Deficiencies in long-term care – who can I turn to for help?

High-quality care always reflects the latest scientific findings. Employees of care facilities can only implement a high standard of care if all this knowledge has been tested in practice, bundled together, processed and made available to them to apply. 

Features of high-quality care:

• The necessary care measures are chosen together with the care recipient and, if necessary, their loved ones.
• High-quality care is implemented in a reliable and transparent manner by staff who have received adequate specialized training. 
• The wishes and the privacy of the person in need of care are respected and their independence is promoted. 
• High-quality care defines specific goals and it promotes health and prevents health risks. 
• High-quality care ensures the safety and protection of the care recipient. 
• Carers support the care recipient’s loved ones and treat them with respect, for example by providing them with instruction in care measures on request.

Mistakes can be made anywhere. However, action is needed in the case of fundamental issues that occur on a regular basis. Some examples of deficiencies in care are provided below:

• Care recipients are not sufficiently supported in terms of mobility and may, for example, suffer from bedsores.
• Personal hygiene care is not provided on a sufficiently regular basis or is not sufficiently thorough.
• Falls repeatedly occur and their cause is not investigated. 
• Incontinence aids such as pads are generally changed too late or too infrequently.
• Inadequate assistance is provided for eating and drinking. 
• Regular and authorized restraining measures are used, such as bed rails or restraining straps.

There is currently a growing initiative throughout Germany to avoid using unnecessary restraints for people who are unwell, old or disabled. The website of the “Werdenfelser Weg” approach provides more information and a listing of facilities who are taking part.

Action is also needed in the following situations:

• There are indications of theft.
• The individual’s privacy is not respected. For example, their letters are opened without their permissions.
• Their living space is dirty or neglected. 
• The care recipient receives little or no social care. There is a lack of social participation.
• Visiting options are limited.  
• Use of communal spaces is regularly restricted.
• Inadequate medical care is provided. Inadequate therapeutic care is provided, for example by physiotherapists.

The first step is to seek a meeting to discuss the issues with the relevant staff member(s). To avoid an escalation, efforts should always be made to voice one’s concerns in a matter-of-fact manner. If there are fundamental issues to discuss, it’s better to arrange a meeting in advance rather than airing grievances in an emotionally charged situation. A specially arranged meeting can also give more authority to the complaints. In addition, it allows the other party to schedule sufficient time for the meeting. In individual cases, it may be useful to have a neutral party attend the meeting also. 

Detailed documentation is important if you believe that there are deficiencies in the quality of care provided.

For this purpose, you can, for example:

• hold a meeting with the care staff in the presence of another person acting as a witness and keep a written record of the meeting (signed meeting transcript)
• keep a care diary, in which you record the deficiencies as precisely as possible
• take photos or video recordings of deficiencies

It is also useful to make another person aware of possible deficiencies in care provision so that they can act as your witness.

Care staff document care measures implemented on a regular basis. Care recipients, their authorized representatives and legal guardians can obtain a copy of this documentation.

You need to be very painstaking and accurate in your documentation of deficiencies in care. In the event of a legal dispute, evidence of a deficiency of care will need to be presented in the most precise terms possible.

Begin by asking for a meeting with the responsible member(s) of staff in the nursing home. If the problems are particularly serious or organizational in nature, the facility’s residential manager should be informed. If the problems cannot be resolved in the next way, care service management is the next port of call. 

You should also inform the board of the nursing home. It represents the interests of residents and can engage with the nursing home management in the event of a complaint. 

If matters do not improve, you should engage in dialog with the managers of the nursing home without delay. The executive board is another possible point of contact.

Who should I contact to discuss poor quality of care provision by a care service?

If you are experiencing issues with a care service, you should similarly begin by addressing the problem with the carer. If the situation does not improve, care service manager is the next port of call. 

If a solution cannot be reached in this way, you should escalate the issue to the board of management or executive board of the care service.

If a solution cannot be reached with the nursing home or the care service, assistance can be sought from external bodies. 

For example, health insurance providers, in their role as social insurance providers, accept complaints about care. Care facilities are also monitored and overseen by the care home supervisory authorities of each federal state in Germany. The relevant care home supervisory authority therefore represents another point of contact if deficiencies are experienced in long-term care provision. The facilities for which the care home supervisory authority is responsible depends on the individual federal state.

If there are specific indications of deficiencies in care, the supervisory authority itself may undertake an investigation. Different courses of action are open to home care supervisory authorities depending on the federal state where they are located. They may, for example:

• order the facility to remedy the deficiencies 
• prevent the facility from admitting new patients 
• prohibit the hiring of staff 
• as a last resort, close the nursing home

Both the care home supervisory authority and long-term care insurance providers can initiate an inspection of the facility by the Medical Review Board.

The Medical Review Board conducts quality inspections and proposes measures for improvement where necessary. 
If the deficiencies detected are not remedied by the specified deadline, the health insurance providers may reduce their payment of benefits to the nursing home, for example. 

The website of the Statutory Health Insurance Alliance for Health (GKV-Bündnis für Gesundheit) lists the relevant regional contacts for the statutory health insurance funds. 

If you have private long-term care insurance, you can contact the relevant insurance company directly. It will then direct your complaint to the relevant regional association of care insurance providers. The regional association can, for its part, initiate an inspection of the nursing home.

You are entitled to receive contractually agreed care services. If deficiencies in care persist despite your complaints, there are various steps to consider taking next.

Can I reduce the nursing home fees paid if there are deficiencies in care?

Nursing home fees are the fees that a care recipient is required to pay on a regular basis to cover the costs of residential care. According to the Residential Care Contract Law (Wohn- und Betreuungsvertragsgesetz), consumers are entitled to reduce the fees they pay if there are deficiencies in their care provision. When doing so, you must explicitly inform the nursing home without delay that you wish to reduce your fees as a result of poor-quality care. 

If receiving benefits from long-term care insurance or social welfare, you can only make reductions in relation to your co-payment (personal contribution).

Legal advice on care and residential care legislation is available, for example, from consumer advice centers and the BIVA Association for Protection in Care (Pflegeschutzbund). You can find care advice centers near you on the website of the Center for Quality in Care foundation (Zentrum für Qualität in der Pflege).

What is the notice period for terminating a contract with a nursing home?

You are entitled to terminate a nursing home contract without notice under certain conditions. This is the case, for example, if there is a substantive reason why it is no longer feasible to continue with the contract. Examples of such reasons include serious failures in care or verbal abuse by staff. In all other cases, the contract can be terminated as of the end of the current month. Notice of termination must be provided to the nursing home by no later than the third working day of the month. 

However, it is not easy to find a place in a new nursing home. You should only ever terminate your contract with the current nursing home once you have found a new place elsewhere. 

For more information about points to consider when terminating your contract with a nursing home, see the consumer advice center website.

Do I have to cover the additional costs of switching nursing homes? 

If you change nursing homes, you may be able to make a claim for compensation. You may be able to claim for moving expenses and additional costs due to having to find care provision elsewhere. However, it is useful to seek advice before attempting to recover costs.

Care recipients availing of home care services in their own home can terminate their service contract at any time. No notice period applies.

It can be difficult to find a new service to provide you with care in your own home. A termination of the contract should not be declared until a replacement service has been found.

The contract may also be terminated by the care service. As no legal provisions apply to care service contracts, the contractually agreed notice period applies. 

For more information about what to do if a service providing care to you at home terminates their contract, see the consumer advice center website.

In the case of prolonged conflict, a neutral arbitrator may be able to help resolve the issue without involving the court system. Conflicts can generally be resolved more quickly and more cost-efficiently than in court. However, the relevant care provider must first agree to an arbitration procedure.

Support for reaching out-of-court agreements is provided by the neutral Federal Universal Arbitration Board. 

If you have suffered damages, you are entitled to compensation. Your claim will have to be presented in court. You should consult a lawyer before asserting a claim for compensation in the event of damages.

Am I entitled to compensation for personal suffering? 

If deficiencies in care cause physical harm, such as bedsores, a claim can be made for compensation for personal suffering (“Schmerzensgeld”).

The quality of care provided in care facilities is inspected regularly. The content and scope of these quality inspections are regulated by law and the results must be published on a regular basis.

The Federal Ministry of Health (Bundesministerium für Gesundheit) provides information on its website about the legally regulated quality system in residential care, which was introduced on a phased basis starting in October 2019. 

The results of the quality inspections conducted by the Medical Review Board are publicly accessible, for example, in the Care Navigator (Pflegenavigator) of the Federal Association of Public Health Insurance Companies (AOK), in the CareFinder (PflegeFinder) of the Federal Association of Company Health Insurance Funds (BKK) or in the care guides (Pflegelotsen) of the Association of Substitute Health Insurance Funds (Verband der Ersatzkassen).

Detailed information about questions relating to the Residential Care Contract Law is provided in the consumer guides published by the BIVA Association for Protection in Care (Pflegeschutzbund).