Exporting Grandma? Some German elderly head abroad for nursing care

Long-term nursing insurance is a pillar the German welfare model, but the system is increasingly stressed by the aging population – leading some elderly to go to other EU countries for care.

Thomas Peter/Reuters
An elderly woman walks along a shopping street in Berlin last September. With Germany's population aging and its long-term nursing care growing more expensive, some German elderly are looking abroad to countries like Hungary and Slovakia to find good, affordable senior homes.

From Germany, the pull of Senior Palace's webpage is hard to resist. "Looking for a senior home to bring the autumn of your life comfortably... where your savings are going to stay intact?"

"Then," the ad says, in German, "Senior Palace is what you need."

Over the past two years, some 70 elderly Germans and Austrians have heard the call. That the "palace" nursing home is more than 400 miles to the east in Slovakia – in a village on the Danube River one hour south of Bratislava, the capital – seemingly did not matter.

Since the European Union's borders moved east, entrepreneurs in Hungary, Slovakia, and the Czech Republic have started luring Germany's oldest citizens by offering them something that experts predict will soon not taken for granted any more in Germany: good, affordable, around-the-clock nursing care.

A pillar of the system

Germany is one of the only nations in the world (the others being Japan, Korea, and the Netherlands) to have dedicated public insurance for long-term care. Based on an equal contribution between employees and employers – roughly 2 percent of people's income – it provides financial protection to anybody who cannot live independently, because of illness or old age.

"We have a budget, a pot, and the contributions are collected into this pot. If you are in need of care, you get it from this solidarity pot," says Vjennka Garms-Homolova, a professor of health care management at the Alicia Salomon University of Applied Sciences in Berlin. "This is not government payment – this is really solidarity."

Along with public pension, disability, and health insurance, long-term nursing insurance – Pflegeversicherung in German – is a pillar the German social welfare model designed by Chancellor Otto von Bismarck 120 years ago, the oldest in the world.

The model has fostered social cohesion and been the envy of many countries. But the "Oma [grandmother] export" phenomenon, as some here refer to sending elderly parents abroad, has revealed the system's limits.

"It is a sign it will be increasingly difficult to pay for the care you need," says Professor Garms-Homolova. Even if it's small, the phenomenon has added fuel to the national debate on how to find better, and cheaper, ways of dealing with long-term care.

"We are used to expecting that the government will step in and help, but that isn’t going to be possible in the future," says Doris Schaeffer, a professor of public health at the University of Bielefeld. "We have to broaden our understanding of caring, to think about other models of informal care giving – one where everybody takes responsibility for their community, for the people living there."

All industrialized countries are aging, but in Germany – as well as in Italy and Japan – the demographic change is particularly dramatic, according to the Organization for Economic Co-operation and Development (OECD). By 2050, Germans aged 60 and over will constitute more than half of the population, up from 26.8 percent today. By then, Germany will have the second oldest population in an OECD country after Japan. Fewer workers will be called upon to finance the benefits of more recipients, something the World Health Organization recently called Germany's "demographic time bomb."

Crisis in nursing care

Germany's graying population will require doubling the number of nursing home personnel by 2050 and adding 800,000 nursing home beds, according to the Bertelsmann Foundation, a private research foundation in Gütersloh. But Germany cannot afford it. Making the situation even more difficult is that nursing care is regarded as an undesirable profession, experts agree.

In the town of Wittenberge in the former East Germany, social worker Rita Langwisch foresees a worrisome development: old-age poverty. Her town, once a robust industrial hub in Communist times, saw its sewing machine factory and other industries close when the Berlin Wall fell. More than 8,000 jobs disappeared, prodding a massive exodus of young people which shrank the town from 36,000 to 18,000 people.

Today, one in 10 people is unemployed. For many, today's jobs aren't the life-long jobs of yesterday. There are mini-jobs, part-time jobs. Families are no longer intact. And more and more women have to work, meaning they are less and less able to look after older parents.

"With the new generation of retirees, that’s when we’re going to have a real problem," says Ms. Langwisch, manager of the local diakonie, a church-run charity in Wittenberge. "In five years from now, old-age poverty is going to be a real problem."

“Who will actually be there to care? This is the problem of the future,” concurs Garms-Homolova, the health care management expert. “We will get only older staff. We have to look at how to reduce the need for care.”

Financial pressure for alternatives

Financial pressure is mainly what drives children to send their parents to a cheaper nursing home in Slovakia or Hungary, says Senior Palace founder Arthur Frank. “Financially, people are pushed to the limit,” Frank says. “The real problem in Germany is that caregivers have a bad reputation – nobody wants to do the job.”

"Here, in Slovakia, we don’t have this.”

While nursing-home costs have skyrocketed to an average of 2,900 euros ($3,800) per month, pensions have remained the same at best, experts agree. His five homes cost between 1,000 and 1,400 euros ($1,300 and $1,800) a month, Frank says.

In Germany, it's still family who mostly care for elderly parents, and more so than elsewhere in Europe, according to EURHOMAP, a European Community-funded research project comparing the home-care situation in 27 EU states as well as Croatia, Turkey, Iceland, Norway, and Switzerland.

"In Germany, one's sense of taking care of one's parents is very strong," says Garms-Homolova.

The way Pflegeversicherung works partially explains why, experts agree. Germans can either get their nursing-home costs partially covered or receive a lump sum, of roughly 700 euros ($910), that can be used by relatives. “The money is one reason why people have traditionally preferred not to take nursing care, but to take the money,” says Prof. Schaeffer.

Deal with insurance?

The money helps Frank's patients or their relatives offset the travel cost to Slovakia, he says. EU law forbids German insurance funds from establishing deals with nursing homes abroad, partly because checking quality is difficult. But the topic in recent years has become part of the public debate.

"It would be wrong to uproot people from their family surroundings just because they need nursing care," says Uwe Deh, chairman of the AOK Federal Association, the largest of Germany’s roughly 180 statutory health insurance funds, in Berlin. "But freedom of movement is a reality, and whoever wants to be cared for in other countries should have the right to do so."

"Good, affordable nursing care shouldn’t become a rarity," says Mr. Deh.

A rare phenomenon, but a worrisome sign

Experts estimate that the number of people going to other EU countries to receive nursing care will remain extremely limited, under 5,000 people a year.

“We’re talking about individual cases,” says Garms-Homolova.

“As long as it is a free choice, why should it be somehow problematic?” she says. “But that poverty is the cause is not right.”

To reduce the need for long-term care, says Schaeffer, change should start by preventing older people from being dependent. That could start with small steps, like promoting the living together of various generations or designing bike lanes adapted to the special, wider bicycle older people may use. "We need more solidarity," Schaeffer says.

In the end, sending your mother to Slovakia may pose more than one moral dilemma. "If you want good nursing home in Czech Republic you have to wait for 10 years," says Garms-Homolova. "Now the better places are occupied by Germans."

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