing home. 

How does the nursing care system work in Germany?

As you may know, all employees in Germany pay compulsory care insurance, or Pflegeversicherung, throughout their working lives and as pensioners. 

People with children pay 3.05 percent of their salaries or pensions into the care insurance pot each month, while people without pay 3.4 percent. This is then matched by the employer – though the additional premium for those without children is paid exclusively by the employee. 

Freelancers can also choose to pay voluntary care insurance, though they generally have to bear both the employer and employee portions of this, so it can end up being much more expensive than it is for employees. 

Anyone who pays care insurance has access to financial support with social care in their old age – or, indeed, whenever they happen to need it. However, it’s worth noting that this financial aid is intended as additional support to cope with the high costs of care, rather than paying for all of it.

Instead, people usually have to rely on the support of relatives, their own savings or assets or private care insurance in order to cover the full costs of their care. 

READ ALSO: What you need to know about the complicated world of German insurance

A carer measures a patient's temperature

A carer measures a patient’s temperature in a care home. Photo: picture alliance/dpa/Getty Images | Halfpoint Images

Will my elderly relatives receive care if they come to live in Germany?

This is a complicated issue and one that it’s best to talk to immigration lawyers, migration advice services or social care advisors about. Since parents and grandparents aren’t considered part of the “core” family in Germany, bringing them into the country tends to be much more difficult than getting reunited with your spouse or your children.

That said, there are routes for bringing family members into the country if they’re facing hardship at home – for example, if they’re unable to take care of themselves due to illness or old age.

Once they’re in the country – or before they arrive – it’s best to seek advice from your private or statutory care insurance provider about what help you (or they) may be entitled to. You can also find a list of care advice agencies by searching the directory run by the Centre for Quality in Care (ZQP), a non-profit and non-governmental organisation that aims to improve long-term care in Germany. 

What support can I get as a carer?

There are numerous forms of financial and other support that you can access in Germany if you end up having to care for a relative. Firstly, there are free training courses available that can help you prepare for the challenges that come with looking after someone, as well as self-help groups that can help you handle the mental strain involved.

If you are a primary carer but find yourself unable to carry out your responsibilities for a certain amount of time – i.e. due to travel or sickness – your care insurance should cover up to six weeks of nursing care as a replacement. 

To reconcile your caring responsibilities with your work, you can also take a certain amount of time off and will be legally protected from losing your job. However, you won’t receive a salary during your time off.  

READ ALSO: Will Germany raise the pension age to tackle its worker shortage?

This includes:

  • Nursing time (‘Pflegezeit’): You can take up to six months of full-time or part-time leave to fulfil your nursing responsibilities, which has to be applied for at least ten days in advance.
  • Family care time (‘Familienpflegezeit’): If you need to care for a relative, you can cut your hours down to a minimum of 15 per week for at least two years. This type of care leave needs to be applied for at least eight weeks in advance. 
  • Short-term loss of working capacity (‘kurzfristige Arbeitsverhinderungen’): In an emergency, you can take up to 10 days’ leave in order to fulfil any caring responsibilities or organise medical care. Your employer won’t pay you for this time, but you can apply for reimbursements through your insurance. This is known as nursing support allowance, or Pflegeunterstützungsgeld.

You may be wondering how you can finance all this time off. Well, your relative’s care insurance should assist with this, since their care allowance can be used to support professional nursing care or care from family members – or a mixture of the two. 

Another important thing to note is that you can receive tax breaks for money spent as part of your caring role. The tax office assumes a lump sum for these outgoings, so you don’t even need to keep receipts or do time-consuming calculations in most cases. 

If you’re caring for someone with a nursing qualification and you spend at least 10 hours a week doing so, your care insurance should also pay your unemployment insurance and pension contributions during that time. 

What financial support is available for people who need care?

The amount of financial support you can get for care in Germany depends on the type of care you opt for and your medical requirements. Broadly speaking, the amount of care you require is categorised in levels, with level one representing only a minor need for care and level five representing the most extensive care requirements. 

At each level, you can either receive your money as a direct “care allowance” to support relatives who care for you or as “nursing benefits-in-kind”, which pays for a professional nursing or care service. You can also choose to combine the two if, for instance, your son or daughter works part-time and cares for you the rest of the time.

Elderly couple care consultation

An elderly couple take a care consultation online. Photo: picture alliance/dpa/compass private pflegeberatung GmbH | compass private pflegeberatung

Here’s how much you can receive at each level of care:

  • Care Level 1: People at this level aren’t considered in need of professional day-to-day care for things like eating, shopping, personal hygiene, etc., though they may have minor disabilities that affect their level of independence. That means they aren’t able to access care allowance or nursing allowance. However, like the other care levels, they are entitled to €125 in ‘care benefit’ per month and can still get financial support with other things, like adapting their living space or paying for a panic alarm.
  • Care Level 2: This level is entitled to either €316 per month care allowance or €724 nursing care benefits-in-kind, as well as support with adapting your living space, installing an emergency alarm, etc. 
  • Care Level 3: This level is entitled to either €545 per month care allowance or €1,363 nursing care benefits-in-kind, as well as additional support for exceptional costs like refitting your living space. 
  • Care Level 4: This level is entitled to €728 care allowance or €1,693 benefits-in-kind, as well as other financial support for refitting your living space, etc.
  • Care Level 5: This level is entitled to €901 care allowance or €2,095 benefits-in kind, as well as other financial support for refitting your living space, etc.

READ ALSO: How long do you have to work to receive a German pension?

How does it work if I want to combine professional nursing with a family carer?

Combining a few professional care services with care from close relatives is a popular choice in Germany. Mixing and matching the two mean that people in need of care have the comfort of being looked after by their loved ones most of the time, but professionals can step to assist where needed, i.e. during work commitments.

Take the example of someone who fits into care level 3 and therefore has a maximum entitlement to €1,363 nursing benefits-in-kind per month. This person may choose to spend 25 percent of this on a part-time nurse who assists at evening meal-times or in the mornings when they are getting dressed. With this part of the allowance accounted for, they still get 75 percent of their ordinary €545 care allowance, which would come to €408.75.  

In other words, whatever you don’t use from the nursing allowance is converted into your care allowance proportionally. 

Staying in a care home

People who don’t have relatives around to look after them or have more severe disabilities may prefer to go to a professional nursing home either on a full- or part-time basis.

Of course, with care homes costing an average of €3,200 per month in Germany – and sometimes even higher – this is by far the most expensive option. However, there is support available to help pay for it.

The first type of financial support would be through your nursing benefits-in-kind, which ranges from €724 to €2,095 per month, depending on your care level. Additionally, you can also get subsidies on top of your own contribution, which vary depending on the length of your stay in the care home.

Trainee at care home in Weimar, Thuringia.

A trainee carries out a shift at a care home in Weimar, Thuringia. Photo: picture alliance/dpa | Martin Schutt

From 1-12 months, you can expect a five percent subsidy on top of your own contribution – so €50 per month for every €1,000 you pay. This goes up to 25 percent in the second year (€250 for every €1,000), 45 percent in the third year (€450 for every €1,000) and and 70 percent from the fourth year on onwards (€700 for every €1,000).

In 2022, people paid around €991 on average out of their own pockets in order to stay in a care home, though this can vary greatly depending on what help you’re entitled to, the type of care home (and room) you pick and whether you’re a part- or full-time resident.

Another thing that’s important to note is that pensioners are often entitled to Wohngeld (additional housing benefit) and that the state will step in if your assets and pension aren’t enough to bear the costs. 

If you do have assets such as property, however, you may have to sell them before you can access help – and any transfer of assets to close relatives in the past ten years may have to be reversed. 

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HEALTH

Should you take vitamin D supplements in Germany?

With the mornings and evenings getting darker, many people may be wondering if taking a vitamin D supplement is recommended in Germany. Here's what to know.

Should you take vitamin D supplements in Germany?

Vitamin D is a vital nutrient for overall health and well-being, and most people are aware that it can be absorbed via sunlight. 

But as long-time residents in Germany know all too well, sunlight is often hard to come by in the autumn and winter months. In December, there’s only a few hours of daylight per day, typically when most people are at work (and it often isn’t even sunny).

This makes it much harder to get enough vitamin D. A deficiency in vitamin D can lead to several health problems in the long run. Muscle weakness and cramps, fatigue and depression are among the symptoms of not getting enough of this vitamin. 

How do I get the most vitamin D in Germany?

It mostly involves getting outside in the warmer months. Germany’s disease control agency, the Robert Koch Institute (RKI), says that vitamin D production happens from March to October and this is when the body builds up reserves for the winter. 

“During this time, the body is not only able to cover its acute needs, but also to build up vitamin D reserves in fat and muscle tissue for the winter months,” says the RKI.

READ ALSO: Your guide to getting through the German winter

The RKI adds that to counteract low vitamin D levels all year round in Germany, current recommendations suggest “exposing your face, hands and arms to the sun uncovered and without sun protection two to three times a week between March and October”.

However experts add that sun protection measures, like wearing sunscreen, must be taken when spending longer periods of time in the sun.

Meanwhile, the German Nutrition Society (Deutsche Gesellschaft für Ernährung or DGE) states: “It is recommended to expose the body to the sun for a total of around five to 25 minutes per day with face, hands and large parts of arms and legs uncovered.”

A number of foods provide some vitamin D. It’s mainly found in fatty fish, roe and fish liver, but red meat, egg yolks and liver are other sources.

Vitamin D is also added to some foods in Germany, such as some milk or vegan milk drinks, yoghurt and other snacks. The nutritional label on food packaging will let people know how much vitamin D they are consuming. 

Although eating foods rich in vitamin D is generally recommended in moderation as part of a varied diet, the DGE says the main focus should be on the body’s own production of vitamin D through exposing skin to sunlight.

READ ALSO: Essential phrases and customs to survive the German winter

What about supplements?

Another way to improve your vitamin D status is to take supplements. 

The German Nutrition Society recommends going down this route if an improvement in vitamin D status cannot be achieved through other routes like getting out and about in the sunlight. 

But be aware that experts also say that taking larger doses over a long period of time can be harmful. 

Pictured are Vitamin D capsules.

Pictured are Vitamin D capsules. Photo by Michele Blackwell on Unsplash

During the height of the Covid pandemic in 2021, the Federal Institute for Risk Assessment (BfR) warned of the health risks of taking vitamin D supplements without taking to a medical professional first. 

“Higher doses should only be taken under medical supervision and taking the individual vitamin D status into account,” the institute said.

“Anyone who wants to take vitamin D on their own should only use supplements with a daily dose of up to 20 micrograms (800 international units),” said the BfR. “With this amount, health impairments are not to be expected.”

According to the BfR, regular daily intake of vitamin D via high-dose preparations – for reasons other than medical reasons – increases the risk of health damage such as the formation of kidney stones or kidney calcification. There have also been cases of acute kidney failure as a result of uncontrolled self-administration of vitamin D preparations, experts said. 

There are a number of people deemed to be more at risk of a vitamin D deficiency.

From the BfR’s point of view, a general vitamin D intake of the upper limit of 20 micrograms per day should only be considered for nursing home residents and other risk groups. 

“This is because vitamin D is produced in the skin under the influence of sunlight. However, many older people hardly exercise outdoors,” the BfR said. Vitamin D production also decreases significantly with age.

READ ALSO: 8 tips for enjoying the cold like a true German

The risk groups for an inadequate vitamin D supply also include people who rarely or never spend time outdoors or who – for cultural or religious reasons – only go outside with their bodies completely covered. Some people who suffer from chronic gastrointestinal, liver or kidney diseases or who take medication that impairs vitamin D metabolism are also more at risk. 

If you suspect that you’re not getting enough vitamin D, go to your GP. They can test for various deficiencies, but bear in mind that these tests are not usually covered by statutory health insurance. 

Even if you don’t test, GPs will be able to advise you on whether you should take a supplement in winter – or all year round – depending on your individual case. 

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