Planning Long-Term Care Capacity to 2040: What Switzerland’s Ageing Population Will Require

A canton can approve a new nursing home, a municipality can expand home-care funding and a Spitex organisation can increase its nominal staffing establishment, yet none of those decisions alone guarantees that an older person will be able to obtain the right care when it is needed. Long-term care capacity is not one number. It is the combined ability of buildings, workers, home-care organisations, families, health services, transport, technology and public financing to support a growing older population across different levels of need.

This is becoming one of the defining strategic questions examined through the Switzerland Ageing, Long-Term Care & Community Support Knowledge Hub. By 2040, Switzerland will have many more people in advanced old age, while the number requiring sustained nursing, personal support or supervision will rise faster than the total population. The challenge is therefore not simply whether Switzerland can create more care. It is whether the Confederation, cantons, municipalities, insurers and providers can shape enough of the right kind of capacity in the right places.

That distinction matters because the choices interact. Reducing reliance on nursing homes increases pressure on Spitex, housing and family support. Expanding institutional capacity creates major workforce and capital requirements. Greater use of technology may release staff time but cannot remove the need for human care. Prevention may delay dependency, but it will not eliminate the growth in very old people living with frailty, dementia and multimorbidity.

Planning to 2040 therefore requires something more sophisticated than forecasting beds. Switzerland needs a portfolio approach to long-term care capacity.

The 2040 challenge is larger than demographic growth alone

Population ageing is the starting point, but not the whole explanation. Long-term care demand is shaped particularly by the growth of the oldest age groups, because the probability of needing significant help with daily living, nursing or continuous supervision rises sharply in advanced age.

Switzerland has already entered a period in which the number of older people is reshaping the balance between the working-age population and those likely to need more health and care support. Longer lives are a major social achievement, and many people remain independent well into later life. Yet even modest changes in the proportion requiring care create large operational consequences when applied across a rapidly expanding population aged 80 and over.

The Swiss Health Observatory’s updated national projections illustrate the scale of the issue. Using 2023 provision as a starting point, a continuation of broadly existing patterns of care would generate very substantial additional demand for both nursing-home and Spitex services by 2040. Even scenarios that move more people with lower levels of care need away from nursing homes do not remove the growth requirement. They change where it appears.

This is why workforce planning, infrastructure planning and service-model planning cannot be separated. A strategy that assumes more home care without modelling the nurses, care workers, travel time and coordination needed to deliver it has not reduced future demand; it has moved that demand into another operating environment.

Nursing-home capacity will remain necessary even in a more community-based system

One of the most important conclusions from Switzerland’s projections is that increasing community provision does not make nursing homes obsolete. It changes their role.

In 2023 Switzerland had more than 92,000 long-term nursing-home beds within the provision considered by the national projection model. Under scenarios in which people with no or relatively light nursing needs are increasingly supported at home or in alternative settings, the projected additional nursing-home requirement by 2040 still remains extremely large. Depending on the substitution assumptions, more than 48,000 to 52,000 additional long-term beds could still be required compared with the 2023 base.

The operational implication is significant. Community substitution is valuable where it matches people’s preferences and can provide safe, sustainable support, but it cannot be treated as a way of avoiding all residential investment. People living with advanced dementia, severe frailty, complex multimorbidity, high levels of dependency or insufficient informal support will continue to need intensive 24-hour environments.

The more productive planning question is therefore not “home care or nursing homes?”. It is how the residential sector should change as lower-need residents increasingly receive alternatives.

That points towards nursing homes becoming progressively more concentrated on people with higher care intensity. Such a shift has consequences for building design, clinical capability, dementia support, end-of-life care, staffing ratios, workforce competence and relationships with hospitals and primary care. A nominal bed added in 2035 may need to support a significantly more complex resident than a nominal bed did several decades earlier.

Organisations examining whether their governance is sufficiently mature to manage this kind of strategic shift can use the Governance Maturity Assessment to structure questions about accountability, capacity risk and decision-making. It does not replace Swiss cantonal requirements, but it can help leaders test whether long-range capacity decisions are being treated as core governance issues rather than annual operational pressures.

A canton cannot plan residential beds without planning the workforce behind them

Buildings are visible and politically tangible. Workforce capacity is less visible but ultimately more decisive. A nursing-home development can be financed, approved and constructed, yet still fail to create usable capacity if qualified personnel cannot be recruited and retained.

This is particularly important because Swiss nursing homes already represent a major employment sector. The workforce is predominantly female, contains substantial part-time employment and includes a mixture of professional nursing, care, support and other roles. Future residents are also expected to present greater clinical and functional complexity.

Capacity planning must therefore distinguish between:

• physical places that exist;
• places that can actually be staffed;
• the skill mix required for the people expected to use them;
• the ability to cover nights, weekends, absence and turnover;
• and the capacity of leadership and specialist roles to supervise increasingly complex care.

A canton that forecasts 1,000 additional beds without forecasting the associated full-time equivalent workforce, training pipeline and retention requirement risks creating theoretical rather than practical capacity.

This is one reason the federal Health2030 strategy connects long-term care directly with sufficient numbers of appropriately qualified staff. The Confederation can influence education, professional policy and national financing frameworks, but operational workforce capacity is ultimately realised through cantons, employers and local labour markets. The distribution problem matters as much as the national total.

A growing canton discovers that beds are not the binding constraint

Consider a fast-growing canton where demographic forecasts indicate a large increase in residents over 80. Its initial infrastructure plan assumes that several hundred additional nursing-home places will be required over the next decade. Land is identified and potential developments are discussed with municipalities and providers.

During detailed planning, however, workforce modelling changes the picture. Existing homes already report persistent difficulty filling qualified posts. A neighbouring hospital is also recruiting from the same labour pool, while Spitex demand is rising. Several providers are maintaining services only through substantial part-time flexibility and repeated recruitment.

The canton therefore tests not only how many beds are required, but how many could realistically be staffed under different assumptions about labour supply, retention and resident complexity. It concludes that building all projected residential capacity without parallel workforce measures would create a significant implementation risk.

The revised plan combines residential development with increased education placements, measures intended to improve retention, redesigned roles, expansion of supported housing and additional Spitex capacity. The canton still expects to need more nursing-home beds, but its capacity strategy is no longer a construction programme. It becomes a workforce-and-service-system programme.

The example illustrates a central 2040 planning principle: the limiting resource may not be the one that is easiest to count.

More home-based care means a major expansion of Spitex capacity

Switzerland has already experienced strong growth in nursing and support delivered at home. That direction is consistent with the preference of many older people to remain in familiar surroundings for as long as possible and with broader policy interest in alternatives to institutional care.

Yet the projected scale of future demand is substantial even without a major additional policy shift. Under a status-quo scenario, national modelling indicates that the number of people aged 65 and over receiving Spitex nursing could increase by around 41% by 2040 compared with 2023, with nursing hours increasing by more than 40%. The additional nursing workload alone has been estimated as equivalent to several thousand additional full-time posts, before allowing fully for travel, administration and other operational requirements.

If Switzerland deliberately supports more people outside nursing homes, the home-care requirement becomes higher again. That is not a weakness in a community model; it is the resource consequence of the model.

Future home-care workforce and scheduling will therefore become a core infrastructure issue. Unlike a nursing home, where staff and residents are concentrated within one location, Spitex has to move labour between homes. The same hour of professional time cannot automatically be converted into the same volume of direct care because geography, traffic, rural distances, fragmented visit patterns and documentation all absorb capacity.

Those operational differences need to be built into cantonal and municipal projections rather than added after policy decisions have already been made.

Geography changes what capacity means

Switzerland’s federal structure makes national demand projections essential but insufficient. The 26 cantons differ in demography, settlement patterns, service history, provider markets, taxation, infrastructure and political choices. Municipal arrangements also affect what older people experience locally.

An urban area with high population density may be able to expand home care through relatively efficient routing and access to a larger labour market. A mountain or rural municipality may face a very different equation. It can have fewer potential workers, longer travel distances, less public transport and smaller service volumes across which to spread specialist capability.

The result is that equivalent projected numbers of older people can generate different capacity requirements.

This is where national projections need to be translated into local service geography. Cantons need to understand where the oldest populations will live, how quickly different municipalities are ageing, whether accessible housing exists, where nursing homes are located, how Spitex organisations are configured and how hospitals and rehabilitation services connect with them.

For long-range modelling, tools such as the Digital Twin Scenario Modeller provide a practical way for organisations to explore how changes in demand, staffing and service capacity interact. Such modelling is not a prediction of the Swiss system, but scenario thinking is particularly valuable where investment choices have long lead times and uncertainty is unavoidable.

Intermediate services can change the demand curve without eliminating care needs

Between ordinary home care and permanent nursing-home residence lies a range of services that can become increasingly important as Switzerland ages. These include short-stay provision, rehabilitation, acute and transitional nursing care, supported or assisted living arrangements, day services and other local models that provide more support than independent living without automatically requiring permanent institutional admission.

The strategic value of these services is flexibility. An older person recovering after hospital treatment may need intensive support for several weeks rather than a permanent move. Someone whose family carer is temporarily unavailable may need respite. A person with modest but increasing support needs may be able to remain outside a nursing home if housing, meals, monitoring and access to care are organised differently.

National projections suggest that redirecting lower-need residents from nursing homes could moderate the growth required in institutional beds. But those residents do not disappear from the care system. Their needs transfer into housing, Spitex, community support and, frequently, family networks.

Capacity planning therefore needs to capture substitution honestly. If 100 projected nursing-home admissions are avoided because people remain at home, the plan should identify the additional home-care hours, housing adaptations, supervision, transport, household support and contingency capacity required to make that outcome sustainable.

This is closely connected with workforce resilience and continuity. Community alternatives are strongest when they are reliable enough to remain in place during deterioration, staff absence or changes in family support, rather than functioning only while circumstances remain ideal.

A hospital discharge exposes a missing layer of capacity

An 86-year-old woman living alone is admitted to hospital after a fall. Before admission she received limited Spitex support and regular help from her daughter. Clinically, she no longer needs acute inpatient treatment, but she has lost confidence with transfers and cannot immediately manage safely at home.

The simplest capacity calculation would ask whether a nursing-home bed is available. A stronger local system asks whether permanent institutional care is actually the right destination.

Rehabilitation is considered, followed by a time-limited period of increased nursing and practical support. The hospital, community professionals and family need to understand what can be organised, how quickly it can start and what happens if recovery is slower than expected. Acute and transitional nursing care may cover a defined short period under Switzerland’s insurance arrangements where the relevant conditions are met, but broader non-nursing support and longer-term arrangements require different funding and local provision.

If the municipality has access to flexible short-stay capacity, rapid Spitex escalation and suitable housing support, the woman may regain sufficient independence to return home. If these options are missing, a permanent nursing-home place can become the default not because her long-term needs necessarily require it, but because the system lacks an intermediate response.

For 2040 planning, that distinction is fundamental. Capacity should be measured partly by the number of pathways available before a permanent placement becomes unavoidable.

Housing policy is becoming part of long-term care capacity

For people to remain at home with increasing frailty, the home itself must remain usable. Steps, inaccessible bathrooms, unsuitable lifts, isolated locations and housing that cannot accommodate equipment or overnight assistance can turn relatively manageable support needs into reasons for relocation.

This means long-term care planning cannot stop at the boundary of the health sector. Accessible housing, assisted living, age-friendly neighbourhoods and proximity to ordinary amenities influence how much formal care is required and whether that care can be delivered efficiently.

The Swiss context is particularly important because many older people remain in long-established homes. Familiarity and continuity can support wellbeing, but properties that worked at 65 may become difficult at 85. Moving can also be financially unattractive or emotionally disruptive, particularly where a person has benefited from a long tenancy or strong local relationships.

Future capacity therefore includes the ability to make ordinary housing work for later life. Equipment, adaptations, accessible new-build supply and housing models that allow graded support can create a wider range of options between complete independence and institutional care.

The principle aligns with independence and community inclusion in later life: the goal is not simply to reduce use of residential beds, but to allow people to live in settings that remain safe, meaningful and sustainable as their needs change.

Family care remains capacity, but it cannot be treated as unlimited capacity

Swiss long-term care already depends heavily on relatives and other informal networks. Families provide practical help, supervision, emotional support, transport and care that would otherwise have to be delivered formally. Many Spitex users also receive support from relatives.

This contribution has major value, but demographic planning can become unrealistic if family care is treated as a free reserve that automatically expands with need. Future generations may have fewer available relatives, live further apart, remain in employment for longer or face their own health and financial pressures.

The relationship between formal and informal care is also changing. Some family carers are employed through Spitex organisations for recognised care activity, adding a new dimension to the formal workforce. That can provide recognition and income, but it also creates requirements for assessment, training, supervision, quality assurance and contingency planning.

Long-term capacity models should therefore distinguish between care that families are willing and able to provide and care that the system merely assumes they will provide.

A municipality’s home-first strategy reaches the limits of family availability

A municipality has successfully supported a growing proportion of older residents at home. Its planning assumptions reflect strong local Spitex coverage and a policy preference to avoid premature institutional care.

Over several years, however, staff begin reporting that many complex home-care packages depend on adult children providing substantial evening, overnight and weekend support. Some relatives reduce employment. Others live in another canton and travel repeatedly. Several households reach crisis when the main family carer becomes ill.

The municipality reviews its capacity model and discovers that formal service hours tell only part of the story. The apparent success of the home-based system is partly dependent on a volume of unpaid care that has never been included in demand planning.

Its revised approach starts monitoring indicators of family sustainability alongside formal service use. Where family input is essential to keeping a package viable, review conversations examine willingness, health, employment pressure and contingency arrangements. Additional respite, day support or temporary residential provision is considered before exhaustion becomes an emergency.

The lesson is not that home care has failed. It is that community capacity is a combination of formal and informal resources, and both need limits.

Demand planning must consider intensity as well as numbers

A system can have the same number of service users in two different years and still require substantially different capacity. What matters is not simply how many people receive support, but how much support each person needs.

This becomes important if Switzerland increasingly keeps people with moderate needs at home and reserves nursing homes for those with higher dependency. Residential admission numbers might then grow more slowly than expected, while the average care intensity of residents rises. Spitex may also see increasing complexity as people remain at home longer with dementia, palliative needs, multiple chronic conditions or intensive medication regimes.

Planning based only on client numbers can therefore understate the real requirement. Useful measures include nursing hours, care intensity, staff skill mix, travel time, night coverage, complexity, dependency and the availability of informal support.

The same applies to safe staffing and deployment. A provider does not need the same staffing profile for 50 relatively independent residents as for 50 residents requiring extensive assistance, dementia support and complex clinical monitoring.

Capacity strategy needs to anticipate this change in case mix rather than respond only after operational pressure appears.

Financing choices will shape where future capacity is built

Swiss long-term care is financed through a combination of compulsory health insurance contributions to recognised nursing care, contributions from insured people and residual financing arranged under cantonal rules, alongside separate household responsibility for many wider support, accommodation and living costs.

That structure influences service development. Nursing care delivered in a nursing home and nursing care delivered at home exist within the same broad insurance framework, but the full economic package surrounding them is different. Housing, meals, household assistance, family input, travel and municipal support can determine which option is genuinely sustainable for an individual and for the wider system.

Long-term investment decisions therefore need to consider who carries costs as provision shifts between settings. A home-based model may reduce or postpone institutional expenditure while increasing Spitex volume and transferring some non-nursing costs or practical workload elsewhere. Conversely, residential care can consolidate service delivery but creates substantial accommodation, infrastructure and staffing requirements.

The planned inclusion of nursing care within Switzerland’s uniform financing arrangements from 2032 will alter the financing architecture, but implementation details and behavioural effects must not be assumed in advance. Reform creates an opportunity to reduce some distortions between settings, yet the operational outcome will depend on tariff design, cantonal implementation and how incentives interact with actual service capacity.

By 2040, financing should ideally help the system place people in the most appropriate setting rather than unintentionally reward one part of the pathway while leaving another underdeveloped.

Technology changes the productivity question, not the need for people

Digital care records, route optimisation, remote monitoring, sensors, medication technology and administrative automation can all contribute to future capacity. Their strongest value lies in using scarce human time more effectively, improving information flow and supporting earlier intervention.

In Spitex, better scheduling can reduce unnecessary travel and make deployment more efficient. Digital records can reduce duplication where information follows the person between services. Remote technology may help identify changes in mobility or wellbeing before they become crises. In nursing homes, automation can reduce repetitive administrative tasks and support clinical oversight.

However, technology should not be converted into simplistic assumptions about replacing care workers. Much long-term care involves intimate assistance, observation, reassurance, judgement and human relationships. Digital systems can also create new workload if poorly designed, require training and introduce privacy, cybersecurity and digital-inclusion concerns.

Organisations considering whether technology could genuinely increase usable capacity can use the Digital Transformation Readiness Assessment to test whether strategy, infrastructure, workforce capability and governance are aligned before assuming productivity gains.

The 2040 question is therefore not how many staff technology can remove. It is how technology can help a constrained workforce spend more time on work that requires human skill.

Capacity planning needs an early-warning system, not a single forecast

A 2040 projection is not a construction instruction. It is a scenario based on assumptions about demography, health, service use and patterns of provision. Those assumptions will change.

The strongest response is therefore to establish a capacity-monitoring system capable of detecting whether the country, canton or provider network is moving above or below expected trajectories.

Relevant indicators could include:

• growth in the population aged 80 and over and in assessed care need;
• nursing-home occupancy, waiting times and the care intensity of residents;
• Spitex client numbers, nursing hours, unmet demand and travel workload;
• workforce vacancies, full-time equivalents, turnover, sickness and training capacity;
• hospital discharge delays or repeated emergency use linked to insufficient community support;
• use of intermediate, respite and supported-housing options;
• and the sustainability of family-care arrangements.

The value lies in combining these measures. A nursing-home occupancy figure alone may appear manageable while Spitex demand is accelerating and hospital discharges are becoming harder. A stable workforce headcount may conceal declining full-time equivalents and rising sickness. A home-care expansion may appear successful while families absorb increasing unpaid work.

The Quality Dashboard Builder offers organisations a practical framework for turning multiple indicators into structured governance intelligence. In the Swiss context, the specific metrics and accountability arrangements would need to reflect cantonal and provider responsibilities, but the principle is transferable: capacity risk becomes easier to manage when decision-makers can see interacting pressures before they become service failures.

A dashboard reveals capacity deterioration before beds run out

A regional provider network reports that nursing-home occupancy has remained broadly stable. On the surface there appears to be no immediate capacity problem.

A broader review tells a different story. Spitex nursing hours are rising quickly, staff sickness has increased, evening visits are harder to cover and temporary residential admissions are staying longer because people cannot safely return home. Hospital teams are also reporting more difficulty arranging timely community support.

No single indicator has crossed a formal threshold, yet the combination shows that the system’s remaining flexibility is being consumed.

Cantonal planners bring providers, municipalities and relevant health partners together to examine the pattern. Instead of responding by immediately adding permanent beds, they model several options: additional Spitex teams, more short-stay capacity, expanded supported housing and targeted workforce measures alongside planned residential development.

The intervention happens before visible service breakdown. This illustrates why future capacity governance needs leading indicators rather than waiting for waiting lists, closed admissions or emergency placements to become the evidence.

Planning should work across several plausible futures

Switzerland cannot know precisely what long-term care will look like in 2040. Healthy life expectancy may improve. Prevention may delay frailty. Housing options may change. Technology may become more effective. Family structures may evolve. Workforce participation, migration and professional roles may alter available labour.

That uncertainty is an argument for scenario planning rather than for postponing decisions.

A useful capacity strategy might test at least three broad futures: continued current patterns of service use; a stronger shift towards home and community support; and a scenario in which rising complexity increases care intensity faster than expected. Each would then be tested against workforce, infrastructure and financing requirements.

This approach helps reveal which investments are robust across several futures. Workforce retention, digital interoperability, accessible housing, flexible intermediate provision and reliable data are likely to remain valuable under most scenarios. A highly specialised infrastructure investment may depend more heavily on a particular projection being realised.

Scenario planning also improves workforce risk and mitigation because it exposes how labour requirements change when care shifts between settings. Supporting more people at home may reduce some residential demand but increase mobile nursing, coordination and evening coverage requirements. The workforce does not disappear; its location and role change.

Cantonal autonomy makes coordination more important, not less

Switzerland’s federal structure allows cantons to shape provision around local circumstances. That flexibility can support innovation and responsiveness, but it also means national demographic pressure will be experienced through 26 different planning environments.

The Confederation has roles in the health-insurance framework, national strategy, professional policy and data infrastructure. Cantons carry major responsibilities for healthcare planning and long-term care arrangements. Municipalities often have important operational and financial roles, while insurers and providers influence how services are delivered in practice.

No single actor therefore controls the entire capacity equation.

The governance requirement is to make dependencies explicit. If a canton expects municipalities to expand community support, the resource assumptions must be clear. If a hospital strategy depends on earlier discharge, Spitex and intermediate capacity need to exist. If nursing-home places are reduced because lower-need residents are expected to remain in the community, suitable housing and practical support need to develop at the same pace.

This is a broader question of governance and leadership: each organisation may fulfil its own formal duties while the combined pathway still lacks enough capacity. Long-term planning therefore requires visibility across institutional boundaries even where legal responsibilities remain separate.

People’s preferences should influence what Switzerland builds

Capacity planning can easily become dominated by places, hours and budgets. Yet the purpose of those resources is to support people through later life.

Many older people want to remain at home, but preference should not be reduced to an assumption that home is always best. A person may feel isolated in an inaccessible apartment, frightened by repeated night-time crises or dependent on an exhausted spouse. Another may value remaining in the same village even if the available housing is less technically efficient. Someone with dementia may need continuity and familiarity, while another person may benefit from the social contact and security of residential living.

A mature system therefore plans for choice across a continuum rather than promoting one setting ideologically.

That requires enough capacity for people to move when needs change rather than being forced into whichever option happens to have space. It also connects future infrastructure with person-centred planning in later life. The test of a capacity strategy is not simply whether the national total balances. It is whether people can obtain support that fits their needs, relationships and preferences without avoidable delay or destabilisation.

What should a credible Swiss 2040 capacity strategy contain?

The strongest strategy would not be a single national target for nursing-home beds. It would connect national projection with cantonal planning and local implementation across a series of interdependent capacities.

At minimum, it needs to answer five strategic questions.

• Demand: how many people are likely to need different levels of care, and where will they live?
• Service mix: what balance of nursing homes, Spitex, supported housing, intermediate care and family support is being assumed?
• Workforce: how many full-time equivalents and which skills are required to make that service mix operational?
• Finance and infrastructure: who will fund the necessary services, buildings, technology and wider support?
• Adaptation: which indicators will trigger a change in plan if demand or supply develops differently from forecast?

These questions turn capacity planning from a demographic exercise into a delivery strategy.

They also prevent substitution from becoming invisible. Every time the system plans to reduce demand in one setting, it should identify where that demand is expected to go and what new capacity must be created there.

International lessons from Switzerland’s capacity challenge

Switzerland’s institutional arrangements cannot simply be transferred to countries with different tax systems, insurance models or administrative structures. Its federalism, compulsory health insurance and strong cantonal role create a distinctive planning environment.

Several underlying principles are nevertheless widely relevant.

First, long-term care capacity should be planned as a system rather than as a bed number. Residential care, home care, housing, workforce and informal support are substitutes only to a limited extent; more often they are interconnected components.

Second, shifting care towards the community does not eliminate resource requirements. It converts institutional capacity into dispersed workforce, housing, travel, technology and family-support requirements.

Third, the workforce should be modelled at the same time as physical infrastructure. A place that cannot be staffed is not effective capacity.

Fourth, the intensity of need matters as much as the number of people receiving care. If institutional provision becomes increasingly focused on people with greater dependency, the staffing and clinical capability attached to each bed must increase accordingly.

Finally, long-range forecasts should guide investment without becoming fixed predictions. The transferable lesson lies in combining projections with live data, quality metrics and performance intelligence so that plans can adapt as the real trajectory becomes clearer.

Conclusion

Switzerland’s 2040 long-term care challenge is not simply to create more places. It is to develop enough usable capacity across an increasingly interconnected system while preserving choice, quality and financial sustainability.

National projections make clear that substantial growth is likely even if Switzerland succeeds in supporting more people outside nursing homes. Residential provision will still need to expand, but its residents are likely to have increasingly complex needs. Spitex will require significant additional workforce and operational capacity. Housing, intermediate services and family support will become more important, while each of those alternatives creates its own resource requirements.

The strategic task therefore belongs across levels of government and across service boundaries. The Confederation can shape national frameworks, workforce policy and financing reform. Cantons must translate population change into realistic regional capacity strategies. Municipalities and providers need to turn those strategies into services that can actually operate. Insurers, professionals, families and older people themselves influence whether the resulting system works in practice.

The strongest direction is a portfolio model: plan nursing homes, Spitex, workforce, housing, technology and intermediate care together; model several plausible futures; and monitor leading indicators so that investment changes as demand develops. Switzerland cannot remove the consequences of population ageing, but it can decide whether growth is met reactively or through deliberate, evidence-led capacity design.