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In 1995, Germany added long-term care provisions to the national health care law. The law established a fund which provides benefits either as cash payment to an informal caregiver, payment for community-based services, or payment for institutional care. The program is designed to encourage family care and community-based care in place of institutional care. Three major issues emerged in the implementation of the program. First, a private, for-profit industry of community-based services developed which posed problems in assuring quality of care. Secondly, the narrow scope of the criteria for qualifying for benefits failed to adequately assess the care needs of persons with dementia and some other disabling conditions. Third, the beneficiaries have increasingly declined the cash option in favor of the more expensive option of receiving services, thus threatening the financial viability of the program. Based on interviews conducting in Germany in July 2005, the paper will note the steps taken to address the three issues above as well as to suggest how the current reform of the national health care law might impact on care for the elderly. [ABSTRACT FROM AUTHOR]