Germany is aging and will therefore not only need significantly more nursing staff in the foreseeable future, but also more home places.

This is the conclusion reached by researchers from the RWI Leibniz Institute for Economic Research in their new nursing home rating report, which is created every two years and is available to the FAZ in advance.

They anticipate that the number of people in need of care will increase from currently around 4.1 million to 4.9 million in 2030 and even 5.6 million in 2040.

Accordingly, a further 322,000 inpatient care places would be needed by 2040, they write.

Today around 820,000 people live in such an institution.

Britta Beeger

Editor in business.

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The authors put the necessary investments at up to 125 billion euros. Public or non-profit capital alone will not be sufficient for this, they write, and argue that the strictly regulated market should be made more attractive for private investors. In the care of the elderly, they are often accused of greed for profit at the expense of employees and residents. Two years ago, the SPD even dared to limit the profits of private nursing home operators. Federal Minister of Health Jens Spahn (CDU) was also fundamentally open to this. "Without private capital it will hardly be possible to create a sufficiently large offer," says RWI health researcher Ingo Kolodziej. However, it will only be made available if it is "risk-adjusted interest", in other words: if the investment is worthwhile.

The situation is tense

On the one hand, the care market, which is worth around 60 billion euros, is a very reliable market because it can be foreseen for years and decades how great the demand will be.

At the same time, however, the economic situation of the around 15,400 nursing homes has continuously deteriorated over the past few years.

As the RWI analysis shows, only around 10 percent of nursing homes posted an annual loss five years ago.

In 2019 it was already 26.5 percent - more than one in four.

The researchers determined this through an analysis of 427 annual financial statements, which cover more than 2100 nursing homes from all federal states and 14 percent of the market.

The scientists describe the situation as "tense". According to the study, the average home generated an after-tax profit of just 0.9 percent of sales in 2019. The authors cite increasing cost pressure as the reason, but the causes are not discussed in detail. It could be due, among other things, to above-average increases in personnel costs. It is noticeable that chains - in Germany, for example, the French Korian Group or the Alloheim Group from Düsseldorf are among the largest providers - are more profitable with a margin of 1 percent than individual institutions (0.5 percent) and less often record an annual loss. At the same time, however, the proportion of homes with a loss among private operators is particularly high.Across all providers, around every fifth facility was exposed to an increased risk of insolvency.

The report does not examine how the corona crisis affected the homes' earnings. A special analysis by the auditing company Curacon suggests that the proportion of facilities with losses could have become significantly smaller thanks to the recently renewed care rescue fund. For 2021, however, many of them expect their results to decline again.

In order to attract more private investors in spite of all this, the researchers advise reducing the density of regulations and expanding entrepreneurial freedom of action. Today, for example, there are 16 state home laws, and different building regulations and personnel requirements apply from state to state. Regulations on the size of the home or the proportion of single rooms are superfluous, says Kolodziej. They also made operation and investments in new and existing facilities more expensive. "Some investors are therefore likely to withdraw from federal states with a high level of regulation, so that the supply becomes scarce."

As the report shows, private operators have actually made a major contribution in the past to increasing the supply of care places. The number of places in private homes has more than doubled since 1999, while the places in non-profit organizations such as the AWO, Diakonie or Caritas have only increased by 28 percent. The number of places in public-law sponsorship - as a rule, this is followed by municipalities or districts - has, however, decreased by a fifth. Overall, the number of people cared for in nursing homes has recently stagnated, while the proportion of outpatient care and also of people cared for at home by their relatives has continued to grow. Outpatient care has also been financially strengthened through several laws.This trend could have accelerated due to the pandemic and the admission freezes in the homes.