On paper, the helper level is the one part of the German care labour market that is not empty: 48,000 unemployed care workers are looking for a role at helper level. Employers still cannot fill their positions. The reason is not recruitment. It is a figure that few people place side by side.
2,131 unemployed per 100 vacancies — and still unfilled
The Federal Employment Agency (BA) publishes an annual analysis of the labour market situation in nursing occupations. Its May 2026 report separates nursing into three levels, and only that separation makes the picture legible.
In the 2025 annual average, 48,000 unemployed care workers were looking for a role at helper level — 79 percent of all unemployed care workers. 32,000 of them had no relevant vocational training. Against this stood around 1,500 registered vacancies for care assistants without training. That produces a ratio of 2,131 unemployed people per 100 registered vacancies (Source: Federal Employment Agency, Blickpunkt Arbeitsmarkt — Labour Market Situation in Nursing Occupations, May 2026).
One level up the picture changes. For nursing assistance — helper roles with a regulated qualification — 16,400 vacancies were registered, and the ratio stands at 223 unemployed per 100 vacancies. For qualified nurses there were 19,800 registered vacancies and an unemployment rate of 1.1 percent (Source: BA, May 2026). How tight the qualified-nurse market actually is, we calculated last week: What a vacant qualified-nurse position costs.
Three levels, three entirely different markets: 2,131 to 100 among the unqualified, 223 to 100 in assistance, 57 to 100 among qualified nurses. Anyone speaking of “the nursing labour market” is describing none of them.
What a care assistant is allowed to do
The answer to the contradiction is not in the labour market statistics but in professional law. Section 4 of the German Nursing Professions Act defines three tasks reserved exclusively for qualified nursing professionals:
- assessing and determining the individual care requirement,
- organising, shaping and steering the care process,
- analysing, evaluating, assuring and developing the quality of care.
These three tasks cannot be delegated. A care assistant can wash, make beds, mobilise, accompany, document and support — but they can neither define nor take responsibility for the care process. That is not a question of experience or trust. It is a statutory allocation.
For workforce planning this draws a hard line: an additional assistant relieves your qualified staff but does not replace any. If you are short of a registered nurse, the fifth assistant does not close that gap either — it only shifts which work the remaining qualified staff have to do themselves.
Why the helper surplus does not close the qualified-staff gap
564,000 people worked in helper roles in nursing in June 2025, which is 32 percent of all employees subject to social insurance in nursing occupations. Over a ten-year comparison this group has grown by roughly half (Source: BA, May 2026). The helper level has not been neglected — quite the opposite.
At the same time, the unemployment rate at helper level stood at 8.2 percent in 2025, up 0.4 percentage points on the previous year (Source: BA, May 2026). Re-employment also takes time: unemployed helpers with training needed an average of 183 days to take up their next job, helpers without training 227 days (Source: BA, May 2026).
The finding is uncomfortable but unambiguous. There are plenty of people looking for helper work. There are few registered vacancies that require no qualification at all. And there is a statutory boundary beyond which only registered staff may work. Surplus and shortage sit in the same occupational field — but not on the same level, which is why they do not cancel each other out.
In practice: the route via unqualified staff solves your problem only where support work is genuinely missing. Where a reserved task lies, you need recognition or training. The same mechanism applies outside nursing, though there without professional law as a brake — set out in our analysis of Filling helper roles: 156 days is the average.
Two legal routes for care assistants from abroad
For organisations recruiting internationally, two routes lead to staff below the qualified level. They differ fundamentally, and confusing them costs months.
Route one: Section 22a of the German Employment Ordinance. The provision governs the employment of care assistants from abroad. It requires the person to meet the conditions for a nursing support activity as determined by federal or state law — either through a state-recognised qualification in a nursing support activity, or through a determination of equivalence by the competent state authority. Section 9 of the Employment Ordinance, the priority review, expressly does not apply. This route is therefore not a helper route in the colloquial sense: it presupposes a recognition procedure.
Route two: Section 26 (2) of the German Employment Ordinance, the Western Balkans regulation. Nationals of Albania, Bosnia and Herzegovina, Kosovo, Montenegro, North Macedonia and Serbia may take up any employment, independent of a formal qualification. The number of approvals is capped at up to 50,000 per calendar year. The initial application must be filed at the German diplomatic mission in the home country, and the person must not have received benefits under the Asylum Seekers Benefits Act in the 24 months before applying.
The wording of the Western Balkans regulation contains no sectoral exception. What matters, though, is that residence law and professional law govern two different things: permission to work in Germany does not replace the professional requirements for a nursing support activity, which the federal states set independently. For activities that do not presuppose a regulated nursing support qualification — companionship, housekeeping, service, daily-living support — this route works. For the care assistant in the professional-law sense, it does not lead around the requirement.
Both routes run through the same seven steps. First, the needs analysis: you submit your staffing requirements, and the active search begins once the complete needs analysis and the signed placement contract are in place. Second, candidate search and pre-qualification, around two to four weeks. Third, candidate presentation via a document portfolio with a video or interview option. Fourth, document collection and legalisation. Fifth, the administrative procedure — the work permit takes around six to eight weeks. Sixth, the visa procedure and flight booking, around four weeks. Seventh, arrival, registration and starting work.
In total that is around four months from contract. The information in this article is for orientation and does not replace legal advice.
From January 2027 the starting position changes
The middle level, where things stick today, is getting a federal basis. On 17 October 2025 the Bundesrat approved the Act introducing a federally uniform nursing assistance qualification. It enters into force on 1 January 2027 (Source: Federal Ministry for Education, Family Affairs, Senior Citizens, Women and Youth, announcement of 17 October 2025).
The key points: the training ordinarily runs 18 months full-time, with part-time and shortened models provided for. It replaces 27 qualifications regulated under state law with a single common arrangement. All trainees receive an appropriate training allowance. The generalist curriculum prescribes mandatory placements in three care settings: residential long-term care, outpatient long-term care and acute inpatient care. Access ordinarily requires a school leaving certificate; applicants without a formal qualification may be admitted following a positive assessment by the nursing school.
For your planning, one point matters most: a nationally uniform assistance qualification makes equivalence determinations under Section 22a of the Employment Ordinance considerably more predictable, because 27 different reference standards are replaced by one. What that will mean in practice is not yet settled — the state authorities have to apply it first. We are not claiming an effect that has not yet had the chance to show itself.
What this means for your workforce planning
Four consequences from the figures.
First: determine the level before you search. Is support work missing, or is responsibility for the care process missing? That answer decides whether you are dealing with a market of 2,131 applicants per 100 vacancies or one in which 57 unemployed people face 100 vacancies. These are opposite problems, and they need opposite strategies.
Second: do not offset the helper surplus against the qualified-staff gap. Section 4 of the Nursing Professions Act draws a line that no staffing strategy shifts. Whoever needs a registered nurse must have someone recognised or trained.
Third: check the legal route before the candidate, not after. Whether Section 22a or Section 26 (2) of the Employment Ordinance applies is decided by the activity and by the qualification already held. Putting that check at the start costs an hour. Making it up later costs a procedure.
Fourth: the lead time belongs in your rota planning. Around four months from contract is not a delay but the price of a hire that otherwise would not happen at all. Measured against the 183 to 227 days that domestic re-employment at helper level takes on average, it is not an unusual order of magnitude.
For the record: we deliberately give no success figures from our own placements in this article. What we describe is the market situation and the legal position, not a result we cannot yet show.
Further reading
- What a vacant qualified-nurse position costs
- Filling helper roles: 156 days is the average
- Two paths into nursing, only one needs recognition
- International nurses are the norm
Sources
- Federal Employment Agency: Berichte — Blickpunkt Arbeitsmarkt. Arbeitsmarktsituation in Pflegeberufen. May 2026. https://statistik.arbeitsagentur.de/DE/Statischer-Content/Statistiken/Themen-im-Fokus/Berufe/Generische-Publikationen/Arbeitsmarktsituation-in-Pflegeberufen.pdf (accessed 4 September 2026).
- German Nursing Professions Act, Section 4 — Reserved activities. Official legal text. https://www.gesetze-im-internet.de/pflbg/__4.html (accessed 4 September 2026).
- German Employment Ordinance, Section 22a — Employment of care assistants. Official legal text. https://www.gesetze-im-internet.de/beschv_2013/__22a.html (accessed 4 September 2026).
- German Employment Ordinance, Section 26 (2) — Western Balkans regulation. Official legal text. https://www.gesetze-im-internet.de/beschv_2013/__26.html (accessed 4 September 2026).
- Federal Ministry for Education, Family Affairs, Senior Citizens, Women and Youth: Bundesrat approves federally uniform nursing assistance qualification. 17 October 2025. https://www.bmbfsfj.bund.de/bmbfsfj/aktuelles/alle-meldungen/bundesrat-stimmt-bundeseinheitlicher-pflegefachassistenzausbildung-zu-272084 (accessed 4 September 2026).
