Austria’s 24-Hour Care Model: Migrant Care Workers, Live-In Support and System Dependence

For an Austrian family trying to keep a parent with substantial care needs at home, the decisive question may not be whether Pflegegeld exists or whether a mobile service can visit twice a day. It may be who will be present during all the hours between those visits. Where somebody requires extensive everyday assistance, supervision or reassurance, Austria has developed a particularly distinctive answer: 24-Stunden-Betreuung, or 24-hour care.

The model has become an important part of the wider system explored through the Austria Ageing, Long-Term Care & Community Support Knowledge Hub. Since a legal framework was established in 2007, people can receive live-in support in private households through self-employed or employed Personenbetreuerinnen and Personenbetreuer. In practice, the model is strongly associated with carers who travel to Austria from other European countries, work an intensive live-in rotation and then return home while another carer takes over.

This arrangement can preserve something extremely important: the possibility of remaining in a familiar home despite needs that would be difficult to meet through intermittent visits alone. Yet its apparent simplicity conceals a complex care economy. Pflegegeld contributes towards costs but does not pay for the whole arrangement. A separate public subsidy may be available. Households often engage an intermediary agency. Employment status changes costs and responsibilities. Some nursing or medical activities require formal delegation. Quality depends on what happens inside a private home, while workforce sustainability depends partly on labour markets beyond Austria’s borders.

Austria’s 24-hour model is therefore more than a service type. It is a revealing example of how autonomy, family responsibility, migration, regulation and public financing can become interdependent within long-term care.

What “24-hour care” actually means in Austria

The term 24-Stunden-Betreuung can easily create the wrong impression for an international reader. It does not ordinarily mean that one worker provides active care continuously for 24 hours a day, nor is Personenbetreuung synonymous with professional nursing.

The model is designed around the presence of a Betreuungskraft in the person’s private household. Depending on the individual arrangement, the worker may help with everyday activities, household tasks, companionship and aspects of personal support. The value of the arrangement lies partly in availability: somebody is living in the household and can provide support across a much wider span of the day than conventional scheduled mobile visits.

That makes the model particularly relevant where a person can still live at home but cannot safely or practically manage long periods alone.

Austria permits Personenbetreuung through two principal legal forms:

• a self-employed Betreuungsperson operating under the regulated framework for the free trade of Personenbetreuung under the Gewerbeordnung; or
• an employed Betreuungskraft working under an employment relationship governed in relevant respects by the Hausbetreuungsgesetz.

The distinction is fundamental. It affects social insurance, employment obligations, working arrangements, public subsidy levels and who carries different legal responsibilities.

It is also important not to determine status merely from the title written on a contract. Austrian guidance distinguishes genuine self-employment through the substance of the working relationship, including the degree of independence over how and when contracted activities are undertaken. Where the reality resembles dependent employment, calling somebody self-employed does not by itself settle the legal position.

This employment-status question sits at the centre of the model’s long-term sustainability because the economics of self-employed and employed care are materially different.

The legalisation of 24-hour care brought an existing reality into formal governance

The 2007 framework was important because live-in care had already become a practical response for households requiring substantial support. Formalisation brought the model within clearer rules and created a public funding mechanism rather than leaving a large part of home-based care in an uncertain legal space.

The resulting architecture crosses several areas of law and administration. The Hausbetreuungsgesetz provides part of the framework for employed live-in care. Self-employed Personenbetreuung operates through the Gewerbeordnung. Health and nursing legislation determines the circumstances in which certain nursing or medical activities may be undertaken following instruction or delegation. Public financial assistance sits within the federal long-term care framework and is administered through the Sozialministeriumservice.

This is significant from a governance perspective. Austria did not create a new professional nursing service and call it 24-hour care. It formalised a distinct form of personal support in the home and then constructed interfaces with professional healthcare, public subsidy and quality assurance.

Those interfaces matter because the people using the model may have high levels of dependency. A legal boundary that looks technical on paper becomes a safety issue when somebody needs medication support, mobility assistance or a task that crosses into nursing practice.

The wider principle of clear organisational responsibility and accountability is therefore highly relevant. In a household involving the person receiving care, relatives, one or more Betreuungskräfte, an agency and potentially nurses or doctors, responsibility must not disappear between participants.

Funding combines Pflegegeld, a specific subsidy and household resources

The economics of 24-hour care illustrate the layered nature of Austrian long-term care financing particularly clearly.

Pflegegeld provides the person with a national cash benefit according to assessed care need. In 2026, level 3 provides €592.60 per month, with progressively higher amounts through the seven-level system. But Pflegegeld is expressly a contribution towards care-related additional costs rather than a complete care budget. Actual 24-hour care costs can substantially exceed it.

A separate federal subsidy for 24-Stunden-Betreuung can therefore become important. Subject to the relevant conditions, support is generally available where the person requires round-the-clock care, receives at least Pflegegeld level 3 and meets the income requirements.

For 2026, the maximum standard subsidy is:

• €400 per month for one self-employed Betreuungsperson, up to €800 for two;
• €800 per month for one employed Betreuungsperson, up to €1,600 for two.

The monthly net-income threshold for the person receiving care is €2,500, with specified increases for dependants. Pflegegeld and certain other payments are excluded from the income calculation, and assets are not taken into account for this subsidy. Länder may also have additional arrangements relevant to households.

The public contribution is therefore meaningful, but a substantial private financing requirement can remain. Families may combine Pflegegeld, the 24-hour subsidy, pension or other income and their own contributions. Eligible care expenditure may also interact with Austrian tax provisions.

The result is neither wholly publicly funded care nor purely private purchasing. It is a mixed financing model in which the viability of remaining at home can depend on both public entitlement and household resources.

Operational scenario: the home-care option exists, but affordability shapes the decision

An 84-year-old woman in Lower Austria has deteriorated following repeated falls. She wants to remain in the house where she has lived for more than four decades. Her daughter lives 40 kilometres away and works full time. Mobile services can support parts of the day, but the family is increasingly concerned about long periods when the woman is alone.

Following assessment, her Pflegegeld reflects her increased care requirement. The family explores 24-Stunden-Betreuung and establishes that the relevant conditions for public financial assistance may be met.

That does not make the decision purely administrative. The family needs to understand the total cost of the proposed arrangement, what the public subsidy and Pflegegeld will contribute, the fees and contractual terms involved, what the Betreuungskräfte will actually provide and how additional nursing requirements will be handled.

They also need a suitable room and living conditions for the carers. Two self-employed Betreuungskräfte are proposed on a rotating basis so that continuity can be maintained across successive live-in periods.

The arrangement allows the woman to remain at home, but the household still carries a material share of the cost. Her daughter therefore compares the option not simply with “no care” but with different combinations of mobile services, family support and possible residential care.

The scenario demonstrates why person-centred planning in long-term care must include economic reality. A preferred home arrangement is meaningful only if it can be sustained financially, operationally and safely rather than assembled temporarily around an unaffordable package.

Self-employment is central to the model’s economics

Although Austrian law permits both self-employed and employed 24-hour care, self-employment has become particularly important to the model.

A self-employed Personenbetreuerin or Personenbetreuer operates a business, requires the appropriate Gewerbeberechtigung, carries relevant social-insurance and tax responsibilities and should possess genuine entrepreneurial independence. The household purchases a service rather than employing the worker in the conventional sense.

This can create flexibility and lower direct labour costs than an employment model. It also changes the distribution of risk.

An employed worker has an employer and the protections and obligations associated with employment. In a self-employed arrangement, the Betreuungskraft carries more responsibility for their own business activity. The household and any Vermittlungsagentur must understand the distinction and avoid creating contractual language that bears little relationship to how work is actually controlled.

That matters especially in live-in care because the worker is physically present in another person’s home for an extended period. The boundary between being available and being directed continuously can become blurred.

The model therefore raises a wider question about fair work and responsible employment. Legal self-employment and fair working conditions are not opposing concepts. A sustainable system still needs transparent remuneration, understandable contracts, appropriate rest, freedom from exploitation and realistic expectations about what one individual can provide.

Austria’s strategic challenge is to retain the flexibility that makes live-in care viable without allowing flexibility to become a mechanism through which workforce risk is transferred invisibly to the carer.

Cross-border mobility is not peripheral to 24-hour care

Austria’s 24-hour care model cannot be understood solely as a domestic workforce arrangement. Its practical operation has become closely connected to European labour mobility.

Many Personenbetreuerinnen and Personenbetreuer travel from Central and Eastern European countries to work in Austrian households. Multilingual federal information for workers is available in languages including Slovak, Romanian, Hungarian, Polish, Croatian and Bulgarian, reflecting the cross-border reality of the sector.

The common rotational pattern is fundamental to how the service works. A Betreuungskraft may live with the person for an extended block before returning to their home country, while another worker takes over. Continuity therefore depends not on one permanent live-in employee but on an organised succession of carers.

This creates a transnational care chain. Austria gains workforce capacity that helps people remain at home. Workers gain income opportunities. Families obtain a level of presence that would often be extremely expensive to reproduce through conventional hourly employment.

But dependence flows in both directions.

Austria becomes exposed to transport disruption, changes in cross-border labour supply, differences in earnings between countries, demographic change in sending countries and the willingness of workers to accept long rotations away from their own families. Sending countries can simultaneously experience care-worker outflow from their own ageing populations.

The transferable lesson is not that labour mobility is inherently problematic. International recruitment can be an important and legitimate component of a care workforce. The governance requirement is to understand when a flexible workforce source has become a critical system dependency.

That is a deeper issue than ordinary care-sector recruitment. It concerns the resilience of an entire service model.

A rotation is a continuity system, not merely a staffing schedule

For the person receiving care, a change of Betreuungskraft can be highly significant. The incoming worker needs to understand routines, mobility, food preferences, communication, medication-related arrangements, risks, household expectations and the boundary between activities they can perform independently and those requiring professional delegation.

This becomes especially important for people living with dementia, sensory impairment or communication difficulties. Familiarity may itself contribute to safety and wellbeing.

A strong rotation therefore requires reliable transfer of information without turning the home into an unnecessarily bureaucratic environment.

Key information needs to remain accessible and current: changes in health, falls, appointments, delegated activities, equipment, emergency contacts, household routines and emerging concerns. The person receiving care and their relatives should know who to contact when a problem cannot wait for the next rotation.

Continuity also has a relational dimension. Constantly introducing new workers may reduce the stability that makes live-in support valuable in the first place. Agencies and households therefore have an interest in maintaining dependable pairings where possible rather than treating Betreuungskräfte as interchangeable units of labour.

This is where workforce resilience and continuity connect directly with person-centred outcomes. The operational measure is not simply whether every day is covered. It is whether coverage preserves knowledge, trust and safe practice.

Operational scenario: a disrupted rotation becomes a system resilience problem

A man with advanced Parkinson’s disease lives with his wife in Upper Austria. Two self-employed Betreuungskräfte normally alternate extended periods in the household. Both live outside Austria and travel by road to begin their rotations.

One carer becomes unavailable shortly before a planned handover. The immediate problem is obvious: the outgoing Betreuungskraft cannot simply remain indefinitely, while the man’s wife cannot safely absorb the full care requirement.

A well-governed arrangement requires more than searching urgently for any available replacement. The intermediary agency needs a contingency route. The family needs clear information. Any substitute must understand the person’s needs and be appropriately capable of performing the agreed activities. Where delegated nursing tasks are involved, the relevant professional requirements must also be addressed.

The episode is resolved through a temporary replacement, but it generates a wider question for the agency: how often are rotations becoming vulnerable because suitable substitutes cannot be secured?

If similar disruptions recur, they should influence recruitment strategy, contingency planning and the size of the available workforce pool rather than being treated as unrelated emergencies.

Organisations examining comparable dependencies can use the Digital Twin Scenario Modeller to test how workforce absence, travel disruption and demand changes affect service continuity. It is not an Austrian regulatory instrument, but scenario modelling is particularly valuable where a service depends on a small number of people arriving at the correct time from another country.

Vermittlungsagenturen occupy a powerful position between household and worker

Many families do not identify, contract and coordinate Personenbetreuerinnen entirely by themselves. Vermittlungsagenturen organise the placement of carers and can therefore become central actors in the 24-hour care relationship.

Their role can include matching, contractual administration, coordination and support when an arrangement changes. For a family unfamiliar with Gewerberecht, social insurance, rotation planning and the boundaries of Personenbetreuung, this intermediation can make the model practically accessible.

But intermediation also creates an additional governance layer.

The household needs transparency about agency charges and services. The Betreuungskraft needs clear contractual information about fees, expectations and their relationship with the agency and client. Matching needs to consider the actual support requirement rather than simply whether a worker is available.

Austria regulates the business of organising Personenbetreuung through the Gewerbeordnung and associated professional rules. The framework matters because an intermediary has influence over both the consumer experience and the conditions under which a potentially vulnerable mobile workforce enters private homes.

The relationship is therefore triangular rather than conventional:

• the person receiving support and family need safe, reliable and understandable care arrangements;
• the Betreuungskraft needs fair, transparent and lawful conditions;
• the agency needs to coordinate the arrangement while complying with its own professional obligations.

A weakness at any point can destabilise the other two.

ÖQZ-24 adds a voluntary quality layer above legal minimums

The Österreichisches Qualitätszertifikat für Vermittlungsagenturen in der 24-Stunden-Betreuung, usually shortened to ÖQZ-24, provides an important additional quality mechanism.

It is an Austria-wide certification for Vermittlungsagenturen that choose to demonstrate standards beyond the statutory baseline. Certification is voluntary; it is not a legal requirement for every agency operating in the sector.

That distinction should remain clear. A certified agency is demonstrating compliance with the certification framework and additional quality requirements, while an uncertified agency is not automatically unlawful merely because it lacks ÖQZ-24.

The certification includes significant operational expectations. These include contractual arrangements around emergency planning and quality assurance through regular home visits by qualified nursing professionals, with certified agencies required to provide such visits at least quarterly.

This brings professional oversight closer to a care model that otherwise operates largely inside private homes.

The underlying principle connects with wider quality standards and assurance frameworks: certification is strongest when it changes everyday practice rather than becoming primarily a badge displayed by the intermediary.

For 24-hour care, the meaningful questions are whether risks are identified earlier, tasks remain within lawful boundaries, carers receive appropriate support, emergencies are anticipated and households know how concerns will be addressed.

Organisations considering similar multi-party governance arrangements can use the Governance Maturity Assessment to test whether responsibility, escalation and assurance remain clear across organisational boundaries. The framework is generic rather than Austrian, but that question is highly relevant to agency-mediated live-in care.

Care, nursing and medical activity require clear boundaries

One of the most important safeguards within Austrian Personenbetreuung is recognising that everyday Betreuung and professional healthcare are not interchangeable.

A Betreuungskraft can undertake the activities permitted within the relevant legal framework. Certain nursing and medical activities may also be performed where the statutory conditions for delegation, instruction and control are satisfied.

This matters because people using 24-hour care frequently have complex needs. A household may gradually move from companionship, cooking and everyday assistance towards more intensive personal care and health-related tasks as the person deteriorates.

Without clear review, role expansion can occur almost invisibly.

A family may reasonably think, “the carer is here, so perhaps they can do this as well”. The Betreuungskraft may feel pressure to agree because they do not want to disappoint the client or jeopardise the placement. Yet presence does not confer professional authority.

Safe escalation requires recognition that a new task may need assessment by a diplomierte Gesundheits- und Krankenpflegeperson or doctor, appropriate instruction and documentation, or a different professional response entirely.

The distinction protects the person receiving care and the worker. It also prevents the apparent flexibility of live-in care from obscuring an increase in clinical complexity.

Operational scenario: increasing complexity changes the professional interface

An older woman in Burgenland has received 24-hour care for two years. Her arrangement initially focused on meals, household tasks, mobility, personal assistance and supervision. Following a hospital admission, she returns home with a more complicated health situation and additional care requirements.

Her family wants to preserve the existing arrangement because she knows her two Betreuungskräfte well and strongly prefers to remain at home.

The correct response is not automatically to replace 24-hour care with residential provision. Nor is it to assume that the existing carers can simply absorb every new task.

The changed requirements are reviewed. Everyday support remains within the Personenbetreuung arrangement, while relevant nursing or medical activities are considered through the appropriate professional route. Where lawful delegation is possible, the Betreuungskraft requires the necessary instruction and oversight. Other needs may require direct professional input.

The governance signal is the change in complexity itself.

If hospital discharge repeatedly results in live-in carers being expected to perform increasingly technical tasks without timely professional review, the weakness sits at the interface between healthcare and home support rather than solely with individual workers.

Strong decision-making and escalation therefore protects the viability of the model. The objective is not to constrain Personenbetreuung unnecessarily, but to ensure that flexibility does not become unmanaged clinical substitution.

Mandatory home visits connect public subsidy with quality assurance

Austria has also linked the public funding of 24-hour care with quality oversight. Where the specific 24-hour care subsidy is claimed, mandatory home visits by qualified nursing professionals form part of the quality-assurance arrangements.

This is important because public money is supporting care delivered in a private household through a model that may involve self-employed workers rather than a conventional regulated care institution.

A home visit provides an opportunity to look beyond whether the contractual arrangement exists. It can identify issues around the care situation, the practical environment, the tasks being performed and areas where professional advice may be needed.

The stronger opportunity is to treat this contact as both assurance and prevention. A quality visit that detects an emerging mobility problem, inappropriate task or exhausted family member can help alter the arrangement before the issue becomes a crisis.

That reflects the broader logic of quality monitoring systems: information has greatest value when it changes practice, not merely when it confirms that a visit occurred.

Worker wellbeing is inseparable from quality

Live-in care creates an unusually close relationship between workplace and private life. For the Betreuungskraft, the workplace is another person’s home and, for the duration of the rotation, also their temporary living environment.

That arrangement can create rewarding relationships and economic opportunity, but it can also produce isolation, blurred boundaries and emotional pressure. A worker may be geographically distant from their own family and support network while carrying substantial responsibility for somebody with high needs.

Austria’s reform measures have increasingly acknowledged this dimension. Support developments have included counselling provision, supervision and multilingual learning opportunities for Personenbetreuerinnen and Personenbetreuer. Multilingual educational material can improve access to information about issues such as mobilisation, falls and emergency situations.

These are important quality measures because workforce wellbeing and competence are not separate from the experience of the person receiving support.

However, training cannot resolve every workforce issue. If remuneration becomes unattractive relative to alternative employment, rotations become excessively demanding or workers experience poor treatment, the labour supply itself can weaken.

The wider workforce wellbeing principle therefore applies even within a largely self-employed model. A system dependent on human presence cannot treat the sustainability of that human workforce as secondary.

24-hour care can preserve autonomy while creating new safeguarding questions

Live-in care has substantial person-centred strengths. It can allow somebody to remain in familiar surroundings, maintain routines and avoid a residential move that they do not want. A stable relationship with a small number of Betreuungskräfte can offer continuity that fragmented visiting services may struggle to reproduce.

But the intimacy of the model also creates distinctive risks.

The person receiving support may be highly dependent on one worker who is living in their home. The worker may simultaneously depend economically on the placement and agency relationship. Relatives may live elsewhere and have only partial visibility of everyday interactions.

Safeguarding therefore needs to work in both directions.

People receiving care need protection from abuse, neglect, financial exploitation or inappropriate practice. Betreuungskräfte need protection from harassment, exploitation, unsafe accommodation, unreasonable expectations and pressure to perform activities outside their role.

The household itself can also become a source of complexity. Family disagreements about money, care decisions or how the worker should spend their time can place the Betreuungskraft in the middle of disputes they are not equipped to resolve.

This makes accessible complaint routes, agency responsiveness, professional home visits and clear escalation particularly important. The wider principles of proportionate safeguarding information sharing are relevant: privacy within the home matters, but so does the ability to communicate concerns when somebody may be at risk.

Operational scenario: quality concerns test the whole agency relationship

A son living in Salzburg notices during visits to his father that the current Betreuungskraft appears exhausted and is increasingly uncertain about several tasks. She tells him privately that the support requirement has become much greater since the previous rotation and that she does not feel confident managing aspects of it alone.

A weak response would treat this as a performance problem: replace the worker and continue the arrangement unchanged.

A stronger response asks what has altered.

The father’s mobility has deteriorated, night-time assistance has increased and expectations have expanded without a structured review. The agency is contacted, the changed support situation is examined and professional nursing input is sought where appropriate. The incoming rotation receives updated information rather than inheriting the same ambiguity.

The worker’s disclosure becomes quality intelligence rather than evidence of individual inadequacy.

If the agency identifies similar patterns across several households, it has a broader governance issue: needs may be escalating without sufficiently prompt reassessment or matching.

Organisations examining this kind of pattern can use the Quality Dashboard Builder to connect workforce, incident, continuity and quality indicators rather than reviewing them separately. The principle is especially relevant in live-in care, where a staffing difficulty may actually be the first visible sign that a person’s needs have outgrown the existing arrangement.

The model creates a hidden dependency within Austrian home care

The strategic significance of 24-hour care becomes clearest when asking what would happen if substantially fewer Personenbetreuerinnen were available.

Some households could increase mobile services. Others could rely more heavily on relatives. Some people might enter residential care earlier. Yet each alternative draws on capacity elsewhere in the system.

This means 24-hour care is not simply an optional private supplement sitting outside Austria’s formal long-term care architecture. It can absorb demand that would otherwise appear in mobile services, residential facilities or family caregiving.

Interestingly, Austria’s official Pflegedienstleistungsstatistik covering Länder and municipal long-term care services does not include 24-hour care within its seven service categories. That statistical distinction is administratively understandable, but strategically it reinforces the need to view the whole care economy rather than only services captured within one dataset.

A person supported at home by rotating Personenbetreuerinnen still represents long-term care demand. The fact that the delivery mechanism sits partly within household purchasing and self-employment does not make that demand disappear from national capacity planning.

The model should therefore be considered alongside home-care demand and capacity, residential provision, family-carer sustainability and workforce policy.

Dependence becomes risky when it is invisible. Once recognised, it can be planned for.

Data needs to connect affordability, quality and workforce sustainability

Good governance of 24-hour care requires several forms of evidence that are often held in different places.

Public authorities can see subsidy applications and expenditure. Social-insurance and trade structures contain information relevant to workforce participation. Agencies hold operational information about placements, rotations and replacement difficulties. Quality-assurance visits reveal household-level issues. Families understand affordability and continuity from the consumer side. Workers understand whether the model remains attractive and sustainable from the labour side.

No single indicator answers the strategic question.

Rising subsidy take-up could indicate improved access, increased demand or both. A stable number of arrangements could conceal greater difficulty recruiting workers. More home visits could reflect stronger assurance without necessarily showing whether concerns are resolved. Agency certification can strengthen confidence but does not replace system-wide visibility.

The stronger analytical approach connects:

• demand for 24-hour care and Pflegegeld levels;
• subsidy use and household affordability;
• workforce supply, turnover and cross-border recruitment;
• rotation disruption and emergency replacement;
• quality-assurance findings and escalation;
• movement between 24-hour care, mobile services and residential care.

This aligns with wider data quality and performance measurement. The purpose of better data is not to turn private homes into institutional reporting environments. It is to make emerging system risk visible early enough to respond.

Technology can support the model, but presence remains its defining resource

Digital care records, scheduling, secure communication, translation support, telecare and remote professional consultation can all improve 24-hour care.

A digital handover can help information travel between rotating Betreuungskräfte. Video communication may support advice from relatives or professionals. Sensors and telecare may improve safety where used proportionately and with appropriate consent. Digital administration can reduce paperwork for agencies and self-employed workers.

Austria has also expanded multilingual digital learning for Personenbetreuerinnen, which is particularly relevant to a transnational workforce.

Yet technology cannot eliminate the core workforce dependency because the defining resource in 24-hour care is human presence.

Artificial intelligence may eventually help with translation, documentation, scheduling, risk recognition and matching. It cannot legitimately be treated as a substitute for companionship, physical assistance or judgement in a changing household situation.

Digitalisation may even create new risks if poorly implemented: surveillance of workers, intrusive monitoring of the person’s home, alert overload or fragmented platforms that add administrative work.

Organisations considering similar technology-enabled care models can use the Digital Transformation Readiness Assessment to examine governance, workforce adoption and implementation readiness alongside technology itself.

Reform needs to address the economics of care, not only the subsidy rate

Austria has already adjusted the public subsidy for 24-hour care. Since September 2023, the maximum support for two self-employed Betreuungskräfte has been €800 per month and for two employed workers €1,600. From 2024, the increased subsidy entered regular financing with the federal government carrying 60 per cent of the financing cost and the Länder 40 per cent.

Higher subsidy can improve affordability, but long-term sustainability cannot be reduced to periodically increasing the payment.

The underlying economics involve what households can afford, what workers can earn, what agencies charge, the cost difference between employment and self-employment, social-insurance obligations, travel and living arrangements, and the availability of alternative work in Austria and workers’ home countries.

If the amount households can sustainably pay diverges too far from the amount workers need to earn, the model becomes unstable regardless of its legal architecture.

This is why workforce conditions and affordability need to be analysed together. Suppressing labour costs may protect household affordability temporarily while weakening recruitment. Increasing household contributions may improve worker economics while making the model inaccessible to more people.

The policy challenge is therefore distributional: who pays for the true cost of continuous home-based support, and how is that cost shared between the state, Länder, individuals and families?

International learning lies in making dependency visible

Austria’s 24-hour care system is institutionally distinctive. Other countries cannot simply reproduce it by introducing a subsidy or creating a category of self-employed live-in carers.

The model depends on Austria’s Pflegegeld architecture, Gewerberecht, social-insurance arrangements, European freedom of movement, household preferences, intermediary agencies and geographical proximity to countries supplying a mobile care workforce.

Its international value lies instead in the questions it exposes.

Can a country expand home-based choice without understanding who supplies the labour? Can a system describe care as person-centred if the workforce model depends on conditions that are unattractive or unstable for workers? Can public subsidy create genuine access if households still face substantial private costs? Can quality assurance reach effectively into private homes without institutionalising family life? And can governments accurately plan long-term care capacity if a major part of the workforce sits partly outside conventional service statistics?

The transferable lesson is that informal, self-employed and migrant labour must be visible within strategic care planning whenever formal services depend on it.

Austria’s model demonstrates the possibilities of flexible live-in support, but it also shows that flexibility does not remove system responsibility. It redistributes it.

The future of 24-hour care will depend on whether Austria can rebalance the model

24-Stunden-Betreuung is unlikely to become less relevant as Austria ages. The desire to remain at home is strong, family capacity is finite and conventional mobile services cannot economically provide continuous physical presence through short scheduled visits.

The stronger future direction is therefore likely to involve improving the model rather than assuming it can simply be replaced.

That means strengthening quality without making household care unnecessarily institutional. It means improving workforce conditions without making the service financially unreachable. It means supporting agencies to provide reliable matching and contingency arrangements while preserving genuine choice. It means maintaining clear professional boundaries while ensuring that people with increasing needs can receive appropriate nursing input at home.

It also means reducing excessive dependence on any single workforce source. Better mobile services, respite, assistive technology, supported housing and stronger family-carer support can diversify the care options surrounding 24-hour care rather than leaving households with a binary choice between a live-in worker and residential provision.

The strategic goal should not be to maximise the number of people using 24-hour care. It should be to ensure that the model is available where it is the right, sustainable and genuinely preferred arrangement.

Conclusion

Austria’s 24-hour care model has enabled many people with substantial support needs to remain in their own homes by combining Pflegegeld, a dedicated public subsidy, household spending, intermediary agencies and a highly mobile workforce of Personenbetreuerinnen and Personenbetreuer. Its legalisation transformed a difficult area of home care into a more explicit framework and created routes for funding, quality assurance and professional oversight.

Its strategic importance now extends far beyond the households using it. The model depends heavily on self-employment, rotational working and cross-border labour. Its affordability depends on the distribution of costs between public funding and families. Its safety depends on clear boundaries between everyday Betreuung and professional nursing or medical activity. Its continuity depends on workers travelling, returning and being willing to remain in the sector.

That makes 24-hour care simultaneously one of Austria’s strongest mechanisms for supporting ageing at home and one of its most important long-term care dependencies.

The forward challenge is not to choose between preserving the model and criticising it. It is to make the dependency governable: fairer workforce conditions, transparent intermediation, stronger quality assurance, better data, realistic contingency planning and a wider range of home and community alternatives around it. Austria’s experience shows that enabling people to remain at home can be a powerful expression of autonomy, but only when the workforce making that choice possible is itself sustainable.