The German statutory health system covers only a fraction of the costs that elderly people face when having to rely on 24-hour care. For thousands, cheaper nursing homes in eastern Europe have become an alternative.
The village of Zabelkow in southeastern Poland - a stone's throw away from the Czech border - may seem like a desolate place, at least to western eyes. There's not much going on apart from a market where locals and a handful of Czechs buy vegetables, fruit and bread.
But on the outskirts of Zabelkow is a large, modern housing complex. Its façade reads "Rezydencja dla Seniorow," or "pensioners' residence." It's here that many elderly Germans have taken up residence, hundreds of miles from home.
With 24 rooms, the brand-new nursing home is the work of German executive consultant Fabrice Gerdes and his father-in-law, a building contractor who hails from the area.
Lower labor costs in Poland allow the two to provide equal - and sometimes better - services for about one-third the cost. Since German retirement homes are only partially covered by German health insurance, the gap in financing often eats into people's lifelong savings. In Germany, many children also have to contribute financially to their parents' assisted living care.
While the building materials for the Zabelkow center are Polish, the furnishings, whether bed sheets, electrical appliances or furniture, are imported from Germany. The home can thus reassure family members that it is not equipped inadequately.
The rooms come complete with wireless Internet connections, German television and video conferencing technology, enabling occupants to see and talk with their relatives back home. There are also rooms for therapeutic exercises, spacious lounges on several floors and even a built-in chapel. The Polish nurses and medical staff all speak fluent German, so as not to subject the occupants to culture shock.
Fabrice Gerdes emphasizes the ease with which visits can be carried out. "We have two airports nearby, Katowice and Ostrava. You can fly here within 90 minutes from almost every German airport. And we also have a shuttle service fetching people from the airports."
In the German media initial criticism of such facilities focused on family members "immorally" sticking parents in eastern European homes.
"Culturally speaking, we're facing one of the biggest taboos here," said professor Harald Walach of the Institute of Transcultural Health Studies, in an interview with DW. "By 2050, we'll have as many people living with dementia in Germany as Berlin is big [3.5 million people]. That's a huge problem, and nobody is really talking about it or looking at it. And nobody knows how to cope with it."
While criticisms of such facilities has died down to some extent, Walach still sees reason for concern. "It's probably true a lot of [people with dementia] have bright moments where they feel and understand things. And you don't know how it will affect them to find themselves in completely different and foreign surroundings."
For Christine Eberle at the German Foundation for the Protection of Patients' Right, the physical location of an assisted care facility is of far less importance than the care itself.
"If you suffer from dementia, you cannot be seriously asked where you want to live," Eberle told DW. "You will need - more than others - nurses who are able to speak German with you. Otherwise you get problems in terms of orientation."
Germany is now facing the reality of a domestic nursing system with huge shortages in skilled staff, particularly those trained to deal with dementia. For a German couple who had just left their elderly relatives behind at the Zabelkow center, there's no reason to have moral qualms about assisted care in Poland.
"We're leaving this place with a very good feeling, knowing that care will be better, and that there are more nurses available for fewer occupants than back home in Germany," they told DW. They added that they were planning to pay a visit once a month.
According to German Health Minister Daniel Bahr, an estimated 5,000 elderly Germans currently live in nursing homes in eastern Europe. An undisclosed number of Germans reside in similar homes in Thailand.
But while that figure has been rising steadily, Fabrice Gerdes at the Zabelkow center says cross-border nursing tourism will never become a mass phenomenon.
"We simply do not have enough staff for another 100 such homes, staff who speak fluent German," Gerdes told DW. "And whoever is able to speak German will try and get jobs in Germany, where they'd get more money than here in Poland or the Czech Republic."
Be that as it may, the home in Zabelkow was fully booked within weeks.
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