Home care in Germany: Out of the gray zone?

No German contract, no German health insurance. Cash in hand, though not much of it. Nearly three-quarters of a million women — mostly from Poland, Slovakia, Romania and Bulgaria — provide care for elderly Germans, in whose homes they live. Without these women, there would be a care crisis. Still, officially, they don't exist.

It's estimated that 90% of live-in care work is undertaken illegally in Germany. The country's growing elderly population increasingly prefers to stay at home: Three-quarters of the approximately 4.1 million people requiring daily care do so. As such, there has been a boom in demand for domestic care that successive governments have — up to now — failed to regulate. Black-market agencies continue to undercut legal ones by avoiding social security contributions and ignoring the minimum wage.

Loopholes in German law mean that the employment model of working for someone in whose house you also live has long gone unrecognized, creating a "gray area." Yet employing someone without a contract and without contributing to social security "is a crime," emphasized lawyer Frederic Seebohm, who is head of a German professional association for live-in care workers.

The estimated 300,000 families — there are no official figures — who employ care workers within this "gray area" overwhelmingly understand that they are breaking the law, he said.

Changing the rules of the game

Care reform recently announced by German Health Minister Jens Spahn, however, "could be a game changer," said Seebohm. Spahn laid out the broad guidelines for the reform in October 2020, saying that "care is the biggest social challenge of the decade." 

While the plan has yet to be presented in parliament, proposals in the working draft would equate to a recognition that live-in care is a widespread reality. And they would be a step toward regulating the sector, even if the legal basis for the work needs further fleshing out.

Austria is far ahead of Germany in terms of regulating the domestic care sector. The country allows live-in care workers to declare themselves as self-employed. Such is the case for Anna Tadrzak, a 50-year-old care worker from Poland, who finds work through the Vienna-based agency Caritas rundum betreut. She works shifts of two to four weeks, and then takes a break for the same amount of time.

Austria's 'good system'

It's a good system, she said, because care work in practice involves being on call 24 hours a day. "When the client calls for you five times a night, then you attend to them five times a night. Every day is different," said Tadrzak. The nature and scope of the work also vary with families' needs and expectations. "Clients don't just want carers; they want cooks, cleaners and shoppers. Sometimes you give an inch and they take a yard — and you can end up without any privacy."

The inherent difficulty in setting boundaries in terms of time and tasks means that, without regulation, care workers are left exposed to exploitation in Germany. The business model of black-market agencies is dependent on the proximity of countries with much lower average incomes, yet whose citizens benefit from freedom of movement within the EU. Agencies based in Germany form partnerships with organizations in Eastern Europe that do the recruiting for them, and then place care workers with German families without registering them with the local municipality, arranging for health insurance or checking their qualifications.

From invisible to critical workers

The COVID crisis exposed an urgent need to bring care work out of the shadows, said Frederic Seebohm. The abrupt closure of national borders during the lockdown in spring 2020 made it difficult for "non-essential workers" — including those without German citizenship or residency — to return to the country. This meant that carers had to be quickly recognized as critical workers — somewhat paradoxically, given that the state has long ignored the informally engaged majority altogether.

It also became imperative for care workers to have access to the German health system. Not only might they require medical treatment if they themselves were to fall ill with COVID-19 — without adequate testing and access to vaccination, they would risk infecting the particularly vulnerable people for whom they care.

The urgency of addressing the care sector in the coronavirus crisis is barely the tip of the iceberg, however. Demand for care workers in both Germany and Austria is vastly outstripping supply. "In Austria, there will be a shortage of between 80,000 and 100,000 care workers by 2030," said Stefanie Zollner-Rieder, a specialist at Caritas, the agency with which Anne Tadrzak works. "The Austrian model works well as far as it goes — but coronavirus has shown us that it needs to be made resistant."

Short-term crisis, long-term trends

Germany has one of the highest over-65 population proportions in the EU. The country's relatively low fertility rate (1.4 children per woman) and longer life expectancy (now around 79 for males and 83 for females born today) will only fuel this demographic trend over coming decades, leaving Germany with the looming question of how to fund the ever-increasing need for care.

The proposed reform, which is expected to create a basis for boosting financial support for those needing care, is particularly politically relevant in Germany given that the runup to the national elections in September is already underway. Even though it may already be too late for the current electoral term, Frederic Seebohm remains optimistic about the likelihood of reforming the sector, considering that a majority of parties agree on the need for change.

The challenge of funding more care is intertwined with that of ensuring that this growing demand for it does not translate into more work being shifted into the "gray zone" and worsening conditions for carers, particularly those for whom the law does not yet provide.

A labor of love

As well as highlighting the precariousness of the care sector, the COVID crisis has shone a spotlight upon the importance of care work and the crucial role of the Eastern European women who overwhelmingly undertake it. Reform in Germany may also lead to change in how people perceive the value of caring for the elderly.

"I put my heart and soul into my work. It's not just about the money — and there's not all that much of that anyway," explained Anna Tadrzak over the phone from Vienna. "It requires a lot of effort and patience, but I am happy with how my job works in Austria, I'm happy with Caritas and with my profession." She is surprised to have received a call from a journalist. "In 15 years, no one has ever taken an interest in my work," she said.