Definition and general information about nursing homes
Ein Nursing home is a facility designed for long-term residency, primarily accommodating and providing care for elderly people. The main focus is on care, accommodation, support, and, if necessary, nursing care. Nursing homes are a central component of elderly assistance under the German Social Code (SGB), especially according to SGB XI and SGB XII.
The definition varies in contrast to other facilities such as care homes, senior residences, and assisted living. Nursing homes are primarily aimed at individuals who do not have significant care needs but are seeking support in everyday life, social contacts, and age-appropriate living arrangements.
Legal foundations and distinctions
Statutory definitions
Das Home law was, for a long time, regulated at the state level in Germany by the respective state home laws. However, in 2009, the nationwide Home law came into effect through the Residential and Care Contract Act (WBVG). The law distinguishes in particular between facilities where care is provided (care home) and those where no or only minimal care services are offered (traditional nursing home).
Distinctions from other types of accommodation
The nursing home is to be distinguished from:
- Care home: Focus on inpatient care services according to SGB XI.
- Senior residence: Usually more upscale living standards with a wide range of services.
- Assisted living: Independent living with defined support services.
What is legally relevant is primarily the extent to which care services are central and how the contract between the resident and the operator is structured.
Sponsorship and supervision
Public and independent sponsors
Nursing homes are operated by various sponsors. There are:
- Public-law sponsors (municipalities, districts)
- Non-profit sponsors (church institutions, welfare associations)
- Private sponsors (companies, foundations)
The legal requirements apply equally to all sponsors, particularly with regard to contract law, residents’ rights, and the observance of minimum standards.
Home supervision
Die Home supervision, usually implemented at the state level, monitors compliance with legal requirements. It particularly examines
- Residential and care contracts
- Staffing levels
- Spatial and hygienic conditions
- Compliance with residents’ rights
The legal basis for this is, depending on the federal state, both the WBVG and additional state laws.
Contract law aspects
Residential and care contract
Admission to a nursing home is based on a written residential and care contract. This governs, among other things:
- Type and scope of services (accommodation, meals, social support, if applicable, care)
- Rights and obligations of both parties
- Termination provisions
- Charges and ancillary costs
The WBVG contains comprehensive regulations to protect consumers from unfair contract terms. Of particular importance are the transparency requirement and the protection of the elderly from disadvantages.
Regulation of charges
Die Home charges must be designed transparently and comprehensibly in accordance with § 8 WBVG. Price increases are only permitted under strict conditions. Changes to the charges must be expressly and in writing communicated to ensure legal certainty.
Protection against termination
Protection against termination according to § 12 WBVG offers special protection for residents. An ordinary termination by the nursing home is only permissible for an important reason, such as serious violations of the contract. Residents enjoy increased tenant protection comparable to housing law provisions.
Residents’ rights and participation
Right to self-determination and participation
Residents of nursing homes have extensive rights:
- Protection of personality and privacy
- Retention of self-determination in daily life
- Participation in social and community life
These rights are especially protected under the WBVG, the UN Convention on the Rights of Persons with Disabilities, and the German constitution.
Participation bodies
Many state home laws provide for the establishment of resident representations or resident advisory boards. Their task is to represent the interests of the residents to the management and to participate in decision-making processes.
Financing and social law
Cost coverage and Social Code
The costs for a stay in a nursing home are usually borne by the residents. If their own resources are insufficient, claims for benefits may exist under the Social Code XII (assistance for care, basic security in old age).
Long-term care insurance
Residents with a care level (according to SGB XI) may use services from the long-term care insurance fund for financing. The amount depends on the assigned care level and is paid directly to the facility if a care relationship exists.
Quality standards and supervision
Quality requirements
Nursing homes are subject to legal requirements concerning:
- Staffing ratios
- Qualification of staff
- Facility equipment (accessibility, proportion of single rooms)
- Hygiene and health protection
- Catering and support
Quality assurance is ensured through regular inspections by home supervision and, where applicable, other supervisory authorities based on respective state legislation.
Complaint management
Residents and their relatives have the right to submit complaints and grievances to the home management or supervisory authority. Establishing a complaints management system is mandatory in order to safeguard the rights and interests of residents.
Summary assessment
The nursing home is a legally complex social institution situated at the intersection of social law, tenancy law, and civil law. The legal foundations ensure on one hand the protection of the individual and social participation in old age, and on the other hand impose binding standards for operation and supervision. The goal is dignified, professionally qualified, and transparent care of the elderly, while safeguarding their rights and dignity.
Frequently asked questions
Who covers the costs for a stay in a nursing home if one’s own income or assets are insufficient?
If one’s own income and assets are insufficient to cover the costs of the nursing home, Social Code XII (SGB XII) applies in Germany—specifically the so-called ‘assistance for care.’ Initially, those affected are required to use their own income and assets, whereby exemptions like protected assets (as of 2024: €10,000 for single persons) must be observed. Certain assets, such as an owner-occupied property, may also be protected. If this is not enough, legally obligated relatives, especially children, are called upon under § 1601 BGB. Only when neither own assets nor maintenance payments are sufficient does the social welfare office step in to cover the uncovered costs. The office regularly reviews the financial circumstances of both the applicant and the persons legally liable to pay maintenance, and may reclaim gifts made up to ten years prior (keyword: ‘gift challenge’). However, since 2020, there is a relief amount: Children only have to pay if their gross annual income exceeds €100,000.
What contractual rights and obligations arise from concluding a home contract?
The home contract under the Residential and Care Contract Act (WBVG) governs the rights and obligations between the resident and the operator. The contract must be concluded in writing and includes, among other things, details of the services (basic care, medical care, catering), charges, notice periods, as well as co-determination and information rights. All cost items and services must be clearly listed and legally binding. Clauses that provide for unclear cost increases, blanket liability exclusions, or unspecified service reductions are, for example, inadmissible. Residents have the right to withdraw from the contract within two weeks of its conclusion (§ 8 WBVG). Operators are required to inform residents of all significant matters and may only terminate under strict conditions—such as serious payment default or gross misconduct. Failure to fulfill obligations by the operator can result in compensation claims.
What legal requirements must be fulfilled for admission to a nursing home?
Admission to a nursing home is subject to certain legal requirements. The key criterion is the presence of a care or support need, which must be determined by the relevant care insurance fund as part of an assessment procedure (usually by the Medical Service—MD). Depending on the result, a care level is assigned that governs cost coverage by long-term care insurance. Admission also depends on a valid home contract that regulates the essential aspects of the stay (scope of services, fees), and in the case of residents requiring supervision, a legal guardianship or power of attorney may be necessary if the resident is no longer able to act legally. In some federal states, additional state regulations must be observed, such as minimum standards for facilities.
What co-determination rights do nursing home residents have?
Nursing home residents have extensive co-determination rights, which are regulated in the WBVG and in the respective state laws on home participation. These include, in particular, the right to participation through a residents’ advisory council or residents’ representative, who must be informed about and involved in decisions on changes in home fees, accommodation, meal offerings, or recreational activities. The residents’ advisory council has the right to participate in decisions affecting community life, can receive complaints and make suggestions. Residents also have individual rights of action—including in the event of violations of personal rights, restrictions in freedom of movement, or inadequate care. The rights to privacy, visitation, and participation in social life are also protected by law and can only be restricted in well-justified exceptional cases (such as in the context of legal guardianship under the German Civil Code).
When and under what circumstances can a nursing home terminate the contract?
Termination by the nursing home is only legally permissible under strict conditions. According to the WBVG, these are mainly serious breaches of contract by the resident, such as significant payment arrears, persistent disturbance of community peace, or violence against staff and other residents. Termination must be in writing and state the reasons. An ordinary termination by the home is only possible with a notice period of at least four weeks and only if further care is otherwise unreasonable. In emergencies (e.g., acute self-harm or danger to others), the home may also terminate immediately, but in these cases must provide appropriate alternative accommodation or support. Terminations for economic reasons (e.g., owner’s own use or repurposing of the home) are generally not permissible as long as a valid home contract exists.
What obligations exist regarding data protection and confidentiality in a nursing home?
Nursing homes are subject to strict data protection requirements under the GDPR as well as specific provisions of the SGB and BDSG. Personal data of residents—in particular health and care data—may only be processed with explicit consent or within the framework of statutory permissions. Care facilities must implement technical and organizational measures to protect data, such as access restrictions, encryption, regular staff training, and the maintenance of processing records. Furthermore, all caregivers and employees are subject to a confidentiality obligation punishable by law (§ 203 StGB), so that information about health status, family relationships, or financial data may not be disclosed without authorization. Violations can result in significant fines or criminal consequences.
What is the legal situation regarding deprivation of liberty measures in nursing homes?
Deprivation of liberty measures (FEM) are strictly regulated in everyday life in nursing homes. FEM include, for example, restraints, bed rails, or locking of room doors. According to German law, these are generally unlawful unless a court order is present (§ 1906 BGB). An exception is only permitted if there is an acute risk to oneself or others and no other less intrusive measure is possible. Even in emergencies, the home must immediately involve the guardianship court to review the legality of the measure. Relatives and legal guardians have the right to information and can take legal action against unlawful measures. Documentation obligations, regular reviews, and the principle of proportionality must always be observed.
