According to AOK Nordost, nursing home operators who employ fewer staff than contractually agreed with the nursing care insurance funds are too rarely held financially accountable. The health insurance company, together with the National Association of Statutory Health Insurance Funds, is calling for overpaid funds for personnel to be fully repaid in the future.
This should be done by reducing the co-payments in the following year, AOK Nordost announced. The reason for the current situation is a legal loophole, explained Jens Kreutzer, head of the nursing care department at AOK Nordost. Insurance funds, social welfare providers, and home operators negotiate the costs for a nursing care place in advance, which also determines the amount of co-payments. However, it is rarely checked afterwards whether the money was actually spent specifically on personnel. According to the Eleventh Social Code Book, surpluses may be retained as profits.
While insurance funds can demand benefit reductions in cases of proven intentional understaffing or long-term vacant positions, these must be accepted equally by operators, insurance funds, and social welfare providers, otherwise an arbitration board will decide. In practice, repayment to residents occurs very rarely, criticized the AOK.
Social welfare providers such as the Berlin health administration also classified the procedure as complex and bureaucratic. There is a need for legislative improvement, demanded Kreutzer. The nursing care insurance funds must be able to enforce fee reductions in cases of proven staff shortages more quickly, more legally securely, and with realistic proof requirements.
According to a spokesperson, the Federal Ministry of Health currently sees no need for change. It pointed out that in cases of planned and targeted violation of obligations, the care contract can be terminated. In such cases, the nursing care insurance funds would have the opportunity to counter fraudulent actions with the necessary rigor.
However, AOK Nordost considers this possibility to be largely theoretical. Due to the shortage of nursing home places, termination of care contracts is practically impossible, as the affected residents must continue to be cared for. Furthermore, it is legally difficult to prove poor quality to nursing home operators.
