Friday, December 03, 2021
The 1 billion euro promise
The intensive care carer bonus could be disappointing
By Sebastian Huld and Thomas Schmoll
There is talk of 3000 to 5000 euros per intensive care nurse. In fact, the traffic light coalition’s corona bonus could be much lower, as a bill available to ntv.de shows. The fact that the same law regulates the compulsory vaccination for carers raises further questions.
While the traffic light coalition initially drove a rolling course in combating the fourth wave of pandemics, at least it started with a flourish when it came to recognizing the nursing staff in hospitals and old people’s homes. The SPD, FDP and Greens want to pay out one billion euros in recognition of the intensive care nurses who are particularly exposed to pandemics. The Union had also advertised a second care bonus.
Numbers are already circulating about what should ultimately reach the individual. Manuela Schwesig, Prime Minister of Mecklenburg-Western Pomerania and member of the SPD team in the traffic light negotiations, demanded up to 5000 euros and tax-free this week. The outgoing Health Minister Jens Spahn also called this target amount as desirable. Alone: The CDU politician no longer has to implement it. How high the bonus actually turns out in individual cases is more than unclear despite the impressive sounding billion-euro promise.
A wording aid available to ntv.de for a draft law that the CDU-led Federal Ministry of Health prepared on behalf of the traffic light parties in the Bundestag shows the complexity of the matter – and that the federal government has only limited influence on how much money the nursing staff actually receive. The money should be paid out according to a key that has already been tried and tested. In the draft law, the same hospitals are named as addressees as for the care bonus paid in the spring: clinics with fewer than 500 beds and at least 20 treated corona cases as well as clinics with 500 beds and more and at least 50 corona cases.
The per capita amount is negotiated in the clinic
The exact allocation is regulated by the Institute for the Hospital Remuneration System (InEK). In the spring, this came to around 1,000 authorized clinics, which were allocated 450 million euros depending on the number of cases, the number of staff and the number of hours on ventilators. The management and staff representatives then made the allocation within the clinics. The clinics are faced with the difficult decision of which nurses had overtime due to the corona situation.
In fact, it is not only the employees in the Corona wards that are feeling the effects of the pandemic. The nurses in other wards also have extra work because, for example, patients spend less time in the intensive care unit than usual. The geriatric departments were also badly affected when the elderly in particular contracted the virus. In addition, according to the formulation aid, clinics that do not have corona patients, but corona clinics are removing other patients, will again be dropped.
This is also criticized by the German Hospital Society: Many employees were left out because “only those hospitals are taken into account that were directly involved in Covid care,” explains a spokesman. There is teamwork between employees of individual facilities, but also between clinics. In the pandemic, many networks were formed in which the hospitals shared the work among themselves. “Those who have increasingly taken over standard care so that other clinics could concentrate on supplying Covid patients are now left empty-handed.”
The tax exemption is already nibbled on
The bonus payment becomes really tricky when it comes to tax exemption. This was 1500 euros in the spring. The traffic light coalition wants to increase the tax exemption for care bonuses according to the coalition agreement to 3000 euros. Any additional income would have to be taxed as income and social security contributions paid, including the employer’s contributions. Clinics then have to decide whether to finance the employer’s contribution out of their own pocket, i.e. whether to actually subsidize the bonus. Or they take the employer’s share from the funds allocated to them. However, this reduces the amount that is paid out to each individual nurse.
Even if the target amount of the traffic light is closer to 3000 euros than 5000 euros, as coalition circles say, the 3000 euros tax exemption would already be partially exhausted by the bonus payments already made by the federal government, states and clinics. When the federal government paid out 450 million euros in the spring, the carers received a three-digit sum of up to 1500 euros. If the maximum amount is reserved for full-time employees, it is even more so only for a minority. The majority of carers do not work full-time in the physically and mentally demanding job. And: the more nurses should participate in the bonus according to the clinic’s internal distribution key, the lower the payout per capita.
In addition, the financing is unclear: The billion euros should initially flow from the liquidity reserve of the health fund through the health insurance companies to the clinics concerned. The federal government must make up for the deficit arising in the health fund with additional grants to the fund. But: “Nobody knows where the money will come from,” says Antje Tillmann, financial policy spokeswoman for the CDU / CSU parliamentary group.
Difficult questions of justice
Paying the billion on a loan “and justifying that with the corona challenge may be legally permissible, but it is not very smart,” says the financial politician. You grant all nursing staff the bonus. But now there was another threat of distribution conflicts. If the bonus is tax-free, there is not only a justice problem, but also a constitutional problem. “The kindergarten teacher and teacher also work hard and run a high risk of illness, which is a constitutional requirement for the tax advantage. It is unfair that the state gives money to one professional group, but not to another, who has also suffered from Corona.”
The German Professional Association for Nursing Professions welcomes the bonus as a “very nice sign of appreciation”, but does not want to make any suggestions on how it should be distributed, “because, in our opinion, it can hardly be fair”. Managing director Bernadette Klapper explains – also with a view to the difficult division of the bonus within the clinics: “We saw with the last bonus payments that questions of justice are quickly asked with the potential to split the professional group.” In any case, the grants are no substitute for “rewarding the extraordinary performance of employees in all nursing settings with urgent, long-term improvements”.
Two projects, one law
Perhaps the traffic light is not just about the recognition of the nurses, but also about cushioning frustration about the working conditions in the hospitals and about the planned vaccination requirements for clinic employees. Finally, in the wording aid, both projects, the bonus and the mandatory vaccination, are regulated in one law. “First the vaccination, then the bonus: It’s a bit like a carrot and a stick,” comments a nurse who is still unvaccinated and does not want to be named here.
That such a bonus is a bit of a compensation for generally poor working conditions was also the position of the Greens co-ruling in the traffic light at the beginning of the year. Kordula Schulz-Asche, spokeswoman for the Greens for the elderly and care policy, said in February that the bonus payments were “now frowned upon as hush money” because they did not change the poor working conditions in clinics.
The National Association of Statutory Health Insurance Funds of all statutory health and long-term care funds is holding back in evaluating the new long-term care bonus because it does not yet know any details. However, he “assumes that the care bonus will be financed from tax revenues as part of the state activities in the context of fighting pandemic”. Whether it can stay at a billion to do justice to the full-bodied announcements remains open for the time being.