Interview with Michael Zellweger, head of pflegehero

1. Care in old age: what challenges and trends are there in Switzerland?

Demographic ageing in Switzerland is being driven by the baby boomer generation and rising life expectancy. By 2045, the proportion of people aged 80 and over is expected to rise to 10–11%. According to the 2021 study “Gute Betreuung im Alter – Kosten und Finanzierung” (Good care in old age – costs and financing) by the Paul Schiller Foundation, more than 620,000 people over the age of 65 lack high-quality support, which corresponds to a shortfall of 20 million hours of care per year. As the need for specialised nursing and care grows, so will the need for qualified staff.

Qualitative changes in ageing are also emerging: longer healthy lifespans and a more active lifestyle in old age are becoming more common. Life expectancy in good health is rising, which means that more people can remain independent into old age. In addition, many people wish to stay in familiar surroundings for as long as possible – moving into a care home is delayed wherever possible.

Old age does not necessarily mean needing help, but it does mean reduced capacities and greater vulnerability. Most older people in Switzerland live in small households, often alone. New forms of housing such as shared housing for older people do broaden the options for older people, but they are not available to the majority. Despite retirement provision, many older people – especially women – also depend on supplementary benefits to the AHV (Swiss old-age and survivors’ insurance). Most have a social network, but some are socially isolated as a result of impairments or poverty.

Neighbourly relationships and neighbourly help are becoming more important, but they need to be organised and supported. Informal help from family members is the most common form of support for older people, and a combination of informal and professional help is becoming more common as needs increase. A shift from inpatient to outpatient care is taking place, but inpatient options are still necessary when the need for care is high.

Albert Wettstein, the former chief medical officer of the City of Zurich’s medical service, argues for improved, partly state-funded outpatient care for older people as an alternative to the forecast of the Obsan report (Swiss Health Observatory), which predicts a need for 921 additional care homes by 2040. Integrated care models are blurring the boundary between outpatient and inpatient care; the aim is to focus increasingly on holistic care.

At the same time, social and political developments are driving a change in the way older people are treated. For example, there are increasing efforts to preserve and promote the resources and skills of older people. These trends point to the need to adapt nursing and care services for older people in order to meet individual needs while also addressing the challenges of an ageing population.

2. There are a large number of family caregivers in Switzerland. Why are many of them not paid?

In fact, around 300,000 people in Switzerland care for their relatives, and only a fraction of them receive a salary for it. Most family caregivers are therefore meeting a need for which a Spitex (home care) organisation would actually be responsible. What many people don’t know: according to a 2019 ruling by the Federal Supreme Court, family members cannot be compensated by health insurers for treatment care, but they certainly can be for basic care. It is important to distinguish between basic care and assistance – the scope of basic care is clearly defined in the Health Care Benefits Ordinance (KLV), and only basic care may be billed to health insurers.

Assistance is not a benefit of compulsory health insurance and is therefore not eligible for compensation. Lack of knowledge about such distinctions may cause uncertainty. Another important reason why many family caregivers are not paid has to do with how society perceives so-called “care work” – which covers both paid and unpaid caring and nursing work: family caregivers do not want to put themselves in the spotlight, because for generations it has been taken for granted that care within the family is provided free of charge.

3. Being cared for at home instead of in a care home: what are the benefits of this concept?

Ultimately, the aim of this concept is to reduce healthcare costs through fewer or later admissions to hospital or a care home and fewer visits to the doctor. And last but not least – as an answer to the current nursing shortage – urgently needed carers are being trained. Another benefit is the familiar environment: people often feel more comfortable and secure in their usual surroundings. The concept of family caregiving makes it possible to stay at home, surrounded by personal belongings, family photos and an environment that one knows and loves. This promotes autonomy and avoids disruptive changes.

In addition, emotional support from family and close friends is often more readily available at home. Contact with familiar people can be a great emotional support and help to improve mental well-being. Care at home can also be tailored to the person’s individual needs. Care services can be adapted to the person’s specific requirements and daily routine, resulting in more personal care. Care at home can be more flexible in adapting to changing needs. And last but not least, in some cases care at home can be more cost-effective than care in a facility, which often costs more.

4. How does pflegehero’s service work?

Companies that hold an operating licence as a Spitex organisation employ people who care for their relatives in return for a salary. As managing director of pflegehero, I work with three companies: Spitex 24, private Care and reha at home in the cantons of Aargau, Basel-Stadt and Basel-Landschaft, Bern, Lucerne, Solothurn and Zurich. The family caregivers are supervised by professionals and must complete a nursing assistant course or equivalent training within one year

5. What are the benefits of pflegehero?

People who care for their relatives themselves receive not only appreciation for a contribution that should not be taken for granted, but also a salary for their work – currently CHF 36 per hour. They are also coached and supervised by qualified nurses. This raises the quality of care. Supporting caregivers helps to reduce healthcare costs: there are fewer and later admissions to hospital or a care home and fewer visits to the doctor. And last but not least, urgently needed potential carers are being trained.

6. How can family caregivers be paid for their services?

Care services are paid according to the following procedure:

1. Needs assessment of the person requiring care by a registered nurse
2. Conclusion of an employment contract with pflegehero or with one of its operating units (reha@home, Spitex 24, private Care)
3. Recording of the care progress report by the family caregiver
4. Submission of the care progress report in the middle and at the end of each month
5. Payment of the salary on the 6th/7th of the following month
6. Completion of nursing assistant training within one year of starting employment in order to extend the employment beyond one year

7. Which services are paid and which are not?

Only basic care can be paid. General basic care includes assistance with activities that people can no longer carry out themselves, such as:

• Help with getting up and going to bed
• Support with dressing and undressing
• Daily personal hygiene
• Exercises and mobilisation
• Positioning in bed and pressure ulcer prevention
• Support with using the toilet
• Help with oral care and personal hygiene
• Bandaging legs, putting on stockings, etc.

8. What requirements apply?

For family caregiving to be paid as described, the following basic requirements must be met:

• Minimum age of the family caregiver: 18 years
• Physical and cognitive ability to provide basic care
• No conflicts under employment law
• Willingness to take quality measures in the care process
• A relative in need of care
• A stable, long-term care situation for the person in need of care
• Consent of everyone involved.

9. What should I do if I am interested in this kind of care or would like more information?

If you have any questions about caring for relatives in Switzerland and how it is paid, you will find a lot of helpful information on our website. We will also be happy to advise you personally – by phone: 0800 247 247 or by email: info@pflegehero.ch