Financing Long-Term Care in Switzerland: Health Insurance, Public Funding and Household Contributions

For an older person in Switzerland, the cost of long-term care cannot be understood simply by asking whether they have health insurance. Compulsory health insurance is universal and contributes towards recognised nursing services, but it does not pay the entire cost of living with long-term support needs. Cantons and municipalities finance important residual costs, individuals contribute towards care, and households may still have to meet expenses for assistance, accommodation, meals and other forms of everyday support. Supplementary social-security benefits can become crucial where personal resources are insufficient.

This mixed financing architecture is one of the defining features explored throughout the Switzerland Ageing, Long-Term Care & Community Support Knowledge Hub. It matters increasingly as demographic ageing raises demand for Spitex, nursing homes and other forms of support. More people requiring care does not place pressure on one national budget. It increases expenditure across compulsory health insurance, cantonal and municipal finances, households and the unpaid contribution made by families.

The central policy challenge is therefore not simply how much Switzerland will spend on long-term care. It is how responsibility for that expenditure is divided, whether financing arrangements encourage the right balance between home and residential care, and whether people with similar needs can access appropriate support without unacceptable differences arising from income, family resources or place of residence. Financing is not an accounting issue sitting behind care. It influences where people live, what support they can use, how much families provide and which service models remain operationally sustainable.

Swiss long-term care is financed by several systems at once

Switzerland does not operate a single long-term care insurance scheme covering the complete cost of dependency. Instead, financing crosses healthcare insurance, cantonal and municipal public expenditure, social-security benefits and personal spending.

The compulsory health insurance system, known through the Federal Health Insurance Act as obligatory healthcare insurance, contributes to specified nursing services. These can be provided at home, including through authorised Spitex organisations, or within nursing homes. The insurance contribution is defined nationally within the statutory framework rather than negotiated as a complete payment for whatever the service actually costs.

The insured person can also be required to contribute towards nursing-care costs within statutory limits. Where the insurer’s contribution and the person’s permitted contribution do not cover the recognised cost of nursing care, the remaining amount is subject to residual financing arrangements established by the cantons and funded by cantons and/or municipalities.

That still leaves other expenditure. A person living at home may require domestic help, meals, transport, supervision or companionship. A nursing-home resident requires accommodation and board as well as nursing care. Those costs are not automatically transformed into compulsory health-insurance benefits simply because they are essential to the person’s ability to live safely.

The financing model therefore contains several distinct categories:

• recognised nursing services to which compulsory health insurance contributes;
• the person’s permitted contribution towards nursing care and ordinary insurance cost-sharing where applicable;
• residual nursing costs borne under cantonal and municipal arrangements;
• non-nursing support, accommodation and living costs that may require other public benefits or personal payment;
• unpaid support supplied by relatives and other informal carers.

Understanding these categories is essential because a funding boundary can change the practical choices available to an older person even when their underlying needs remain the same.

Compulsory health insurance makes a contribution, not a complete payment

The Swiss model distinguishes between the actual cost of providing nursing care and the contribution made by compulsory health insurance. For approved nursing services, the insurer pays nationally regulated amounts. Home-based nursing contributions depend on the type and duration of the service, while nursing-home contributions are structured according to assessed levels of care need.

This is an important distinction from systems in which a public payer purchases an entire package at an agreed provider price. Swiss compulsory health insurance is financing a defined share of eligible nursing care rather than assuming responsibility for the complete cost of long-term support.

Eligibility for that contribution also depends on statutory conditions. The care must fall within recognised nursing categories, the person’s need must be assessed appropriately, relevant medical requirements must be met and services must be delivered by an authorised provider. These controls connect clinical need, professional assessment and reimbursement.

The practical implication is that good documentation has financial as well as clinical significance. A home-care organisation needs records that demonstrate what nursing was required and delivered. A nursing home needs an assessment of care intensity capable of supporting the relevant reimbursement category. Changes in the person’s condition can therefore affect not only the care plan but the financing attached to it.

This creates a natural connection with recording and evidencing person-centred care. Documentation should not become reimbursement-driven bureaucracy, but neither can a multi-payer system function safely if the relationship between assessed need, delivered care and claimed funding is unclear.

The difference between nursing and support matters financially

One of the most important boundaries in Swiss long-term care is between recognised nursing services and wider assistance with daily life. From the individual’s perspective, these activities may form one seamless need. From a financing perspective, they can sit in different categories.

An older person may require wound care, medication-related support and assistance with personal care that qualifies within insured nursing services. The same person may also need help shopping, cleaning, preparing meals or maintaining social contact. Those activities can be essential to remaining at home, yet they are not automatically reimbursed under the same compulsory insurance arrangements.

In residential care, the distinction becomes equally visible. Nursing-home fees contain components associated with nursing care, but residents also have accommodation, meals and other support costs. Compulsory health insurance does not simply pay the complete nursing-home invoice.

The classification matters operationally because it can influence service design. A home-care provider may deliver both nursing and household assistance, but the two activities can have different funding sources. If public and insurance financing is stronger for one part of the package than another, families may face greater responsibility for precisely those everyday activities that make the nursing intervention workable.

For policymakers, the risk is designing financing around administrative categories while demand presents itself as a whole-person problem. Strong individualised support therefore needs to identify the complete requirement first and then make the funding responsibilities transparent, rather than allowing the funding categories to define the person’s life.

Residual financing makes cantons and municipalities financially consequential

The concept of residual financing is central to Swiss long-term care. Once compulsory health insurance has made its regulated contribution and the individual has made any permitted nursing-care contribution, the remaining recognised nursing cost must be dealt with under cantonal arrangements. Depending on the canton, responsibility may sit with the canton, municipalities or a combination of both.

This makes public authorities financially responsible for the gap between nationally defined insurance contributions and the real cost of providing eligible nursing care. As wages, workforce costs and complexity increase, that gap can become increasingly important.

The design of residual financing therefore affects provider sustainability. If recognised provider costs rise faster than the funding available through the combined insurance, personal and residual financing arrangements, organisations can face pressure even where demographic demand is strong. Conversely, poorly controlled cost growth places increasing pressure on public budgets.

Cantonal variation also matters. Different rules for determining recognised costs, provider arrangements and municipal responsibility can create different operating environments across Switzerland. A service model financially sustainable in one canton cannot automatically be assumed to work identically in another.

Organisations examining similar relationships between expected delivery, cost and assurance can use the Commissioner Evidence Builder to structure evidence about service commitments, funding assumptions and actual delivery. Its terminology reflects UK purchasing arrangements and it does not determine Swiss reimbursement, but the underlying principle is relevant: funding decisions are stronger when the service being financed and the evidence demonstrating delivery are clearly connected.

Scenario: a Spitex organisation cannot treat every hour as financially equivalent

A Spitex organisation experiences a steady increase in older clients with complex needs. Demand appears positive from a service-volume perspective, but managers notice that the financial position is becoming more difficult.

The caseload now contains more people requiring coordination with doctors, several visits each day and substantial travel between homes. At the same time, many clients need domestic assistance alongside nursing. The organisation therefore delivers a mixture of activities that sit within different financing arrangements.

Simply counting total hours obscures the problem. Some activity attracts compulsory health-insurance contributions under the nursing-care framework. Some depends on residual public financing. Other support is funded through different arrangements or paid privately. Travel and coordination consume workforce time even where they are not experienced as direct face-to-face care.

The organisation responds by analysing the cost of different service types, care intensity, geography and staffing requirements rather than treating every visit as a standard unit. It shares emerging evidence with the relevant public authorities before financial pressure affects access or quality.

The lesson is that funding adequacy cannot be judged from demand alone. A service can be fully occupied and still become financially fragile if the reimbursement structure does not reflect the resources required to deliver the changing case mix. This is where performance and quality data need to include economic and operational signals as well as clinical activity.

Home care and nursing homes create different financial experiences

Switzerland’s financing architecture means that moving from home care into a nursing home changes more than the location of care. It can alter which costs appear, who pays them and how the household experiences financial responsibility.

At home, a person may continue paying ordinary housing and living costs while receiving reimbursable nursing care and purchasing or receiving support through separate arrangements. Relatives may also provide substantial unpaid help. In a nursing home, accommodation, board and support are incorporated more visibly into institutional charges alongside the nursing component.

This makes simple comparisons between “the cost of home care” and “the cost of a nursing home” potentially misleading. Home care can appear less expensive if unpaid family work and ordinary housing expenditure are excluded from the analysis. Residential care can appear more expensive because accommodation and support costs are consolidated into one visible setting.

The stronger comparison asks what resources the whole arrangement consumes and who bears them. That includes formal nursing, assistance, housing, family time, travel and the cost of maintaining safety outside an institution.

Household contributions make affordability a care-system issue

Personal expenditure is an intentional component of the Swiss model. People pay compulsory health-insurance premiums and may face ordinary cost sharing for healthcare, while long-term care can generate additional contributions and non-covered expenditure. The financial effect varies according to the person’s needs, resources, living arrangement and canton.

This does not mean older people are expected simply to meet unlimited care costs privately. Switzerland’s social-security architecture includes mechanisms intended to protect people whose recognised living and care-related expenses exceed their available income and resources. Supplementary benefits to old-age and survivors’ insurance can become particularly important for people with limited means, while helplessness allowance can provide support to eligible individuals who require substantial assistance because of impairment.

Nevertheless, navigating the system can require understanding several distinct entitlements. A household may need to differentiate between insurance-funded nursing, cantonal residual financing, supplementary benefits, helplessness allowance, privately purchased assistance and ordinary living costs.

The practical burden of complexity matters. A benefit is less protective if people do not know it exists, cannot understand eligibility or encounter administrative difficulty at precisely the point when care needs are increasing.

Financial navigation should therefore be considered part of accessible long-term care. Families need clear information before major decisions are made, particularly where a move into a nursing home, an increase in home support or a change in family circumstances can materially alter household expenditure.

Supplementary benefits are part of the long-term care safety net

Supplementary benefits have an important place in Swiss social protection because old-age pension income alone may be insufficient to cover recognised living and care costs for some people. They are not simply an optional charitable addition; they form part of the statutory social-security structure where eligibility conditions are met.

The way relevant costs are recognised and administered involves cantonal implementation within the federal framework. This again illustrates the interaction between national entitlement and local administration.

For people in nursing homes, supplementary benefits can be particularly significant because accommodation and living costs sit outside the compulsory health-insurance contribution to nursing. Without a wider social-protection mechanism, the distinction between nursing and accommodation could create major affordability problems for people with modest resources.

There are still policy choices embedded in this system. Rules around recognised expenditure, income and assets affect who receives support and how much personal resource is expected to be used. Those rules can also influence families’ perceptions of the financial consequences of residential care.

The governance objective should be to understand not merely how many people receive support but whether financing arrangements maintain reasonable access to appropriate care. Measures of affordability and unmet need therefore deserve a place alongside conventional expenditure data.

Scenario: residential care becomes necessary, but the family first sees only the headline fee

An 88-year-old woman has been living at home with increasing Spitex support and substantial assistance from her son. Following repeated falls and worsening cognitive impairment, the family and professionals agree that a nursing home is becoming the safer and more sustainable option.

Her son initially assumes compulsory health insurance will cover most of the cost because the move is being driven by care needs. When he receives information about the nursing home, he sees separate elements for nursing, accommodation and other charges. The distinction between the insurer’s nursing contribution, the resident’s contribution, residual public financing and personally payable living costs is difficult to understand.

The financial conversation therefore becomes part of the transition. Her resources and potential entitlement to supplementary benefits are assessed, and the family receives an explanation of which costs sit in which part of the system. That allows the decision to be made on a realistic basis rather than through fear generated by the headline price.

The operational lesson is important. Care-pathway decisions should not assume families understand the financing architecture simply because the rules are formally available. Financial uncertainty can delay decisions, create conflict between relatives or lead people to reject appropriate options without understanding what public support may apply.

Good support planning and review therefore includes practical financial navigation where a change of setting materially changes the household’s obligations.

Family care reduces visible expenditure but does not remove cost

One of the most significant financing questions in long-term care is the treatment of unpaid family support. When relatives shop, supervise, transport, coordinate appointments or provide personal assistance, that activity may reduce the amount of formal care purchased by insurers, cantons, municipalities or households.

Economically, however, the care is not cost-free. A daughter may reduce working hours. A partner may experience declining health from sustained caring. A relative may travel long distances several times each week. Families can purchase equipment or domestic support privately to make care at home workable.

This creates a form of hidden financing. Instead of appearing as public expenditure, part of the cost is absorbed through unpaid time, lost earnings and family resources.

The distinction matters especially when policymakers compare home and residential models. A home-based pathway may deliver better autonomy and lower formal expenditure, which can be highly desirable. But if its viability depends on intensive unpaid support, the system needs to recognise that dependence rather than presenting the reduction in public spending as pure efficiency.

The principles within family partnership and carer support are therefore also financing principles. Sustainable care requires visibility of what families contribute and what happens if they can no longer provide it.

Financing can shape whether care moves towards home or institutions

Switzerland faces a strategic objective shared by many ageing countries: supporting more people outside institutions where this is safe, desired and sustainable. Financing can either reinforce or frustrate that goal.

If nursing services are reimbursed effectively at home but essential domestic assistance, supervision or housing adaptations remain difficult to fund, the overall package can still become fragile. Conversely, if institutional arrangements make all necessary support easier to assemble in one place, a nursing-home admission can become operationally simpler even where the person might have preferred to remain at home.

This does not mean one setting should always be financially favoured. People with high and continuous needs will continue to require residential and nursing provision. The stronger principle is that funding boundaries should not create avoidable incentives towards a more restrictive or expensive setting simply because the complete support package is easier to finance there.

That brings financing into contact with independence and community inclusion. If policy intends to support ageing at home, the relevant question is whether the combination of insurance, public financing, housing and personal support makes that intention operationally credible.

Scenario: home care is cheaper for the public system only because a daughter absorbs the gap

An older man with Parkinson’s disease lives at home. He receives professional nursing and personal-care support, while his daughter visits daily, prepares meals, handles laundry, accompanies him to appointments and remains available for unplanned problems.

A comparison of formal expenditure suggests that supporting him at home costs substantially less than residential care. On that basis, his pathway appears both person-centred and economically efficient.

When his daughter accepts a new job further away, the hidden financing becomes visible. Without her daily contribution, the man requires additional practical help, meal support, transport and more flexible cover around his professional visits. Some of these needs sit outside the same insurance arrangements as nursing care.

The revised cost of maintaining him safely at home is therefore higher than the original public expenditure suggested. Remaining at home may still be the preferred and appropriate option, but the comparison is now more honest.

This scenario illustrates why strategic financing models should distinguish between public expenditure and total resource use. The purpose is not to monetise every family relationship. It is to avoid building long-term policy on an assumption that invisible support has no economic limit.

Provider sustainability depends on how recognised costs are determined

Residual financing creates an operational relationship between providers and the public authorities responsible for meeting the uncovered portion of recognised nursing costs. The way costs are assessed therefore matters to service sustainability.

Providers face labour costs, training, management, technology, property, travel, administration and quality-assurance requirements. Home care can be particularly sensitive to geography because staff time between visits consumes productive capacity. Residential services carry significant fixed costs and need sufficient staffing across the day and night regardless of short-term fluctuations in occupancy.

If public funding frameworks recognise costs inadequately, organisations may respond by limiting expansion, changing service mix or seeking efficiency measures that eventually affect workforce and quality. If funding lacks challenge or transparency, the opposite risk arises: public expenditure grows without enough assurance that resources are producing value.

The relevant governance objective is therefore not simply lower cost. It is sustainable, explainable cost linked to quality and need.

The Quality Dashboard Builder can help organisations examining similar questions connect financial and capacity indicators with continuity, workforce and quality measures. It is not designed to calculate Swiss reimbursement, but its broader discipline is useful: financial performance should not be interpreted separately from what happens to access and care quality.

Workforce pressure is also a financing pressure

Long-term care is labour-intensive. Switzerland can invest in technology, housing and new service models, but much of care will continue to depend on people. Rising demand therefore converts workforce pressure directly into financing pressure.

Recruitment difficulty can increase wages, agency or temporary staffing costs and management workload. Higher complexity can require more qualified staff. Improving retention may require investment in supervision, career development, staffing levels and employee wellbeing. Training additional professionals also requires public and institutional expenditure before they enter the workforce.

Switzerland’s reliance on internationally educated health professionals adds another dimension. Cross-border and international recruitment can increase capacity, but competition for workers is likely to remain strong as neighbouring countries age. A financing model that assumes a permanently abundant external workforce may therefore underestimate future cost.

Strong workforce resilience and continuity should consequently be treated as part of financial planning. Low turnover and effective deployment are not merely human-resources outcomes; they influence the cost and stability of care.

Demographic ageing will expose which costs are merely being transferred

As long-term care demand rises, policy choices can shift expenditure between payers without reducing the underlying requirement for support. This is one of the most important risks in multi-payer systems.

A change that reduces compulsory health-insurance expenditure may increase cantonal or municipal costs. A tighter public financing rule may increase personal expenditure. Greater reliance on home care may reduce residential costs while increasing unpaid family work. Earlier hospital discharge may reduce acute expenditure while requiring stronger community capacity.

None of those shifts is automatically wrong. Different payers legitimately hold different responsibilities. The problem arises when a transfer is described as efficiency even though total resource use or risk has simply moved elsewhere.

This creates a need for whole-system evidence. Financial governance should ask:

• whether changes reduce total avoidable cost or merely redistribute it;
• whether personal contributions remain affordable;
• whether family-care demands are increasing as formal expenditure falls;
• whether provider funding remains sufficient to maintain safe capacity;
• whether savings in one sector generate additional pressure in another;
• whether outcomes for older people improve alongside financial change.

The Digital Twin Scenario Modeller can help organisations explore comparable interactions between demand, workforce, capacity and cost under alternative assumptions. It is not a Swiss financial forecasting instrument, but scenario modelling is particularly valuable where demographic change creates several plausible future pathways rather than one certain expenditure trajectory.

Scenario: a canton redesigns funding and finds the pressure moving elsewhere

A canton wants to strengthen ageing at home and reduce the rate at which people with relatively low nursing needs enter residential care. It expands community provision and expects slower growth in nursing-home expenditure.

Early results appear encouraging. Fewer lower-intensity admissions occur and residents remain in their communities for longer. Several years later, however, municipalities report rapidly increasing expenditure on practical support, Spitex organisations are struggling with workforce demand and family carers are requesting more assistance.

The policy has not failed. It has changed the location of care successfully. But the financing architecture has not fully followed the service redesign.

The canton therefore evaluates the total pathway rather than measuring only nursing-home utilisation. It examines home-care intensity, municipal expenditure, household contributions, carer burden and eventual admissions. Funding arrangements are adjusted so that the intended community model has the infrastructure required to remain sustainable.

The governance lesson is that service transformation and financial transformation need to happen together. A policy that moves care without moving resources risks creating hidden pressure at the receiving end.

Digitalisation can improve financial transparency, but it can also increase complexity

Better digital information has the potential to make long-term care financing more transparent. Integrated data can support more accurate care assessment, clearer reimbursement, faster identification of changing need and improved analysis of how people move between settings.

For providers, digital records can strengthen the connection between assessment, delivered activity and billing. For public authorities, better information can improve visibility of utilisation, costs and capacity. For people and families, digital access could make entitlements and charges easier to understand where systems are designed around the user rather than administrative structures.

There are limits. Digitising a complicated process does not make the underlying rules simpler. A portal containing several funding categories can still be difficult for an older person to navigate. Automated decision support can also create risks if people cannot understand how a classification or reimbursement decision was reached.

The wider principles of digital records, data and information governance therefore apply to financing as well as clinical care. Data need to be accurate, appropriately shared and capable of being challenged where a decision affects access or personal cost.

Organisations planning such transformation can use the Digital Transformation Readiness Assessment to consider whether governance, workforce capability and digital resilience are strong enough to support change. It does not interpret Swiss insurance law, but it can help test whether digital infrastructure is improving the service rather than simply automating administrative burden.

Equity cannot be judged from insurance coverage alone

Switzerland’s universal requirement for compulsory health insurance provides an important foundation, but long-term care equity depends on more than insurance status. People with similar nursing needs can have different household circumstances, housing, family networks and access to non-nursing support.

Geography can also affect practical cost. A rural resident may face fewer provider options or greater travel-related constraints. Cantonal rules can shape personal contributions and public support differently. A person living alone may need to purchase support that somebody living with a partner receives informally.

Equity therefore needs to consider both formal entitlement and the resources required to turn entitlement into a sustainable care arrangement.

This does not require every canton to spend the same amount or every household to contribute identically. It requires visibility of whether financing differences produce unreasonable barriers to appropriate care.

Monitoring should consequently include outcomes and access, not just expenditure. Waiting for Spitex, delayed nursing-home entry, avoidable hospital stays, family breakdown and unmet support needs can all be financial-system indicators when lack of an affordable care arrangement contributes to them.

Funding reform has to preserve quality as well as solvency

Long-term care financing debates naturally focus on sustainability. Demographic ageing will increase expenditure, and public authorities, insurers and households cannot treat resources as unlimited. But a narrow pursuit of cost containment can damage the very outcomes the system is intended to protect.

Reducing staffing below what complex care requires can generate falls, medication problems, hospital transfers and workforce turnover. Limiting community support can accelerate nursing-home admissions. Excessive household charges can encourage people to delay asking for help until needs become more acute.

Financial governance therefore needs an explicit relationship with quality assurance and governance. Cost, activity and outcomes should be reviewed together.

An apparent efficiency is more credible when it maintains or improves independence, continuity and safety. A cost increase may be justified where it prevents more expensive deterioration elsewhere. Conversely, increasing expenditure should not automatically be interpreted as improved care if outcomes remain unchanged.

This is where the Governance Maturity Assessment can support organisations examining whether financial, quality and strategic decisions are genuinely connected. It is not a Swiss compliance framework; its usefulness lies in testing whether decision-makers receive sufficiently integrated evidence to understand the consequences of resource choices.

The future debate is likely to be about distribution as much as total cost

Switzerland’s long-term care expenditure will face sustained upward pressure as the population ages, particularly as the number of people at advanced ages increases. The future policy debate will therefore involve more than identifying new sources of money.

It will need to consider how costs are shared between compulsory health insurance, taxation, cantonal and municipal budgets, households and family carers. It will also need to consider whether current financing boundaries remain aligned with the service model Switzerland wants.

If more care is expected to take place at home, financing for community infrastructure and non-nursing support becomes increasingly important. If nursing homes care for residents with progressively higher acuity, their workforce and cost structures will change. If family availability declines, formal service demand may rise even without a change in underlying population health.

The stronger opportunity lies in making those interactions visible before financial pressure forces reactive change.

Future reform does not necessarily require replacing the mixed Swiss model with a single national payer. The more immediate requirement is coherence: financing arrangements that understand how costs move through the system and preserve access regardless of which institution ultimately pays a particular component.

What other countries can learn from Switzerland’s financing model

Switzerland’s arrangements are shaped by compulsory health insurance, federalism, cantonal autonomy and its wider social-security system. Those institutions cannot be transplanted directly into countries financed predominantly through general taxation or a dedicated social long-term care insurance scheme.

The transferable lessons are more fundamental.

First, separating healthcare from everyday support may clarify payment responsibility, but it can make whole-person care harder to finance. Systems need mechanisms that reconnect the categories around the person.

Second, mixed funding requires strong transparency. People should be able to understand what is covered, what they contribute and which public supports exist.

Third, public savings should be assessed across the whole pathway. Shifting expenditure to another level of government, to households or to unpaid carers is not automatically a genuine efficiency.

Fourth, provider sustainability matters. An entitlement has limited value if reimbursement arrangements do not support enough skilled organisations to deliver it.

Finally, demographic planning and financial planning need to be integrated. The future cost of long-term care depends not only on population size but on workforce, housing, service configuration, family availability and the intensity of care delivered at home.

Conclusion

Financing long-term care in Switzerland is fundamentally an exercise in shared responsibility. Compulsory health insurance contributes to recognised nursing care; insured individuals may make defined contributions; cantons and municipalities carry residual nursing responsibilities; households meet other living and support costs; and supplementary social-security mechanisms provide important protection where personal resources are insufficient. Alongside all of this sits a substantial amount of unpaid family care.

The model’s strength is that it draws on several sources of financing rather than placing the entire burden on one institution. Its challenge is that the boundaries between those sources do not always match the way people experience care. Nursing, domestic support, housing, family assistance and accommodation may be funded differently even though they combine into one practical arrangement.

Demographic ageing will make those interfaces increasingly visible. Switzerland will need to judge financial sustainability not only by controlling expenditure but by understanding where costs move, whether providers can maintain capacity, whether households retain affordable access and whether community-based models are being supported with the resources they actually require.

The strongest future financing system will therefore not simply pay bills more efficiently. It will connect money with policy intent: sustaining independence where possible, ensuring high-quality residential care where necessary, supporting the workforce and avoiding hidden transfers of pressure onto municipalities, providers or families. In long-term care, financial sustainability and human sustainability ultimately describe the same system from different directions.