Switzerland’s Long-Term Care Workforce Challenge: Recruitment, Retention and Rising Demand

A nursing home may have an available room but insufficient qualified staff to admit someone with complex needs. A Spitex organisation may have referrals waiting while struggling to cover evening routes. A nurse may value long-term care but leave after repeated short-notice rota changes, while another reduces working hours because combining shift work with family responsibilities has become unsustainable.

These are not separate workforce problems. They sit at the centre of Switzerland’s ability to meet the demographic challenge examined across the Switzerland Ageing, Long-Term Care & Community Support Knowledge Hub. Demand for long-term care is expected to rise substantially towards 2040, yet additional beds, Spitex capacity and community services are meaningful only if enough people with the right skills are available to deliver care.

Switzerland has already recognised nursing workforce sustainability as a national policy issue. The Nursing Initiative was accepted by voters and cantons in 2021, creating a constitutional mandate to strengthen nursing. Its first implementation stage, including an education offensive, entered into force in July 2024. A second stage addressing working conditions and professional development has been developed by the Federal Council and remains subject to the parliamentary process rather than representing current nationwide employment law.

The central challenge is therefore larger than recruitment. Switzerland needs to educate more people, retain more experienced staff, use professional skills effectively, improve working conditions and ensure that workforce growth reaches the parts of long-term care where demand will rise fastest.

The workforce challenge is being driven by demand as well as shortages

Switzerland’s long-term care workforce debate can easily be reduced to vacant posts. The deeper issue is that the amount and complexity of care required are increasing.

Updated national projections indicate that total demand for long-term care among people aged 65 and over could rise by around 43% by 2040 if demographic and service-use assumptions develop broadly as expected. That would mean roughly 140,000 additional older people requiring nursing-home, intermediate or home-based long-term care compared with the baseline used in the projections.

The workforce implication is substantial. More people will need support, but they are also likely to enter some services later in their trajectory because Switzerland is seeking to sustain ageing at home wherever appropriate. Spitex is already dealing with increasing volumes of care, while nursing homes increasingly support residents with greater frailty, multimorbidity, dementia and dependency.

Workforce planning therefore needs to consider several dimensions simultaneously:

• the number of staff required as demand grows;
• the proportion of qualified nurses and other professionals within teams;
• the skills required for increasingly complex care;
• where workers are geographically available;
• how many hours employees are willing and able to work;
• how many trained professionals remain in nursing over the long term.

A simple vacancy count cannot answer those questions.

This is why workforce planning in long-term care needs to be connected directly to demographic, dependency and service-capacity modelling. The workforce requirement is determined by the model of care Switzerland chooses to develop, not simply by the size of the older population.

Long-term care competes for workers within the wider health system

Long-term care does not recruit from a workforce reserved exclusively for Spitex and nursing homes.

Hospitals, rehabilitation services, psychiatric services, community providers and long-term care organisations all draw from overlapping professional groups. This means that increasing nursing supply nationally does not automatically guarantee that the additional workforce will enter older people’s care.

Official Swiss workforce statistics illustrate the scale of the sectors involved. Hospitals account for the largest share of healthcare employment, while nursing homes and home-care services together employ a substantial workforce of their own. Long-term care therefore competes within a large labour market in which working conditions, professional opportunities, location and organisational reputation can influence where people choose to work.

For nursing homes, recruitment can be affected by perceptions that institutional long-term care offers fewer specialist or career opportunities than acute healthcare. Spitex presents a different challenge: autonomous work in people’s homes can be professionally rewarding, but travel, fragmented schedules, lone working and unpredictable changes in demand create operational pressures not experienced in the same way on a hospital ward.

These differences matter because workforce strategy cannot be identical across care settings.

A national education initiative may increase the overall number of nurses, yet individual sectors still need employment models capable of attracting them. Long-term care providers therefore need a distinctive proposition built around professional autonomy, continuity with people, meaningful relationships, development opportunities and credible working conditions.

The Nursing Initiative has changed the national workforce policy environment

Switzerland’s Nursing Initiative, accepted in November 2021, established nursing as an issue requiring action by both the Confederation and cantons. Article 117b of the Federal Constitution requires nursing to be recognised and promoted as an important part of healthcare and emphasises the availability of sufficient qualified nursing professionals.

The Federal Council divided implementation into two stages.

The first stage entered into force on 1 July 2024. Its most visible workforce component is the education offensive, intended to increase tertiary-level nursing qualifications through higher vocational colleges and universities of applied sciences. Cantons remain responsible for ensuring sufficient training capacity, while federal financial contributions support additional measures.

The same implementation stage also created changes enabling nurses to bill specified services directly to social insurance under defined conditions and introduced measures intended to support efficiency in primary healthcare.

Importantly, the Nursing Initiative did not centralise responsibility for healthcare workforce planning. Cantons retain major responsibilities for healthcare provision and training. This means implementation can still differ according to cantonal workforce conditions, institutions and priorities.

The introduction of national nursing workforce monitoring alongside the first implementation stage is also significant. National policy now has a stronger mechanism for tracking indicators relating to training, staffing and workforce development over time.

That shift from policy commitment to measurable workforce evidence is important for workforce assurance. Switzerland will need to know not merely how much money is invested in training, but whether the number, distribution and retention of qualified professionals improve sufficiently to change future capacity.

Scenario: increasing training places does not immediately solve a nursing-home shortage

A canton identifies persistent difficulty recruiting qualified nursing staff into several nursing homes. It responds partly through the education offensive, expanding supported training opportunities and working with institutions to increase clinical placement capacity.

The policy is necessary, but the operational benefit takes time.

Students entering nursing education today do not become experienced long-term care professionals immediately. They require teaching, placements, supervision and successful qualification. During that period, organisations already facing staffing pressure must release experienced practitioners to supervise learners.

One nursing home therefore finds itself in an apparently contradictory position. It wants to expand student placements because future recruitment depends on them, but its existing senior nurses already have heavy clinical and coordination workloads.

The provider redesigns its approach rather than treating placements as an additional task layered onto existing work. Experienced staff are given defined supervision responsibilities, learning time is included in workforce planning and students rotate through dementia care, rehabilitation-focused practice and end-of-life support so that long-term care is experienced as a clinically demanding field rather than a narrow custodial role.

Retention is considered from the start. Students are offered structured pathways into qualified positions and continuing development after graduation.

The result is not an instant solution to vacancies. It is the creation of a stronger workforce pipeline.

The scenario illustrates why education policy needs operational capacity behind it. Increasing course places without expanding high-quality clinical learning environments can move a bottleneck rather than remove it.

Retention may be as important as recruitment

A country can increase nursing education substantially and still experience persistent shortages if too many qualified professionals leave the occupation early, reduce working hours or move away from sectors experiencing the greatest demand.

This is one reason the second stage of Nursing Initiative implementation focuses on working conditions and professional development.

As of August 2026, the Federal Council’s proposed Federal Act on Working Conditions in Nursing has been submitted to Parliament but should not be described as current nationwide law. The proposal is intended to regulate areas including working time, rota predictability, compensation and other employment conditions, while changes to the Health Professions Act would support professional development and provide a clearer legal basis for advanced practice nursing.

The policy direction reflects an important diagnosis: workforce shortages cannot be solved through training alone if the employment environment encourages people to leave.

Retention is affected by multiple factors. Pay matters, but so do staffing levels, management quality, workload, shift predictability, professional autonomy, development opportunities and the extent to which staff believe they can provide the quality of care they were trained to deliver.

This places staff retention within service-quality governance rather than treating it as an isolated human-resources metric.

High turnover can disrupt continuity for residents and Spitex clients, increase recruitment costs, weaken informal team knowledge and place additional pressure on remaining staff. Retention is therefore both a workforce outcome and a care outcome.

Working conditions shape both available headcount and available hours

Workforce capacity is not determined simply by how many people hold nursing qualifications.

Part-time employment is common across healthcare, and the number of hours staff are willing or able to work can change materially according to working conditions. A provider may therefore have a relatively large number of employees but considerably less full-time-equivalent capacity.

This is particularly important in a predominantly female workforce where employment frequently intersects with caring responsibilities outside work. Unpredictable rotas, unsocial hours and repeated requests for additional shifts can make increasing contracted hours unattractive even where employees wish to remain in nursing.

Long-term care providers have limited control over some structural factors, but organisational choices still matter. Workforce stability can improve where rotas are predictable, managers respond to workload concerns, staff can influence working patterns and escalation processes prevent chronic understaffing from becoming normalised.

There is also a significant relationship between staffing levels and retention. If a vacancy repeatedly increases the workload of existing colleagues, that pressure can create further departures. Organisations then enter a cycle in which shortage generates more shortage.

Breaking that cycle requires more than vacancy advertising. Leaders need visibility of workload, turnover, sickness, overtime, agency dependence where relevant, unfilled shifts, training capacity and employee experience.

Organisations examining these questions can use the Governance Maturity Assessment to test whether workforce risks are reaching decision-makers with sufficient clarity. The framework is not a Swiss regulatory instrument, but its emphasis on accountability, escalation and assurance is relevant where staffing risk directly affects service capacity.

Scenario: a Spitex rota looks staffed until travel and complexity are considered

A regional Spitex organisation appears adequately staffed when managers compare contracted nursing hours with scheduled visits. Nevertheless, employees regularly finish late and short-notice absence causes substantial disruption.

A deeper review finds that the original capacity calculation has treated care hours as though they were interchangeable.

Several rural routes involve significant travel. A growing number of clients require complex wound care, palliative support or assessment rather than predictable basic interventions. New referrals frequently arrive following hospital discharge and require more coordination than the initial visit allocation assumes.

Qualified nurses are consequently carrying tasks that require their expertise while also absorbing travel delays, telephone coordination and work that could sometimes be organised differently across the team.

The provider changes its planning model. Travel is treated as real workforce consumption rather than incidental time. Caseloads are reviewed according to complexity as well as number of visits. Certain administrative activities are redesigned, and teams examine whether appropriately trained colleagues can undertake tasks that do not require the same level of professional expertise.

The organisation also tracks how often shifts are changed at short notice and whether particular routes consistently generate overtime.

No additional worker has been created by the redesign. Yet usable capacity improves because the provider has begun measuring the work actually being performed.

This distinction is increasingly important in safe staffing and deployment. Staffing models need to account for complexity, geography and coordination rather than assuming that one hour of nominal availability always produces one hour of direct care.

Skill mix will matter as much as total workforce growth

Not every long-term care task requires the same professional qualification, and not every complex care situation can safely be managed through substitution.

Switzerland therefore faces a skill-mix challenge as well as a numerical workforce challenge.

Teams may include registered or diplomierte Pflegefachpersonen, healthcare assistants with vocational qualifications, care assistants, trainees and other workers whose roles vary by setting and canton. Spitex statistics also show rapid growth in employment among people without specific professional training or with basic support preparation in parts of the private market, influenced partly by models in which family carers become paid employees.

This creates both opportunity and governance responsibility.

A more varied workforce can allow qualified nurses to concentrate on assessment, clinical judgement, coordination and complex care. But task allocation needs to reflect competence rather than simply staffing availability. Expanding lower-qualified roles without clear supervision can transfer risk rather than create sustainable capacity.

The same principle applies in nursing homes. An organisation may meet a numerical staffing target while lacking sufficient expertise during particular shifts to manage deterioration, medicines, complex wounds, dementia-related distress or end-of-life care.

Strong skill-mix planning therefore asks:

• which decisions require qualified nursing judgement;
• which tasks can be undertaken safely by other trained staff;
• where supervision is required;
• how competence is assessed and maintained;
• whether night and weekend skill mix reflects actual resident needs;
• how changes in dependency alter the required professional profile.

This is particularly important as the long-term care population becomes more clinically complex.

Higher dependency is changing what long-term care staff need to know

The workforce needed in 2040 will not simply be a larger version of today’s workforce.

As older people remain at home longer and nursing-home admission occurs increasingly at higher levels of dependency, staff need greater capability in frailty, dementia, multimorbidity, palliative care, medicines, nutrition, mobility, communication and recognition of deterioration.

Spitex teams are also increasingly managing complex situations that previously might have been associated more strongly with institutional care.

This makes continuing professional development essential. Qualification is the beginning of workforce capability, not the end.

For long-term care organisations, the strategic question is whether their training architecture follows their changing population. If the proportion of clients living with dementia increases but workforce competence remains unchanged, capacity exists on paper but not necessarily in practice.

This is why workforce skills in older people’s care need to be linked to population profiles and service strategy.

Clinical complexity also reinforces the value of professional roles with advanced expertise. The Federal Council’s proposed changes relating to Advanced Practice Nursing reflect a wider direction in which nurses with advanced education may take on broader responsibilities. The precise future legal and service model remains subject to the legislative process and subsequent implementation, so this should not be presented as an established national long-term care model.

The underlying principle is nevertheless relevant: workforce development can increase capacity by enabling professionals to work more fully to their competence, not only by adding more people.

Scenario: dementia complexity exposes a hidden skill shortage

A nursing home has relatively stable overall staffing but sees a growing number of residents with advanced dementia, mobility impairment and multiple long-term conditions.

Management initially believes its workforce problem is manageable because vacancy rates are lower than those of neighbouring providers.

Incident patterns suggest otherwise.

Falls have increased, distress is more common during evening care and staff frequently seek senior support for situations involving changes in behaviour or possible physical illness. Several experienced nurses report that junior colleagues are committed but do not yet feel confident distinguishing dementia-related distress from pain, infection, delirium or medication effects.

The provider therefore stops treating workforce assurance as a headcount question.

It maps resident need against competence on each shift, strengthens dementia and frailty development, increases practice coaching and reviews where senior clinical expertise is available during evenings and weekends. Care assistants receive training relevant to their roles while clear boundaries remain around decisions requiring qualified nursing assessment.

The organisation also examines its environment and routines, recognising that some distress reflects how care is organised rather than a deficit in the resident.

Over time, escalation becomes earlier and more consistent. The provider still needs sufficient staff, but the central workforce risk has become clearer: it previously had enough people to run the rota without always having the right capabilities distributed across it.

The distinction is central to dementia workforce competence and increasingly to residential long-term care as a whole.

Foreign-trained professionals remain important to Swiss care capacity

Switzerland has long relied on internationally recruited health professionals, reflecting its location, labour market and close economic relationships with neighbouring European countries.

International recruitment can provide valuable expertise and help services respond to workforce gaps, but high dependence on external supply creates strategic vulnerability.

Neighbouring countries are ageing too. They also need nurses and care professionals. A workforce model that assumes Switzerland will always be able to recruit sufficient trained staff from abroad therefore faces increasing uncertainty.

Language is another operational consideration. Switzerland’s multilingual environment means recruitment patterns vary between German-, French- and Italian-speaking regions, while professional recognition and language capability affect how readily internationally trained staff can enter particular roles.

Integration matters after recruitment as well. Staff need orientation to the Swiss health system, organisational processes, documentation requirements and local professional expectations. Retention can be weakened if internationally recruited employees are treated primarily as vacancy solutions rather than long-term colleagues with development needs and career ambitions.

International recruitment therefore belongs within a broader workforce portfolio rather than functioning as a substitute for domestic education and retention.

The issue will be examined in greater depth later in this Switzerland series because migrant labour raises additional questions about cross-border dependency, ethical recruitment and the sustainability of care work across Europe.

Technology can release capacity, but it cannot manufacture a workforce

Technology is frequently presented as part of the answer to workforce shortages. It can be, but only when the task being changed is understood clearly.

Digital documentation can reduce duplication. Better scheduling can improve Spitex routes. Mobile access to records can reduce unnecessary administrative journeys. Remote communication can extend specialist support. Sensors and assistive technology may help some people remain independent with fewer avoidable interventions.

Automation may also remove repetitive administrative work that currently consumes professional time.

None of these automatically reduces staffing requirements. New systems require procurement, implementation, training, data governance and ongoing support. Poorly designed technology can increase workload by creating parallel records or additional alerts.

The useful question is therefore not whether technology replaces workers, but whether it enables scarce professional time to be used more effectively.

Organisations considering substantial digital workforce redesign can use the Digital Transformation Readiness Assessment to examine whether operational processes, workforce adoption, digital capability and governance are aligned before technology is scaled.

In workforce terms, successful technology should improve productivity without weakening relationships, judgement or continuity. Long-term care remains fundamentally human work.

Retention requires attention to the experience of care work

Workforce sustainability ultimately depends on whether long-term care remains work that skilled people want to continue doing.

That brings culture, supervision and professional identity into the workforce debate.

Employees are more likely to remain where they feel supported to exercise judgement, receive useful supervision, can raise concerns and see that staffing problems are acted upon rather than normalised. Conversely, repeated inability to deliver care to an acceptable standard can contribute to moral distress and disengagement even when contractual employment conditions appear competitive.

Long-term care also offers strengths that workforce strategy should make visible. Staff can develop sustained relationships with people and families, see progression over time and practise with considerable autonomy. In Spitex, professionals work directly within the realities of people’s everyday lives. In nursing homes, staff can develop deep expertise in complex ageing, dementia and palliative support.

Those characteristics can support recruitment if organisations build professional development around them.

This means leadership needs workforce intelligence extending beyond turnover percentages. Exit reasons, internal movement, sickness absence, employee feedback, supervision quality and willingness to recommend the organisation as a workplace can reveal problems earlier.

Attention to staff engagement and wellbeing is therefore not separate from service performance. Workforce experience affects continuity, learning and the capacity to provide relational care.

Scenario: a provider stops treating turnover as an annual statistic

A medium-sized long-term care organisation experiences increasing turnover among nurses and experienced care staff. Its annual workforce report attributes departures mainly to the competitive labour market.

Senior leaders begin examining the pattern in greater detail.

The data show that departures are concentrated in two services. Exit interviews repeatedly mention unpredictable changes to shifts, weak supervision and difficulty accessing development. Sickness absence is also rising in the same teams.

The provider compares this with services where retention is stronger. Pay scales are similar, suggesting that remuneration alone does not explain the difference.

Managers introduce more stable rota planning, strengthen supervision expectations and create clearer progression opportunities for experienced staff. Senior nursing time is protected for coaching rather than being consumed entirely by shift cover. Workforce indicators are reviewed quarterly rather than waiting for the annual report.

Not every departure is prevented. Some employees move for family reasons, relocation or different career opportunities. The objective is not zero turnover.

What changes is organisational understanding. Recruitment demand begins to fall because fewer avoidable departures occur, and management can distinguish structural labour-market pressure from problems within its own control.

The example demonstrates why continuous professional development, supervision and working conditions need to be analysed together. Retention is usually produced by the employment system as a whole rather than one isolated initiative.

Workforce evidence needs to connect staffing with quality and capacity

Switzerland’s National Nursing Workforce Monitoring creates an increasingly important evidence base for understanding whether Nursing Initiative measures are producing change. By August 2026, national monitoring included a substantial range of indicators, with additional measures continuing to develop.

This creates stronger visibility at federal and cantonal level, but organisations also need evidence that makes sense operationally.

Useful workforce information should show not simply who is employed but whether staffing supports the care being delivered. Depending on the setting, relevant indicators may include:

• qualified staff and skill mix relative to assessed need;
• turnover and the reasons people leave;
• sickness absence and overtime;
• vacancy duration and recruitment success;
• student placement capacity and progression into employment;
• training, competency and professional development;
• service restrictions, admission delays or unmet demand attributable to staffing.

Quality data should then be examined alongside workforce data.

If falls rise while qualified staffing declines, that relationship warrants investigation. If a Spitex service repeatedly delays new referrals because routes cannot be staffed, workforce pressure has become an access issue. If turnover rises sharply within one team, leadership should understand whether quality and continuity are also changing.

The Quality Dashboard Builder can help organisations structure this type of multidimensional evidence. It does not prescribe Swiss staffing standards, but it can help connect workforce indicators with quality, demand and operational performance.

This matters because workforce shortages become most visible to older people not as labour-market statistics but as delayed support, unfamiliar staff, shortened continuity or services that cannot accept them.

Capacity planning to 2040 needs a workforce model, not simply a bed model

Switzerland’s future long-term care capacity cannot be planned successfully by projecting beds and service volumes independently of workforce availability.

An additional nursing-home bed has no practical value without sufficient staff. Expanding Spitex hours requires workers capable of covering the routes. Intermediate housing still depends on accessible support and clinical escalation. Moving more care into the community changes the location of workforce demand rather than making it disappear.

Cantonal planning therefore needs scenarios that connect demographics, service models and labour supply.

Several questions become critical. What happens if nursing-home demand grows faster than recruitment? How much additional Spitex capacity would be required if more people remain at home? Does that create greater demand for qualified community nurses? What happens if staff participation rates fall even while the number of registered professionals rises?

Different assumptions can produce very different workforce requirements.

The Digital Twin Scenario Modeller provides organisations and system partners with a general framework for exploring interactions between workforce, demand, capacity and service stability. It is not a substitute for Swiss demographic or cantonal planning models, but scenario-based thinking is increasingly important where future service decisions depend on variables that cannot be predicted with certainty.

The strongest plans will also test the consequences of workforce constraints rather than assuming that every planned service can automatically recruit.

What international systems can learn from Switzerland’s workforce response

Switzerland’s workforce challenge is shaped by federalism, cantonal responsibility, vocational and tertiary education structures, compulsory health insurance and substantial international labour mobility. Those arrangements cannot be reproduced wholesale in other countries.

Several broader lessons are nevertheless important.

First, workforce policy needs to address supply and retention simultaneously. Expanding education while experienced staff leave does not produce sustainable capacity.

Second, national investment still requires local implementation. Training initiatives depend on providers being able to offer high-quality placements and supervision.

Third, staffing should be measured through effective capacity rather than headcount alone. Part-time working, travel, care complexity and skill mix all affect how much care a workforce can actually deliver.

Fourth, international recruitment can strengthen services but should not become the only answer to structural workforce shortages, particularly when neighbouring countries face similar demographic pressures.

Fifth, workforce and service-model reform need to occur together. Moving care from institutions towards the community changes professional roles, travel patterns and skill requirements.

The transferable lesson lies less in any one Swiss policy mechanism and more in treating workforce sustainability as a system-design problem. Education, employment conditions, professional development, service models and care demand have to move in the same direction.

Conclusion

Switzerland’s long-term care workforce challenge is not simply that more nurses and care workers will be needed. The more difficult task is creating a workforce that can grow, remain in practice and develop the capabilities required by a rapidly ageing population.

The Nursing Initiative has created an important national framework. The education offensive now provides a mechanism for expanding tertiary nursing training, supported by the Confederation and cantons, while national monitoring gives decision-makers better evidence about workforce development. Proposed second-stage reforms recognise that recruitment cannot succeed without attention to working conditions, retention and professional development, although those proposals should remain clearly distinguished from measures already in force.

Implementation will determine the impact. Nursing homes and Spitex organisations need sufficient qualified staff, but they also need sustainable rotas, effective skill mix, good supervision, credible career pathways and technology that releases rather than consumes professional time. Cantons need to connect education and labour-market policy with the future configuration of long-term care.

Above all, workforce planning needs to remain connected to people. For an older person, staffing pressure is experienced through whether support is available, whether familiar workers return and whether the team has the competence to respond as needs change.

As Switzerland plans towards 2040, workforce capacity will increasingly determine how much of its long-term care strategy can actually be delivered. Buildings, financing reforms and service innovation matter, but none can compensate for a care system that lacks enough skilled people able and willing to remain within it.