Germany Long Term Care Market Overview, 2031

Key Insights

• Germany's long-term care market is one of the largest and most established in Europe, anchored by the statutory long-term care insurance system. At the end of 2025, approximately 6.01 million people in Germany received benefits from the statutory long-term care insurance. The number of people in need of care has more than doubled from 3.0 million in 2015 to 5.7 million in 2023, with the proportion of the population requiring care rising from 3.21% to 6.24%.
• The German long-term care market is characterized by a strong preference for home-based care. Approximately four out of five people in need of care in Germany are cared for at home. About 0.8 million care-dependent individuals receive care in inpatient facilities, representing roughly one-quarter of all people in need of care.
• The nursing home sector in Germany comprises approximately 11,666 fully inpatient nursing homes with around 915,309 beds. However, the sector faces significant capacity constraints 2025 saw no net increase in nursing homes, with 101 new openings offset by 101 closures, resulting in only 681 additional nursing home places created. Experts project a need for approximately 145,937 additional places by 2040, equivalent to about 1,460 new homes with 100 beds each.
• The assisted living and outpatient care segments are growing faster than inpatient care. Between 2022 and 2025, the number of outpatient care services increased by 4.7%, assisted living facilities by 8.1%, and day care facilities by 10.3%, while inpatient nursing homes declined by 0.2%. There are currently 8,074 assisted living facilities with approximately 331,346 supervised housing units in Germany.
• Germany is facing a severe long-term care workforce shortage. The Federal Institute for Vocational Education and Training has projected a need for 150,000 additional nursing staff by 2040. By 2035, up to one-third of professionally active nursing staff in long-term care are expected to leave the profession. The average time to fill a nursing position in Germany is approximately 230 days.

Market Outlook

• According to the research report, "Germany Long Term Care Market Overview, 2031," published by Bonafide Research, the Germany Long Term Care Market is anticipated to grow at more than 5.00% CAGR from 2026 to 2031. This growth is supported by accelerating demographic aging, persistent workforce shortages, and the continued expansion of home- and community-based care services.
• Germany's demographic trajectory is a primary driver of long-term care demand. At the end of 2023, the number of people in need of care under SGB XI totaled approximately 5.6 million. According to projections from the Federal Statistical Office, the number of people in need of care is expected to grow to as many as 8.2 million by 2055. This represents a 37% increase driven solely by demographic aging.
• The demand for nursing home places is expected to significantly outpace supply. While the number of fully inpatient nursing homes declined slightly from 11,702 in 2022 to 11,666 in 2025, the population requiring care continues to grow. The ratio of available nursing home places per 1,000 people in need of care has declined dramatically from 345.7 in 2009 to 212.5 in 2019. This supply-demand gap is expected to widen further.
• The assisted living and outpatient care segments are expected to continue their strong growth trajectory, driven by the preference of most Germans to age in place. A TK-Meinungspuls 2025 survey shows that while 90% of elderly people prefer to be cared for at home, 77% would consider assisted living. Approximately 400,000 age-appropriate housing units are currently missing in Germany, particularly in the service living and assisted living segments.
• The long-term care insurance system faces significant financial pressure. Expenditures of the statutory long-term care insurance increased by 11.2% in 2025. The contribution rate was increased to 3.6% effective January 1, 2025, with childless employees paying a surcharge of 0.6 percentage points, bringing their total to 4.2%. The federal government is providing short-term stabilization loans of €0.5 billion in 2025 and €3.2 billion in 2026.

Market Dynamics

Driver: Accelerated Demographic Aging and Rising Care Dependency Germany is experiencing a profound demographic shift that is fundamentally reshaping the long-term care landscape. The number of people in need of care has more than doubled from 3.0 million in 2015 to 5.7 million in 2023, with the proportion of the population requiring care rising from 3.21% to 6.24%. By the end of 2025, approximately 6.01 million people received benefits from statutory long-term care insurance. According to the Federal Statistical Office, the number of people in need of care is projected to reach as many as 8.2 million by 2055. This demographic trend is driven by increasing life expectancy, the aging of the baby boom generation, and declining fertility rates. The oldest-old population, aged 85 and above, has the highest prevalence of care dependency, creating sustained pressure on Germany's long-term care delivery system and financing mechanisms. The annual number of care assessments reached a record high of 3.1 million in 2025, reflecting the growing demand for care services.



Challenge: Severe Workforce Shortages and Capacity Constraints Germany's long-term care market faces a persistent and intensifying workforce crisis that threatens service availability and quality. The Federal Institute for Vocational Education and Training has projected a need for 150,000 additional nursing staff by 2040. By 2035, up to one-third of professionally active nursing staff in long-term care are expected to leave the profession due to retirement and other factors. The average time to fill a nursing position in Germany is approximately 230 days. The number of employees in the care sector is stagnating, and estimates suggest that at least a quarter of a million qualified nursing professionals will be missing by mid-century. The workforce shortage is compounded by capacity constraints in the nursing home sector. In 2025, no net additional nursing homes were opened in Germany 101 new openings were offset by 101 closures, resulting in only 681 additional nursing home places created. The shortage of nursing home places is particularly acute, with waiting lists for nursing home places growing longer. Experts project a need for approximately 145,937 additional places by 2040. Without significant investment in workforce recruitment, training, compensation, and capacity expansion, Germany's long-term care system will face increasing difficulty in meeting growing demand.

Trend: Shift Toward Outpatient and Home-Based Care A fundamental shift in long-term care delivery is occurring in Germany, with services increasingly being delivered in outpatient and home-based settings rather than inpatient facilities. Approximately four out of five people in need of care in Germany are cared for at home. About 0.8 million care-dependent individuals receive care in inpatient facilities, representing roughly one-quarter of all people in need of care. While the number of inpatient care recipients has increased from 563,000 in 1999 to 800,000 in 2023, their proportion of all people in need of care has declined. Between 2022 and 2025, the number of outpatient care services increased by 4.7%, assisted living facilities by 8.1%, and day care facilities by 10.3%, while inpatient nursing homes declined by 0.2%. This trend is driven by multiple factors, including the strong preference of most Germans to age in place, with 90% of elderly people preferring to be cared for at home. The assisted living sector is also expanding, with approximately 400,000 age-appropriate housing units currently missing in Germany. The federal-state working group "Zukunftspakt Pflege" has proposed measures to strengthen outpatient care, including bundling benefits into a single budget to make outpatient services more flexible and accessible.

Policies

• The statutory long-term care insurance system, established under SGB XI, is the cornerstone of Germany's long-term care financing. As of January 1, 2025, the contribution rate is 3.6% of assessable income, with childless employees paying a surcharge of 0.6 percentage points, bringing their total to 4.2%. The contribution assessment limit for long-term care insurance in 2025 is €5,512.50 per month (€66,150 annually).
• The federal government is providing short-term stabilization loans to the statutory long-term care insurance system, with €0.5 billion in 2025 and €3.2 billion in 2026. This intervention reflects the growing financial pressure on the system, which recorded a deficit of €1.5 billion in early 2025.
• The Bund-Länder-Arbeitsgruppe "Zukunftspakt Pflege" (Federal-State Working Group "Future Pact for Care") presented its key recommendations in December 2025. The proposals include strengthening prevention and sustainability in long-term care, supporting home care with targeted professional guidance and preventive measures, making outpatient services more flexible and accessible through bundled benefits, ensuring care provision in rural areas by enabling care funds and municipalities to become care facility operators, reducing bureaucracy in personnel deployment and quality assurance, promoting innovation in digitalization and artificial intelligence, and addressing the sustainable financing of the care insurance system.
• The Pflegekompetenzgesetz (Nursing Competence Act) is being developed to strengthen the attractiveness of nursing professions. The legislation aims to expand the scope of services that nursing professionals can perform, better utilize nursing competencies, and ensure long-term care provision.
• A comprehensive Pflegereform (Care Reform) is being developed with the goal of taking effect by the end of 2026 or early 2027. The reform aims to reduce care-related co-payments and make the financing basis of the care insurance system sustainable. The system of five care grades and the partial benefit principle will be maintained.
• Expenditures of the statutory long-term care insurance increased by 11.2% in 2025. Social assistance expenditures for long-term care increased by 13.3% to €6 billion, representing 27.8% of total social assistance expenditures.

Segment Analysis

Germany Long-Term Care Market By Service Type • Home Healthcare: Home healthcare represents the largest and fastest-growing service segment in Germany's LTC market, driven by the strong preference of most Germans to age in place. Approximately four out of five people in need of care in Germany are cared for at home. Between 2022 and 2025, the number of outpatient care services increased by 4.7%, reflecting growing demand for home-based care. Home healthcare services in Germany are financed through the statutory long-term care insurance system, with benefits including nursing care benefits, care allowances, combination benefits, and relief benefits ranging from €131 to €2,299 per month depending on care grade. As of 2025, there are 17,938 outpatient care service locations in Germany.
• Nursing Care / Skilled Nursing Facilities: The nursing facility sector in Germany comprises approximately 11,666 fully inpatient nursing homes with around 915,309 beds. About 0.8 million care-dependent individuals receive care in inpatient facilities, representing roughly one-quarter of all people in need of care. However, the sector faces significant capacity constraints. In 2025, no net additional nursing homes were opened 101 new openings were offset by 101 closures, resulting in only 681 additional nursing home places created. The ratio of nursing home places per 1,000 people in need of care has declined dramatically from 345.7 in 2009 to 212.5 in 2019. Experts project a need for approximately 145,937 additional places by 2040. The average cost of nursing home care in Germany is significant, with care-dependent individuals facing average co-payments of €3,248 per month, including an average nursing-related co-payment of €1,760 at the beginning of 2025.
• Assisted Living Facilities: Assisted living is a growing segment in Germany's LTC market. There are currently 8,074 assisted living facilities with approximately 331,346 supervised housing units in Germany. Between 2022 and 2025, assisted living facilities increased by 8.1%, making it one of the fastest-growing segments. Approximately 400,000 age-appropriate housing units are currently missing in Germany, particularly in the service living and assisted living segments. A TK-Meinungspuls 2025 survey shows that 77% of elderly people would consider assisted living. Rents in assisted living facilities are typically 10% to 50% above comparative market rents, depending on equipment and services.
• Hospice and Palliative Care: Hospice and palliative care services in Germany are delivered across multiple settings, including homes, inpatient hospice facilities, and palliative care units in hospitals. The growing prevalence of chronic conditions and increasing life expectancy are driving demand for end-of-life care services. The statutory long-term care insurance system provides benefits for palliative care as part of the broader care services covered under SGB XI. The number of people receiving end-of-life care is expected to grow as the population continues to age.
• Other Services: This segment includes day care facilities, short-term care, and respite care services. Day care facilities have grown by 10.3% between 2022 and 2025, making it the fastest-growing segment. There are currently 7,182 day care locations with 120,000 places in Germany. Short-term care benefits of up to €1,854 per year are available, with an increased amount of €3,539 per year for children under 25 with care grades 4 or 5. The need for these services is growing as families seek alternatives to full-time institutional care while maintaining their caregiving responsibilities.

Germany Long-Term Care Market By Payer Type • Public: The statutory long-term care insurance system (Soziale Pflegeversicherung) is the dominant payer for long-term care services in Germany. As of January 1, 2025, the contribution rate is 3.6% of assessable income. The system is financed through contributions from employers and employees. Expenditures of the statutory long-term care insurance increased by 11.2% in 2025. At the end of 2025, approximately 6.01 million people received benefits from the statutory long-term care insurance. The public payer segment is the largest and fastest-growing payer type, reflecting the universal nature of the statutory long-term care insurance system.
• Private: Private sources account for a significant portion of long-term care financing in Germany. The private long-term care insurance system (Private Pflegeversicherung) covers individuals who are not subject to statutory long-term care insurance. In 2025, private long-term care insurance expenditures increased by 12.5% compared to 2023. Private long-term care insurance is mandatory for individuals who are privately insured for health care. The private long-term care insurance system operates alongside the statutory system, providing coverage for approximately 10-15% of the population.
• Out-of-Pocket: Out-of-pocket payments represent a substantial component of long-term care spending in Germany. In inpatient care, long-term care insurance benefits are limited to a maximum of €2,096 per month in 2025. All costs above this amount are borne by the care-dependent individuals themselves. Average out-of-pocket costs for nursing home residents amount to €3,248 per month. The largest component of this is the uniform nursing-related co-payment, which averaged €1,760 at the beginning of 2025. Accommodation and meals average €990, while investment costs average €498. A subsidy system provides relief based on length of stay: 15% reduction in the first year, 30% in the second, 50% in the third, and 75% from the fourth year onwards. However, out-of-pocket costs vary significantly by federal state, ranging from €2,679 in Saxony-Anhalt to over €3,500 in Bremen, Saarland, North Rhine-Westphalia, and Baden-Württemberg.

Germany Long-Term Care Market By Gender • Female residents account for the largest share of Germany's long-term care spending, driven by higher life expectancy and higher rates of disability in advanced age. Women are more likely to reach advanced ages where care dependency is highest. The majority of people in need of care in Germany are women, reflecting their longer life expectancy. According to Destatis data, women represent approximately 61.1% of all people in need of care. Women also dominate the long-term care workforce. The caregiving workforce is predominantly female, with the majority of nurses and caregivers being women. Women are more likely to live alone in old age, increasing their reliance on formal paid care services rather than informal family caregiving. Female representation is particularly pronounced in the 85+ age group, which has the highest per capita care utilization.
• Male residents account for a smaller but growing share of Germany's long-term care spending. According to Destatis data, men represent approximately 38.9% of all people in need of care. The need for long-term care affects persons of all ages and is generally measured by limitations in an individual's ability to perform daily personal care activities. As male life expectancy increases, the representation of men in the older adult cohort is slowly growing. The gender gap is gradually narrowing as male life expectancy increases, which may gradually increase the male share of long-term care spending.

Germany Long-Term Care Market Economics

• The cost of long-term care services varies significantly by service type, geographic location, and facility. In inpatient care, average out-of-pocket costs for nursing home residents amount to €3,248 per month, including a uniform nursing-related co-payment averaging €1,760, accommodation and meals averaging €990, and investment costs averaging €498. Total nursing home costs vary significantly by federal state, ranging from €2,679 in Saxony-Anhalt to over €3,500 in Bremen, Saarland, North Rhine-Westphalia, and Baden-Württemberg.
• Staffing costs represent the largest operating expense for all long-term care providers. The workforce shortage is a significant cost driver. The Federal Institute for Vocational Education and Training has projected a need for 150,000 additional nursing staff by 2040. By 2035, up to one-third of professionally active nursing staff in long-term care are expected to leave the profession. The average time to fill a nursing position in Germany is approximately 230 days. Rising personnel costs for urgently needed nursing staff are a key cost driver. The number of employees in the care sector is stagnating, and at least a quarter of a million qualified nursing professionals are expected to be missing by mid-century.
• Public financing of long-term care is under significant pressure. Expenditures of the statutory long-term care insurance increased by 11.2% in 2025. Social assistance expenditures for long-term care increased by 13.3% to €6 billion. The contribution rate was increased to 3.6% effective January 1, 2025, with childless employees paying a surcharge of 0.6 percentage points. The federal government is providing short-term stabilization loans of €0.5 billion in 2025 and €3.2 billion in 2026.
• Out-of-pocket costs represent a substantial burden on households. A subsidy system provides relief based on length of stay: 15% reduction in the first year, 30% in the second, 50% in the third, and 75% from the fourth year onwards. However, out-of-pocket costs remain significant, particularly for those with shorter lengths of stay.
• The economic value of home- and community-based services relative to institutional care is a key policy consideration. Home-based care is generally less expensive than institutional care on a per-patient basis, and the shift toward outpatient care is expected to continue. The federal-state working group "Zukunftspakt Pflege" has proposed measures to strengthen outpatient care, including bundling benefits into a single budget to make outpatient services more flexible and accessible.


Considered in this report
• Historic Year: 2020
• Base year: 2025
• Estimated year: 2026
• Forecast year: 2031

Aspects covered in this report
• Long-term care Market with its value and forecast along with its segments
• Various drivers and challenges
• On-going trends and developments
• Top profiled companies
• Strategic recommendation

By Service Type
• Home Healthcare
• Nursing Care / Skilled Nursing Facilities: 
• Assisted Living Facilities
• Hospice & Palliative Care:
• Other Services

By Payer Type
• Public
• Private
• Out-of-Pocket

By Gender
• Male
• Female