For years, the population pyramid in Germany has been shifting into an alarming shape:
While it still resembled a pyramid at the end of the 1990s (shown in red in the graph), by 2022 it will look more like a tree that no longer has strong roots. This is because the population is aging due to increased life expectancy (according to the Federal Statistical Office, one in five people is over 66 years old) and the birth rate is not rising sufficiently. In July 2025, the Federal Statistical Office reported once again that the birth rate is falling.
This poses challenges for the healthcare system: because the baby boomers will be retiring in the foreseeable future, the number of people requiring care will increase, while their jobs will become vacant. Unlike private nursing care insurance, the pay-as-you-go system in social nursing care insurance relies on contributions from the younger generation to support care in an ageing society. This creates a financing gap that does not occur with private health insurers, as they are financed on a funded basis. In both cases, the shortage of skilled workers is having a severe impact on care facilities.
Skills shortage
According to a study by the German Economic Institute (IW), this shortage will peak at up to 768,000 skilled workers by 2028. The joint study by WifOR and PwC even predicts up to 4 million by 2030. The main cause is demographic change, which is forcing all industries to develop sustainable strategies and solutions.
International skilled workers
One solution that at least slows down the declining birth rate in Germany is immigration. The Bertelsmann Foundation even refers to it as a cornerstone. Care facilities have already responded to this and are looking for skilled workers internationally. As politicians also support recruitment through international agreements, almost one in four geriatric nurses now comes from abroad, mainly from outside Europe.
Integration of international skilled workers
Integrating these workers is a very complex task and should be accompanied by an integration management concept, as described by the German Competence Centre for International Skilled Workers in the Health and Care Professions (DKF).
According to the DKF, companies should consider the following points:
- Make the application process fair and transparent
- Establish a company integration management system and involve employees
- Prepare for arrival with visas, contracts, language requirements and intercultural preparation
- Onboarding with contact persons and sustainable integration
The topic is discussed in great detail by the German Care Network, which shows how important it is to deal with international skilled workers in a well-thought-out manner.
Complications for international skilled workers
It has been shown that many skilled workers suffer from racism in the healthcare system and condescending behaviour from both patients and superiors.
It therefore helps to establish a contact person in the company and offer intercultural preparation before the start of work in order to prevent difficulties. In addition, language barriers can be overcome with the help of apps with voice and simultaneous translation functions.
Digitalisation
Digital applications can also support nursing staff in many other areas.
- Digital documentation systems can save up to an hour per shift in documentation requirements.
- Electronic medication services can take over routine tasks in combination with telemedicine.
- Wearables can take over the measurement of vital functions in patients in the future.
- Robots are already being used or researched to provide service, monitoring and social interaction.
Sophisticated digitalisation with appropriately implemented applications relieves the burden on nursing staff. However, this requires comprehensive internet coverage and appropriately trained or retrained specialists.
Further training and new career fields
Further training opportunities are essential to support the workforce through the changes brought about by digitalisation. New career fields created by digital applications, as described here, should also be integrated into the existing workforce. Open communication and transparency can make the working atmosphere more attractive for both future and existing employees.
Improvement of working conditions
Working conditions in the care sector remain challenging to the poor.
- A work-life balance is now an important benchmark, not only for Generation Z, and should be taken into account by companies.
- The 4-day week can also be introduced in care facilities.
- The expansion of childcare and other Benefits improves working conditions.
- The skills of nursing staff can be supported through further training measures and the integration of academization, significantly increasing the appreciation of their work.
Personnel planning and interdisciplinary cooperation
The latter point also enables interdisciplinary cooperation with other departments and higher hierarchies on an equal footing. Giving nursing staff greater appreciation and more discretion not only increases the attractiveness of their profession, but also improves the quality of care, thus saving time and personnel. In order for staff to participate in further training, a duty roster is required that is both flexible and tailored to their respective life situations. Life-stage-appropriate personnel development also addresses personal life-changing circumstances such as the loss of a loved one or the birth of a child. The ability to respond flexibly in such situations contributes significantly to employee appreciation and the attractiveness of the company.
On the other hand, the increased use of temporary workers should be significantly reduced. Compared to permanent staff, temporary workers often have higher hourly wages and more attractive working hours – a circumstance that leads to imbalances within the team. In addition, they usually lack the necessary familiarity with patients and with the processes in the hospital, which limits their responsiveness in everyday life. Attempting to bridge staffing shortages in this way therefore often leads to an inefficient use of time and resources.
Recruiting and retaining staff
An experienced HR consultancy can provide individualised and professional guidance on how to successfully plan staffing under these circumstances. Digital recruiting channels are particularly suitable for recruiting prospective nursing staff from among the digital natives of Generation Z and can be supported by active sourcing.
Conclusion
Demographic change poses a double challenge for the care sector in Germany: the number of people in need of care is steadily increasing, while at the same time many experienced professionals are retiring – and the next generation is not following suit to the same extent.
There are several ways to address this care crisis. First and foremost, international professionals are increasingly being recruited and hired. The associated challenges, such as linguistic, cultural or legal hurdles, can be overcome with targeted integration and training measures. Here, too, advancing digitalisation is providing support, offering several valuable applications for integration and everyday care. However, the diverse applications should always be used with due consideration for data protection regulations and the dignity of patients. Further training and new professional fields can make processes more efficient and save valuable time.
In addition, working conditions must be significantly improved in order to retain existing staff and attract new skilled workers.
Professional personnel consulting can provide crucial support in this process. It helps to develop individual solutions that position the care facility as an attractive and sustainable employer.
