Background information

Where people with dementia receive care and support

The following table provides estimates of the number of people with dementia living at home, in various types of residential care and in hospitals or psychiatric institutions (Schweizerische Alzheimervereinigung, 2003/2004).

The percentage of residents who have dementia in general/non-specialised residential homes is 2%. In general/non-specialised nursing homes, about 60-65% of the residents have dementia (Bartelt, 2012).

The organisation of care and support for people with dementia

The overall organisation of care and support

In Switzerland, the healthcare system is complex. Tasks and responsibilities are distributed between Confederation, Cantons and Communities (communes). The Cantons play an important role in healthcare. They decide the planning of long-term care homes, or even have their own dementia strategies (Canton of Vaud, Geneva and Valais).

Support for people with dementia and carers is financed by different sources: social insurances for old age and incapacity, obligatory health insurance, income taxes and of course the private income and fortune of the people concerned.

Social insurances (Old Age and Survivors insurance and Incapacity insurance) cover the costs for the “vital minimum” for all residents in Switzerland. They are financed by obligatory payroll deduction (under the AHV and IVG laws). This is called the 1^st pillar. The 2^nd pillar is the Occupational Benefit Plans concerning old-age, survivors and invalidity, financed by the employers and the employees.

The obligatory health insurance contributions (premiums) are set according to age, gender and rates applied in each region of the country (costs vary from one region to another and health politics are largely the responsibility of the cantons). They are not linked to earnings or income. Each person is insured individually. People whose contributions represent 8 to 10% of their income may be entitled to means-tested tax-based subsidies from the State and the cantons. The cantons have the power to define the criteria for the granting of such subsidies.

The obligatory health insurance covers part of the cost of home care (provided by the home care organisation – Spitex or other home care organisations) or residential care (based on prices that are determined by the cantons (law ruling the financing of long term care). Patients/service users must pay an annual franchise and make a further contribution towards costs. The remainder of the cost is covered by the cantons. People may opt for a higher franchise in order to reduce their health insurance premium.

People who have difficulty coping with daily life activities may apply for an incapacity allocation from the State. This allocation is not linked to earnings or income.

Private insurance offers the possibility to take out a special insurance for this kind of costs.

The Swiss Federal Constitution lays down the following social provisions:

‘Art. 41

1 The Confederation and the Cantons shall, as a complement to personal responsibility and private initiative, endeavour to ensure that:

1. everyone has access to social security;
2. everyone has access to the healthcare that they require;

(…)

2 The Confederation and Cantons shall endeavour to ensure that everyone is protected against the economic consequences of old-age, invalidity, illness, accident, unemployment, maternity, being orphaned and being widowed.

(…)

4 No direct right to state benefits may be established on the basis of these social objectives’.

A National Dementia Strategy will be elaborated by the Federal Office of Public Health and the cantonal directors of health. It will define objectives but the realisation of these objectives will be at a cantonal level.

The national Strategy is in the consultation phase in the moment. It will adopted by the Dialog Nationale Gesundheitspolitik in November 2013. More information can be found on: http://www.bag.admin.ch/themen/gesundheitspolitik/13916/index.html?lang=fr

The provision of care in addressed in national policies: the law on general health insurance includes rules for services (type and quantity) that will be covered by the insurance.

At federal level, everyone has access to the healthcare they require. And what the insurance has to pay. More information can be found on: http://www.bag.admin.ch/themen/krankenversicherung/index.html?lang=en

Each canton decides how many homes they need.

How specific aspects of care and support are addressed

The provision of care and support is addressed in federal law and in dementia plans of three Cantons.

There is a dementia action plan in the Canton of Vaud. The Canton of Valais has dementia recommendations while the Canton of Geneva has a report in view of the implementation of a cantonal Alzheimer Plan. 

On 12 March 2012, the Swiss Council of States (upper house of the federal Parliament) approved a series of proposals which effectively call upon the government to prepare a national dementia plan.

On 21 November 2013, the ‘Swiss national health policy dialogue’ adopted its national dementia strategy. This strategy clearly spells out the necessity to act and proposes defined objectives. The main points are: access to information and individualised counselling, coordination of basic services for tailored access to early screening, diagnosis, treatment, support and care, specific training for care providers, financing of care and support adapted to the needs of the person. (See press release of the Swiss Alzheimer Association in French at: http://www.alz.ch/index.php/communiques-de-presse.html.)

The cantons will now have the responsibility of implementing this strategy. 

Training

Which social and healthcare professionals provide care and support

The type of training that social and healthcare professionals receive

Training of social and healthcare professionals in dementia in not addressed in any national policy in Switzerland. The country is currently developing a national policy where this will be addressed.

The training for the doctors is regulated on Federal level (see also http://www.fmh.ch/bildung-siwf.html). The training of other social and healthcare professionals is done at Federal and Cantonal level. OdASanté is the body in charge of the trainings of the continuous trainings of health professionals across Switzerland. The trainings lead to Federal or Confederation qualifications. More information about this organisation can be found on: http://www.odasante.ch/index.php?l=fr.

The amount of training in dementia that GPs receive in the course of their professional training to become a GP differs from one university to the next. Dementia is included in courses on psychiatry, geriatrics and internal medicine. GPs are obliged to do 80 hours of continuing education per year but not specifically in dementia.

There is no official standard for training in dementia but lot of courses are organised by employers. Alzheimer Switzerland started a training (or sensitisation) programme for the auxiliary personal in the homes.

Curaviva, the Association for Swiss homes and social institutions also provide training.

Support for informal carers

At the time of going to print, the Swiss national dementia strategy was approved and consequently, provisions relating to the support of carers (and people with dementia) are likely to change in coming months.

Respite

Some branches of Alzheimer Switzerland offer private respite care at home on a one-to-one basis. This service is possible by the hour and also for whole days and nights. It is financed by the family and so far some subsidies have been received from the State. The respite carers receive a small remuneration.

Nursing homes offer short-term stays to relieve carers (as long as the bed is not occupied by a long-term resident…). These can be partly funded by the State and partly by service users.

Work/tax related support for carers and carer allowances

Carers do not have any legal right to paid or unpaid time off work for caring. However, the law (the Employment Law in the Code of Obligations, Art. 329) has been extended by jurisprudence. It is therefore possible to have paid time off work to care for a terminally ill person but otherwise people are dependent on the goodwill of their employer.

Art 36 of the Employment Law of 13/3/1964 states that employers have to take family responsibilities (including the care of a sick relative) into account when fixing working hours. Employees do not have a legal right to flexible working hours but a lot of companies in Switzerland offer flexible working hours to all their staff.

In Switzerland, there is a system of “bonifications pour tâches d’assistance “(allowances for caring activities). These allowances do not constitute cash allowances per se but represent a bonus added to a person’s individual pension account. In other words, a person who provides care for a family member’s benefits from an additional income. This is the first pillar of the AVS (http://www.ahv-iv.info/ahv/00161/00183/index.html?lang=fr).

In some cantons, the family carers receive a direct payment. This solution is also on the political agenda at Federal level.

National Alzheimer Association

The Swiss Alzheimer Association provides the following services and support.

References

Bartelt G., (2012).Auswertung von RAI-Daten im Auftrag der Schweizerischen Alzheimervereinigung. Technischer Bericht. St. Gallen.

Harvey R. J. (1988).Young Onset Dementia: Epidemiology, clinical symptoms, family burden, support and outcome. Dementia Research Group. Imperial College of Science, Technology and Medicine. London. EURODEM

Nationale Umfrage (2004).Schweizerische Alzheimervereinigung und gfs. Bern: Erhebliche Unterversorgung. Studie “Verbreitung und Versorgung Demenzkranker in der Schweiz”.

Schweizerische Alzheimervereinigung (2003; 2004).Wegweiser für die Zukunft, 2003, Schweizerische Alzheimervereinigung, Leben mit Demenz in der Schweiz, Eckdaten 1 und 2, 2003, 2004. Schweizerische Alzheimervereinigung

Acknowledgements

Marianne Wolfensberger, Swiss Alzheimer Association