Germany and Austria 2026 need ~300,000 additional caregivers and nurses in coming years (BMG, BMSGPK projections). Classical sources (Philippines, Poland) are no longer sufficient — more Pflegedienst firms are turning to Croatia, BiH, Serbia and North Macedonia.
Definition: Caregivers (Pflegekräfte) from Western Balkans refers to qualified caregivers and nurses from Croatia, BiH, Serbia, N. Macedonia and Montenegro working for German or Austrian Pflegedienste (ambulatory care), Pflegeheime (nursing homes), or in 24h-Betreuung (private 24/7 care).
TL;DR
- DE deficit 2026: ~200,000–300,000 Pflegekräfte missing (BMG, Pflegepersonal-Bericht 2025)
- AT deficit 2026: ~50,000 24h-Betreuung positions + 30,000 ambulatory care (BMSGPK)
- Main sources 2024–2025: Philippines (#1, ~25,000), Croatia/BiH/SRB (rising), Vietnam, Brazil
- Salaries DE 2026 (gross): Pflegekraft €2,500–3,200, registered nurse €2,800–3,800
- Salaries AT 2026 (gross, 24h-Betreuung): €2,200–2,800 + accommodation included
- Time to qualification recognition: 3–12 months (Anerkennung Verfahren) for nurses
- Biggest barrier: B1–B2 language level (medical terminology)
1. Three work models in DE/AT
Model A — Pflegedienst (ambulatory care DE)
- Worker visits clients at home 2–3× daily
- Accommodation: own rental or shared
- Salary: €2,500–3,200 gross (per TVöD or sectoral CBA)
- Working hours: 40h weekly, shift work
Model B — Pflegeheim (nursing home DE/AT)
- Worker works in institution on shifts (8–12h)
- Accommodation: own (often rental near home)
- Salary: €2,700–3,500 gross + shift bonuses
- Biggest benefit: stable schedule
Model C — 24h-Betreuung (Austrian private care)
- Worker lives with client (4–8 weeks rotation with another worker)
- Accommodation + food: included at client's home
- Salary: €2,000–2,800 net (Austrian model is specific)
2. Required qualifications
For Pflegedienst and Pflegeheim
- Diploma in nursing care or registered nurse (recognized in DE/AT via Anerkennung Verfahren)
- B1–B2 German (medical terminology)
- Experience minimum 1–2 years
- Medical fitness + psychological assessment
For 24h-Betreuung
- Diploma not required (basic training sufficient)
- A2–B1 German sufficient
- Experience (working with elderly, dementia, physically limited)
3. Anerkennung Verfahren — qualification recognition
For registered nurses
- Process of official recognition of HR/BiH/SRB diploma in DE/AT
- Duration: 3–12 months depending on state
- Most common outcome: Defizitbescheid — worker must complete additional training (3–12 months) or pass Kenntnisprüfung (knowledge exam)
- Process cost: €300–800 + cost of additional training (up to €5,000)
For caregivers (Altenpflege Helfer)
- Simplified process — often 3–6 months
For 24h-Betreuung
- No Anerkennung process for most positions
- Worker registers as self-employed or through agency
4. Salaries 2026 — detailed
Germany (gross/month)
| Position | Beginner | Experienced | Senior |
|---|---|---|---|
| Pflegehelfer (assistant) | €2,300 | €2,600 | €2,900 |
| Altenpfleger | €2,800 | €3,200 | €3,800 |
| Krankenpfleger (nurse) | €3,000 | €3,500 | €4,200 |
Plus: shift bonuses (25–50%), night work (40–60%), Sunday/holidays (50–100%).
Austria (gross/month)
| Position | Beginner | Experienced |
|---|---|---|
| Pflegeassistenz | €2,200 | €2,500 |
| Diplomierte Krankenpfleger | €2,800 | €3,400 |
| 24h-Betreuung | €2,000–2,500 net | – |
5. Realistic process — from contact to first day
For Pflegedienst (most typical)
- Phase 1: agency contact, need definition (1–3 days)
- Phase 2: pre-screening candidates, video interview (5–10 days)
- Phase 3: contract, fees, visa application (7–14 days)
- Phase 4: visa D + travel (4–8 weeks)
- Phase 5: Anerkennung in parallel (3–12 months — worker can work as Pflegehelfer while process ongoing)
- Phase 6: language course B1–B2 (parallel, 2–6 months)
Realistic timeline to "full Pflegefachkraft status": 6–18 months.
For 24h-Betreuung (shorter process)
- No Anerkennung process
- No Kenntnisprüfung
- Realistic timeline: 6–10 weeks from agency contact to first week with client
6. Biggest pitfalls 2026
Trap 1: Assumption that HR/BiH diploma "automatically" applies in DE/AT
No. Need Anerkennung Verfahren. Plan: 6–12 months.
Trap 2: Weak language = weak care quality
Worker with A2 German can't communicate with elderly patients at level required by DE/AT standard. B1 minimum, B2 for independence.
Trap 3: 24h-Betreuung without clear "off time"
Worker who doesn't get real break burns out in 2–3 weeks. Standard: 2–3h breaks daily + 1 free day weekly.
Trap 4: Low pay for Pflegedienst → exit after 6 months
Caregivers who pass Anerkennung become valuable and other firms pay them more. Without loyalty program (bonuses, annual) — they leave.
Trap 5: Bad screening for 24h-Betreuung
Client who gets wrong worker = traumatic experience. Specialised agency must do detailed match (cultural fit, language, physical ability).
7. Frequently asked questions (FAQ)
Can Croatian caregivers work in DE/AT without Anerkennung?
Yes, as Pflegehelfer (assistant) — lower level, lower pay. For full Pflegefachkraft position Anerkennung is needed.
How long does 24h-Betreuung rotation realistically last?
Standard: 4 weeks with client + 4 weeks home. Some workers prefer 2+2 (shorter, more frequent rotations).
Are Pflegekräfte from HR/BiH "accepted" in DE/AT?
Yes, very well. Germany and Austria publicly speak of "need for European Pflegekräfte" as alternative to more distant countries.
What if Pflegekraft decides to stay in DE/AT permanently?
After 5 years of work they can request permanent residence (Niederlassungserlaubnis).
Do 24h-Betreuung workers need driving license?
Often desirable (clients may need transport to doctor). Not mandatory.
8. Action plan
- Define need: how many Pflegekräfte needed, what level (assistant, Fachkraft)
- Language training plan (allow 3–6 months for B1)
- Anerkennung plan (allow 6–12 months for full qualifications)
- Specialised agency that runs entire process (language + Anerkennung + permits)
- SLA: agency delivers a first qualified candidate within 15 working days, Anerkennung in 8–12 months, language B1 in 6 months
Sources:
- BMG (DE) — Pflegepersonal-Bericht 2025
- BMSGPK (AT) — projections Pflegekräfte 2026
- TVöD (DE) — collective agreement public sector Pflegekräfte 2026
- AT KV Pflege — collective agreement 2026
- People Pons experience with healthcare 2020–2025
Numbers are indicative. This article does not constitute medical or legal advice.
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