Need for care & differences between Spitex & nursing home stay

When do you need care & what does the need for care mean for those affected?

Generally speaking, the need for long-term care is defined as a situation where a person can no longer cope with everyday life on their own due to an accident, illness, disability or simply old age. As soon as medical care and support for day-to-day activities become necessary over a longer period of time, this is considered a need for care. In addition to the medical care already mentioned, the necessary support also includes help with personal hygiene, eating or general household tasks. Relatives often step in for the simpler assistance activities that do not require special training. For everything else, there are trained specialists from public or private Spitex providers or inpatient care in appropriate facilities. A stay in such a facility usually generates higher costs than Spitex services at home. And, of course, these costs have to be paid by someone.

Who pays the care costs in Switzerland & what care insurance is available?

Although there is now a lively debate about this, there is (still) no compulsory care insurance in Switzerland. The costs are therefore still covered by the existing social insurance system, i.e. by the compulsory health insurance, the public sector and also by the people affected themselves. Since 2011, the newly regulated care financing system has been in place to relieve the financial burden on compulsory health insurance and people in need of care. This standardized care financing, which is not entirely uncontroversial, is the basis for the classification of individual care needs and their reimbursement by health insurance. Appropriate supplementary insurance for outpatient or inpatient care services can help to reduce the uncovered costs incurred. However, you should make a careful calculation beforehand, as this supplementary insurance may only really be worthwhile for those who are financially better off.

How is the need for care determined & what are the differences between Spitex and residential care?

Determining care needs in care homes

The homes determine the care requirements using one of the care requirements instruments (BESA, RAI/RUG, Plaisir) at the beginning of the stay, then again after 6 months and then annually. If the resident's condition changes significantly or if the resident so wishes, an extraordinary interim review can be carried out. Which of the recognized care needs instruments is used varies from home to home. However, all instruments are classified into 12 care levels of 20 minutes each, e.g. according to the BESA system, which is particularly widespread in German-speaking Switzerland:

When determining the need for care in care homes, the focus is therefore on the physical and mental condition of the residents. This can make the billing of services opaque for those affected or their relatives and unfortunately also facilitates fraud.

Determining care needs with Spitex

Spitex companies work somewhat differently when determining the need for care and are, so to speak, more performance- and customer-oriented, especially private Spitex providers. In addition to the person as a client, the focus here is on the service and not on the condition of the person concerned or a care level. This also makes the billing of services more transparent for those involved.

At Spitex, whether private or public, the care requirements are initially determined by a qualified care professional and the actual time required is then calculated accordingly. However, public Spitex organizations are usually somewhat inflexible in this respect and fixed to this fixed amount of time. Private Spitex providers provide the same medically prescribed services at the same cost, but can respond more flexibly and individually to the needs of the person in need of care and their relatives and offer additional services as required.

How high are the care costs & what are the differences between Spitex and residential care?

Accounting for care costs in care homes

In care homes, the total costs for the respective stay are divided into 3 categories, whereby the first two are increasingly summarized as accommodation costs:

• Boarding costs
• care costs
• Care costs

The person in need of care or their relatives must pay for the pension and care costs. The care costs are divided between three parties, namely the compulsory health insurance, the public sector, i.e. the respective municipalities or cantons, but also the persons in need of care themselves. However, the latter must pay a maximum of CHF 21.60 per day. The proportion and amount of costs covered by health insurance depend on the care level determined and amount to CHF 9 per care level, but a maximum of CHF 108 per day for care level 12. The public sector must cover the remaining costs.

Care cost billing with Spitex

We have written this more detailed article on this topic. Spitex organizations distinguish between the following three categories of medically prescribed services:

• Basic care (e.g. personal hygiene, help with dressing and undressing, assistance with eating and drinking, etc.)
• Treatment care and examination (e.g. changing dressings, administering medication, etc.)
• Clarification, advice and coordination (e.g. assessment of care needs)

Compulsory health insurance covers the following costs per day for these three categories in accordance with Art. 7a KLV para:

• CHF 54.60 for basic care measures
• CHF 65.40 for examination and treatment care measures
• CHF 79.80 for clarification, advice and coordination measures

In addition to their individual deductible and co-payment, those in need of care pay a cantonal patient contribution, sometimes also referred to as patient participation, for these services subject to compulsory health insurance. However, this patient contribution may only amount to a maximum of CHF 15.95 per day or CHF 5821.75 per year - regardless of the canton in which they live. The remaining costs are then borne by the respective canton or municipality. You have to pay for services not prescribed by a doctor yourself, but here too there are many state support tools, which we presented in an earlier series of articles.

So which is better: Spitex at home or a stay in a nursing home?

Unfortunately, this question cannot be answered in the same way for everyone. Too many individual factors play a role here, such as the level of care, the care options available to relatives and, of course, the available assets. Even the assets of relatives can be a factor to consider. In both cases, the Swiss social insurance system will of course cover at least part of the costs.

The advantages of Spitex

The bottom line is that Spitex is often cheaper for those affected or their relatives, especially for the lower care levels. We have also written three helpful blog posts on the financing of uncovered services. In addition to the economic arguments, there are of course the numerous advantages of outpatient care compared to a stay in a care home:

• the familiar surroundings of your own home
• the self-determined and familiar daily routine
• the proximity to relatives who are supported by Spitex, for example, in providing care
• A constant reference and care person
• Individual service packages tailored precisely to the needs of the person in need of care

Do you have any questions about the need for care or Spitex services? Simply take advantage of our non-binding and free initial consultation! We will clarify your personal situation or that of your relatives with you and advise you on your entitlement to state support tools or on insurance issues:

Request a consultation

Ultimately, it is a very personal decision that is better to think about in good time so that you have enough time to make the right preparations. The fact is, however, that care costs will also rise sharply in Switzerland as a result of demographic change. It is not only the many family carers and nursing professionals who will be called upon in the future, but above all the politicians who must take the right measures quickly to ensure that everyone receives the care they need.