Switzerland

Demographic information (Federal Statistical Office, 2009)

• Inhabitants: 7,785,806
• No. of citizens 65+: 1,308,691
• No. of citizens 75+: 625,338
• No. of people with long-term care needs: about 488,000, of which 259,272 in residential care and 228,477 in home care

Characteristics of health, social and long-term care delivery

Switzerland does not, strictly speaking, have a clearly outlined system of long-term care. Frailty and dependency are still  primarily viewed as resulting from ill-health or social precarity and the (formal) support required is thus provided within the health care and social services and social care systems. Reliance on informal care remains substantial.

Cantons are formally in charge of organizing and of contributing to cover the costs of long-term care. During the past decade, many of them have embarked on policy planning in the field of global old age policy. On the other hand, the central – or federal – State has limited competencies in this field. The LTC delivery system is therefore highly decentralized and cantons have not yet actively seeking to coordinate their efforts in that concern.

Where formal care is concerned, home health and home care services on the one hand, and nursing homes on the others, are the main pillars of the  LTC delivery system. German speaking regions of Switzerland have so far relied more heavily on the latter, whereas French-speaking areas have developed home care services and home health care to a greater degree. Legal changes in health insurance reimbursement, which were approved in 2008 but came into force in 2011, mean that about 65% of the cost of health care (primarily nursing care) provided by either nursing homes or home health services is covered by compulsory health insurance. Patients or residents themselves  can be made to cover up to 20% of such costs, with a ceiling of approximately 8,000 CHF/year. The remainder is covered by public authorities (cantons and communes). Also, ongoing development strategies are different in both part of the country. In the German speaking regions, developpement and integration of the service delivery process is carried out for the most part by existing providers themselves – i.e. primarily by home care organizations; in French-speaking, Western Switzerland, impulses for the creation of integrated care networks stems mostly from public authorities.

Background information on key-issues

Quality assurance and quality management in LTC

(...) Switzerland cannot truly be said to have a national concept of elderly policy. In August 2007 the federal government issued a report outlining its global strategy, as a response to a motion voted by Parliament 4 years earlier. The document put forward represents the results of the work of an interdepartmental group formed within the federal administration; representatives of interest groups, in particular associations of retired persons, were not associated with the preparation of the report. The paper deals with issues of mobility, housing, work, financial resources, social participation and health; it sets forth the main focuses of a strategy intended to integrate all aspects of the life of elders into a global perspective, both because it is interdisciplinary in nature and because it does not restrict itself to the field of direct competency of the federal level of government. However the federal government specifies that it intends to outline the contours of a strategy for elderly policy; it does not wish to "establish a plan of action" (Conseil fédéral suisse, 2007: 1) (more ...)

Governance and financing of LTC

(...) In its most general usage, governance – in French the term 'gouvernementabilité' proposed by Michel Foucault (Lemke, 1997) is an alternative to this word borrowed from the English – means a way to lead men, society, or a sector of society. It is the art of governing, to aim for a specific goal; this goal, however, must be defined by the political realm. While the concepts of governance and of policy are distinct, they are also linked, as if governance contained, by anticipation, the aim it pursues. All paths lead to Rome, but this is only true as long as Rome is the only destination. For this report, we will use this view of the term governance, which is at once distinct from and dependant upon the political realm (more ...)