Context
Germany’s long-term care (LTC) system is facing increasing pressure due to demographic changes. The number of people requiring care is projected to rise from approximately 6.0 million in 2023 to around 8.2 million by 2055. At the same time, the working-age population is shrinking, raising sustainability challenges for the pay-as-you-go LTC insurance system.
In response to staffing challenges and evolving care needs, the 2017 Nursing Professions Act (Pflegeberufegesetz) made changes to nursing education. For example, it replaced the three separate three-year professional trainings for nurses with a generalist training combining the three branches of geriatric (long-term), pediatric and adult care. Additionally, a university level nursing degree (as a primary qualification) was introduced. However, training for nursing assistants remains fragmented, with 27 different programmes across the 16 federal states.
Impetus for the reforms
Projections indicate a need for 150 000 additional nursing staff by 2040. According to the Federal Ministry of Health, ensuring high-quality professional care cannot be achieved by increasing the number of registered nurses alone. A more diversified and competency-based workforce mix is required, especially one that effectively integrates nursing assistants. The reforms aim to improve care delivery, increase efficiency, reduce bureaucracy and place greater emphasis on prevention.
Main purpose
The primary objectives are to make nursing careers more attractive and to strengthen the professional nursing profile. Expanded responsibilities for qualified nurses are intended to improve chronic disease management, transitional care and prevention, especially in underserved areas, while alleviating pressure on physicians.
Key features of the reforms
The Act on Expanding Competencies and Reducing Bureaucracy in Nursing Care (Gesetz zur Befugniserweiterung und Entbürokratisierung in der Pflege) grants nurses with three-year vocational training or a university degree the authority to independently carry out selected tasks currently under the directive of physicians, such as diabetes care, wound management and dementia-related interventions. A scientifically grounded “scope of practice” will be developed to define professional nursing tasks based on competencies. The act is also intended to reduce bureaucracy, for example, by lowering documentation requirements and extending the intervals between quality assessments in nursing homes in case of positive outcomes.
The Act on Introducing a Federal Nursing Assistant Training Program (Gesetz über die Einführung einer bundeseinheitlichen Pflegefachassistenzausbildung) establishes a uniform, federally regulated 18-month training program for nursing assistants. The curriculum includes mandatory placements across inpatient long-term care, home care and acute care hospitals. Nursing assistants will be recognized as a health profession, enabling consistent, cross-sector remuneration for the training programme. Additionally, simplified recognition of foreign qualifications will rely on competency tests or adaptation courses rather than full equivalency assessments.
Implementation timeline
The Federal Government introduced both legislative proposals on 6 August 2025. The National Association of Statutory Health Insurance Physicians, the Federal Association of Health Insurance Funds, and relevant nursing associations are entering into negotiations about the scope and content of the new competencies for professional nurses and the qualifications required. According to the legislative proposals, they are expected to reach an agreement by April 2027, with the new nursing assistant training program scheduled to begin in 2027.