Germany is failing to manage elder care

Peter Müller* has been confined to a wheelchair for the past three years. He sits at home next to his wife, who has Parkinson's disease, and says life would be impossible without their Polish caregiver. 

Germany's population is aging. Everyone in this country could face the reality of needing care sooner or later. 

But what if you are old and need help, but do not want to move into a nursing home and have no children for support?

Peter and his wife are faced with that very dilemma. He is bound to a wheelchair. She has Parkinson's. But they wanted to stay in the house they moved into half a century ago, right after their wedding.

For three years now, the Müllers have been sharing their home with a Polish caregiver.

"We wouldn't be able to manage anything without her," Peter Müller says. 

Watching the three of them sitting together over coffee, one gets the feeling they have known one another for decades. The woman from Poland who cares for them is practically family. In her previous job, she managed to get a bedridden woman back on her feet within only a few weeks, now she runs the entire Müller household. She is a "24-hour caregiver." At 8 a.m., she wakes Mrs. Müller and gives her a shower. At 8:45 a.m., she brings Mr. Müller coffee to his bedside, then she does the washing, cooking, and cleaning. 

Besides a talent for organization, what else does a perfect caregiver need to have? "You have to put your heart into it, and speak the language," she replies.

The Müllers had their basement cleared out so that their caregiver could move in there. Her husband also works as a full-time caregiver, for another family in the neighborhood. Their children are all adults. Every few months, the Polish couple return to their small farmhouse in Poland. 

A market worth billions, rife with abuse

For decades, the informal deal has been this: Germans needing care pay foreign workers on average about €1,600 ($1,900) a month net — a salary that is low by German standards, given the number of hours and amount of work involved. Payment is often in cash, without a bill or receipt, and therefore untaxed — an attractive prospect for many in Poland, Romania, or Bulgaria.

Today, caregiving for the old and disabled in Germany is a sector worth billions of euros, and one rife with reports of abuse: middlemen lining their pockets; families exploiting their caregivers or treating them like modern slaves; careworkers who steal or just vanish overnight.

It has happened to the Müllers, too. Peter Müller recounts how his wife once called out all night for her caregiver, who was simply no longer there. 

"Germany better be careful that untrained people do not keep coming, who have no idea of caregiving," he says. 

 

A far-reaching court ruling

In Germany, the issue of caregiving is like those of infrastructure, digitization, and education: The country just muddles through. Policymakers kick the can down the road, shrinking away from the long-overdue reform that would hold for the coming decades.

Everyone knows that it cannot go on like this much longer. Germany already has more than 4 million people in need of care, and that number keeps rising. According to estimates, by 2035, the country will need half a million caregivers — 120,000 more than today, as the baby boomer generation will be needing help.

This year in June, a ruling by Germany's Federal Labor Court sent shockwaves through the sector. It found that caregivers from abroad were entitled to Germany's minimum hourly wage of €9.35 — even for the hours when they are on standby.

That means, the Müllers would also have to pay their caregiver for her nights. "We cannot finance that. We would have to sell our house to be able to afford that," Peter Müller says.

 

Live-in caregivers work around the clock

The Müllers found their caregiver through Angela Meyer. 

She is a trained pediatric nurse and has been finding caregivers from Poland, Romania, Bulgaria, and Ukraine for people needing help all over Germany for eight years now. She came to her new occupation through a domestic emergency of her own, when suddenly her mother needed care. 

Angela Meyer knows about cases of exploitation and of workers who end up being overwhelmed by their tasks. "Fifteen percent are unsuited to this profession," she estimates. She says she's become good at detecting unsuitable applicants. "When the first question in the interview is 'how much can I earn?' I say goodbye immediately."

What matters for Meyer is professional experience and knowledge of the German language. Also, with a background as a healthcare worker herself, she knows how important health insurance is. So she brokers caregivers only if they have health insurance, which she also helps them to organize if necessary.

She finds the federal court's ruling on 24-hour care unrealistic. "Hardly anyone actually works around the clock. For those who need that level of help we'd have to impose a three-shift system," Meyer says. "A model like that is unaffordable and will never work. And besides, not enough Germans would be willing to do this kind of job." 

Meyer says the caregivers she has spoken with are outraged at the ruling because they now fear they will soon lose their jobs. "They need the work, it feeds their families back home, but when the price gets jacked up so steeply, the patients will no longer be able to pay it," Meyer says. "And the caregivers will have to stop coming. No one should be exploited, but this ruling helps no one."

'Care is society's pivotal issue' 

Claus Fussek is an author and has been writing about the issue of care for the elderly for 30 years now. "I speak the uncomfortable truths that, actually, everyone already knows about. Doing so is not especially courageous, everything is just so obvious," he says.

Fussek's mother died in February. For 10 years, women from Romania helped him care for her. He says Germany cannot manage to care for the elderly without help from these migrant workers.

"These people, who work here for one, two, three months in a row, we have to help them and treat them well. Some have huge problems and no one they can talk to. We must support them and make sure they are not left alone," Fussek says.

And the Federal Labor Court's ruling? It's essentially the right one, Fussek says. But he fears, however, that this ruling will simply drive up the number of caregivers who work illegally  with no kind of social insurance at all, as their employers cannot afford to pay for around the clock assistance.

Care for the elderly is an issue Germany urgently needs to deal with. Once the baby boomers — individuals born between 1955 and 1969 — are in need of care, the system will collapse, says Fussek. "We have to finance care through a combination of taxes and social security contributions for it to remain affordable. We have to change the whole concept," said Claus Fussek. 

And if too little is done in the next few years and politicians continue to avoid this uncomfortable topic in an election year, what then? Fussek has a drastic answer: "Eldery care is a question about the fate of society. If we don't manage to get this sorted, we may have to seriously consider active forms of euthanasia because there will be no one left to provide care." 

*This is a pseudonym. Our protagonist did not wish to be named in this article.

This article was translated from German.

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