Elderly care: new opportunities

Since the introduction of the general nursing training in 2020, care facilities have been able to offer adaptation measures themselves as part of the recognition of foreign nursing qualifications. The measures can be a knowledge test or an adaptation period. A recent study from the recognition monitoring project in the Federal Institute for Vocational Education and Training shows that the scope provided by legislation opens up huge opportunities for ensuring the supply of skilled workers in elderly care. However, it also poses challenges for facilities.

In the interview, the author's Carolin Böse and Rebecca Atanassov outline the experience of care facilities so far in implementing adaptation measures, where the barriers exist and how recognition and integration can work well together.

Why have you used your study to focus on care facilities and the recognition of international nurses?

Rebecca Atanassov: There are huge challenges facing the German health system. There is a lack of skilled workers today in elderly care in particular – and demand continues to rise. Until the introduction of the Nursing Professions Act in 2020, care facilities were rarely able themselves to offer adaptation measures for a recognition procedure. This meant they were only able to use the potential offered by international nurses in a limited way. However, now they are able to train them directly in their own facility which also helps increase potential and retain them over the long term. It is this new approach which we have examined more closely in our study.

How have care facilities been utilising these options so far?

Carolin Böse: It differs greatly. We have focused on in-patient care facilities in which people of an advanced age are cared for. Some of these care facilities are already active and are successfully implementing adaptation measures. Others are barely aware that they are entitled to do so. Obstacles include a lack of information or staff shortages – but also the concern that recognised skilled workers will subsequently move into hospitals.

Obvious benefits are clearly seen wherever adaptation measures are implemented. If international nurses are integrated at an early stage and provided with professional support, they are more frequently retained within the facility. Staff with a foreign qualification who have been employed for many years are able to complete the recognition of their occupation in a familiar environment and work as a general nurse.

What are the key success factors in ensuring successful implementation?

Rebecca Atanassov: As Ms. Böse has just implied, recognition and integration need to be considered together. The adaptation measure needs to be established within a comprehensive integration concept. This includes a dedicated contact person, support upon arrival and the embracing of a culture of openness. This way, nurses can be retained over the long term in the care facility.

Qualified practice trainers prepared specifically for supporting international skilled workers are also important. Cooperation with nursing colleges and training providers as well as secure funding are further requirements for ensuring that smaller care facilities in particular are also able to offer adaptation measures.

What conclusions do you draw from your study?

Carolin Böse: General nursing training paves the way for greater involvement of care facilities in the recognition procedure. Insufficient use has so far been made of this opportunity, despite care facilities benefiting from this over the long term. This helps them retain international skilled workers and strengthen the future viability of their facility.

However, this requires clear structures, regional networks and reliable funding. Many facilities are not yet aware of existing support offers relating, for example, to the funding of language courses or integration management. Information events and examples from practice may help in this respect.

When recognition, language development and integration are considered together as a single entity, care facilities make an important contribution to ensuring the supply of skilled workers. And they create places of work in which international nurses wish to remain.

The interview took place in November 2025. Dr. Rebecca Atanassov and Carolin Böse are research assistants in the Federal Institute for Vocational Education and Training’s Recognition Monitoring Project. Contact for questions: anerkennungsmonitoring@bibb.de

The study entitled “Care facilities and the recognition of professional qualifications obtained abroad – opportunities, challenges and success factors” has been published in November 2025 in the “BIBB Discussion Paper” series.