Assistive Technology and Smart Care in Switzerland: Supporting Independence at Home

An older person living alone may be managing well until one small change alters the balance: a fall in the bathroom, uncertainty about medicines, a missed meal, a daughter who can no longer visit every evening, or increasing anxiety about what would happen in an emergency. The question is not always whether the person needs institutional care. Increasingly, it is whether the home environment, professional support and carefully chosen technology can make remaining at home sustainable.

That question matters across the Switzerland Ageing, Long-Term Care & Community Support Knowledge Hub because Switzerland’s demographic trajectory is increasing demand for both Spitex and residential long-term care. National projections indicate substantial growth in care needs towards 2040, while nursing-home capacity could become increasingly constrained if service patterns remain broadly unchanged.

Assistive technology can form part of the response, but only if its role is understood properly. Emergency call systems, medication dispensers, movement sensors, digital reminders, fall detection, remote monitoring and connected household devices may strengthen independence, extend professional visibility and reassure families. They cannot replace appropriate nursing, household support, relationships or accessible housing.

The central policy challenge is therefore not to put more technology into older people’s homes. It is to design forms of smart care that help people retain control while allowing Spitex, medical services, families and community support to intervene earlier and more intelligently when needs change.

Assistive technology sits between care, housing and everyday life

Assistive technology is a broad term. Some devices compensate directly for an impairment: mobility aids, adapted controls, amplified communication equipment or environmental modifications. Others provide alerts, prompts or information that help a person manage daily life.

Smart care extends this further by connecting technology to a wider support system. A sensor detecting unusual movement has limited value if nobody knows who should review the alert. A medication reminder may help one person remain independent but be unsafe for another whose cognition has deteriorated. Remote monitoring can support a nurse’s judgement, but only if somebody is responsible for acting when the information changes.

For Swiss long-term care, this boundary between technology and service is particularly important. Responsibility for support is distributed across the Confederation, cantons, municipalities, compulsory health insurance, service providers and households. Spitex provides a major part of nursing and support at home, while family members frequently provide additional assistance.

Assistive technology therefore enters an already complex care ecosystem. It may be purchased privately, supplied through a service, supported through insurance or other benefits where eligibility applies, or introduced through local initiatives. There is no single national smart-home entitlement that provides a standard technology package to every older person.

This variation matters because equipment only becomes useful when it is connected to the person’s actual circumstances, funding arrangements and support network.

Switzerland’s ageing strategy increasingly depends on making home sustainable

Most older people would prefer to retain autonomy for as long as possible, and Swiss long-term care policy increasingly has to consider how that preference can be sustained as the population ages.

Spitex already plays a substantial role in enabling people to remain at home. Home nursing activity has continued to grow, and the sector is increasingly managing people with complex medical, palliative, psychiatric and social needs rather than only providing relatively simple assistance.

Spitex Switzerland’s developing Care@Home 2040 vision reflects this direction. It places the person at the centre of networks combining medical, nursing, therapeutic and social support. It should be understood as a strategic vision rather than a nationally implemented service model, but it shows how home-based care is being reimagined.

Technology can strengthen that model in several ways:

• helping people complete everyday activities independently;
• providing earlier warning when health or routines change;
• supporting communication between the person, family and professionals;
• reducing unnecessary travel or administrative work where remote contact is appropriate;
• making some risks manageable without removing ordinary freedom.

However, home-based care is not automatically cheaper, safer or preferable in every situation. Severe cognitive impairment, unpredictable health deterioration, unsafe housing or exhausted family support can make increasingly complex technological arrangements less sustainable than a different care setting.

The strongest policy approach therefore treats technology as one component of a broader assistive technology and support strategy rather than as evidence that every person can remain at home indefinitely.

Emergency response technology remains one of the clearest applications

Emergency call systems are among the most established technologies supporting older people at home. The principle is straightforward: a person who falls, becomes unwell or feels unsafe can request help without needing to reach a conventional telephone.

More advanced systems may add automatic fall detection, wearable devices, environmental sensors or mobile connectivity beyond the home.

The technology can increase confidence, particularly for people who live alone, but its effectiveness depends on the response pathway around it.

An emergency alarm needs an agreed answer to several operational questions. Who receives the alert? Can that person enter the property? What happens if the older person does not answer? When should family, Spitex, emergency medical services or another responder be contacted? How is an equipment failure recognised?

The technology does not remove those decisions. It makes them more visible.

Scenario: a fall alert becomes useful because the response was planned in advance

An 86-year-old widower lives in his own flat in a Swiss town. He remains mobile and strongly wishes to continue walking independently around his home, but he has fallen twice during the previous six months.

His daughter lives 40 kilometres away. She wants him to move into a nursing home because she worries that he may fall at night and remain on the floor for hours. He does not consider that proportionate to his current abilities.

Following discussion with him, his family doctor and Spitex team, an emergency-call arrangement is introduced alongside a review of the home environment. The purpose is not to stop him walking. It is to shorten the period between an incident and assistance.

The response plan specifies who receives an alarm, who holds authorised access to the home, what happens when he cannot speak through the device and when emergency medical help is required. His daughter understands that the technology reduces one particular risk but does not guarantee that falls will never happen.

Six weeks later he falls while getting up during the night. The system generates an alert, contact is attempted and the agreed responder attends. He has no serious injury and does not require hospital admission.

The outcome is not simply that a device “prevented” institutional care. The stronger outcome is that a clearly defined risk was made more manageable while the older man retained a level of independence he valued.

Positive risk-taking should guide technology decisions

Technology is often introduced in response to risk, but risk reduction can easily become excessive restriction.

An older person who occasionally becomes disorientated may be discouraged from walking outside. Someone who has previously fallen may be advised not to use stairs. A person with dementia may find family members increasingly monitoring their movement because technology makes that possible.

The existence of a technical capability does not automatically justify its use.

The stronger principle is positive risk-taking and risk enablement: identifying what matters to the person, understanding the actual risk, introducing proportionate safeguards and reviewing whether those safeguards remain appropriate.

This requires careful distinction between enabling technology and restrictive technology. A location device used with an older person’s agreement to support independent walking can increase freedom. The same device used continuously without meaningful involvement may become surveillance.

Organisations exploring these decisions can use the Positive Risk-Taking Planner to structure thinking about autonomy, benefit, foreseeable harm and proportionate safeguards. It is a generic decision-support framework rather than a Swiss legal instrument, and any use must remain consistent with applicable Swiss law and professional responsibilities.

Medication technology can support independence but cannot replace clinical oversight

Medicines are another important area for smart care. Older people with several long-term conditions may manage multiple prescriptions, different dosing times and frequent changes following medical review or hospital admission.

Automated dispensers and reminder systems can help some people continue managing medicines with less direct assistance. Digital medication records may also improve professional visibility.

Yet medication technology introduces significant governance requirements. The system must reflect the current prescription. Somebody must know when medicines have changed. Missed doses or repeated non-administration may require professional review rather than another automated reminder.

Cognitive ability also matters. A person who understands the device and can respond appropriately may gain independence. Someone who no longer understands what the device is asking them to do may become anxious or take medicines incorrectly.

Technology therefore needs to be linked to ongoing assessment rather than installed once and assumed to remain appropriate.

This distinction becomes particularly important during transitions from hospital to home, when medication regimens may have changed and the risk of conflicting information is greater.

Remote monitoring can extend professional visibility between visits

Remote monitoring creates one of the strongest opportunities for technology-enabled home care because professional services are necessarily intermittent.

A Spitex nurse may visit once or several times during a day, but the person continues living for many hours without a professional present. Selected technologies can provide information between visits that would otherwise remain invisible.

Depending on the individual and clinical purpose, this may include agreed health measurements, changes in movement, unusual inactivity or other indicators suggesting that the person’s normal pattern has changed.

This aligns with wider remote monitoring and telecare approaches, but the value lies in interpretation rather than data collection alone.

A single unusual reading may be insignificant. A gradual pattern of reduced activity alongside missed meals and increasing fatigue may be more important. Technology works best when information is considered together with professional observation and what the person says about their own health.

Scenario: a sensor identifies change, but professional judgement determines the response

A 79-year-old woman with heart failure lives independently in a rural area. Spitex provides regular nursing visits, while her son visits at weekends.

Her care arrangement includes agreed remote monitoring because previous deterioration has developed gradually between visits. The technology is intended to provide additional information, not continuous surveillance.

Over several days, the system identifies a reduction in her normal level of movement. A routine health measurement has also moved outside the agreed range. Neither data point automatically generates an emergency response.

A Spitex nurse contacts her and discovers that she has become more breathless and has stopped preparing normal meals because walking to the kitchen feels tiring. The nurse completes a clinical assessment and contacts the medical practice.

Her treatment is reviewed, additional Spitex input is temporarily arranged and her son is informed with her agreement. Hospital admission is avoided.

The provider subsequently reviews the episode. It confirms that the alert threshold generated useful information, but it also notes that the meaningful intervention came from combining technology with conversation and clinical judgement.

If the system had simply classified reduced movement as a fall risk, an important health deterioration might have been missed. Smart care therefore depends on context: technology detects change, while skilled practitioners determine what the change means.

Dementia creates some of the most difficult smart-care decisions

Assistive technology can be particularly valuable for people living with dementia. Calendar prompts, automated lighting, simplified phones, door alerts, medication support, location technology and environmental sensors may extend independence as memory and orientation change.

But dementia also makes consent, proportionality and interpretation more complicated.

A sensor indicating that somebody has opened the front door at 02:00 may identify a genuine safety concern. It may also record an ordinary choice made by an adult in their own home. A family member receiving repeated location information may feel reassured while the person being monitored experiences little benefit themselves.

Technology should therefore sit within person-centred dementia planning, not replace it.

Professionals and families need to understand the person’s routines, previous preferences, communication and reasons for behaviour. Apparent “wandering”, for example, may represent a meaningful wish to walk, find a familiar place or maintain a lifelong routine.

The stronger question is not how to stop movement, but how to make valued movement safer while responding appropriately when the risk changes.

Technology may support that balance, particularly when combined with dementia-aware environmental design, reliable human contact and regular review.

Family carers can benefit from technology, but responsibility must not simply be transferred to them

Family care is already deeply embedded in Swiss long-term care. Many older people receiving formal home support also rely on relatives for shopping, supervision, transport, administration and emotional support.

Smart-care technology can reduce some uncertainty for families. A daughter may no longer need to telephone repeatedly to check whether her father has returned home. A medication system may reduce daily prompting. Remote communication can make it easier for relatives living further away to remain involved.

However, technology can also create a new unpaid role: permanent digital responder.

A family member may begin receiving alerts throughout the day and night, interpreting information they do not fully understand and feeling responsible for deciding whether professional help is needed.

This can increase rather than reduce carer burden.

The design of family partnership in dementia and long-term care therefore needs explicit boundaries. Families should know:

• which alerts they will receive;
• what they are expected to do;
• when professional services take responsibility;
• how urgent situations are escalated;
• how arrangements change if the family can no longer provide the assumed response.

Technology should help formal and informal support work together. It should not make relatives the default 24-hour monitoring service merely because an app allows alerts to be sent to them.

Scenario: smart care reveals that the support model depends too heavily on a daughter

An 83-year-old man with early dementia lives alone. His daughter has supported him for several years and checks his smart-home application frequently from work.

Door sensors show when he leaves home, a medication device reports missed doses and a household sensor identifies unusual inactivity. The arrangement initially reassures both of them.

As his dementia progresses, alerts become more frequent. His daughter begins leaving meetings to telephone him and drives to his home several evenings each week. On paper, the technology-enabled arrangement still appears successful because he remains at home.

During a Spitex review, the nurse asks how the system is working for both of them rather than looking only at the man’s safety data. His daughter admits that she is exhausted and worried that missing an alert will make her responsible for harm.

The support plan is redesigned. Spitex input increases, professional escalation is attached to selected alerts and the family stops receiving routine notifications that do not require action. His medication support is also reassessed because reminders alone are no longer reliable.

Technology remains part of the model, but the governance question changes from “is the system functioning?” to “is the whole arrangement sustainable?”

The scenario illustrates why family capacity must itself be monitored. A technologically sophisticated home-care plan can still be fragile if its real operating system is an exhausted relative.

Digital inclusion is a safety and equality issue

Switzerland has high levels of internet access, including among many older adults, but digital participation still differs substantially by age, education, income, health and confidence.

The difference is particularly important among people aged over 80, the group most likely to experience long-term care needs. Some use smartphones, tablets and online services confidently. Others depend heavily on relatives or avoid digital services because of complexity, security concerns or limited experience.

This means smart care cannot assume one model of the “older user”.

A technically elegant application may fail if text is difficult to read, login procedures are confusing or software updates require assistance. Technology may also become unusable following a stroke, visual deterioration or cognitive change even though the person previously managed it independently.

The principle of digital inclusion therefore requires more than providing a device.

People may need installation, explanation, accessible interfaces, ongoing technical support and a non-digital alternative where appropriate. Designers also need to consider Switzerland’s multilingual context and the needs of people whose preferred language differs from that used by a standard interface.

Strong smart-care models treat digital capability as something that can change over time and include it within review.

The home must remain a home

Smart care is different from hospital technology because it enters private domestic space.

A hospital patient reasonably expects extensive clinical monitoring for a limited period. A person living at home may spend years surrounded by sensors, cameras, microphones or connected devices if technology is introduced without careful limits.

That creates important ethical questions.

Movement data can reveal when someone sleeps, uses the bathroom, leaves the property or receives visitors. Voice-enabled technology may capture sensitive conversations. Location devices can create detailed records of movement outside the home.

These issues sit within digital safeguarding and technology-enabled risk as well as data protection.

Good governance therefore considers data minimisation: collecting only what is necessary for the agreed purpose. A system designed to detect prolonged inactivity may not need to record every movement. A family member may need an alert that assistance is required rather than continuous access to the person’s location.

This is where technical design becomes a rights issue. The best smart home is not the home collecting the most data. It is the one using the minimum proportionate technology necessary to support the outcomes the person values.

Technology has to work with housing, not compensate endlessly for unsuitable housing

Assistive technology is sometimes treated as though any home can be made suitable through enough devices. That assumption is unsafe.

Older Swiss housing can present practical barriers including stairs, inaccessible bathrooms, limited space for equipment or buildings that are difficult to adapt. Technology may help manage some risks but cannot remove every structural obstacle.

Automated lighting may reduce night-time falls risk, but it does not make a steep staircase accessible. A remote alarm may shorten the response after a fall, but it does not remove the environmental cause of repeated falls. Smart door controls may support access, but they cannot resolve every mobility barrier within a building.

For this reason, assessment should consider assistive technology alongside physical adaptations, equipment and housing options.

The broader policy direction is also changing. Amendments to Switzerland’s supplementary-benefits arrangements will increase support for eligible people receiving certain help and assistance at home from 2028, while changes connected with wheelchair-accessible housing and additional space for night assistance begin earlier. These reforms apply within the supplementary-benefits framework rather than creating a universal technology or housing entitlement.

The underlying principle is nevertheless important: sustaining independence may require investment in the home environment as well as care hours.

Spitex organisations need to govern technology as part of care

As technology becomes embedded in home care, Spitex organisations increasingly need capabilities that go beyond purchasing equipment.

They need to understand which technologies fit which care situations, how devices connect to professional workflows, what happens when systems fail and whether staff have the competence to interpret the information produced.

This creates a lifecycle rather than a procurement event:

• assess whether technology is appropriate for the person;
• agree the intended outcome and boundaries of monitoring;
• install and test the system;
• train the person, relatives and professionals who will use it;
• monitor alerts, faults and unintended consequences;
• review whether the technology remains proportionate as needs change.

The review stage is particularly important. Smart-care systems can remain in place long after the original reason for introducing them has changed.

A person may become unable to respond reliably to reminders. A family carer may move away. A sensor may generate so many false alarms that staff begin ignoring it. A new health condition may require a different response.

Technology governance therefore needs the same discipline as other aspects of care planning.

Organisations can use the Digital Transformation Readiness Assessment to structure questions about infrastructure, leadership, workforce capability and technology governance. It is not a Swiss accreditation framework, but it can help identify whether an organisation has the operational foundations required before smart-care systems become more complex.

Workforce capability will determine whether smart care adds value

Assistive technology is sometimes described as a response to workforce shortages. That is only partly accurate.

Technology can reduce unnecessary travel, automate selected administrative processes and allow some monitoring to happen remotely. It may help a smaller workforce use its time more intelligently.

At the same time, smart care creates new work.

Someone has to assess suitability, install systems, respond to alerts, interpret data, troubleshoot failures, support users and review whether the technology is still appropriate. More data can also create more work if systems generate excessive notifications.

The workforce requirement is therefore role redesign rather than simple substitution.

Spitex nurses may increasingly need confidence interpreting remotely generated information. Care workers need to know when a technology problem is actually a change in the person’s needs. Service managers need to understand supplier performance and cyber resilience. Clinical leaders need assurance that automated thresholds are supporting rather than distorting professional judgement.

This creates a stronger link between smart care and workforce competence in older people’s services.

Technology should remove low-value burden where possible so professionals can spend more time on the work machines cannot replicate: observation, judgement, reassurance, relationship-building and understanding what matters to the individual.

Quality evidence needs to show whether technology improves life

Counting devices is a weak measure of smart-care success.

A canton or provider could install hundreds of sensors without demonstrating that people experienced greater independence, fewer avoidable emergencies or better quality of life.

The stronger evidence set combines safety, experience, operational and outcome information.

Useful measures may include whether technology:

• helped the person continue activities they valued;
• reduced the consequences of falls or other emergencies;
• identified deterioration earlier;
• reduced unnecessary professional visits without reducing necessary human contact;
• improved family sustainability rather than shifting responsibility onto relatives;
• generated false alarms, equipment failures or privacy concerns.

This is consistent with stronger data quality and performance measurement. The technology itself generates data, but those data should not become the only definition of success.

A person may have fewer alerts because they have stopped moving around independently. Technically, the system looks quieter; personally, the outcome may be worse.

Providers and system partners can use the Quality Dashboard Builder to structure balanced indicators covering outcomes, risk, experience and operational performance. Used in the Swiss context, it should complement rather than replace local quality requirements and professional judgement.

Scenario: a canton measures independence rather than the number of devices

A canton supports an initiative aimed at helping older people remain at home through a combination of Spitex, emergency alarms, remote monitoring and selected smart-home technology.

Initial reporting concentrates on activity: numbers of devices installed, people enrolled and alerts generated.

After a year, decision-makers realise that the information does not show whether the programme has improved people’s lives.

The evaluation framework is redesigned. It begins tracking whether people remain at home in line with their preference, emergency response times, avoidable hospital use, changes in formal care hours, family-carer experience, false alarms and cases where technology is withdrawn because it is no longer appropriate.

Interviews with older people reveal another issue. Some value the reassurance provided by monitoring, while others report that excessive family notifications make them feel watched.

The canton does not conclude that technology is either successful or unsuccessful. Instead, it identifies which combinations work for different circumstances.

This changes future investment. Rather than purchasing one standard technology package for every participant, local services are encouraged to select proportionate solutions around agreed outcomes and review them as needs evolve.

The governance improvement is significant: smart care becomes an adaptive service model rather than a device-distribution programme.

Scaling smart care will require stronger interoperability and supplier discipline

As more technologies enter the home, fragmentation can become a serious problem.

An older person could potentially have one system for emergency calls, another for medication, another for remote health monitoring and separate applications used by Spitex, the family doctor and relatives.

Each may work individually while collectively creating complexity.

Switzerland’s wider digital-health transformation therefore matters to assistive technology. DigiSanté and related work on data standards and interoperability create an opportunity for information to move more coherently between systems over time.

However, smart-home and consumer technologies extend beyond conventional clinical systems. Not every device will necessarily be designed around national healthcare infrastructure.

Providers and cantons therefore need supplier discipline. Procurement should examine whether data can be exported, whether interfaces are available, how software updates are managed, what happens when a supplier leaves the market and whether the person can change provider without losing important information.

Cyber security is equally important. A connected device may become part of the care pathway even when it was originally marketed primarily as consumer technology.

This means technology choice should increasingly consider interoperability, security, accessibility, lifecycle cost and exit arrangements alongside headline functionality.

Smart care can support a community shift, but it cannot create community capacity by itself

The longer-term strategic opportunity is to use technology as one element of a broader shift towards sustainable community care.

Switzerland’s projected growth in long-term care demand means that simply expanding nursing-home capacity is unlikely to be the only response. Spitex, accessible housing, prevention, rehabilitation, family support and intermediate models will all influence how much care can safely be provided outside institutions.

Assistive technology can extend that capacity at the margins.

It can make a person who is almost able to live independently more secure. It can help professionals identify change earlier. It can make some tasks manageable without direct assistance. It can help families remain involved without being physically present at every moment.

But technology cannot create a workforce where none exists. It cannot repair unsuitable housing, eliminate social isolation or turn an exhausted family into a sustainable care network.

This distinction will become more important as technologies become more persuasive. Artificial intelligence and increasingly sophisticated sensors may make it technically possible to monitor many dimensions of everyday life. The operational question will remain whether doing so improves the person’s life.

The strongest future model is therefore likely to combine person-centred technology and digital enablement with accessible housing, flexible Spitex, professional healthcare and community relationships.

The international lesson is to govern outcomes rather than gadgets

Switzerland’s experience highlights a wider challenge facing ageing societies.

Technology policy can easily become product-led. Governments announce devices, providers count installations and innovators demonstrate increasingly sophisticated monitoring capability.

The transferable lesson lies in asking a different question: what problem in the person’s life or care pathway is the technology intended to solve?

That question creates a more disciplined sequence. Start with the outcome, understand the person’s strengths and risks, consider the human and environmental support already available, select technology only where it adds value and then monitor whether the outcome actually improves.

This approach also avoids presenting technology as a universal answer to demographic ageing. The person requiring occasional reassurance after a fall needs a different response from somebody with advanced dementia, unstable health and an exhausted family carer.

Countries with more centralised systems may be able to standardise technology more quickly than Switzerland. Others may have similarly fragmented responsibilities. The institutional mechanism will differ.

What remains transferable is the underlying principle: assistive technology works best when it is integrated into care, housing, workforce and governance rather than treated as a separate innovation programme.

Conclusion

Assistive technology has a credible and increasingly important role in Switzerland’s response to demographic ageing. Emergency call systems, medication support, sensors, remote monitoring and connected-home technologies can help older people remain independent, provide earlier warning when needs change and make professional support more responsive.

But the strategic value of smart care will depend less on the sophistication of individual devices than on the system built around them. Spitex organisations need clear escalation pathways. Families need defined roles rather than unlimited digital responsibility. Professionals need the skills to interpret information. Technology suppliers need to meet expectations around security, reliability and interoperability. Most importantly, older people need genuine influence over what is introduced into their homes and how their information is used.

Switzerland’s federal structure means adoption will continue to vary between cantons, municipalities, providers and households. That variation can support innovation, but it also makes shared standards, evidence and governance increasingly important as technology becomes embedded in ordinary long-term care.

The strongest future direction is therefore not the fully monitored home. It is the intelligently supported home: one in which technology removes avoidable barriers, makes selected risks more manageable and strengthens human care without overwhelming privacy, autonomy or ordinary life. If Switzerland can maintain that balance while community-care demand grows, smart care can become part of sustainable long-term care rather than simply another layer of technology.