Questions about Spitex and care services@Model.TitleTagString>
What is Spitex and how does it work?
Spitex is not a protected term. It is derived from the German “spital-extern” and refers to services provided outside the hospital, such as home care and day-to-day help and support. There are 577 public Spitex organizations, 289 private ones and 1,015 self-employed nursing professionals (Federal Statistical Office, as at 2017, in German and French only) in Switzerland, which are recognized by health insurers. They promote, support and enable living at home for people of all age groups who depend on help to do so.
Spitex for children provides intensive, all-round care and support for seriously ill, disabled or dying children at home, and is offered by only few care providers. The cost of services covered by basic health insurance is paid for by the child's basic insurance.
What is the difference between a private and public Spitex organization?
As a rule, public organizations have an obligation to provide care for the municipality or canton and are therefore obliged to accept all assignments, even if it is not cost-effective to do so. Private organizations have no obligation to provide care. They can define minimum assignment hours and turn down requests for care services.
Both public and private Spitex providers require a cantonal operating licence, for which they must fulfil certain criteria in relation to staff and service range, and can therefore bill health insurers for their services.
At comparis.ch, public organizations are described as providers "with a service contract" and private organizations as "private organizations".
Are Spitex services covered by (basic) health insurance?
The health insurer only pays for services that are prescribed by a doctor, listed in the Health Insurance Benefits Ordinance (KLV) and provided by the qualified personnel of approved Spitex providers.
The services covered by the health insurer are split into three categories: a) needs assessment / advice / coordination (e.g. with the doctor and relatives); b) examination and medical treatment (e.g. preparing and administering medication) and c) basic care (e.g. showering / bathing / washing, dressing and undressing, eating and drinking, going to the toilet, getting up / lying down / walking or dental care). The costs are covered by compulsory basic insurance minus the annual deductible and the coinsurance. More information can be found in the care cost calculator.
Services not covered by health insurance are day-to-day help and support, such as shopping, preparing meals, cleaning, washing, ironing, etc. Certain tasks can be covered by a private supplemental insurance policy. Under certain circumstances, supplementary benefits and/or helplessness allowances may also be applied for.
How much do home care and support services cost?
The rates for home care services are uniformly set by the federal government; the rates for support services are not, which is why they vary. It is worthwhile comparing the various providers and their services. The rates are usually published on the website of the respective provider. Support from relatives may also be an option.
Who pays for Spitex care and support?
The costs for prescribed home care services are paid by three parties: the health insurer (54.60, 65.40 or 79.80 francs per hour), the Spitex clients (maximum 15.95 francs per day) and the public authorities (canton or municipality). The amount to be paid by the Spitex clients themselves depends on the canton, the chosen deductible and the age (younger or older than 18 years) and can be calculated using the care cost calculator.
The costs for support services and domestic help must be borne by the clients themselves, but contributions may be received through supplemental insurance, helplessness allowances and/or supplementary benefits.
Am I entitled to financial support?
Anyone who needs help over a longer period of time for day-to-day life activities such as getting up, dressing, going to the toilet, eating, personal hygiene, etc. is entitled to a helplessness allowance based on whether the incapacity is slight, moderate or severe, but regardless of age, income and assets.
Anyone whose income (incl. pension) and assets mean that they are living below subsistence level is entitled to supplementary benefits (EL/PC). Supplementary benefits are part of the Swiss social security system and are not welfare or social assistance benefits. EL/PC can be applied for from the cantonal AHV/AVS compensation office. Asset and income limits for EL/PC vary from canton to canton. For example, supplementary benefits can be used to cover the deductible and coinsurance for mandatory basic insurance, domestic help and transport.
Anyone who has taken out supplemental insurance should verify whether it contributes to care or domestic help costs. Contributions can amount to up to 100 francs per day, but are usually limited to 30 days per year.
If the above benefits are not sufficient to allow you to live above subsistence level, you can apply for social assistance at the municipality where you live.
As a carer of a relative in need of care, you can claim care credits from the cantonal AHV/AVS compensation office in the canton of residence of the person requiring care. Only great-grandparents, grandparents, parents, parents-in-law, spouse, siblings, children, stepchildren and grandchildren are considered “relatives”. “In need of care” means that the relative receives a helplessness allowance from the AHV/IV or AVS/AI due to a moderate or severe incapacity. To be eligible for care credits, carers must be easy to reach for the person in need of care. “Easy to reach” means that the carer does not live more than 1 hour's journey or 30 km away from the person in need of care for at least 180 days per calendar year.