Buy, trim for efficiency, sell – nursing homes are increasingly being targeted by the capital market. Not all parties see this as a problem.
International corporations and private equity investors are stirring up our healthcare system. Profits are particularly easy to achieve due to the stable macroeconomic situation, the risk is manageable – if there is nothing more to get from the insurance companies, those in need of treatment and care, the state steps in. More than every twentieth inpatient care place was in the hands of such financiers at the end of 2019, in the particularly profitable non-clinical long-term intensive care of ventilated patients, their market share was already a good third.
Private equity companies trim the facilities for efficiency within a few years, which is achieved through further acquisitions, downsizing and the centralization of services. After a few years, the grown old people’s home chain is then resold with substantial profits – the so-called “buy-and-build strategy”. The profits often end up in tax havens. This is how money flows out of our solidarity-financed health and social services that are urgently needed elsewhere.
Read here what the activities of major investors can mean for working conditions, quality of care and safety. This article is about what the Bundestag parties want to do against the pursuit of profit at any price – or not.
CDU / CSU
Shortly before the end of the legislative period, Jens Spahn brought the law for a “care reform” through the Bundestag. Elderly care workers should in future be paid according to regional collective agreements, otherwise the facilities will not get a contract with the care insurance funds. The additional costs are to be paid by the childless and taxpayers. The profits of investors, however, remain untouched. The Federal Government also refers to the legally anchored “principle of subsidiarity”, which severely restricts the role of the state in care for the elderly. In the one published today, the two conservative parties put their trust in non-profit and private operators, the special role of the strongly profit-oriented investors remains unmentioned: “We want to strengthen the diversity of care providers as an expression of a pluralistic society. Here, too, we hope for better offers from the competition. ”When asked about investor activities, the health policy spokeswoman for the CDU / CSU parliamentary group Karin Maag added:“ In a social market economy, the state is not entitled to decide between permissible and impermissible returns . In principle, I think that is also correct for the care sector: I cannot say where a limit value for the return values would be quantified here, it is not that easy to regulate. ”However, profits should not be at the expense of the persons being cared for or those who work professionally go to the care workers.
SPD
Labor Minister Hubertus Heil, who failed with his goal of a comprehensive collective agreement for the care of the elderly, negotiated the minimum compromise of the Nursing Reform Act as a coalition partner of the CDU / CSU. Otherwise, two years ago, the SPD demanded limiting returns in order to make care less attractive for investors. When asked to the office of health politician Martina Stamm-Fibich, it is said that a legal review is currently being carried out to determine how the plan could be implemented. The position paper also says: “We want to repeal the current statutory priority regulation for private individuals in Section 11 of the Book XI of the Social Code.” In an interview with the SPD health expert Karl Lauterbach said that capital investors in the care sector should not only be stopped, but pushed back. “A large part of the care has to be returned to the municipalities.” In addition, it says: “Profits that are generated from funds of the community of solidarity should flow back into the health system as mandatory and as far as possible.”
AfD
The topic of investors does not appear in the election manifesto. We asked the health policy spokesman Detlev Spangenberg. He opened his answer with this sentence: “The AfD stands for a market economy and not for a planned economy.” Profits are not fundamentally wrong, but the state must set the framework so that “not only investors benefit”. Otherwise he advocates better controls. “Rules must be introduced and then checked by chambers, the medical service and other competent authorities at all levels of government to ensure that they are adhered to in such a way that the pursuit of profit does not take place on the back of patients and employees”.
The left
In its provisional election manifesto 2021, the demands that the legally anchored claim to profit must be canceled without replacement. Transnational care groups should be denied access to the German care market via a tax certificate in Germany, care facilities would have to work in a public interest-oriented manner. An interesting proposal that was discussed in the party was not included in the program, according to the reply from nursing policy spokeswoman Pia Zimmermann: a legally prescribed “minimum holding period” for purchased nursing homes, specifically to meet the short-term interests of private equity investors put a stop to it.
FDP
The role of investors does not appear in the election manifesto. When asked, the nursing policy spokeswoman Nicole Westig writes that she thinks it is important to differentiate between the many owner-managed private nursing companies and the large investors when it comes to providers. “So far, the latter has assumed a market share of around 5 percent. The FDP has no interest in this percentage increasing, and therefore considers it eminently important to back up the small and medium-sized care companies.”
Alliance 90 / The Greens
In their election program, they advocate a profound structural change in care for the elderly, the “neighborhood maintenance”. The concept is based on models such as Denmark or the Netherlands. The municipalities should undertake a binding plan of care needs themselves, neighborhood, relatives and friends networks should take responsibility for older people and those in need of care – guided and supported by specially qualified care professionals. Older people can then stay longer in their own four walls, which on the one hand would meet their needs and on the other hand would relieve the social security systems because inpatient care in homes is more expensive. When asked about the future role of investors, the care policy spokeswoman Kordula Schulz-Asche writes that modern and innovative care concepts are emerging, especially in the private sector. The crucial question, however, is “whether and how companies whose main purpose is to make a profit can ensure good care at all”.
