Nursing Homes in Switzerland: Capacity, Care Needs and the Changing Residential Care Model

A place in a Swiss nursing home increasingly represents the end of a much longer care pathway. Before admission, an older person may have lived for years with support from family members, Spitex, general practitioners, therapists, meal services and assistive technology. Moving into residential long-term care often occurs only when that combination can no longer provide sufficient supervision, nursing, safety or relief for an exhausted family carer.

This changing threshold is important across the Switzerland Ageing, Long-Term Care & Community Support Knowledge Hub. Switzerland has developed substantial home and community provision, but nursing homes remain indispensable. In 2023, more than 92,000 people were living in retirement and nursing homes at the end of the year, around three quarters of residents were aged 80 or over, and more than 100,000 residential places were available nationally. The sector employed more than 100,000 full-time-equivalent staff.

The strategic issue is not simply whether Switzerland needs more residential capacity. It is what that capacity will be required to do. As lower-level needs are increasingly supported at home, nursing homes are receiving people later, with greater frailty, dementia, multimorbidity and nursing dependency. Average care intensity has been rising, while national projections indicate that unchanged patterns of provision could create capacity pressure before 2030.

Residential care is therefore changing from a broadly defined older people’s housing model towards a more clinically and operationally demanding component of the long-term care system. Planning additional beds without redesigning workforce, quality, infection prevention, financing and transitions would address only part of the challenge.

Nursing homes remain a major part of Swiss long-term care

Switzerland had 1,474 retirement and nursing homes in 2023. They represented a mixed landscape of public institutions, publicly supported private organisations and fully private providers. Ownership and organisational form vary, as do relationships with cantons and municipalities.

This diversity reflects Switzerland’s wider federal structure. The Confederation establishes important national legal parameters, including compulsory health-insurance arrangements, but the cantons hold major responsibilities for health-service planning and the organisation of long-term care. Municipalities also play substantial roles in many cantons, including financing, ownership, local planning or ensuring access to services.

Consequently, there is no single national nursing-home market operating identically from Geneva to Graubünden. Bed supply, financing arrangements, admission practices, provider mix and the balance between institutional and home-based care differ across cantons.

This variation is not inherently a weakness. It permits different approaches to geography, population structure and local preference. But it makes national capacity planning more complex. A national total can conceal areas with surplus capacity, areas where waiting pressure is growing and areas where the greater problem is finding sufficient staff to operate nominally available places.

The distinction between physical and operational capacity is critical. A registered bed does not constitute usable capacity if the organisation cannot recruit the staff needed to support the resident safely.

Residents are arriving with higher levels of care need

Residential care has become progressively more concentrated on people with substantial dependency. In 2023, the average amount of nursing care provided per resident reached around 110 minutes each day, continuing an upward trend. That measure does not capture every element of support, but it demonstrates a clear movement towards greater care intensity.

The shift is partly the intended consequence of stronger home care. If people with lower needs can remain at home safely, residential provision becomes available for those requiring more intensive support. This can improve independence and potentially use institutional capacity more effectively.

It also changes the nature of the nursing home.

A higher-dependency resident population means greater prevalence of frailty, cognitive impairment, complex medication, mobility needs, continence support, nutritional risk and end-of-life care. Staff require stronger observation and clinical judgement as well as relationship-based care. Small changes can signal major deterioration.

This makes frailty, falls, medicines and safety increasingly central to residential service design. A nursing home can no longer be planned primarily around accommodation and routine assistance. It must function as a capable long-term care environment without becoming unnecessarily medicalised.

That balance matters. Residents are not hospital patients who happen to stay for longer. The nursing home is their home, sometimes for several years. Clinical competence therefore has to coexist with ordinary life, relationships, personal possessions, choice and meaningful activity.

Admission is increasingly about whether the home-care system can still hold

The decision to enter a nursing home is rarely determined by one diagnosis. It usually reflects the interaction between the person’s needs and the capacity of the environment around them.

Two people with similar health conditions can follow different pathways. One may live with a spouse in an accessible apartment close to intensive Spitex provision. Another may live alone in an inaccessible rural house with no nearby family. Their formal clinical needs may be comparable while the sustainability of home care differs significantly.

Admission decisions therefore need to consider more than nursing minutes. Relevant factors include:

• the level and predictability of supervision required;
• mobility, falls and the suitability of the existing home;
• cognitive impairment and the person’s ability to manage safely between visits;
• availability and sustainability of informal family care;
• the intensity of Spitex and other community services required;
• the person’s own wishes, relationships and quality of life.

This is closely connected with person-centred planning for older people. Residential admission should not become an automatic response to one risk, but neither should remaining at home be treated as an objective that overrides the person’s wider experience.

Scenario: the nursing need has not changed, but the care system around the person has

An 88-year-old man with Parkinson’s disease lives with his wife. Spitex visits three times daily for personal care, medication and mobility support. His wife prepares food, helps him transfer at other times and responds whenever he becomes confused at night.

Over several months his formal nursing requirements remain broadly stable. What changes is his wife’s health. She develops severe back pain and can no longer assist safely with transfers. She also reports sleeping only intermittently because she is listening for her husband during the night.

Simply adding another short daytime visit would not address the problem. The real change is the loss of sustainable support between professional contacts.

The couple, family and professionals therefore reassess the whole arrangement. Additional equipment and temporary support are considered, but the husband now requires a level of unpredictable assistance that cannot realistically be covered through scheduled visits without his wife continuing as the main responder.

A nursing-home placement is explored close enough for his wife to visit regularly. The decision is difficult, but it is not presented as a withdrawal of independence. Continuing the previous arrangement would effectively require his wife to provide care beyond what she can safely sustain.

The operational lesson is that residential need cannot be understood solely through the formal care package. Family capacity is part of the real system, and deterioration in that capacity can change what constitutes an appropriate care environment.

Financing separates nursing costs from the wider cost of living in a home

Swiss nursing-home financing is divided across several components. Compulsory health insurance contributes towards recognised nursing services according to the assessed level of nursing need. The contribution is structured across twelve care levels, with higher daily payments corresponding to greater care requirements.

The resident may also make a limited contribution towards nursing costs. Remaining recognised nursing costs are financed through arrangements established by the cantons and, depending on the canton, municipalities.

That does not mean compulsory health insurance pays for the entire nursing-home stay. Accommodation, meals and other non-nursing elements are separate from the insurer’s nursing contribution and are generally borne by residents, with social-security mechanisms such as supplementary benefits becoming important where personal resources are insufficient.

This distinction explains why residential long-term care can create significant household expenditure even within a health system with compulsory insurance.

It also creates an important governance requirement. Providers need accurate care assessment because nursing intensity affects reimbursement, while cantons and municipalities need confidence that residual financing reflects legitimate care costs.

At the same time, funding architecture should not distort care. The fact that different elements are paid through different routes does not mean residents experience them separately. Personal care, meals, mobility, social participation and nursing all form one daily life.

Residential care is expensive, but simple cost comparisons can mislead

In 2023, the average cost of a day in a Swiss retirement or nursing home was around CHF 342. Monthly institutional costs had increased sharply, and total sector expenditure exceeded CHF 11 billion.

Those figures naturally create pressure to expand less expensive community alternatives. In many situations, that is appropriate. Supporting someone at home can protect independence and avoid institutional expenditure.

But comparing average Spitex expenditure with average nursing-home expenditure without considering dependency can be misleading. Many people receiving home care require relatively low-intensity intervention, while nursing-home residents increasingly represent the highest-need part of the population.

A meaningful comparison therefore needs to examine equivalent need. High-intensity home support involving several visits each day, family supervision, overnight responses, equipment and housing adaptations can have a very different cost profile from occasional home nursing.

The better policy question is not which setting is inherently cheaper. It is which combination of services produces sustainable care, good outcomes and appropriate use of resources for people at different levels of need.

This is where quality data and performance metrics become important. Cost information should be analysed alongside dependency, outcomes, hospital use, workforce and resident experience rather than interpreted in isolation.

Capacity pressure is now a medium-term planning issue

Switzerland’s demographic projections point towards substantial growth in long-term care need through the 2030s and beyond. Updated national modelling indicates that if patterns of care provision remain broadly unchanged, nursing homes could encounter capacity constraints before 2030.

This does not mean every canton will experience shortage at the same time. The starting position differs substantially between regions. Some cantons have historically relied more heavily on nursing-home provision, while others have developed stronger ambulatory or intermediate models.

The projections therefore need to be translated locally. Cantons should understand not simply how many older people will live in their population, but what proportion is likely to develop substantial care dependency, how strongly home care can expand and which residents could be supported through alternative housing or intermediate services.

Infrastructure lead times make this urgent. Creating new nursing-home capacity involves planning, land, capital, regulatory approval and workforce development. Waiting until occupancy becomes critical risks leaving hospitals, families and Spitex services carrying unmet demand.

At the same time, indiscriminate expansion could lock resources into an institutional model even where future policy successfully shifts more lower-intensity care into the community.

Capacity planning therefore requires scenarios rather than one fixed forecast.

The real capacity constraint may be workforce rather than buildings

Swiss nursing homes already represent a substantial employment sector. In 2023 they employed around 144,000 people, equivalent to more than 103,000 full-time posts. Care and everyday-support roles accounted for the majority of the workforce, and women occupied close to four fifths of full-time-equivalent positions.

The workforce has expanded considerably since 2010, but future demand is rising at the same time as Switzerland faces broader nursing and care-worker shortages. Residential care therefore competes for staff with hospitals, Spitex and other health services.

Higher resident dependency further changes the calculation. More residents do not simply require more workers; they may require a different skill mix. Dementia, palliative care, complex medication and multimorbidity increase the need for qualified nursing competence alongside care assistants and other support roles.

This is why workforce planning and practice competence in older people’s services must be connected directly to capacity planning. A canton can authorise hundreds of additional places, but those places will not function safely without enough trained staff to operate them.

Recruitment is only part of the issue. Retention, working conditions, supervision, career development and the distribution of work across professional groups determine how much care capacity a workforce can sustain.

International recruitment also remains relevant within Switzerland’s health and care labour market. It can relieve immediate shortages but creates dependence on labour from neighbouring and other countries. A long-term strategy therefore needs domestic training and retention as well as migration.

Scenario: a canton has beds available but cannot use all of them

A canton has historically maintained sufficient nursing-home capacity and does not appear, on paper, to have a bed shortage. Several facilities nevertheless report that they cannot admit residents as quickly as expected.

Initial analysis focuses on physical occupancy. The deeper review reveals a different problem. Some rooms are technically available, but providers are restricting admissions because nursing vacancies mean opening every place would increase resident-to-staff pressure beyond what managers regard as safe.

The canton therefore changes the way capacity is monitored. Reporting distinguishes licensed or physical beds from staffed and operational beds. Vacancy levels, agency dependence, sickness absence and turnover are considered alongside occupancy.

Providers also work with education and workforce partners on placements, retention and skill mix. The objective is not to lower professional standards so that more beds can open. It is to understand which roles require registered nursing competence and where trained support staff can safely take greater responsibility.

The scenario demonstrates why headline bed numbers can provide false reassurance. Residential capacity is produced by buildings, workforce and operating conditions together.

Organisations examining similar questions can use the Digital Twin Scenario Modeller to test interactions between demand, staffing and usable service capacity. It is not a Swiss planning model, but the principle is particularly relevant where workforce availability determines whether nominal infrastructure can actually operate.

Dementia is reshaping the residential care environment

Dementia is one of the most important drivers of residential long-term care. Many people can remain successfully at home during earlier stages, particularly where family and Spitex support are strong. Advanced cognitive impairment can eventually create needs for supervision, structured environments and skilled behavioural and communication support that are difficult to provide through intermittent visits.

This changes physical design as well as staffing. Residents may benefit from environments that reduce unnecessary complexity, support orientation, provide safe access to outdoor space and allow movement without excessive restriction.

Staff need to understand distress as communication rather than simply responding to behaviour as a problem to suppress. Continuity becomes important because familiarity can reduce anxiety and help professionals understand subtle changes.

Person-centred dementia planning therefore needs to remain visible after admission. Institutional routines should adapt where possible around the person’s history, habits and preferences rather than expecting every resident to fit the same timetable.

The distinction is important because rising dependency can encourage operational standardisation. Efficient meal rounds, medication rounds and staffing patterns are necessary, but efficiency becomes counterproductive if residents lose ordinary control over waking, eating, activity and relationships.

A nursing home must be both a healthcare environment and somebody’s home

This dual identity creates one of the sector’s most important governance tensions.

Nursing homes need infection prevention, medicines management, clinical escalation, falls prevention and safe staffing. They also need privacy, autonomy, meaningful activity, relationships, visitors and opportunities for residents to take ordinary risks.

Controls designed entirely around organisational safety can unintentionally reduce quality of life. The pandemic made this tension particularly visible. Measures intended to reduce infection could also restrict contact with families, movement and social participation.

The lesson is not that infection prevention should be weaker in long-term care. Residents may be highly vulnerable to infection. It is that controls need to reflect the setting and preserve autonomy wherever possible.

This connects directly with positive risk-taking in later life. A resident who understands the consequences may still value leaving the home, eating particular foods or maintaining routines that contain manageable risk.

Organisations considering comparable decisions can use the Positive Risk-Taking Planner to structure discussion of preference, benefit, foreseeable harm and proportionate controls. It does not replace Swiss clinical or legal frameworks, but it helps guard against equating institutional responsibility with the elimination of ordinary life.

Infection prevention is becoming more systematic across Swiss nursing homes

The COVID-19 pandemic exposed the particular vulnerability of residential long-term care to infectious disease and highlighted variation in infection-prevention capability between institutions.

Switzerland has since strengthened the national approach. The NOSO Strategy, which addresses healthcare-associated infections, now includes a dedicated Action Plan for Retirement and Nursing Homes covering the period to 2029.

The plan is important because nursing homes operate under conditions different from acute hospitals. Residents live together over long periods, many require close personal assistance and maintaining social interaction is itself part of wellbeing.

The action plan therefore aims to strengthen infection prevention while explicitly preserving residents’ quality of life, independence and autonomy. Priorities include stronger cantonal and institutional infection-prevention structures, designated contacts, networking, minimum structural requirements, national recommendations and better staff training.

The first national point-prevalence survey in 2024 found healthcare-associated infection in around 2.3% of participating nursing-home residents. Urinary, respiratory and skin or soft-tissue infections were prominent, while a proportion of residents were receiving systemic antibiotics.

The significance goes beyond infection statistics. It illustrates the move towards more consistent quality standards and assurance frameworks in a sector historically shaped strongly by cantonal and institutional variation.

Scenario: infection control protects residents without recreating pandemic restrictions

A nursing home experiences several respiratory infections during winter. Residents include people with advanced frailty and dementia, making rapid spread a serious clinical concern.

The immediate response includes testing where clinically appropriate, enhanced hygiene, review of staff practices and measures around affected areas. Management deliberately avoids treating whole-home visitor exclusion as the automatic first response.

Instead, the institution assesses transmission risk, supports relatives to understand precautions and considers the consequences of restrictions for individual residents. A woman receiving end-of-life care continues to see close family with appropriate measures because preserving those relationships is part of her care.

Following the outbreak, the home does more than record that the infection episode ended. It reviews staffing, personal protective equipment availability, cleaning arrangements, vaccination messaging and how quickly deterioration was recognised. Learning is shared with the designated infection-prevention lead and incorporated into future training.

The governance strength lies in connecting infection prevention with quality of life rather than treating them as separate objectives. Controls remain clinically meaningful, but proportionality becomes part of the assurance process.

This approach reflects the wider shift from emergency pandemic rules towards sustainable infection-prevention capability embedded in everyday residential care.

Transitions between hospital and nursing home require stronger interfaces

Nursing homes interact constantly with acute hospitals. Residents may require emergency treatment, elective procedures or specialist review and then return to the home. Other people enter a nursing home directly after hospitalisation because returning home is no longer feasible.

These transitions contain risk. Medication may have changed. Mobility may be reduced. A new wound may require treatment. The nursing home needs enough information and skill to take responsibility safely when the resident arrives.

The reverse interface matters as well. When a resident is transferred to hospital, acute staff need accurate information about medication, cognition, baseline function, advance-care preferences and the reason for deterioration.

Strong hospital and community care interfaces therefore matter to residential care even though the linked principles are often discussed in relation to home care. Long-term care providers are part of the same flow system.

Repeated emergency transfers can also reveal opportunities for improvement. Some hospitalisation is unavoidable, but patterns may identify earlier deterioration, gaps in out-of-hours clinical access or insufficient capability within the home.

Governance should therefore examine transfers not as isolated events but as information about how effectively the interface is working.

Short stays and transitional functions complicate the traditional nursing-home model

Although nursing homes are principally associated with long-term residence, Swiss facilities also support people for shorter periods. Some admissions provide respite, recovery or temporary support after hospital treatment.

This creates a different operational requirement from permanent residential care. A short-stay resident may arrive with active rehabilitation goals and a realistic expectation of returning home. The care model should preserve that trajectory rather than allowing institutional routines to reduce independence.

Assessment on admission should therefore clarify whether the objective is long-term residence, stabilisation, respite or transition. Staff need to know what functional abilities should be maintained or rebuilt.

The distinction also matters for families and hospital teams. A temporary nursing-home placement should not become a permanent pathway simply because no one is actively coordinating the return home.

As Switzerland seeks more flexible alternatives between hospital, home and permanent institutional care, nursing homes may increasingly contribute transitional capacity. Doing so successfully requires different outcome measures from long-term residential provision.

Quality assurance must look beyond structural compliance

A safe building, adequate staffing establishment and correct documentation are essential, but they do not by themselves establish that residents experience good care.

Residential quality needs to bring several perspectives together. Clinical indicators can show falls, pressure injuries, medication issues, infections or hospital transfers. Workforce indicators can show turnover, skill mix and absence. Complaints and incident data reveal another part of the picture.

Resident experience adds information that those measures cannot. Do people have meaningful choices? Can they maintain relationships? Do they feel safe? Are routines sufficiently flexible? Do staff know them?

This is particularly important because high dependency can make some residents less able to articulate concerns through conventional surveys. Families, representatives and observation may therefore contribute to assurance, while communication methods need to match residents’ abilities.

The challenge is connecting these data rather than producing separate reports. Rising falls may relate to increasing frailty, staffing changes or environmental factors. Increased hospital transfers may reflect a more dependent caseload rather than poor care. Governance needs enough context to interpret change.

The Quality Dashboard Builder can help organisations develop a balanced view across quality, workforce, risk and outcomes. It is not a Swiss regulatory dashboard, but the approach is useful where residential leaders need to distinguish isolated indicators from a developing system pattern.

Scenario: good occupancy hides deteriorating service resilience

A nursing home reports consistently high occupancy, few complaints and stable financial performance. On conventional measures, the service appears strong.

Over twelve months, however, management data show increasing sickness absence, more use of temporary staff and a gradual rise in falls during evening periods. Family feedback also suggests residents are seeing more unfamiliar workers.

No single measure breaches an obvious threshold. Taken together, they indicate declining resilience.

The provider reviews evening staffing and discovers that vacancies are being covered numerically but not always with the same experience and familiarity. Residents with dementia are particularly affected by changes in continuity.

Recruitment and retention action is combined with stronger induction for temporary staff, revised deployment and closer monitoring of falls by time of day. Family feedback is reviewed again after implementation.

The important governance point is that quality deterioration often appears as a pattern before it becomes an incident. Mature assurance systems connect workforce, resident experience and safety rather than waiting for one severe event to trigger attention.

The Governance Maturity Assessment can help organisations examine whether accountability, escalation and oversight are sufficiently developed to recognise this type of cross-cutting risk. It does not assess Swiss regulatory compliance, but the governance principle is transferable.

Digitalisation can reduce administrative burden and strengthen continuity

Nursing homes generate large volumes of information: care assessments, medication records, clinical observations, incident reports, appointments and communication with families and external professionals.

Better digital systems can reduce duplication and make changes more visible. Staff moving between shifts can access current information more reliably, while structured data can support quality monitoring.

Digital integration with hospitals, doctors, pharmacies and other parts of the health system offers additional value. Residents frequently move across organisational boundaries, yet information does not always move as easily as the person.

The opportunity therefore lies partly in interoperability and system integration. Reducing repeated data entry and improving access to relevant information can release professional time and reduce transition risk.

Technology should not be positioned as a substitute for the residential workforce. Much nursing-home care is relational, physical and dependent on observation. Digital systems can remove administrative friction and support decision-making, but they also create requirements around cybersecurity, training, data quality and privacy.

For residents, technology should remain proportionate. Sensors or monitoring may support falls prevention or safer movement, but institutional convenience alone is not sufficient justification for intrusive surveillance.

Residential design will need to reflect greater complexity without becoming hospital-like

Future nursing homes are likely to care for a more dependent population. Buildings therefore need to support mobility equipment, dementia care, infection prevention, palliative care and increasing clinical complexity.

At the same time, turning the physical environment into something resembling a ward would undermine the residential character of care.

Smaller-scale living areas, accessible outdoor space, private rooms and environments that support orientation can combine safety with ordinary life. Design can also affect workforce productivity. Long distances between rooms, poorly located equipment and layouts that obstruct observation increase staff workload.

Climate resilience will become more relevant as well. Older and frail residents can be particularly vulnerable to heat, making ventilation, shading and temperature management increasingly important aspects of infrastructure planning.

Capital decisions therefore need to anticipate the resident population likely to use the building over several decades rather than designing solely around current dependency.

The strongest architecture supports changing levels of care without making every resident live in a permanently clinical environment.

Cantonal planning needs to connect nursing homes with the whole long-term care pathway

Forecasting nursing-home beds in isolation can produce the wrong answer because residential demand is partly determined by what happens elsewhere.

Stronger Spitex provision may delay admission. More accessible housing may allow people with physical disability to remain independent. Better dementia support may sustain some families for longer. Conversely, a shortage of community services can push people towards residential care at lower levels of dependency.

Cantonal planning therefore needs to model several interacting capacities:

• long-term nursing-home places and the dependency levels they support;
• Spitex volume, intensity and workforce availability;
• intermediate, respite and transitional provision;
• age-appropriate housing and community support;
• family-carer sustainability;
• hospital discharge demand and avoidable delayed transitions.

The objective is not to minimise nursing-home use. It is to ensure that each part of the system is used for needs it is well designed to meet.

If nursing homes increasingly focus on higher dependency, planning should expect higher staffing intensity and greater clinical complexity per resident. Fewer low-need admissions do not necessarily mean residential resources can simply be reduced.

Future financing reform will alter the institutional context

Switzerland is moving towards uniform financing of ambulatory and inpatient healthcare services, with nursing care scheduled to enter the revised financing architecture at a later stage.

For nursing homes, this is a future reform rather than the current financing model. Existing arrangements continue to involve compulsory health-insurance contributions, resident contributions and residual financing determined through the cantons and municipalities.

The future changes matter because financing incentives can influence where care is delivered. A system should not encourage institutional care simply because one payer faces lower costs there, nor encourage home care where the total arrangement is unsustainable.

More uniform financing offers an opportunity to look more coherently across settings, but payment reform cannot by itself solve capacity or workforce problems. Nor does it remove accommodation and living costs from residential care.

The strongest measure of future financing reform will therefore be whether it supports clinically and socially appropriate pathways rather than merely redistributing expenditure between insurers and public authorities.

The residential model will become more specialised rather than disappear

The expansion of ageing-at-home policy can sometimes create the impression that nursing homes belong to an older model of care that will gradually become less important. Demographic projections suggest a different conclusion.

Home and community services are likely to expand significantly, but the number of people reaching advanced old age and substantial dependency will also rise. Even if a smaller proportion of older people enters residential care, the absolute number requiring it may still increase.

The role of the nursing home is therefore likely to become more specialised. Future residents may arrive later, require more nursing and stay for shorter periods on average than earlier generations. Dementia, palliative care, complex frailty and multimorbidity will increasingly shape service design.

This creates a strategic shift from nursing homes as a broad destination for older people who need support towards nursing homes as a high-capability residential component within a wider continuum.

That evolution should also protect resident rights. Higher dependency does not reduce the importance of choice and control. In fact, the greater the organisation’s power over a person’s daily environment, the stronger the responsibility to preserve individuality.

What other countries can learn from Switzerland’s changing residential sector

Switzerland’s nursing-home arrangements are shaped by its federal constitution, compulsory health insurance, cantonal health responsibilities, municipal involvement and relatively distinctive division of care costs. Other countries cannot simply replicate those mechanisms.

Several principles nevertheless have wider relevance.

First, expansion of home care does not remove the need for residential capacity. It changes the population residential services will support.

Second, bed planning without workforce planning is incomplete. Physical capacity becomes meaningful only when sufficiently skilled people can operate it.

Third, institutional quality should combine clinical safety with autonomy. Strong infection control, medication governance and falls prevention need not require residents to surrender ordinary life.

Fourth, funding should be interpreted across the whole pathway. Comparing average institutional and community costs without adjusting for care intensity can produce misleading policy conclusions.

Finally, residential care should be connected with hospitals, home care and intermediate provision rather than treated as an isolated destination. A nursing home is part of the wider care system before, during and after admission.

Planning to 2040 requires a different concept of capacity

The challenge facing Switzerland is larger than constructing enough additional rooms. By 2040, residential capacity will be determined by infrastructure, workforce, clinical capability and the performance of home and community care around it.

Planning therefore needs to ask not only how many places will be required, but what type of places. A bed designed for a relatively independent older resident is not operationally equivalent to a place supporting advanced dementia, complex nursing or end-of-life care.

Cantons will also need contingency within their systems. Operating permanently at near-total occupancy leaves little flexibility for urgent admission, respite or people who cannot return home after hospital treatment.

Better forecasting can help avoid both under-capacity and unnecessary institutional expansion. The central variable is how successfully Switzerland can support lower and moderate needs outside nursing homes while ensuring sufficiently capable provision for people whose needs eventually exceed what home-based arrangements can sustain.

This makes residential planning inseparable from workforce, housing, family support and Spitex strategy.

Conclusion

Nursing homes will remain an essential part of Swiss long-term care even as ageing at home becomes more prominent. Their role, however, is changing. Residents are increasingly admitted later in the care pathway and with greater dependency, making residential services more clinically demanding while preserving the fundamental requirement that they remain places to live rather than extensions of hospitals.

Switzerland’s immediate challenge is therefore not simply to increase the number of beds. Updated projections indicate that capacity pressure could emerge before 2030 if current patterns continue, but physical expansion without sufficient workforce would create only nominal capacity. Future planning has to connect bed supply with nursing competence, dementia capability, financing, hospital interfaces, infection prevention and the strength of community alternatives.

The sector also faces an important quality test. Rising complexity makes stronger clinical governance necessary, yet safety cannot become the sole definition of good residential care. Residents still need privacy, choice, relationships, meaningful activity and proportionate freedom to take ordinary risks.

The strongest future direction is a differentiated long-term care system in which Spitex, age-appropriate housing, intermediate support and family services sustain people outside institutions where that remains workable, while nursing homes concentrate increasingly sophisticated support around those who genuinely need continuous residential care. Switzerland’s success will depend less on choosing between home and nursing homes than on ensuring that both have the capacity, workforce and governance to perform the roles an ageing population will require.