24-hour care – support from live-in care staff

Many people in need of care want to live in their own homes for as long as possible and avoid having to move into a care facility. The greater their need for care, the higher the level of support they require from carers – in many cases, support is needed throughout the entire day. For their loved ones, this usually presents a significant physical and psychological challenge as well as a strain on their time that cannot be managed alone. 

One option for providing as much support as possible is to employ a person to care for the care recipient while living with them in their home. This is known as live-in support or live-in care. German families often choose people from eastern and southern Europe as carers. These carers are usually employed by foreign private care companies or working independently as contractors on placement in Germany. A German placement agency is often involved. Some German care services also employ foreign care staff (without further qualification) and place these in the homes of care recipients. 

This model is also known as 24-hour care. However, the name is misleading in a number of ways and cheap care provision by carers from foreign countries is not legally possible: 

• Carers sourced from outside of Germany often have no qualification in care or their qualification is not recognized in Germany. As a result, they are not permitted to provide post-treatment care. There are also other care tasks that cannot be funded as a long-term care insurance benefit in this case.
• German employment law applies to foreign care staff – round-the-clock care by a single carer is not permitted. It costs the same to employ carers from foreign countries and carers from Germany. 
• Those who employ self-employed care staff run the risk of them being in bogus self-employment – which may mean that significant payments will be due at a later date. The costs are also substantial – you can expect to pay between 2,200 and 3,000 euros per month for this model of care. 
• In many cases, it is not possible to meet the care recipient’s desire for a dedicated carer by employing foreign care staff.  
• Many foreign carers speak little to no German, which presents a considerable problem in the very sensitive and private sphere of health and care. 

These considerations are frequently not explored in sufficient depth when employing and placing care staff.  

Another difficulty for care recipients and their families is that they do not know with certainty that all legal requirements have been fulfilled in the case of a placement or whether the employment relationship is even legal – it is difficult to fully understand and assess the legal problems associated with the individual models of employment. The potential consequences, some of which may be severe, are usually borne by the care recipient and their family.  

In addition, carers from foreign countries often work under very poor working conditions in these circumstances. 

At present, there is little legal assistance available to live-in carers. Carers from foreign countries can seek advice from the “Faire Mobilität” (Fair Mobility) advisory network of the German Trade Union Confederation (Deutscher Gewerkschaftsbund). 

For North Rhine-Westphalia, legal advice is available from the Pflegewegweiser NRW care information project.

Anyone who cannot verify that they have completed a qualification in a caring profession that is recognized in Germany is not permitted to provide post-treatment care. This type of care includes, for example, wound care, administration of medication and injections and putting on dressings and compression stockings.

Foreign workers placed in German homes by 24-hour care agencies generally have no qualifications in care. They can provide support with the following tasks: 

• General support: assistance with daily tasks, accompanying the person on visits to the doctor etc. 
• Basic care tasks: helping the person to dress and wash themselves, eat etc. 
• Domestic help: washing, cleaning, shopping, cooking etc.

Specialist knowledge is strongly recommended when caring for people with conditions such as advanced dementia. Proper management of challenging behavior helps avoid excessive strain on the carer and the potential occurrence of care-related abuse. 

There are three legals models for employing live-in care staff in your own home:

• Employer model: The care recipient or a family member takes on the role of an employer.
• Placement model: An employee of a foreign private care company or a self-employed carer works on placement in a German household. Self-employed carers are placed by agencies. Agencies also charge for placement costs, travel costs, and insurance.
• Self-employed model: The care recipient or a family member concludes a contract with a self-employed carer. It is becoming increasingly common for agencies to also place self-employed carers in households.

The choice of care model can have far-reaching consequences for the consumer. It is therefore essential to obtain detailed information about the benefits and drawbacks of each model and to closely examine the assurances provided by placement agencies.

The employer model – points to consider 

With the employer model, the care recipient or a family member employs the care staff. This means that they are responsible for the contract of employment and for taxes.

This can be a lot of work but, from a legal perspective, is the safest model to choose. You can seek assistance from a lawyer or tax advisor, for example. It can take up to two months to complete all necessary formalities.

The advantage of this model is that the carer reports directly to you. This means that you can, within the framework of the applicable legislation, determine working hours, define the precise role and tasks of the carer and set out a code of conduct. For example, you may stipulate that the carer must not smoke during working hours.

For more information about the employer model, refer to the Pflegewegweiser NRW care information project.

The placement model – points to consider

In the placement model, the carer is employed by a foreign private care company and is sent to your home in Germany on a placement (also known as an intra-EU posting/assignment).

The foreign company is responsible for paying the carer’s wages and for paying social security contributions and taxes in the country of origin. Carers should have an A1 certificate to prove that they have social insurance in their country of origin.

For more information about the A1 certificate, contact a consumer advice center.

An intra-EU posting can last 24 months at most. Once this period is exceeded, the carer is subject to German social security regulations.

The carer reports only to the foreign company as the employer in this model. All instructions should, in theory, come from the company.

In most cases, a German placement agency takes responsibility for communication between you and the foreign company. With this model, you therefore conclude two contracts, both of which you should examine in detail.

Self-employed model – points to consider

In the self-employed model, the carer is an independent operator and is not employed by an agency. It is also becoming increasingly common for agencies to arrange placements for self-employed carers.  

Self-employed individuals are not subject to employment legislation and the minimum wage does not apply. With this model, you run the risk of the carer being in bogus self-employment. This means that, while the carer may be classified as providing an independent service based on a service or work contract, they are in fact acting in the capacity of an employee – for example, by working for one employer only.

Managerial authority is also an issue with bogus self-employment – you are not permitted to give self-employed persons specific work directions. The tasks of a self-employed carer are based on their assignment, which they are free to carry out as they see fit.

If a carer lives in the home of a care recipient, works only for that care recipient and receives instructions from them, it can be presumed that they are in bogus self-employment. This means that you may need to make back-payments of social security contributions for them as well as tax on their wages. Significant fines, financial penalties or custodial sentences are also possible.

Foreign carers may also work on a self-employed basis in Germany. The same prerequisites apply in relation to bogus self-employment. They must operate a business in their home country and, like employees, work for no more than 24 months on a posting abroad. Alternatively, they can register their business in Germany. If they do so, the 24-month limit no longer applies. 

Consumer advice centers offer essential advice on hiring self-employed carers.

For more information and details of self-employment and bogus self-employment, contact a consumer advice center.

The costs to you depend on which model you choose. 

Employer model 

You must pay the national minimum wage and social security contributions (health insurance, long-term care insurance, unemployment insurance and pension insurance) as well as contributions to the German Employers’ Liability Insurance Associations (“Berufsgenossenschaften”) for your employee. From a legal perspective, this is the safest model to choose. Based on a minimum wage of 12.41 euros per hour, you can expect to pay at least 2,800 euros per month. This figure includes, for example, the costs of labor, employer contributions to tax and social security, accident insurance, and pro-rata travel expenses. Accommodation and meals – which you are also required to provide – are not included.

Placement model 

Foreign private care companies can charge various rates, depending on the tasks the carer is to carry out and on their language skills. They are also required to pay their employees at least the German minimum wage as well as contributions and taxes in the country of origin. You can generally expect to pay between 2,500 and 3,000 euros per month with this model. On top of this, there are often also commission fees to pay to the German agency. 

Self-employed model  

You negotiate a professional fee with the carer. Note that you must not be unethical in your negotiations and remember that self-employed care staff will need to pay social security contributions in their home country out of the money you pay them. 

Regardless of the chosen model, the person in need of care will have to cover any additional costs as they arise – for example, the carer’s travel costs, accommodation and meals, Internet access, phone charges, as well as agency charges and fees. 

If you choose live-in support, you must plan for the costs of employing a carer, as well as for the costs of part-time care during the carer’s rest periods and vacation days.

You will need to pay for most of the costs of a live-in carer out of your own funds. If you receive a care allowance, you can use it for this purpose. You can claim a budget for support from care services (non-cash care benefits) if the service you use has been approved by the long-term care insurance fund. Other long-term care insurance benefits can only be used indirectly. 

You can avail of these benefits to ensure care for the care recipient during the live-in carers’ breaks and rest periods: 

• Partial residential care: The care recipient spends part of their day in a day care facility. A small number of facilities also provide overnight care and support. 
• Additional relief allowance: This is a budget that can be used to cover the cost of care services for a few hours or to supplement day care. 
• Respite care allowance: This benefit can only be used under specific circumstances and is subject to strict requirements. 

If you require professional nursing care for some care tasks, you can apply for a combination of non-cash care benefits and a care allowance. The amount of care allowance you receive will be reduced as a result. 

If you require medical post-treatment care, this must be prescribed by a doctor and provided by a care service. The health insurance provide covers the costs, so that use of the care service does not come out of your non-cash care benefits budget or nursing care allowance.  

German employment law applies to live-in carers, even if the carer is placed in your home by a foreign company. Whether you have employed a carer or entered into a contract with them, there are a number of basic requirements that you must ensure are in place: 

• Compliance with working hours legislation 
• Provision of work materials 
• Provision of living space 

What is important to consider in relation to working hours? 

You must ensure that care staff comply with the legally prescribed working hours, break times and rest periods and that you put other care alternatives in place to allow them to take vacation leave. It may be possible to use a day care service, for example. 

Employees are permitted to work no more than 48 hours per week and must have at least one day off per week. In this case, their working hours must be distributed over 6 days, as the maximum number of hours they may work each day is 8. Working 10 hours a day is only permitted in exceptional circumstances. A rest period of 11 hours must normally be ensured between workdays. A break of at least 30 to 45 minutes is mandatory, depending on how many hours are worked in the day. 

If you want the carer to be close by and available to you on-call – for example, at night – this is considered an on-call service. As such, you are required to pay at least the minimum wage in this case. For example, if the care recipient requires support with using the toilet at night and this occurs with varying frequency and at different times each night, the carer is considered to be on-call for the entire night and not just for the ten minutes that they spend helping the care recipient use the toilet. 

If care genuinely needs to be provided for more than 8 hours a day, at least 2 carers should be hired to work on a rotating basis. And, if “real” 24-hour care is needed, this number should be increased to 3. You will also need staff to cover vacation and sick leave. 

What are the space requirements? 

You should provide the carer with their own room as a minimum. They must also be given access to a bathroom and kitchen. An Internet connection is also strongly recommended. 

Do I need to provide work materials? 

You must provide carers with all materials that they need to do their job. These include care aids, for example. If the carer is self-employed, you are not obliged to provide work materials unless this is specified in the contract. 

Essential information about the legalities of hiring a live-in carer is provided by the Pflegewegweiser NRW e.V. care information project. 

While not an essential prerequisite, it is a good approach to discuss with the carer, before they begin working for you, what types of support you need and also what rules apply in your home and what kinds of behavior and habits you are happy to accommodate and those you are not. This should ease the process of getting used to living with a person you do not know. It also reduces the potential for conflict. The support you require should also be specified in the contract. 

Placement agencies in Germany can help people in need of care find a live-in carer via a foreign private care company or a self-employed carer and to conclude a contract with them. They often also act as a point of contact in Germany for requests and complaints. Some foreign care companies send employees or self-employed carers to Germany directly.

Not all placement agencies and foreign care companies are reputable and legally compliant. It is not always clear to customers, from looking at offers and draft contracts, what exactly they can expect in terms of care provision, what their obligations, what costs are involved and whether the arrangement is legally compliant.  

Agencies charge between fees ranging from 70 euros to a four-figure amount for their services – and this is often not clearly communicated from the outset. 

For many years, there were no binding standards that applied to the placement of foreign care staff in Germany. Even now, the DIN standard that applies to the placement and hiring of foreign care staff is not always a guarantee of a reputable agency and qualified staff (DIN SPEC 33454: “Caregiving for people in need of support through live-in caregivers from foreign countries – Requirements for brokers, service providers and caregivers”). There are also good agencies that do not have this seal of approval. 

It is therefore important to be very thorough when selecting an agency: 

• Contact several placement agencies, ask them to send you documentation and compare offers and draft contracts.
• Ask questions about anything that is unclear or seems odd to you.
• Put the company to the test by asking specific questions about the scope of its activities, about social security and employment arrangements for its workers and request documentation.
• Keep a written record of all arrangements.  

You may need to conclude two contracts – an agency contract with the placement agency and a care contract with the foreign care company or self-employed foreign carer. Examine both contracts carefully. 

A good placement agency will, for example: 

• work in an open and transparent way and keep a written record of all information and arrangements 
• give you time and avoid putting you under pressure 
• ask you specific questions in order to assess your needs and may offer a home visit 
• answer all questions in detail 
• offer solutions to problems

For more information about choosing a placement agency and important legal aspects of contractual arrangements, contact a consumer advice center.

The Pflegewegweiser NRW care information project explains how to go about finding international care staff.

Extensive information about live-in care is provided in the brochure “Ausländische Haushalts- und Betreuungskräfte in Privathaushalten” (“International Home Helpers and Carers in Private Homes”) (in German) published by the Pflegewegweiser NRW e.V. care information project.