Abstract

Objective: The establishment of the German long term care (LTC) system in 1994 represents a path breaking event in welfare state development in the post Golden Era. In it, an entirely new branch of social security can be found – one which has since seen expansion in benefits, particularly for those affected by dementia, representing a growing and substantial group of the elderly population. This expansion is at odds with the larger climate of welfare state retrenchment and restructuring experienced in Germany within other policy areas since the 1970s, especially in health care. In an effort to understand these developments, the present study examines the importance of agency and structure in bringing about reform.

Data and methods: Primary (e.g. policy and legal documents) and secondary literature are used to provide thick description on historical developments of LTC in Germany, including the rationale and institutional logic surrounding the foundations of the system.

Results: Our findings point to the special role of federal institutional structures in influencing fiscal and social policy in Germany; the functional limitations of the health care system which gave rise to the need for a separate system to address LTC coverage; and the political entrepreneurialism of politicians in defining the policy rationale and seizing a window of opportunity for reform.