Long-Term Care in Germany: What Adult Children Need to Know

You settle in Germany for the health system, parental leave, and predictable payroll deductions. Then a parent abroad needs nursing care, or you open a payslip and notice a Pflegeversicherung surcharge because you have no children. The rules that felt automatic on arrival start asking who pays first.

Two worries come up quickly: that nursing-home bills will fall on you, and that German law blocks you from helping family overseas. Both have some truth. Long-term care insurance (Pflegeversicherung) only covers part of chronic care. Adult children can owe parental maintenance (Elternunterhalt) above a high income line. You can take emergency leave for a relative abroad, but you usually get no wage replacement if the parent is not insured in Germany. Tax deductions for overseas support exist, with strict proof rules.

Below: what you pay in, what care levels pay out, how leave and Elternunterhalt work across borders, how tax relief works without getting rejected, and why a hardship visa for aging parents rarely succeeds. For health cover in general, see Health Insurance in Germany. For spouse and child visas, see Family Reunification in Germany.

What you pay into long-term care insurance

Pflegeversicherung is a separate pillar from health insurance (Krankenversicherung). It subsidises chronic daily care, not acute hospital treatment. If you have statutory health insurance, you are automatically in statutory long-term care insurance. If you are privately insured, you must hold equivalent private long-term care cover.

For 2025 and 2026, the baseline rate is 3.60% of gross pay up to the contribution ceiling. Who has children changes the employee share. The employer’s share stays 1.80% in most of Germany; the surcharge or discount hits your net pay.

• Childless, age 23+: total 4.20% (employee 2.40%, employer 1.80%). The 0.60 point childless surcharge does not apply under age 23 or if you were born before 1 January 1940.
• One child: total 3.60% (employee 1.80%).
• Two to five children: employee share falls by 0.25 points per extra child while that child is under 25, down to 0.80% employee share for five or more children.

Saxony is different. The state kept the Buß- und Bettag holiday instead of funding a full employer share when the system started, so employees there pay a larger slice of the same total rates.

Contributions stop above the assessment ceiling (Beitragsbemessungsgrenze): €5,512.50 per month in 2025, rising to €5,812.50 per month in 2026 (€69,750 per year). Income above that is not charged for health or long-term care insurance.

Care levels, benefits, and what insurance does not cover

When someone needs care, the Medical Service (Medizinischer Dienst) assesses independence and assigns a care level (Pflegegrad) from 1 (minor impairment) to 5 (most severe). Policy preference is outpatient before inpatient (ambulant vor stationär): home care is supported more than an automatic move into a nursing home.

Benefit amounts rose 4.5% on 1 January 2025 and stay fixed through 2026. The next mandated adjustment is not before 1 January 2028.

Monthly cash and service budgets (home care)

• Pflegegrad 1: no Pflegegeld or outpatient service budget; institutional care subsidy €131
• Pflegegrad 2: Pflegegeld €347; outpatient services up to €796; institutional subsidy €805
• Pflegegrad 3: €599 / up to €1,497 / €1,319
• Pflegegrad 4: €800 / up to €1,859 / €1,855
• Pflegegrad 5: €990 / up to €2,299 / €2,096

Pflegegeld is cash paid to the person needing care (often passed to family carers). Pflegesachleistungen pay licensed outpatient services. You can mix the two proportionally.

Extra pots most families use

• Relief budget (Entlastungsbetrag): €131/month for Pflegegrad 1–5 (recognised domestic help, shopping support, groups)
• Consumable aids: €42/month (gloves, disinfectant, bed pads)
• Digital care apps (DiPA): €53/month where certified apps exist
• Home adaptations: one-time up to €4,180 (stairlift, wider doors, accessible bathroom); up to €16,720 pooled if several people with a Pflegegrad share a household
• Short-term and respite care: from mid-2025, one flexible annual budget of €3,539 for Pflegegrad 2–5 (Kurzzeitpflege and Verhinderungspflege combined)

Nursing homes still leave a large private bill. Facilities often cost over €3,100 out of pocket per month. Insurance pays a tenure-based share of the care-related co-payment: 15% in year one, 30% in year two, 50% in year three, 75% after 36 months. Room and board remain largely on the resident.

Emergency leave when a parent lives abroad

Under the Caregiver Leave Act (Pflegezeitgesetz), you can take up to 10 working days of short-term leave (kurzzeitige Arbeitsverhinderung) per calendar year to organise emergency care for a close relative whose health has suddenly worsened. That right covers relatives abroad. Your employer must grant the time if you provide a medical certificate showing acute need and impairment at least at the level of Pflegegrad 1. You also get special protection against dismissal during that window.

Wage replacement (Pflegeunterstützungsgeld) is where expats usually hit a wall. The state replaces about 90% of net pay for those days, capped at €135.63 per day (roughly 70% of the daily contribution ceiling for 2026). Payment comes from the care recipient’s long-term care insurance, not from yours. If your parent is not in the German Pflegeversicherung system, you still get the leave, but no wage replacement. Budget for unpaid days when the crisis is overseas.

When adult children may owe parental maintenance

German civil law (BGB) ties adult children to support parents who cannot cover their own care costs. If a German agency (or a foreign municipality) covers a shortfall, it may seek repayment from children living in Germany.

The €100,000 shield. Under the Relatives Relief Act (Angehörigen-Entlastungsgesetz), you are only in scope for Elternunterhalt if your annual gross income exceeds €100,000. A spouse’s or partner’s income does not count toward that threshold. Dual-income households often assume household income matters; for the gate, only the biological child’s income does.

If you are above the line. Authorities look at adjusted net income (bereinigtes Nettoeinkommen): typically the last 12 months of net pay (or three to five years if self-employed), minus taxes, social contributions, work travel, debts taken on before the liability arose, private retirement savings up to 5% of gross, and priority support for your own spouse and children.

Self-retention (Selbstbehalt). You keep a protected monthly buffer. In October 2024, the Federal Court of Justice (BGH) set the single-person minimum at €2,650/month, including about €1,000 for warm rent. Higher proven rent (common in Munich or Frankfurt) can raise that figure. Married couples often keep roughly €4,500–€5,000 for the household. Of the surplus above self-retention, current practice for 2025/2026 is that you owe about 30% as Elternunterhalt (down from the older 50% approach). Siblings share pro rata by adjusted net income. The parent may keep protected assets (Schonvermögen) of about €10,000 alone or €20,000 as a couple before children are billed.

German authorities rarely chase foreign assets directly. Agencies in the parent’s country can still use tools such as the Hague Maintenance Convention or EU maintenance rules against people living in Germany. If your parents rely on public funds abroad and you earn above the threshold, treat cross-border claims as a real risk, not a theoretical one.

Tax deductions, hardship visas, and paperwork to prepare

Tax relief (§ 33a EStG). You may deduct maintenance to overseas parents as extraordinary burdens (außergewöhnliche Belastungen). For 2025/2026, the theoretical maximum is €12,096 per supported parent per year, scaled by the Ministry of Finance country groups (Ländergruppeneinteilung):

• Group 1 (100%): up to €12,096 (e.g. USA, UK, Australia, Spain, Saudi Arabia, Bahamas)
• Group 2 (75%): up to €9,072 (e.g. Romania, Cuba)
• Group 3 (50%): up to €6,048 (e.g. India, Brazil, Mexico)
• Group 4 (25%): up to €3,024 (e.g. Afghanistan, Ethiopia)

The list changes; check the current BMF country table for the tax year you file. Deduction is also capped by the sacrifice limit (Opfergrenze): roughly 1% of your net income for every €500 of net income, reduced by 5 points for a spouse and for each child receiving child benefit. Support above that limit is ignored.

Bank transfer only from 2025. Cash handed over on visits, Western Union cash pickup, and unregulated e-wallet transfers no longer qualify. Payments must go by bank transfer to an account in the parent’s name. You also need a German-translated maintenance declaration (Unterhaltserklärung) proving need (Bedürftigkeit). If the parent is of working age without severe disability or primary caregiving duties, the tax office may assume they should work and reject the claim.

Hardship visa for parents (§ 36 Abs. 2 AufenthG). Parents of adult non-EU residents are “other family members.” A visa only avoids außergewöhnliche Härte (exceptional hardship). Age, loneliness, poverty, or ordinary age-related illness is not enough. Courts usually require severe loss of autonomy and proof that only you in Germany can provide the care (local professional care available abroad normally kills the claim). Even then, you must fully finance the parent: no German welfare or statutory Pflegeversicherung on arrival, and private health insurance for an elderly ill foreigner is expensive and hard to obtain. Successful cases are rare. Prefer Family Reunification in Germany for spouse and child routes; do not count on parent reunification as a plan B.

Cross-border power of attorney. A German Vorsorgevollmacht alone often fails abroad. Notarise it, then add an Apostille (Hague Convention) or full embassy legalisation for the parent’s country. Without that bridge, local courts can freeze accounts or appoint a guardian and shut you out of medical and money decisions when a crisis hits.

Practical order for most expats

1. Confirm your payroll Pflege rate (children under 25, Saxony, income ceiling).
2. If a parent abroad has a crisis, use the 10-day leave right and budget for unpaid days unless they have German care insurance.
3. If your gross income is near or above €100,000, get advice on adjusted net income and self-retention before you assume zero liability.
4. If you send money abroad, use named bank transfers and keep Unterhaltserklärung paperwork for § 33a.
5. Put an internationally valid power of attorney in place before cognitive decline, not after.