Background information about dementia and home care services
According to the Swiss Health Survey carried out in 2004, there are 78,000 people aged 65 to 79 and 120,000 people over 80 years of age requiring home care. This represents 29% and 45% respectively of all those receiving home care.
25,700 people receiving home care are considered by their carers to have dementia (results of a national survey carried out by the Association Alzheimer Switzerland in 2004, published in “Vivre avec la maladie d’Alzheimer en Suisse, Les chiffres-clés 2”).
28,000 people, equivalent to 10,000 full time posts, work in the home care services domain. Over 90% are directly involved in providing care services. They mostly consist of qualified nursing staff, health care auxiliaries, home aids, care assistants and trained household aids.
Since the Federal Law on Health Insurance came into force in January 1996, health insurances have been obliged to refund part of the costs of prescribed care. At the same time, providers have found themselves obliged to reduce costs and increase efficacy. This has led to a wave of mergers which is still continuing. The number of care organisations (including those covering home care) has been reduced by about 50% since 1995. This has entailed a reduction in costs e.g. regrouping offices and vehicles. Most of the 700 state-approved local organisations of aid and home care are attached to one of the 26 cantonal associations of aid and home care which in turn are members of the Swiss Association of aid and home care services.
Legislation relating to the provision of home care services
In Switzerland, legislation exists at federal, cantonal and communal level.
The legal basis of Spitex organisations can be found in the federal law on health insurance (LaMal), (art. 35).
A definition of care is provided in article 7 of the federal law “RS 832.112.31 ordonnance du DFI sur les prestations dans l’assurance obligatoire des soins en cas de maladie”. Such care is divided into categories, i.e. instructions and advice, examinations and care, and basic care.
The organisation of care and home care is determined by the federal law “RS 832.102 ordonnance sur l’assurance-maladie”.
Organisation and financing of home care services
Irrespective of age, any person, who is in need of care due to illness/disease, accident, disability, limitations due to age or maternity, can request the organisation of aid and home care within their home region. The necessity for the care and a needs assessment are required conditions for access. From the beginning of 2006 at the latest, there will be a standard assessment tool for carrying out needs assessments known as the RAI-Home-Care (Resident Assessment Instrument – Home Care).
Home care services are organised on an ad hoc basis in the cantons. There is no obligation at federal level to provide such services, although there may be within a canton. Patients are free to decide whether to be cared for at home or in an establishment. However, the insurance companies will no longer pay if a person remains in hospital when it is no longer necessary.
The costs for care services are fixed by federal law. Home care services are recognised and financed through an obligatory care insurance according to conditions determined by federal law. Access to care services is also determined by cantonal law.
The tariffs requested from clients for home care services do not generally cover the costs. The difference is covered by federal, cantonal or communal grants. Some people take out supplementary insurances to cover the part that they have to pay.
Home care services are divided into two categories - those that are refundable and those that are not. Those that are refundable cover care which has been prescribed and for which an assessment has been carried out. For these services, the “ordonnance sur les prestations de l’assurance des soins” (OPAS) has the following hourly prices:
- Basic care for simple and stable conditions (FR 30 to Fr 47)
- Basic care for unstable and complex situations as well as for examination and care (Fr 45 to Fr 68)
- Assessment of needs and advice on medical prescription (Fr 50 to Fr 73)
The amount refunded by the insurance companies is determined by a price convention which is negotiated every year by the insurance companies and the cantonal aid/home care associations.
Generally speaking, carers and relatives are not legally responsible for the healthcare of their parents. With regard to the financing of care, there are exceptions in certain cantons or communes where close relatives, who are well off, may be required to financially contribute towards care.
Kinds of home care services available
A wide variety of services are available within the domain of home care services. Basic services include care and health care services, family support, household help and social accompaniment. Other services vary according to the local aid and home care organisations.
- Assessment and advice - services financed by the health insurances in accordance with the federal law (LAMal)
Additional relevant services:
- Rental of auxiliary aids
- Home meals service
- Meal at midday/day care centre
- Transport service
- Holidays in homes for the elderly
- Advice in case of respiratory problems
- Advice on nutrition and diabetes
- Home pedicure
- Home hair dressing
- Home ergotherapy
- Social advice
- Accompanying the dying and their relatives/friends
- Help switchboard
- Cleaning service
- Gardening service
The various branches of the Association Alzheimer Switzerland also offer different services e.g. support at home (in the Canon of Geneva, in collaboration with the Red Cross and Pro Senectute), the Alz’Amis (in the canton of Vaud) etc. To be precise, these are psycho-social support services and not nursing care services. They are financed by the beneficiaries of the Association and through a grant from the Federal Office of Social Insurance.
Palliative care is quite well developed in Switzerland. In addition to specialised hospitals and units, there are also Mobile Palliative Care Teams which provide palliative care at home (Stuckelberger and Wanner, 2005).
Consultation with people with dementia and carers
There are no legal obligations or formalities concerning consultation with people with dementia.
The Association Alzheimer Switzerland is currently organising, in collaboration with the Association Suisse des Services d’Aide et de Soins à Domicile, a series of regional conferences/debates on the theme: Living with Alzheimer’s disease at home – yes, but how?
- Enquête nationale, Vivre avec la maladie d’Alzheimer en Suisse, Les chiffres-clés 2, La prise en charge actuelle.
- Information provided by Marianne Wolfensberger
- Statistique de l’aide et des soins à domicile (Spitex) 2004 de l’Office fédérales des assurances sociales ( www.bsv.admin.ch )
- Stuckelberger, A.and Wanner, P. (2005), National Background Report for Switzerland, EUROFAMCARE: ( http://www.uke.uni-hamburg.de/extern/eurofamcare/documents/nabare_switzerland_rc2_a4.pdf )
Last Updated: mercredi 15 juillet 2009