Spitex and Home Care in Switzerland: Supporting Older People to Remain Independent

For many older people in Switzerland, long-term care begins not with a move into an institution but with somebody arriving at the front door. A Spitex nurse may assess a new wound, help with medication or personal care, monitor deterioration after hospital discharge, coordinate with a doctor or identify that an older person’s ability to manage at home has changed. Alongside nursing, home-care organisations may provide or coordinate household assistance, support with everyday living and other services that help make remaining at home possible.

Spitex is therefore one of the most important operational parts of the Switzerland Ageing, Long-Term Care & Community Support Knowledge Hub. It sits at the meeting point between healthcare, long-term care, families and the home itself. Its importance is increasing as Switzerland’s ageing population creates stronger demand for alternatives to institutional care and as people remain at home with more complex combinations of frailty, chronic illness, dementia and disability.

The term can sound like a single national service, but Spitex is better understood as a field of home-based care provision. Public-interest organisations with service obligations, private commercial providers and self-employed professionals all operate within the wider Swiss system. Cantonal and municipal arrangements influence local provision, compulsory health insurance contributes towards eligible nursing care, and people or public authorities may finance other forms of assistance differently.

The strategic question is no longer whether home care should play a major role. It already does. The more demanding question is whether Switzerland can expand and deepen home-based care without making families the default provider of everything that falls between professional visits.

Spitex is a service model rather than one national organisation

Spitex derives from the German expression for assistance and care outside hospitals and institutions. In practice, it encompasses organisations and professionals delivering services to people in their own homes. The landscape includes non-profit and public-interest providers carrying defined local service responsibilities, profit-making organisations and self-employed nurses.

That diversity matters because the organisations do not all have identical roles. In many areas, public-interest Spitex organisations have a Versorgungspflicht, or obligation to ensure service availability within an agreed population or territory. This can mean accepting complex, low-volume or geographically difficult cases that would not necessarily be attractive on commercial grounds.

Private providers can add capacity, choice and specialised services, while self-employed professionals form another part of the ambulatory care landscape. The resulting mixed market is characteristic of Swiss long-term care more broadly: public responsibility coexists with multiple organisational forms of delivery.

Home care should therefore not be reduced to a simple provider category. Its effectiveness depends on a network connecting the older person, family members, doctors, hospitals, therapists, pharmacies, municipalities, cantons, insurers and other community services.

This wider perspective aligns with home-care service models and pathways. A successful visit is important, but the stronger test is whether all of those visits combine into a coherent pathway that supports the person between professional contacts as well as during them.

Home nursing is only one part of what people need to remain at home

Compulsory health insurance contributes towards defined nursing activities provided at home where the statutory requirements are met. These include assessment, advice and coordination; examination and treatment measures; and basic nursing care.

That framework covers important professional interventions, but an older person’s ability to live independently depends on much more than nursing. Shopping, cleaning, laundry, preparing meals, transport, companionship and supervision can be just as important to the viability of the home arrangement.

The financing boundary between nursing and household or social support therefore has significant practical consequences. Someone with relatively limited clinical need may nevertheless require several hours of help across the week to continue living safely. Conversely, a person with substantial professional nursing needs may be physically capable of completing many other tasks independently.

Strong home-care planning has to recognise both forms of need even where they are funded differently. If the nursing assessment becomes the only lens through which the person is seen, important risks can remain outside the formal care plan.

This is particularly important for people living alone and for those with cognitive impairment. A person may be physically capable of making a meal but repeatedly forget to eat. Another may manage dressing independently but no longer recognise medication correctly. The operational requirement is therefore broader than task completion: it is understanding how health, function, cognition and environment combine.

Spitex has become a major part of the Swiss care infrastructure

Home-based care now operates at substantial scale. Hundreds of thousands of people receive nursing or assistance in their homes each year, and use is particularly significant among people aged 80 and over. The workforce delivering these services has also expanded considerably over time.

The direction is unsurprising. Most older people prefer to remain in familiar surroundings for as long as possible, and supporting people at home can avoid or delay institutional care where needs can be met safely. Shorter hospital stays and stronger treatment outside hospitals also increase demand for community capacity.

But growth in volume does not necessarily mean growth in resilience. As more care moves into homes, the average complexity of those homes can increase. Home-care teams increasingly encounter palliative needs, multiple conditions, dementia, psychiatric needs, complex medication and significant family-carer pressure.

The operational model therefore has to evolve from scheduled domestic visiting towards distributed clinical and social coordination. That requires stronger professional autonomy, supervision and communication.

The importance of complex care at home will consequently increase across Switzerland. The home can support high levels of independence, but it is not automatically a low-intensity care environment.

Assessment determines what support enters the home

Spitex services rely on professional needs assessment. A nurse evaluates what care is required, the circumstances in which it will be delivered and how those needs translate into an agreed plan. Where compulsory health-insurance reimbursement is involved, eligible nursing interventions have to meet the relevant legal and professional requirements.

Assessment is therefore both clinical and operational. It has to identify what should be done, who should do it, how often it is required and what signs should trigger reassessment or medical escalation.

Home-care professionals often see aspects of life that are difficult to observe in a consultation room. They can see whether someone is eating, whether the fridge is empty, how far the toilet is from the bed, whether medication is organised safely, whether stairs are becoming difficult and whether a spouse appears exhausted.

These observations create a powerful form of preventive intelligence. They allow services to notice changes before they become hospital admissions or residential-care crises.

The value is greatest when the information leads somewhere. Recording that an older person is becoming less stable is not enough if no one owns the next action. Strong decision-making and escalation pathways therefore matter as much as the initial assessment itself.

Scenario: a routine visit reveals that the care model has changed

An 87-year-old woman receives Spitex support twice each day following a period of illness. Her care plan includes medication support, assistance with washing and observation of a chronic leg wound. Her daughter lives nearby and normally visits several evenings each week.

Over several visits, staff notice small changes. The woman appears more tired, food in the kitchen is going uneaten and she has started asking the same question repeatedly. The wound itself is stable, meaning the formal nursing task has not deteriorated.

A task-focused service could continue delivering the existing interventions and regard the visits as successful. Instead, the observations are brought together. The team contacts the appropriate medical professional, discusses the change with the woman and her daughter and reassesses the home arrangement.

The review identifies dehydration, reduced nutrition and emerging cognitive concerns. Additional practical support is arranged temporarily and the daughter’s role is clarified rather than simply expanded. The care plan is adjusted and the woman avoids an immediate crisis.

The important point is that no single dramatic incident triggered the response. Home care created longitudinal visibility. Staff saw a pattern because they entered the same environment repeatedly.

This is one of Spitex’s major system advantages: regular home contact can turn subtle functional change into actionable information before deterioration becomes acute.

Funding shapes which parts of home support are easiest to organise

Swiss compulsory health insurance pays fixed contributions towards eligible nursing care delivered at home. The amount varies according to the category and duration of nursing activity. Insured people may also make a limited contribution, while the remaining recognised nursing cost is dealt with through cantonal and municipal residual-financing arrangements.

Household and social-support services are different. They are not generally covered as compulsory health-insurance nursing benefits and may instead be paid privately, through supplementary insurance where applicable, through municipal or cantonal support or through other social-security mechanisms.

This distinction can create a structural tension. The clinical component of remaining at home may have an established reimbursement route while the everyday assistance that makes the arrangement sustainable is financially less straightforward.

That tension is particularly important for people with modest incomes and limited family support. A person may technically have access to necessary nursing care while struggling to fund cleaning, meals or supervision.

The result can be premature escalation to a more intensive setting even though the missing intervention is not clinical.

For system leaders, funding therefore needs to be considered alongside outcomes-based home care. The relevant question is not simply whether each reimbursable activity has been delivered, but whether the whole arrangement is preserving independence, safety and quality of life.

Public-service obligations matter where care is difficult to deliver

Local service obligations are a particularly important part of the Spitex landscape. Some organisations are required to ensure access within defined areas or populations, including for people whose needs are complex, urgent or geographically inconvenient.

This creates costs that are easy to overlook in simplistic provider comparisons. A service with a broad public mandate may need to maintain availability even when demand is unpredictable, travel long distances, accept short visits and provide specialist capacity that is not continuously utilised.

Commercial and public-interest organisations can therefore operate within different risk profiles even when both provide high-quality nursing.

Good local governance needs to distinguish between genuine inefficiency and the cost of maintaining universal service capability. A provider carrying a territorial obligation should still be expected to manage productivity and quality, but its performance cannot be assessed as though it can select only the most convenient activity.

That principle becomes more important as Switzerland relies more heavily on community-based care. A home-first strategy needs somebody to remain responsible when the case is difficult, rural, urgent or unattractive economically.

Home care redistributes risk rather than removing it

Remaining at home can protect autonomy, familiarity and community connection, but it also changes where care risks are managed. Nursing homes concentrate staff, equipment and supervision in one location. Home care distributes responsibility across private residences, professional visits and family networks.

That changes the operational environment. Staff may work alone. Homes may contain stairs, poor lighting, pets, clutter or inaccessible bathrooms. Medication may be handled by several people. Emergency assistance is not immediately present between visits.

The objective should not be to eliminate every risk before someone is allowed to remain at home. Doing so would undermine autonomy and make institutional care the default whenever uncertainty exists. Instead, risks need to be understood proportionately and reviewed with the person.

This is where the principles of positive risk-taking for older people are useful. The question is not simply whether staying home contains risk, but whether those risks are understood, mitigated and balanced against the benefits the person values.

Organisations examining similar decisions can use the Positive Risk-Taking Planner to structure discussion about choice, benefit, foreseeable harm and proportionate controls. It is not a Swiss clinical or legal assessment tool, but it can help leaders think more clearly about independence without treating safety and autonomy as opposites.

Family carers make many Spitex arrangements possible

Formal home care rarely operates in isolation. Relatives frequently provide meals, transport, shopping, companionship, supervision, emotional support and coordination around professional visits. For many older people, this combination is exactly what allows them to remain at home.

National evidence shows that a substantial proportion of people using home-care services also receive help from relatives. This overlap should change how services interpret demand. A person receiving a relatively small number of formal hours may still have significant total support needs if the majority is being met informally.

Family involvement can reflect preference and strong relationships. It can also conceal fragility. A daughter may appear readily available because she has reduced employment. An older spouse may continue providing personal care despite deteriorating health. A relative may perform increasingly complex tasks because no alternative has been arranged.

Assessment should therefore identify not only whether family support exists but whether it is sustainable. Relatives should be asked what they are willing and able to provide rather than treated as a permanently available extension of the workforce.

The wider principles of family partnership and carer support are central to effective Spitex. Professional care and family care should complement one another without shifting undefined responsibility across the boundary.

Scenario: the formal care package stays stable while the real package collapses

An older man with advanced heart disease receives Spitex visits in the morning and evening. His wife prepares meals, manages appointments, monitors him between visits and helps him move around the apartment.

On paper, the professional package remains stable for months. There are no missed visits and no major incidents. Then his wife is admitted to hospital unexpectedly.

The home arrangement changes overnight. The nursing interventions still occur exactly as planned, but there is now nobody present for meals, supervision or unplanned needs. The man himself has not become clinically worse, yet the care system around him has lost a critical component.

Spitex reassesses the situation immediately. Additional temporary support is explored, medication and nutrition risks are reviewed and the municipality and relevant services are involved. The team also considers whether short-term residential or transitional provision is necessary if safe cover cannot be arranged.

The governance lesson is that informal care is part of operational capacity even where it is not formally purchased. If services record only their own inputs, the fragility of a home-care arrangement can remain hidden.

A mature home-care model therefore includes family-carer resilience in assessment and escalation rather than discovering dependence only after the carer disappears.

Hospital discharge is increasing the importance of Spitex capability

Home care is increasingly connected to acute healthcare. Older people leaving hospital may require wound management, medication changes, rehabilitation support, monitoring and assistance with daily living. A timely Spitex response can help make discharge feasible and avoid unnecessary extended hospital stays.

The challenge is that “medically ready for discharge” does not necessarily mean “ready to live safely at home”. The home environment, family availability, equipment and community-service capacity all matter.

Spitex therefore plays a critical role at the interface between hospital treatment and everyday life. Staff may be the first professionals to see whether the assumptions made during discharge planning work outside the institution.

This makes hospital and home-care transitions an important quality domain. Discharge information needs to arrive early enough, medication changes need to be understandable and the receiving service needs sufficient capacity to begin care when required.

A weak interface creates cost elsewhere. Delayed home-care availability can prolong hospital stays. Poor information can cause medication errors or duplication. An unrealistic home plan can result in readmission.

Home-care capacity therefore contributes to hospital flow even though Spitex organisations are institutionally separate from hospitals.

Home care increasingly requires multidisciplinary coordination

As people remain at home with more complex needs, Spitex staff interact with a wider range of professionals. General practitioners, specialist doctors, physiotherapists, occupational therapists, pharmacists, palliative-care teams and social-support organisations may all contribute.

Coordination becomes particularly important where no one professional sees the person frequently enough to understand the whole picture. The Spitex team may have the most consistent visibility but cannot assume clinical responsibility for decisions outside its scope.

Clear interfaces are therefore needed. Professionals should know who manages medication changes, who reviews worsening mobility, who responds to nutritional deterioration and who coordinates when several issues arise together.

Digital information exchange can support this, but governance matters just as much. A shared record does not automatically resolve unclear ownership.

The Governance Maturity Assessment can help organisations considering similar multi-agency arrangements examine accountability, escalation and oversight. It does not determine Swiss professional responsibilities, but it provides a useful structure for asking whether everyone involved knows what they own.

Workforce sustainability is becoming the limiting factor

Expanding home care requires more than allocating additional funding. It requires people able and willing to deliver care in dispersed environments.

Spitex work demands substantial professional autonomy. Staff often work alone and must recognise deterioration, make judgements within their competence and communicate effectively with other professionals. Scheduling can also be demanding because many clients need support at similar times of day.

Travel reduces productive time, particularly outside urban areas. Split shifts and irregular demand can affect job quality. Increasing clinical complexity raises skill requirements at the same time as Switzerland faces wider nursing shortages.

The workforce is also changing. Growth in private providers and newer employment models, including arrangements involving paid family carers, is altering the composition of the home-care workforce. These developments may increase formal recognition and support for care that was previously unpaid, but they also raise questions about training, supervision, quality and the appropriate boundaries between family and professional roles.

For this reason, workforce skills in older people’s care need to develop alongside service growth. Home care cannot be expanded safely by treating every hour of labour as interchangeable.

Scenario: expanding home care creates a scheduling problem before a staffing problem

A Spitex organisation receives funding to increase capacity because the canton wants more older people supported outside nursing homes. Recruitment initially keeps pace with growth, yet missed preferences and staff dissatisfaction begin increasing.

The difficulty is not the total number of employees. Demand is concentrated around the same periods. Many clients require morning personal care or medication, and a smaller group needs several visits across the day. Travel between communities creates additional pressure.

Managers therefore analyse demand by time, geography and clinical urgency rather than total hours alone. Visits that genuinely require a particular time are distinguished from those that can be moved safely. Team geography is redesigned and continuity is protected for people with the most complex needs.

Some administrative tasks are simplified digitally, but technology is not used to compress visits below what care requires. Workforce data are reported alongside waiting times and continuity rather than as a separate human-resources dashboard.

The organisation discovers that nominal staffing capacity and usable care capacity are different measures.

This is the operational significance of home-care workforce and scheduling. Expanding headcount can fail to expand meaningful service capacity if demand patterns, geography and skill mix are not modelled together.

Quality in home care cannot be judged only from completed visits

Home-care quality is more difficult to observe than institutional care because delivery occurs across thousands of private residences. Managers and cantonal authorities cannot simply walk through one site and see the service operating.

That makes evidence crucial. Useful indicators include missed or late visits, continuity of staff, reassessment frequency, medication incidents, falls, hospital transfers, complaints, workforce turnover and the proportion of care delivered by appropriately skilled workers.

Person-centred outcomes matter as well. Does support help people maintain mobility? Are family arrangements remaining sustainable? Are people able to continue activities and relationships that matter to them?

Quality information also needs to distinguish isolated events from system patterns. One hospital admission may be unavoidable. A recurring rise in hospital transfers across a particular population may indicate insufficient monitoring, delayed escalation or an increasingly complex caseload.

The Quality Dashboard Builder can help organisations structure comparable measures across capacity, workforce, safety and outcomes. It is not a Swiss regulatory dashboard, but it illustrates an important principle: home-care assurance needs to connect activity with what happens to people over time.

Digital care can reduce coordination burden without replacing relationships

Home care is particularly well suited to useful digital innovation because so much operational work occurs across dispersed locations. Mobile records, digital scheduling, secure communication and remote monitoring can help professionals access information without returning to an office and can reduce repeated administration.

Remote monitoring may also support selected older people between visits. Sensors, communication tools and digital medication support can provide additional information or reassurance where they are appropriate and consented to.

The opportunity is significant, but technology should not be framed simply as a way to replace home visits. Many Spitex interventions are physical, relational or require professional judgement in the home. A sensor can indicate that somebody has not moved; it does not necessarily explain why.

Digital tools also shift work. Alerts have to be reviewed, equipment maintained and data interpreted. Staff need training. People and families need to understand what technology does and what it does not do.

This is why remote monitoring and telecare should be integrated into the care model rather than layered on top of it as a separate innovation project.

Organisations considering this transition can use the Digital Transformation Readiness Assessment to examine strategy, workforce adoption, information governance and cyber resilience. It is not a Swiss regulatory instrument, but it can help determine whether digital change is operationally mature enough to support real care.

Scenario: remote monitoring adds information but also creates responsibility

An older woman with recurrent falls lives alone and strongly wishes to remain in her apartment. Her Spitex team and family agree to introduce movement monitoring and an emergency-call solution alongside scheduled care.

The technology initially works well. Her daughter feels reassured and the woman retains more privacy than she would with frequent precautionary visits.

Several weeks later, repeated alerts begin occurring overnight. Staff discover that the woman is getting up frequently because of worsening urinary symptoms. The technology has not prevented deterioration, but it has detected a change earlier than scheduled visits might have done.

The service then faces the important governance question: who is responsible for responding to patterns rather than individual alerts?

The care plan is revised so recurring events trigger clinical review. The relevant medical professional is contacted, the woman’s risk is reassessed and the purpose of the monitoring is explained again to her and her family.

The scenario shows why technology requires an operational pathway. Collecting more information without defining who interprets it can create a new form of risk. Effective digital home care links data to named responsibility, escalation and review.

Housing can determine the limits of Spitex

Home care is only as sustainable as the home itself. Switzerland’s housing stock includes apartments and houses that were not designed around significant mobility impairment or intensive care.

Stairs, small bathrooms, narrow doors and inaccessible entrances can make everyday support much harder. A person may require more staff time simply because safe transfers are difficult. Family carers may be unable to assist without injury. Equipment may not fit.

Housing adaptation and assistive technology can therefore delay residential admission for some people. But there are practical and financial limits to what can be changed, particularly in rented or older properties.

This means long-term care planning should connect with housing policy rather than assuming Spitex can compensate indefinitely for unsuitable environments.

The principle is closely related to equipment, assistive technology and home adaptation. The stronger intervention sometimes changes the environment rather than increasing the number of care hours delivered inside it.

Spitex is increasingly part of the prevention infrastructure

Because home-care professionals see people regularly, they are well placed to identify preventable deterioration. Falls risk, dehydration, medication problems, reduced mobility, loneliness and carer exhaustion can all become visible before they result in major events.

This gives Spitex a potentially important preventive role, although prevention should not be interpreted as expecting nurses to solve every social issue they encounter.

The important capability is recognition and connection. Staff need to know when to escalate clinically, when rehabilitation might help, when community services are relevant and when the existing care plan no longer matches need.

Prevention also requires enough time to notice. Highly compressed task scheduling can undermine the observational value of home care. A service optimised entirely around minutes of reimbursable intervention may lose part of what makes repeated home contact useful.

The broader principles of prevention and early intervention therefore apply strongly. Avoiding deterioration often depends on connecting small warning signs before they become large problems.

Care@Home points towards a broader future model

The future development of Swiss home care is increasingly being discussed through broader Care@Home concepts. The idea extends beyond traditional Spitex visiting by considering how medical, nursing, therapeutic and social support can be organised more coherently around the person at home.

This does not mean Switzerland already operates one national Care@Home model. Development remains emerging and should not be confused with universally implemented practice.

The direction is nevertheless important. As hospital treatment becomes more ambulatory and more older people remain at home with high levels of need, the boundary between healthcare at home and conventional long-term home care will become less clear.

Future models may involve stronger multidisciplinary networks, remote clinical support, home-based diagnostics, rehabilitation, palliative care and closer coordination between hospitals and Spitex.

The opportunity is substantial because the person’s home can become a more capable care setting. The risk is creating a complicated collection of professionals and technologies without one coherent pathway.

Care at home therefore needs integration by design rather than simply the accumulation of services.

Future financing reform will change the environment around Spitex

Switzerland’s move towards uniform financing of healthcare services will eventually extend to nursing care. Ambulant and inpatient healthcare services are due to enter the new financing model first, with nursing care at home and in nursing homes following later.

The long-term care changes are not yet fully implemented and should not be described as current Spitex financing. Their significance lies in the future relationship between insurers and cantons and the intended movement towards a more uniform financing architecture.

For home-care providers, the period before implementation will be important. Financing reform may change incentives and administrative arrangements, but it will not remove the underlying cost drivers of community care: workforce, travel, case complexity, coordination and service obligations.

Nor will it automatically resolve the divide between insured nursing and wider household support. A stronger home-care strategy will still need to address the non-clinical assistance required for ageing in place.

Financing reform should therefore be judged partly by whether it helps services follow people across settings rather than simply redistributing payment responsibility.

Planning for 2040 means modelling the intensity of home care, not only client numbers

Long-term care projections indicate substantial growth in demand over the coming years. For Spitex, the important question is not simply how many more people will receive services.

Intensity matters. A person receiving one short visit each week creates a very different workforce requirement from somebody receiving several daily interventions, complex medication support and regular multidisciplinary coordination.

Future planning therefore needs to model:

• the number of people likely to use home-based nursing and assistance;
• the average intensity and complexity of future caseloads;
• the workforce and skill mix required at different times of day;
• the amount of unpaid family support assumed within the model;
• geographical travel requirements and rural service obligations;
• the extent to which housing and technology can reduce or reshape formal care demand.

The Digital Twin Scenario Modeller can help organisations explore comparable interactions between demand, workforce and service capacity. It is not a Swiss forecasting system, but scenario modelling is particularly relevant where a shift towards home care can change workforce requirements even if total long-term care need remains the same.

What other countries can learn from Spitex

Spitex has developed within Switzerland’s distinctive combination of federalism, compulsory health insurance, cantonal responsibility and municipal involvement. The model cannot therefore be transferred directly into systems with very different funding and administrative arrangements.

There are nevertheless several useful international principles.

First, home care works best when it is treated as infrastructure rather than a collection of visits. Providers need assessment, escalation, coordination and workforce capability as well as scheduling.

Second, home-based nursing and everyday support should be understood together even when they are financed separately. A clinically appropriate intervention can still fail if the person cannot eat, shop or move safely around the home.

Third, family care needs to be visible. Formal hours alone can significantly understate the resources supporting a person at home.

Fourth, local service obligations matter. A home-care system needs a credible answer for people whose needs are geographically difficult, complex or financially unattractive.

Finally, technology is most useful when it strengthens professional and personal relationships rather than attempting to substitute for them indiscriminately.

The strategic challenge is not simply more home care, but more capable home care

Switzerland has strong reasons to continue expanding support outside institutions. Older people often prefer to remain at home, nursing-home capacity faces demographic pressure and advances in community healthcare make more complex care feasible outside traditional facilities.

But increasing the number of Spitex visits is not enough. The future system will need greater capability around complex care, rehabilitation, dementia, palliative support, digital coordination and rapid response after hospital discharge.

It will also need stronger links with housing, municipal services and families. Home care becomes unstable when professional provision is expected to compensate for every weakness in the surrounding environment.

The strategic opportunity is therefore to develop a continuum in which nursing, practical support, technology, rehabilitation and community infrastructure can increase or reduce as needs change.

That allows remaining at home to be a genuine supported choice rather than an expectation placed on the person and family because institutional capacity is limited.

Conclusion

Spitex is one of the foundations of Switzerland’s long-term care system because it brings professional care into the place where most older people wish to remain: their own homes. Its contribution extends beyond individual nursing tasks. Repeated contact creates opportunities for assessment, prevention, coordination and early recognition of deterioration, while broader home-support services can sustain the everyday conditions that make independence possible.

The model’s future importance is also what makes its pressures significant. More complex care at home demands skilled staff, workable financing, reliable hospital interfaces, sustainable family involvement and housing capable of supporting changing needs. Digital technology can improve coordination and monitoring, but it cannot remove the need for professional judgement, human contact or clear accountability.

As Switzerland’s population ages, the strongest policy direction is not simply to transfer activity from nursing homes into private residences. It is to build sufficiently capable community infrastructure around the person. That means recognising the full cost of home care, the hidden contribution of families, the realities of rural delivery and the increasing clinical intensity of Spitex work.

Ageing at home becomes sustainable when independence is supported rather than assumed. Switzerland’s next challenge is therefore to ensure that Spitex remains not merely available, but resilient enough to carry a larger and more complex share of long-term care without transferring the unresolved burden onto older people and their families.