The introduction of the German mandatory long-term care insurance in 1995 has led to major changes in the delivery of medical services in nursing homes. This is a result of the assessment process, the demographic changes, modified access to facilities and the changing socioeconomic resources of informal caregivers. The fusion of the health care and long-term care insurance system is now being proposed by bipartisan committees. This will lead to major changes as well as the immediate announced changes of the long-term care insurance. The article gives an overview of these recent developments based on expert opinion.