It costs too much to take care of the western world’s old and frail in their own homes or care homes. German is beginning to export the work to low-wage service economies.

Mrs T, who is 87 and a widow, lives in a big house in Berlin that her husband built for the children they intended to have but never did. Her only family is a niece who lives 700km away and a distant relative in the US. Her voice is hoarse because she doesn’t get to talk often, she is unsteady on her feet and she can’t remember the way to the doctor’s surgery: he has diagnosed her with progressive senile dementia.

Mrs T is sure of one thing: she will not move to a retirement home, a view shared with two thirds of Germans, if opinion polls are correct. Their views have been confirmed by media reports of staff hastily fitting gastric tubes to residents because there were no carers to feed them, and not changing incontinence pads for hours. The Federal Association of Private Social Service Providers (BPA) estimates a current shortfall of 30,000 nurses, perhaps 220,000 by 2020. Not enough qualified staff, difficult working conditions (staff are overstretched in upmarket retirement homes too), and a worse shortage in the home care sector.

Norbert Blüm, social affairs minister in Helmut Kohl’s “black and yellow” coalition government did introduce compulsory long-term care insurance in 1995, with employers and employees contributing equally. It was never designed to cover all risks though, because it was tacitly believed that Germans would not live long enough to become dependent, or that their families would look after them. Angela Merkel’s government continues to count on private care, but family arrangements have limits: grown children rarely live in the same area as their parents, and female relatives (wives, daughters and daughters in-law), who used to looked after the elderly at home at minimal cost, are not as available as they once were.

Retirement home residents pay between €1,000 and €3,000 a month, plus board and lodging, on top of their insurance payments. The state will intervene if they do not have the means (and a survey by the Federal Statistical Office (...)