Migrant workers keep German healthcare system afloat, experts say – EURACTIV.com

Germany’s health and elderly care system depends on migrant workers, experts say, with 690,000 people born in another country working in the sector.

With an aging population whose demand for care continues to grow and labor shortages already abundant, migrant workers are an essential part of the German care sector.

“Without immigrant professionals at all levels of the healthcare system, as the COVID-19 pandemic has shown at the latest, the German healthcare system would face a collapse,” said a report by the German Expert Council on Integration and Migration lit.

Of the 4.2 million people working in the entire German health and care sector, 690,000 were born abroad, according to the expert council.

While foreign-born workers are spread across all types of medical professions, from doctors and nurses to auxiliary and more administrative professions, the highest share is recorded among older workers, where 25% of all workers have emigrated from abroad.

Most older people in need of care are cared for at home, not in fixed facilities such as nursing homes. But with the decline of traditional multi-generational households, the demand for support from external staff is high.

The largest group of migrants in the German care sector therefore operates in a legal gray area, the so-called home care, which means that they go directly to the homes of the elderly and help their families. caring for their elderly parents at home.

Although the exact numbers are unknown, estimates range from 300,000 to 700,000 migrants working in such an arrangement.

Often, families are promised round-the-clock support for their elderly relatives by placement agencies, but “this is not even legally possible”, explained Justyna Oblacewicz of “Faire Mobilität”, a funded helpdesk. by the German government and trade unions. legally advise affected workers.

While on paper workers would often have a legal form of employment, either through the rules of the EU Posted Workers Directive or by being self-employed in their home country, “you have a completely different reality which is lived but not recorded anywhere,” Oblacewicz told EURACTIV.

While contracts would often only cover a 30-40 hour working week per week, workers would need to be available around the clock for potential emergencies.

However, as confirmed by a decision of the Federal Labor Court in 2021, this would also be considered working time and should therefore be remunerated at least with the minimum wage – which in practice is generally not the case.

Main region in Eastern Europe where workers come from

Most workers working directly in households are women over 50, from countries in central and eastern Europe, Oblacewicz said.

The main countries of origin are Poland, Romania and Slovakia, notes the expert council.

But while EU nationals take the lion’s share of affected workers, a growing number of third-country nationals are also believed to be working under such agreements, Oblacewicz said, citing Ukraine and Serbia as examples.

This reflects the general trend of migration to medical and care-related professions, with the largest groups of immigrant workers in Germany coming from countries that joined the EU in 2004 or later, as well as other non-EU countries. Eastern European EU.

Unlike health or care professionals in fixed nursing homes, who must have their foreign qualifications recognised, workers in family households often have no medical or care-specific qualifications, the expert said.

“The problem is that often no special qualifications are required, which means recruitment works in such a way that they can be recruited within days and they don’t need to have a nursing background. “, she said.

Often workers didn’t know what to expect from the job and so were quickly overworked, Oblacewicz said.

The German healthcare system encourages home care

This practice would also be encouraged by the operation of the German long-term care insurance system.

If the elderly are affected by certain medical conditions, such as dementia, families can choose between inpatient care and a direct payment (nursing allowance) ranging from €300 to €900 per month, depending on the medical conditions of the person. concerned person.

The expert council noted that 80% would choose the option of caring for loved ones at home.

Thus, the long-term care insurance payment can be used to partially pay the monthly fees of home care agencies, much of which typically stays with the agencies, instead of reaching the workers.

“The problem is that nursing allowance is used to support such business models, which when in doubt are questionable,” Oblacewicz said.

(Editing by Janos Allenbach-Ammann/Nathalie Weatherald)