Refinancing Nurse Recruitment Costs in Germany: Pflegebudget and Care Rates Explained

The short answer

There is generally no standalone grant that pays your recruitment costs back. But in many cases you can build them into what you negotiate with the health or care insurers and social welfare offices. Hospitals do this through the nursing budget (Pflegebudget). Care homes and home-care services do it through their care rates (Pflegevergütung).

For care homes and home care, two things matter most: the costs have to be planned and shown before the negotiations, and since 2023 they’re linked to recruitment under the state quality seal “Faire Anwerbung Pflege Deutschland”.

Which costs can count

In 2021, the Federal Ministry of Health explained which recruitment costs can be considered (BMG). For recruitment under the quality seal, these include travel, language courses and professional qualification in Germany, plus certain costs the nurse has already paid that you reimburse.

Qualification in Germany can include the measures that lead to recognition, such as preparation for the knowledge exam (Kenntnisprüfung). Only costs your organisation actually bears count. For the hospital nursing budget, the BMG speaks of staff costs without public subsidies.

Hospitals: the Pflegebudget

Since 2020, hospitals have received their nursing staff costs through a separate, hospital-specific budget (§ 6a KHEntgG), agreed locally with the health insurers (GKV-Spitzenverband).

As a rule, nurses still in recognition are listed in their professional group, not as staff without a qualification, and shown as separate items. According to the BMG, their staff costs, recruitment costs and qualification costs are shown in the Pflegebudget. Costs that don’t fit there are covered through the DRG case rates.

One change to plan for: the GKV-Beitragssatzstabilisierungsgesetz, passed in July 2026, limits cost increases in the hospital sector for 2027 to 2029. Funding for nursing-relief measures in the Pflegebudget continues only at a reduced level in 2027 and 2028 (BMG, Rödl & Partner). Recruitment plans should therefore go into budget planning early, together with your controlling team.

Care homes and home care: the care rates

Care homes and home-care services agree their rates with the care insurers and social welfare offices in advance, for a future period. The rates have to let a facility that is run economically cover its costs (§ 84 SGB XI). Recruitment costs you expect to have can be part of this.

In practice, this means you show the type, content, scope and cost of your recruitment in good time before the negotiations. There’s generally no refund for costs you’ve already had. If no agreement is reached, an arbitration board (Schiedsstelle) can set the rates.

Since the Pflegeunterstützungs- und -entlastungsgesetz (PUEG) of 2023, care facilities can include recruitment costs more easily in their rate negotiations. This is linked to recruitment under the quality seal, but it doesn’t guarantee that the costs will be accepted in every negotiation (BMG).

The quality seal

“Faire Anwerbung Pflege Deutschland” is a state quality seal for recruitment from countries outside the EU. It’s awarded as a RAL quality mark by the GAPA association, with approval from the Federal Ministry of Health (BMG).

A central rule is that the employer pays: recruitment must be free of charge for the nurse. If you work with an agency, check whether it holds the seal. You’ll find more about the seal on the GAPA association’s website.

How this differs from Agentur für Arbeit funding

Refinancing and funding are two different things. Refinancing means you include costs in the budget or rates you negotiate with the insurers. Funding from the Agentur für Arbeit is a grant towards course costs and wages while your nurse prepares for the knowledge exam.

Both can matter for the same nurse, but costs that someone else has already paid aren’t your costs. Our post on funding the knowledge exam explains the Agentur für Arbeit route.

What to do before your next negotiation

Start with a plan of how many nurses you want to recruit and what that will cost, from travel to exam preparation. Document it so you can show type, scope and cost to the insurers. If you work with an agency, choose one with the quality seal.

Rate negotiations depend on your state, your contracts and your association’s practice. Talk to your provider association or controlling team before you put numbers on the table. This post gives an overview, not legal or financial advice.

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How CareSteps helps

Qualification in Germany can be one of the costs that count. Whether that applies to exam preparation in your case is part of your negotiation. The CareSteps education centre is an AZAV-approved provider and prepares internationally trained nurses for the knowledge exam. We’ll give you the course costs and timings you need for your planning.

Next steps

Recruiting abroad this year? Book a consultation and we’ll show you how exam preparation fits into your budget.