Elderly Care in Germany: Profession, Training and the Staffing Shortage

Elderly care (Altenpflege) is one of the most important — and most strained — professions in Germany. This article explains the role, the training, the staffing shortage, and the ways to address it.

Introduction: Why Elderly Care Matters More Than Ever

Germany is ageing. More than five million people are now classified as in need of care, and that number rises every year. With it grows the demand for qualified elderly-care professionals who support these people in daily life, provide medical care, and help them live with dignity.

At the same time, elderly care is the field where Germany's skilled-worker shortage is felt most acutely. Vacancies often stay open for months, and many facilities can no longer fill all their places simply because the staff aren't there. Elderly care has become a textbook example of one of the biggest societal challenges of the coming decades.

This article offers an overview: what does an elderly-care worker actually do? What does the training look like today? How severe is the shortage really — and what solutions exist, from domestic training to recruiting international professionals?

What Is Elderly Care? An Overview of the Profession

Elderly care involves far more than basic personal care. Care workers help older people live as independently as possible and take responsibility where independence is no longer enough.

Core responsibilities include:

Personal care — help with hygiene, nutrition, mobility, and dressing.

Medical and treatment tasks — wound care, administering medication, measuring blood sugar, giving injections, and working with doctors.

Support and social companionship — conversation, activation, structuring the day, and accompanying people through difficult phases of life, including end-of-life care.

Documentation and organisation — thorough care documentation, care planning, and coordination with relatives, doctors, and therapists.

Elderly care is therefore a demanding profession that combines professional knowledge, physical resilience, and a high degree of empathy.

Training: From Elderly Care to Generalist Nursing

One point still causes confusion: the standalone training profession of "Altenpfleger/in" in its classic form no longer exists for new trainees.

With the nursing-profession reform that took effect on 1 January 2020, the previously separate training tracks in elderly care, general nursing, and paediatric nursing were merged into a single, generalist qualification. Anyone entering elderly care today typically completes the three-year training to become a Pflegefachfrau or Pflegefachmann (qualified nursing professional).

The advantage: the qualification is recognised EU-wide and allows work across all care settings — from residential elderly care and home care to hospitals. Those who want to focus on caring for older people can do so through specialisation placements. For staff who completed their training under the old rules, the job title "Altenpfleger/in" of course remains valid.

Home Care, Residential, Day Care: Where Elderly Care Happens

Elderly care doesn't only take place in nursing homes. Broadly, there are three forms of provision:

Residential care — permanent care in nursing homes when care at home is no longer possible.

Home care — care services that look after people in their own homes, allowing many to stay at home as long as possible.

Day and night care — partial-residential care that complements home care and relieves relatives.

For care workers, these settings mean very different working days — from planned rounds in a home-care service to shift work in a residential facility.

The Skilled-Worker Shortage in Elderly Care

Few sectors are hit as hard by the skills shortage as elderly care. Tens of thousands of positions already sit unfilled, and the average time to fill an open elderly-care role is among the longest of any profession in Germany.

The causes are structural:

Demographics — the baby-boomer generation is reaching the age of care while smaller cohorts enter the profession. The gap between demand and available staff keeps widening.

Strain and turnover — physically and emotionally demanding work, shift patterns, and high responsibility lead many professionals to leave the field early or move to part-time.

Training gap — despite rising trainee numbers, domestic intake isn't enough to meet demand. Depending on the study, Germany faces a shortfall of several hundred thousand care workers by 2035.

For facilities, the message is clear: without additional sources of staff, care provision cannot be secured in the long term.

Pay and Working Conditions

Pay in elderly care has improved noticeably in recent years, partly due to mandatory collective-agreement coverage and higher minimum wages in care. The starting salary of a qualified elderly-care professional — depending on region, employer, and pay scale — is often between roughly €3,000 and €3,800 gross per month, plus premiums for shift, weekend, and night work.

Beyond pay, working conditions increasingly decide whether facilities can retain staff: reliable rosters, a good team, development opportunities, and genuine appreciation for the work done.

Ways Out of the Staffing Shortage

There is no single fix for the elderly-care shortage, but rather a bundle of approaches:

Strengthen training — more training places, better practical mentoring, and more attractive entry conditions for young people and career changers.

Retain professionals — healthy working conditions, relief from bureaucracy, and fair pay to reduce turnover.

Recruit international professionals — the targeted recruitment of qualified care workers from abroad. For many facilities this has become an indispensable element in filling open positions.

That last point is gaining importance. More and more providers work with specialised partners and platforms that support the entire process — from selecting suitable candidates and recognising qualifications to on-site integration. This is exactly where TalentSure comes in: as a platform that makes the journey of international care workers to Germany transparent and easy to follow.

Recognition of Foreign Nursing Qualifications

Nursing is a regulated profession in Germany. That means anyone who trained abroad may only work as a qualified care professional after a formal recognition process.

The recognition procedure checks whether the foreign training is equivalent to the German one. Where significant differences exist, they can be bridged through an adaptation course or a knowledge examination. Until full recognition is granted, international care workers can often already work as care assistants while qualifying in parallel.

For employers it is crucial to keep this process in view from the outset — thorough documentation and a clear roadmap significantly shorten the time until a professional can work at full capacity.

Language and Integration

Professional qualification alone is not enough. In care, language is safety-critical: misunderstandings can directly endanger care. As a rule, at least a B1 language level — often B2 — is expected.

Cultural and organisational integration matters just as much. Successful facilities invest in language support, intercultural training for the whole team, mentoring programmes, and help with finding housing and dealing with authorities. Integration is not a one-off step but a process that must be supported well beyond the first months — and it pays off, because well-integrated professionals stay with the team for the long term.

Conclusion: Building a Future for Elderly Care

Elderly care is a demanding, meaningful profession with a secure outlook — and, at the same time, a field whose staffing needs can hardly be met without additional measures. The answer lies in a combination: strong domestic training, better working conditions, and the targeted, well-supported recruitment of international professionals.

Facilities that take these routes early and in a structured way secure not only their own ability to provide care, but also contribute to one of the most important social tasks of our time.