Caregivers (Pflegekräfte) from Western Balkans for DE/AT Pflegedienste 2026

More Pflegedienst firms in Germany and Austria are hiring caregivers and Pflegefachkräfte from Croatia, BiH, Serbia and North Macedonia, because the classical sources (the Philippines, Poland) no longer cover demand. Projections from the BMG and BMSGPK put the need at around 300,000 additional caregivers and nurses in the coming years.

Caregivers (Pflegekräfte) from the Western Balkans are qualified caregivers and nurses from Croatia, BiH, Serbia, North Macedonia and Montenegro who work for German or Austrian Pflegedienste (ambulatory care), in Pflegeheime (nursing homes) or in 24h-Betreuung (private 24/7 care in the client's home).

Key facts at a glance

• Germany is short of around 200,000 to 300,000 Pflegekräfte in 2026 (BMG, Pflegepersonal-Bericht 2025).
• Austria needs about 50,000 people for 24h-Betreuung and 30,000 for ambulatory care in 2026 (BMSGPK).
• The main source countries in 2024 and 2025 were the Philippines (first, around 25,000), Croatia, BiH and Serbia (rising), Vietnam and Brazil.
• Gross monthly pay in Germany in 2026: €2,500–3,200 for a Pflegekraft, €2,800–3,800 for a registered nurse.
• Gross monthly pay in Austrian 24h-Betreuung in 2026: €2,200–2,800, with accommodation included.
• Recognition of a nursing qualification (Anerkennungsverfahren) takes 3 to 12 months.
• The biggest barrier is German at B1–B2 level, including medical terminology.

1. Three work models in DE/AT

Model A: Pflegedienst (ambulatory care, Germany)

The worker visits clients at home 2–3 times a day and works 40 hours a week in shifts. Workers find their own accommodation, either a rented flat or a shared one. Pay is €2,500–3,200 gross under TVöD or a sectoral collective agreement.

Model B: Pflegeheim (nursing home, Germany and Austria)

The worker works 8 to 12 hour shifts in the institution and lives in their own accommodation, often a rented flat nearby. Pay is €2,700–3,500 gross plus shift bonuses. For the worker, the main advantage is a stable schedule.

Model C: 24h-Betreuung (private care, Austria)

The worker lives with the client and rotates with a second worker every 4 to 8 weeks. Accommodation and food in the client's home are included. Pay is €2,000–2,800 net, as the Austrian model has its own rules.

2. Required qualifications

For Pflegedienst and Pflegeheim

• a diploma in nursing care or as a registered nurse, recognised in Germany or Austria through the Anerkennungsverfahren
• German at B1–B2, including medical terminology
• at least 1–2 years of experience
• medical fitness and a psychological assessment

For 24h-Betreuung

• no diploma required, basic training is enough
• German at A2–B1
• experience with elderly people, people with dementia or people with limited mobility

3. Anerkennungsverfahren: how qualifications are recognised

For registered nurses

A nursing diploma from Croatia, BiH or Serbia has to be officially recognised in Germany or Austria. The procedure takes 3 to 12 months, depending on the federal state. The most common outcome is a Defizitbescheid, after which the worker either completes additional training (3 to 12 months) or passes the Kenntnisprüfung (knowledge exam). The procedure costs €300–800, and additional training can cost up to €5,000 on top of that.

For caregivers (Altenpflege Helfer)

The procedure is simpler and often takes 3 to 6 months.

For 24h-Betreuung

Most positions require no Anerkennung. The worker registers as self-employed or works through an agency.

4. Salaries 2026 in detail

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

On top of base pay come shift bonuses (25–50%), night work bonuses (40–60%) and Sunday and holiday bonuses (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 first contact to first working day

For Pflegedienst (the most common case)

• Phase 1: first contact with the agency and defining the need (1–3 days)
• Phase 2: pre-screening of candidates and video interviews (5–10 days)
• Phase 3: contract, fees and visa application (7–14 days)
• Phase 4: visa D and travel (4–8 weeks)
• Phase 5: Anerkennung in parallel (3–12 months), during which the worker can already work as a Pflegehelfer
• Phase 6: B1–B2 language course, also in parallel (2–6 months)

Reaching full Pflegefachkraft status realistically takes 6 to 18 months.

For 24h-Betreuung (a shorter process)

There is no Anerkennung and no Kenntnisprüfung. Realistically, it takes 6 to 10 weeks from first contact with the agency to the first week with a client.

6. Biggest pitfalls 2026

Trap 1: Assuming a diploma from Croatia or BiH applies automatically in DE/AT

It does not. The worker needs the Anerkennungsverfahren, so plan for 6 to 12 months.

Trap 2: Weak German leads to weak care

A worker with A2 German cannot communicate with elderly patients at the level German and Austrian care standards require. B1 is the minimum, and B2 is needed to work independently.

Trap 3: 24h-Betreuung without real time off

A worker who never gets a real break burns out within 2–3 weeks. The standard is 2–3 hours of breaks a day and 1 free day a week.

Trap 4: Low pay at a Pflegedienst, and the worker leaves after 6 months

Once caregivers pass the Anerkennung, they are worth more on the market and other firms offer them higher pay. Without a loyalty programme, such as annual bonuses, they leave.

Trap 5: Poor screening for 24h-Betreuung

For the client, the wrong worker can be a traumatic experience. A specialised agency has to match worker and client carefully on cultural fit, language and physical ability.

7. Frequently asked questions (FAQ)

Can Croatian caregivers work in DE/AT without Anerkennung?

Yes, as a Pflegehelfer (assistant), which is a lower level with lower pay. A full Pflegefachkraft position requires Anerkennung.

How long does 24h-Betreuung rotation realistically last?

The standard is 4 weeks with the client and 4 weeks at home. Some workers prefer 2+2, with shorter and more frequent rotations.

Are Pflegekräfte from Croatia and BiH accepted in DE/AT?

Yes, very well. Germany and Austria speak publicly about the need for European Pflegekräfte as an alternative to recruiting from more distant countries.

What if a Pflegekraft decides to stay in DE/AT permanently?

After 5 years of work, they can apply for permanent residence (Niederlassungserlaubnis).

Do 24h-Betreuung workers need a driving licence?

It is often an advantage, since clients may need a lift to the doctor, but it is not mandatory.

Related: Westbalkanregelung 2026 employer guide, C+E drivers from the Western Balkans for EU spedition and CNC operators and welders for serial production.

8. Action plan

1. Define the need: how many Pflegekräfte you need and at what level (assistant or Fachkraft).
2. Plan language training and allow 3 to 6 months to reach B1.
3. Plan the Anerkennung and allow 6 to 12 months for full qualification.
4. Work with a specialised agency to find candidates. You hire the worker directly and submit the work permit application yourself, and the agency helps collect the documents for it.
5. Agree on timelines (SLA): the agency delivers the first qualified candidate within 15 working days of signing the order. Plan 8 to 12 months for the Anerkennung and 6 months for B1 German.

Sources:

• BMG (DE): Pflegepersonal-Bericht 2025
• BMSGPK (AT): Pflegekräfte projections 2026
• TVöD (DE): public sector collective agreement for Pflegekräfte 2026
• AT KV Pflege: collective agreement 2026

The numbers are indicative. This article is not medical or legal advice.