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ESPN Thematic Report on work-life balance measures for persons of working age with dependent relatives in Switzerland

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Abstract and Figures

The Swiss system of long-term care is highly fragmented. As in other policy fields, the responsibility for long-term care services is at the cantonal and municipal level. As a consequence, there are some differences between cantons and regions regarding the way long-term care services are organised and financed. Additionally, private means are an important element for financing long-term care; social insurances, such as the retirement and the disability insurance, provide only complementary payments. Home care and care by individuals for their dependent relatives are an important element of the Swiss system of long-term care. For example, about 40% of old-aged persons in need of care receive home care, many of them by relatives of working age. But there is also a large number of younger persons, for example children and adults with disabilities, who receive care from their relatives. Against this background, the Swiss system of support for persons of working age with dependent relatives is underdeveloped. For example, only five cantons and a few municipalities provide financial benefits for those who take care of dependent persons at home. The services that exist are no income replacement but rather a recognition for the services provided by volunteers. With regards to benefits in kind, more options are available. Cantons, municipalities and NGOs provide support to persons with dependent relatives. Nonetheless, these services are not well coordinated and do not entail a lot of measures to improve the work-life balance for persons of working age with dependent relatives. As a consequence, persons of working age with dependent relatives need to work less without adequate financial compensation. Consequently, they often depend on other working persons in their family. Most problematically, due to lack of alternatives, women often decide to reduce their workload in order to care for dependent relatives without adequate financial compensation, or guarantees for professional reintegration after the period of care. Overall, in Switzerland there is no systematic support – especially financially – for those who need to support their dependent relatives. Given the economic and social importance of long-term care services provided by relatives, this report recommends increasing the coverage and amount of financial support for persons of working age with dependent relatives. Furthermore, it is necessary to provide better coordination of the existing services and to increase the incentives and possibilities for taking time off from caring for dependent relatives.
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Philipp Trein
February 2016
ESPN Thematic Report on
work-life balance measures
for persons of working age
with dependent relatives
Switzerland
2016
EUROPEAN COMMISSION
Directorate-General for Employment, Social Affairs and Inclusion
Directorate C Social Affairs
Unit C.2 Modernisation of social protection systems
Contact: Emanuela Tassa
E-mail: Emanuela Tassa @ec.europa.eu
European Commission
B-1049 Brussels
EUROPEAN COMMISSION
Directorate-General for Employment, Social Affairs and Inclusion
2016
European Social Policy Network (ESPN)
ESPN Thematic Report on
work-life balance measures
for persons of working age
with dependent relatives
Switzerland
2016
Philipp Trein, IDHEAP, University of Lausanne
The European Social Policy Network (ESPN) was established in July 2014 on the initiative of the
European Commission to provide high-quality and timely independent information, advice,
analysis and expertise on social policy issues in the European Union and neighbouring countries.
The ESPN brings together into a single network the work that used to be carried out by the
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Support on the Socio-Economic Impact of Social Protection Reforms (ASISP) and the MISSOC
(Mutual Information Systems on Social Protection) secretariat.
The ESPN is managed by LISER and APPLICA, with the support of OSE - European Social
Observatory.
For more information on the ESPN, see:
http:ec.europa.eusocialmain.jsp?catId=1135&langId=en
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Work-life balance measures for persons of working age with dependent relatives Switzerland
3
Contents
SUMMARY/HIGHLIGHTS ................................................................................................. 4
1 DESCRIPTION OF MAIN FEATURES OF WORK-LIFE BALANCE MEASURES FOR WORKING-
AGE PEOPLE WITH DEPENDENT RELATIVES .................................................................. 5
1.1 Overall description of the long-term care regime .................................................... 5
1.2 Home care by relatives of working age as a problem in Switzerland .......................... 5
1.3 Description of carers’ cash benefits ....................................................................... 6
1.3.1 Benefits for carers .................................................................................... 6
1.4 Description of carers’ benefits in kind .................................................................... 8
2 ANALYSIS OF THE EFFECTIVENESS OF WORK-LIFE BALANCE MEASURES FOR
WORKING-AGE PEOPLE WITH DEPENDENT RELATIVES .................................................. 9
2.1 Assessment of individual measures ....................................................................... 9
2.1.1 Coverage and effectiveness of financial benefits and benefits in kind ............... 9
2.1.2 Employment effects ................................................................................ 10
2.1.3 Overall effects on the well-being for the carer and the cared for ................... 11
2.2 Assessment of overall package of measures and interactions between measures ...... 11
2.3 Policy recommendations .................................................................................... 12
REFERENCES .............................................................................................................. 14
Work-life balance measures for persons of working age with dependent relatives Switzerland
4
Summary/Highlights
The Swiss system of long-term care is highly fragmented. As in other policy fields, the
responsibility for long-term care services is at the cantonal and municipal level. As a
consequence, there are some differences between cantons and regions regarding the way
long-term care services are organised and financed. Additionally, private means are an
important element for financing long-term care; social insurances, such as the retirement
and the disability insurance, provide only complementary payments.
Home care and care by individuals for their dependent relatives are an important element
of the Swiss system of long-term care. For example, about 40% of old-aged persons in
need of care receive home care, many of them by relatives of working age. But there is
also a large number of younger persons, for example children and adults with disabilities,
who receive care from their relatives. Against this background, the Swiss system of
support for persons of working age with dependent relatives is underdeveloped. For
example, only five cantons and a few municipalities provide financial benefits for those
who take care of dependent persons at home. The services that exist are no income
replacement but rather a recognition for the services provided by volunteers. With
regards to benefits in kind, more options are available. Cantons, municipalities and NGOs
provide support to persons with dependent relatives. Nonetheless, these services are not
well coordinated and do not entail a lot of measures to improve the work-life balance for
persons of working age with dependent relatives. As a consequence, persons of working
age with dependent relatives need to work less without adequate financial compensation.
Consequently, they often depend on other working persons in their family. Most
problematically, due to lack of alternatives, women often decide to reduce their workload
in order to care for dependent relatives without adequate financial compensation, or
guarantees for professional reintegration after the period of care.
Overall, in Switzerland there is no systematic support especially financially for those
who need to support their dependent relatives. Given the economic and social
importance of long-term care services provided by relatives, this report recommends
increasing the coverage and amount of financial support for persons of working age with
dependent relatives. Furthermore, it is necessary to provide better coordination of the
existing services and to increase the incentives and possibilities for taking time off from
caring for dependent relatives.
Work-life balance measures for persons of working age with dependent relatives Switzerland
5
1 Description of main features of Work-Life Balance measures for
working-age people with dependent relatives
1.1 Overall description of the long-term care regime
In Switzerland, the system of long-term care is as decentralised as the health care
system. At the national level, the most important institutions in this policy field are
health insurance funds. They finance ambulatory medical care if it is related to illness,
but not if it is related to old age. Other services, such as social assistance, activity
therapy, or staying in nursing homes are billed to the patient directly. Switzerland spends
over 2% of its GDP on long-term care. This is about double the OECD average (1.1% in
2011). This is partly due to the large proportion of the population aged over 65 in
Switzerland (17.1% in 2011) in relation to the OECD average (12.2% in 2011). It is also
related to the fact that the Swiss health system is comparatively expensive (OECD 2014).
The responsibility for long-term care belongs to the cantons, which can delegate this
responsibility to municipalities or private organisations, an option which they use
frequently (Kocher 2010; OECD 2011). Health insurance funds, cantons, and
municipalities finance directly about 40% of long-term care cost. The remaining 60% are
covered by households. Yet, to ease financial pressure on families and individuals social
benefits, such as invalidity allowances and supplementary benefits, cover another 24% of
the total expenditure, so that the households have to cover 36% of the costs for long
term care (OECD 2011).
The provision of care occurs either in medical nursing homes, nursing departments of old
age or disability homes, or ambulatorily. An organisation called Spitex (Acronym for the
German phrase „Spitalexterne Hilfe und Pflege“ care services provided out of hospitals)
is responsible for the provision of ambulatory care (Gmür and Rüfenacht 2015). In
addition to formal care services, informal care also plays an important role in
Switzerland. Informal care entails care services that are provided by volunteers, families,
and dependents of the person in need (Zumbrunn and Bayer-Oglesby 2015).
In Switzerland, access to long-term care depends largely on private assets (Höpflinger et
al. 2011). Health insurance funds partly pay for ambulatory long-term care services
provided by Spitex, if a doctor prescribes them. The insurance contribution consists of a
daily rate for basic care, yet patients have to contribute to it out of their own pockets, in
addition to the franchise1 of their health insurance. If an individual cannot raise the out-
ofpocket contributions, they can apply for complementary benefits
(Ergänzungsleistungen) to the AHV (Alters- und Hinterbliebenen-Versicherung - Old Age
and Survivors Insurance) and IV (Invalidenversicherung Disability Insurance)
insurances. If the insurance funds do not pay for the services a patient needs, or if these
services were removed from the portfolio of the insurance’s contribution, and if there are
no private means available, those in need can apply for social assistance from the
foundation ProSenectute. This is a national foundation whose goal is to prevent and
relieve poverty in old age, with cantonal and regional centres2 .
1.2 Home care by relatives of working age as a problem in Switzerland
In Switzerland, home care is an important part of the system of long-term care.
According to estimates, in 2010, 120,000 individuals aged over 65 needed long-term
care, of whom 48,000 were cared for at home. Additionally, around 70,000 old-aged
individuals received some amount of assistance at home. Furthermore, in 2012, about
1 Insured persons can choose to pay an initial annual amount for health coverage ranging from CHF 300 to
CHF 2500 in return for lower premiums. This amount is called “franchise”.
2 http://www.srf.ch/gesundheit/gesundheitswesen/spitex-wie-man-zur-hilfe-kommt-was-sie-kostet, last access
October 11, 2013.
Work-life balance measures for persons of working age with dependent relatives Switzerland
6
80,000 individuals aged 18 or older received home care (Zumbrunn and Bayer-Oglesby
2015: 311).
An important share of home care is provided by relatives of the dependent persons,
mostly by female relatives of persons who are in need of care (Höpflinger et al. 2011:
72), such as daughters of old-aged individuals or mothers of children with chronic
diseases or disabilities. If the dependent person is in need of intensive care, the situation
is very challenging for relatives. If the person in need of care is a dementia patient, for
example, relatives are constantly afraid of losing the relationship with the person they
care for. As a consequence, persons of working age with dependent relatives often suffer
from fear, depression and exhaustion (Zumbrunn and Bayer-Oglesby 2015: 312).
Furthermore, intensive care for dependent relatives can have negative economic
consequences for their carers, because having a job and taking care of dependent
relatives at home cannot often be combined easily. The SwissAgeCare survey (Perrig-
Chiello et al 2010) showed that more than half of the women taking care of their
dependent relatives at home reduced their workload and one sixth gave even up their job
completely. Contrariwise, this effect is not as strong for men (Perrig-Chiello 2012).
However, this information is based on a small number of cases (Zumbrunn and Bayer-
Oglesby 2015: 313).
The problem discussed is by no means unique to Switzerland, but it is highly relevant for
this country, because cash benefits and benefits in kind are limited for persons with
dependent relatives. Due to the fragmented system of long-term care, in which
responsibility for public regulation and financing of long-term care services is at the
cantonal and the municipal level and personal contributions are very important, only few
cantons and municipalities provide cash-benefits for persons with dependent relatives.
What is more, although there are more benefits in kind available than there are financial
support schemes, benefits in kind for persons of working age with dependent relatives
remain fragmented and not well coordinated.
1.3 Description of carers’ cash benefits
1.3.1 Benefits for carers
The results of a survey on financial services and benefits in kind for persons with
dependent relatives, which was published in 2014, show that financial support for
persons with dependent relatives exists in five out of 26 cantons at the cantonal level
and overall in 37 out more than 2500 municipalities. The survey includes policies aimed
at supporting persons of working age with dependent relatives of all age groups. In other
words, the policies support persons caring for the elderly but also those who care for
younger persons with disabilities or chronic diseases. Table one shows in which cantons
and municipalities these schemes exist, and when they were put into place
(Bischofberger et al. 2014: 38).
Work-life balance measures for persons of working age with dependent relatives Switzerland
7
Table 1: Cantons and municipalities offering cash benefits for persons with
dependent relatives
Canton Nr. of
rules Nr. of
municip.* Municipalities Year of
establishment
Cantonal regulation
Basel City 1 3 Basel, Riehen, Bettingen 1990s
Ticino 1 1 -- 1998
Vaud 1 1 -- 2006
Valais 1 1 -- 1992
Cantonal and regional regulation
Fribourg 7 20 Ueberstorf, Zumholz, Plafeien,
Tafers, Brünisried, Alterswiel, St.
Ursen, Giffers, Rechthalten,
Estevayer-le-Lac, Cheyres, Bullem
Crésuz, Fribourg, Villars-sur-Glane,
Chésopelloz
1990s
Municipal regulation
Basel Country 5 5 Allschwill
Muttenz
Laufen
Schönenbuch
Arlesheim
--
1989
1997
1999
1994
Zurich 2 2 Opfikon
Hedingen 1989
1998
Luzern 1 1 Meierskappel 2006
Schwyz 1 1 Küssnacht 2012
St. Gallen 1 1 Altstätten 2012
Schaffhausen 1 1 Schaffhausen 2005
Number of municipalities that responded to the survey.
The results in table 1 imply that cash benefits for persons of working age with dependent
relatives are poorly developed in Switzerland. What is more, and importantly for this
report, existing schemes do not take into account whether a person that takes care of
dependent relatives is of working age or not (Bischofberger et al. 2014: 48). The figures
reported in table 1 are indicative, as they are based on a survey and not on a complete
inventory count. Nevertheless, they imply that very little cash benefit services are
available for persons taking care of their dependent relatives.
The cash benefit schemes for persons of working age with dependent relatives are
organised either on the cantonal, the regional or the municipal level. In short, they
provide financial support for family members and other affiliated persons who take care
of someone in need of care. In most cases, the benefits aim at increasing incentives for
homecare and to avoid that the dependent person is sent to a nursing home. A further
motive for these benefits is to provide recognition for the relatives who take care of
dependent persons at home (Bischofberger et al. 2014: 41). Most of these contributions
amount to between CHF 20 and CHF 30 (EUR 18-27) per diem, which is not enough to
compensate for the loss of pay that a person of working age taking care of a dependent
Work-life balance measures for persons of working age with dependent relatives Switzerland
8
relative might suffer due to reduced working hours (Zumbrunn and Bayer-Oglesby 2015:
313).
These findings imply that the system of cash benefits for carers remains highly
fragmented in Switzerland. Due to the decentralised system of long-term care, financial
support is only available in a few cantons and municipalities. The financial benefits that
exist cannot remunerate the caring person for job-related income loss.
1.4 Description of carers’ benefits in kind
In Switzerland, there is a large variety of benefits in kind for persons with dependent
relatives. For example there are services which provide someone to replace the carer
once a week, allow them to take holidays or provide psychological assistance.
Furthermore, information and counselling are available, as well as courses to form
individuals’ caring capacities, as well as facilitated groups and self-help groups for
persons of working age with dependent relatives (Zumbrunn and Bayer-Oglesby 2015:
313). Again, the following information includes policies aimed at supporting persons of
working age with dependent relatives of all age groups.
Benefits in kind for persons of working age with dependent relatives are organised
regionally, in Switzerland. Consequently, the services vary greatly between regions and
cantons. Overall however, a large number of cantons and communities considers
relatives of dependent persons as an important resource for assuring the provision of
long-term care services (Moor and Aemisegger 2011). For example, the canton of Vaud
one of the biggest cantons in Switzerland has integrated individuals, who take care of
their dependent relatives into the cantonal strategy “maintien a domicile” that aims at
increasing the number of long-term care patients who are being cared for at home. In
this canton, the number of long-term stays in nursing homes is low, compared to a high
rate of short-term stays and a high degree of home care overall (Holten et al. 2013).
Table 2: Benefits in kind for persons with dependent relatives
Type of
service Cantons
(N=21) Municipalities
(N=1166) NGOs
(N=126) Not for
profit
Spitex
(N=35)
For profit
Spitex (N=71) Sum
Counselling 2 444 342 86 136 1,010
Information
and Training 16 582 382 60 121 1,161
Coordination
and logistics 1 880 240 132 184 ,
Housework,
care 0 277 56 84 140 557
Peer support 2 338 386 47 152 925
Company in
difficult
situations
1 311 75 25 62 474
Timeout 0 326 93 15 132 566
Regeneration 0 43 70 2 30 145
Table two shows the results of a survey regarding the benefits in kind for persons of
working age with dependent relatives. Again, these figures emerge from a survey that
Work-life balance measures for persons of working age with dependent relatives Switzerland
9
was taken in 2013.3 Each questionnaire asked for the overall number of services per unit
within a certain category. For example, an NGO can provide several counselling services,
for example regarding legal issues, but also offers that provide support by peers for
persons with dependent relatives. Therefore, the table shows the overall number of
respective offers in Switzerland, according to the survey (Bischofberger et al. 2014: 63-
64).
The results in table two show that most of the services provided entail coordination and
logistical support for persons with dependent relatives. The second most provided service
is information and training for dependent relatives followed by services that provide
counselling. The smallest number of services concerns support in housework and care, as
well as support during crises and regeneration programmes for persons with dependent
relatives. Therefore cantons provide above all information, whereas the highest number
of services is provided at the municipal level and by NGOs (Bischofberger et al. 2014:
63-64). The distribution of these services among different providers reflects, again, the
structure of the Swiss long-term care system. This means that it ascribes a lot of
importance to municipalities, but also to non-governmental organisations, which provide
an important share of the benefits in kind for persons of working age with dependent
relatives.
2 Analysis of the effectiveness of work-life balance measures for
working-age people with dependent relatives
Overall, individuals who care for their dependent relatives are a very important element
of the Swiss long-term care system. There is no national system of support of persons of
working age with dependent relatives. Below, the report discusses the performance of
various elements of the existing system.
2.1 Assessment of individual measures
2.1.1 Coverage and effectiveness of financial benefits and benefits in kind
In Switzerland, financial support for persons with dependent relatives is not very well
developed, in the sense that it does not cover a large number of cantons and
municipalities across the country. Out of 26 cantons, 5 have reported having a cantonal
cash benefits scheme. Furthermore, 37 out of about 2,300 municipalities reported having
cash benefits for persons with dependent relatives4. These figures show that there is a
very low number of programmes that organise financial support for persons with
dependent relatives, relative to the overall number of jurisdictions. Amongst the cantonal
programmes that are available, four out of five are in non-German-speaking or bilingual
cantons, although German speakers form the majority of the Swiss population.
Furthermore, the amounts paid by financial compensation schemes are not enough to
replace income loss for dependent relatives. The problem is that these schemes do not
take into account whether the person taking care of dependent relatives is of working
age, or not. Consequently, persons who take care of their dependent relatives at home
are disadvantaged financially when they work less in order to take care of their
dependent relatives at home (Bischofberger et al. 2014: 41; Zumbrunn and Bayer-
Oglesby 2015: 313).
Compared to cash benefits, services coverage for persons with dependent relatives is
higher. The survey that has been mentioned throughout this report sheds light on the
effectiveness and the problems regarding benefits in kind for persons with dependent
3 The data was collected in an online survey, which was sent to all cantons and municipalities in Switzerland, all
for profit and not for profit Spitex organisations as well as a number of selected regional and cantonal branches
of NGOs that provide services for persons with dependent relatives (Bischofberger et al. 2014: 30-31).
4 Number of municipalities in 2014:
http://www.bfs.admin.ch/bfs/portal/de/index/regionen/11/geo/institutionelle_gliederungen/01b.html, last
accessed February 15, 2016.
Work-life balance measures for persons of working age with dependent relatives Switzerland
10
relatives in Switzerland. In particular, there are a number of obstacles to claiming
services for dependent relatives. For example, dependents are often reluctant to seek
help from their relatives, do not recognize that they need support and there is a lack of
information regarding support measures. In addition, costs for taking a break from
homecare are often too high (Bischofberger et al. 2014: 94). Furthermore, there are a
number of weaknesses in the Swiss system of support for persons with dependent
relatives. These are, principally: lack of coordination between different service providers
and levels of government, a lack of sensitivity for the problems of relatives, and
insufficient possibilities for recreation during intense periods of care for dependent
relatives (Bischofberger et al. 2014: 95).
2.1.2 Employment effects
In Switzerland, there is no national scheme that regulates employment compensation for
persons of working age with dependent relatives. Amongst the cantonal and municipal
systems providing cash benefits for relatives with dependent persons, very few of the
cash benefits meet the standards of an actual payment for those who provided homecare
services. Existing exceptions are the canton Ticino and the city of Opfikon. In Opfikon, a
carer can claim 1.5 hours (at a rate of CHF 28.85 per hour) per day and per dependent
person for homecare services provided for dependent relatives. Such a regulation could
be an incentive to share the care duty between various persons, but the regulations in
Opfikon do not allow for several persons claiming benefits to care for the same person
(Bischofberger et al. 2014: 48).
Nevertheless, in at least 19 cantons, relatives can demand compensation for salary
shortfalls for reasons of sickness and invalidity. As the mentioned survey shows, not
many individuals take advantage of these types of services, as they require in most
cantons a working contract between the working person and the dependent relative. The
advantage of this system is that persons with dependent relatives can claim social
security benefits. However, it seems that not many individuals who are in need of long-
term care are willing to complete the necessary paperwork or to find someone to assist
them with this (Bischofberger et al. 2014: 48).
In some cantons, it is possible to employ persons of working age with dependent
relatives in the local Spitex organisation, under specific circumstances. This system has
received a positive evaluation, because the work by persons of working age for their
dependent relatives is valued, remunerated and the quality of the care services by
relatives can be assured (Rex and Bischofberger 2014). Furthermore, since 1997,
working persons with dependent relatives can put forward pension claims with the Swiss
public pension insurance (AHV) to account for their care work (Zumbrunn and Bayer-
Oglesby 2015: 313).
Another problem for persons of working age with dependent relatives is that after a
period of unpaid care work at home, it is quite difficult to re-enter the job market. In
Switzerland, there is a programme, which is called Dossier freiwillig engagiert” that
allows individuals who care for their dependent relatives to document the time they
spend taking care of that person5. The document needs to be certified by the local Spitex
organisation or a doctor, and documents the qualifications and experiences that have
been obtained while taking care of a dependent relative (Zumbrunn and Bayer-Oglesby
2015: 313).
Furthermore, a number of training programmes have evolved recently, which aim to
support persons with dependent relatives. For example, since 2008, a course of study
exists at the College of Higher Education (“Fachhochschule”) in Bern, which provides
knowledge on how to support persons with dependent relatives. The programme is
5 http://www.dossier-freiwillig-engagiert.ch/, last access, February 16, 2016.
Work-life balance measures for persons of working age with dependent relatives Switzerland
11
implemented in coordination with the Red Cross, the Spitex of the canton of Bern and
other organisations (Zumbrunn and Bayer-Oglesby 2015: 314).
2.1.3 Overall effects on the well-being for the carer and the cared for
The effects of care on dependent persons by relatives is an important element of the
Swiss long-term care system, because it allows sick or handicapped individuals to stay at
home and enjoy being taken care of in an environment they know by individuals they are
close to (Zumbrunn and Bayer-Oglesby 2015: 311).
Nevertheless, since support measures for persons with dependent relatives are not
coordinated in Switzerland, there are no overall evaluations of these programmes. The
regional solutions that exist however show positive results. For example, as mentioned
before, the canton Vaud, which explicitly includes persons of working age in the cantonal
strategy to increase home care, reports satisfaction with the strategy, as it increases the
percentage of persons being cared for at home (Zumbrunn and Bayer-Oglesby 2015:
314).
Overall, persons who provide home care for their dependent relatives are to a large
extent on their own, above all financially. Whereas there are a certain number of benefits
in kind to support persons caring for their dependent relatives, financial support coverage
is very low and the benefits that are paid are little. Consequently, if someone takes care
of dependent relatives at home, it is necessary to have private financial means, or to
work less. Therefore many persons of working age with dependent relatives work less
without receiving equivalent financial compensation, in many Swiss municipalities. This is
a disadvantage for those who do not have flexibility in their jobs, private means, or the
support from other relatives. Without support from relatives or friends, persons of
working age face the challenge of either reducing their working percentage without being
compensated, or to send their relatives to nursing homes, if this is at all possible. As with
other aspects of the Swiss system of long-term care, private funds are important to
ensure that a dependent person is taken care of at home well, and for persons of working
age to deal with such a situation financially and personally.
2.2 Assessment of overall package of measures and interactions
between measures
In Switzerland, about 40% of old-age persons who are in need of medium to intensive
care, receive this at home. This is less than in other European countries, for example in
Germany, where about 70%] of this cohort receive home care, as well as financial
allowances from the long-term care insurance (about 50% of those who need long-term
care are being taken care of at home alone by relatives) (Zumbrunn and Bayer-Oglesby
2015: 314). In Switzerland, care in nursing homes, which is much more expensive than
home care, plays a more important role (Bischofberger et al. 2014: 48).
One estimate shows that voluntary home care services that were provided in
Switzerland for persons living in the same household were worth CHF 2.36 billion
(EUR 2.17 billion) , and CHF 1.19 billion (EUR 1.09 billion) for long-term care services for
those living in other households (Rudin and Strub 2014; Zumbrunn and Bayer-Oglesby
2015: 314).
Summing up the previous analysis, the Swiss system of support for persons who care for
dependent relatives has the following weaknesses:
Coverage with financial assistance schemes for persons of working age caring for
dependent relatives is weak. Only a few cantons and municipalities have
programmes to support those caring for dependent relatives (Table 1). Given the
high value of care services by relatives, the Swiss system of financial benefits and
benefits in kind for persons taking care of their dependents is remarkably
underdeveloped. Investments in financial support for home care by volunteers
would be important in Switzerland, because in neighbouring countries, such as
Work-life balance measures for persons of working age with dependent relatives Switzerland
12
Austria or Germany, those in need for LTC receive financial benefits (Pflegegeld).
Consequently, about half of the group of those in need of LTC receive home care
by dependent relatives, which is possible due to the mentioned financial benefits
(Zumbrunn and Bayer-Oglesby 2015). Furthermore, there is the potential to
economise on expenditure for long-term care, because the current system relies
heavily on care in nursing homes.
The existing programmes pay only very little money to persons of working age
with dependent relatives. The payments are by far not income replacement and
provide just symbolic recognition of care for dependent relatives. As a
consequence, since caring for dependent relatives often requires a reduction in
working hours in a regular job, carers depend on financial support from their
dependent relatives themselves or from third parties. What is more, long
absences from the labour market complicate reintegration after a period of care.
Given that women shoulder the majority of care work for dependent relatives in
Switzerland, they are particularly at risk of suffering the negative consequences,
which the absence of adequate financial compensation for care work potentially
has for carers. Caring for dependent relatives potentially detaches women in
Switzerland from the labour market and reduces their financial independence.
Since female relatives or female affiliated parties of dependent persons provide
most of the care work for persons who are of old, disabled, or chronically sick,
they are the most disadvantaged by the low coverage of financial support for
persons caring for dependent relatives.
Although out of pocket payments are an important element in paying for care in
nursing homes, with the number of old aged persons on the increase
continuously, it is likely that the number of those who will need financial
assistance for long-term care will also augment. Providing relatives and friends
with financial incentives that allow them to take care of their dependents without
high financial penalties, as well as giving them the possibility of returning to the
labour market even after long periods of care, will not only help to economise
costs, but prove attractive from a human point of view, because persons in need
of care have the possibility of receiving care at home from someone who is close
to them.
Benefits in kind services are not well coordinated. As the reported survey has
shown (Table 2), there are various benefits in kind to support carers, which are
furnished by different types of providers. The problem is that these services are
not well coordinated and beneficiaries often do not know about complementary
offers by other providers.
2.3 Policy recommendations
Based on the presented analysis, this report proposes the following policy
recommendations regarding persons of working age with dependent relatives:
It is important to increase the coverage and as well as the amount of financial
compensation for persons of working age with dependent relatives. The current
system is highly fragmented and in most cantons there are no schemes that
explicitly provide financial support for persons who take care of dependent
relatives. Specifically, it would be good to ask cantons or municipalities to find a
solution to this problem many different models are available in Swiss cantons
and communities. Another important policy recommendation concerns the amount
of the contributions. Currently, they cannot replace income for persons of working
age, and should be higher. A possible solution to this could be to employ
dependent relatives for their service, for example with the local Spitex
organisation, everywhere in Switzerland, which would allow for their training
and to control the quality of the care. At the same time, working as a carer for
Work-life balance measures for persons of working age with dependent relatives Switzerland
13
some time provides continuity of income and work life, and values the care work
that has been provided.
Regarding benefits in kind, the main policy recommendation is to improve
coordination, or at least information of the services that are available. A main
shortcoming that has been reported is that many services are available, but often
they are not coordinated not even in an informal manner, which means that
there is no central information point regarding all services, such as one-stop-shop
in modern social policies that coordinate different services. Furthermore, it is
necessary to improve services that relieve caring persons from their duty for some
time and allow them to take care of themselves and to take a break from care
work. Such a measure could be implemented easily if the person providing home
care was hired by the local Spitex organisation. This solution would not only
provide the possibility of paying for care work, but also allow for controlling
whether the person taking care of a dependent relative needs more work life
balance measures and a break from the actual care work.
Work-life balance measures for persons of working age with dependent relatives Switzerland
14
References
Bischofberger, Iren, et al. (2014), 'Betreuungszulagen und Entlastungsangebote für
betreuende und pflegende Angehörige: Schweizweite Bestandsaufnahmen',
(Zürich/Bern: Bundesamt für Gesundheit (BAG)/Careum/BASS).
Gmür, Rahel and Rüfenacht, Marcel (2015), 'Spitex', in Willy Oggier (ed.),
Gesundheitssystem Schweiz, 2015-2017 (Bern: Hogrefe), pp. 413-24.
Holten, Karin van, Jähnke, Anke, and Bischofberger, Iren (2013), Care-Migration
transnationale Sorgearrangements im Privathaushalt (Neuchatel: OBSAN).
Höpflinger, François, Bayer-Oglesby, Lucy, and Zumbrunn, Andrea (2011),
'Pflegebedürftigkeit und Langzeitpflege im Alter: Aktualisierte Szenarien für die
Schweiz' (Bern: Verlag Hans Huber).
Kocher, Gerhard (2010), 'Kompetenz- und Aufgabenteilung Bund - Kantone -
Gemeinden', in Gerhard Kocher and Willy Oggier (ed.), Gesundheitssystem Schweiz,
2010-2012 (Bern: Hans Huber), pp. 133-44.
Moor, Christine and Aemisegger, Andreas (2011), 'Unterstützung pflegender Angehöriger
in den Kantonen. Zusatzanalyse zum Bericht "Kantonale Alterspolitiken in der
Schweiz', (Zürich: Zentrum für Gerontologie).
OECD (2011), OECD-Reviews of Health Systems: Switzerland (Paris: OECD Publishing).
--- (2014), 'OECD Health Data', in OECD (ed.), (Paris: OECD).
Perrig-Chiello, Pasqualina (2012), 'Familiale Pflege–ein näherer Blick auf eine komplexe
Realität', in Pasqualina Perrig-Chiello and François Höpflinger (eds.), Pflegende
Angehörige älterer Menschen: Probleme, Bedürfnisse, Ressourcen und
Zusammenarbeit mit der ambulanten Pflege (Bern: Hans-Huber), pp. 111-210.
Perrig-Chiello, Pasqualina, François Höpflinger, and Brigitte Schnegg (2010),
'SwissAgeCare-2010 Forschungsprojekt im Auftrag von Spitex-Schweiz: Pflegende
Angehörige von älteren Menschen in der Schweiz.' (Bern: Spitex Schweiz).
Rex, Christine and Bischofberger, Iren (2014), 'Erfahrung und Know-how nutzen:
Anstellung pflegender Angehöriger bei der Spitex', Krankenpflege - Soins infirmiers,
107 (2), pp. 14-17.
Rudin, Melanie and Strub, Silvia (2014), 'Zeitlicher Umfang und monetäre Bewertung der
Pflege und Betreuung durch Angehörige', (Bern: Büro Bass).
Zumbrunn, Andrea and Bayer-Oglesby, Lucie (2015), 'Pflege durch Angehörige', in Willy
Oggier (ed.), Gesundheitssystem Schweiz, 2015-2017 (Bern: Hogrefe), pp. 311-18.
Work-life balance measures for persons of working age with dependent relatives Switzerland
15
... The benefits that exist are not income-replacement benefits, but rather a recognition for the services provided by volunteers. Regarding benefits in kind, there are more offers available, such as counselling or information and training services (Trein 2016). Cantons, municipalities, and non-government organisations (NGOs) provide support to persons with dependent relatives. ...
... Cantons, municipalities, and non-government organisations (NGOs) provide support to persons with dependent relatives. Nonetheless, these services are not well coordinated and do not entail many measures to improve work-life balance for persons of working age with dependent relatives (Trein 2016). Due to the high cost of LTC services, the fragmented system of coverage for costs, and the lack of support for persons of working age with dependent relatives, there are strong incentives for households to recruit carers outside the formal sector. ...
... Consequently, they often depend on other working persons in their family. Most problematically, due to a lack of alternatives, women often decide to reduce their workload in order to care for dependent relatives without adequate financial compensation or guarantees of professional reintegration after the period of care (Trein 2016). Statistical information supports this point. ...
Technical Report
Full-text available
The Swiss long-term care (LTC) system is highly decentralised. Competencies for LTC regulation, financing, and provision are separated between the federal government, the cantons, and the municipalities. According to the OECD, Switzerland spent 2.3 per cent of its GDP on LTC in 2015. This is considerably more than the OECD average (1.3 per cent). There is no specific LTC insurance. Health insurance funds, pension funds, taxpayers, and patients finance LTC services, which can be provided either in nursing homes, or at home by professional care services or relatives. Due to the decentralised LTC system, the mix of LTC provision varies between cantons. The main challenges for the Swiss LTC system are equity in access as well as employment-related issues. For example, the health insurance system pays for medical services but not for non-medical services in LTC, such as household work. Patients need to cover these expenses out of their own pocket, through supplementary payments from the public old-age and/or invalidity insurance pension funds, or by social assistance for which cantons and municipalities pay. Thus, there is a risk of cost-shifting to the weakest party, i.e. patients. The second challenge concerns employment, notably maintaining and expanding the workforce of professionals, but also creating flexible solutions that either compensate working caregivers with dependent relatives for their care work, or that guarantee flexibility in job arrangements, for example to take leave or have flexible working hours. The national government has taken steps to address employment-related concerns by investing in more qualification options in the LTC sector and assessing the need for informal care workers who take care of dependent relatives.
... Compared to the national and cantonal levels, the scope of these competencies is small. They may well become more important in the future, as expenditures for long-term care are very likely to increase (Trein 2016;Vatter and Rüefli 2014, 835-836). ...
... This section is based on a report written by the author about support for people of working age who have dependent relatives(Trein 2016). ...
Chapter
Full-text available
This chapter summarizes the institutional foundations, actor conflicts, and main policy challenges for health policymaking in Switzerland. Federalism, liberalism, subsidiarity, and direct democracy have shaped long-term trends and current politics in Swiss health policymaking. Cantons and municipalities, as well as private actors that include health insurance funds and professional organizations, play an important role in financing and providing health care services and enjoy considerable influence in the policy process. Responsibilities are fragmented, all-encompassing national regulations are limited, and individual co-payments for patients are high. Therefore, policymakers face difficulties in coordinating national health policies, in reducing costs, and in putting comprehensive preventative health policies in place.
Article
An increasingly ageing society together with concerns about sustainability of old-age benefits call for reforming the care structure of many western welfare states. However, finding an acceptable balance between the formal care provided by institutions and informal care provided by family members is a delicate policy choice with profound ethical implications. In this respect, literature on intergenerational familial relationships can offer insights to inform policymaking in this field and help resolve the ethical concerns that excessive reliance on informal caregiving might entail. In this contribution, we start by presenting – with Switzerland as a case study – the challenges of the current care structure and illustrate some of the ethical issues that reshaping the balance between formal and informal care raises. We then review and analyse available theoretical literature on intergenerational familial relationships and present three dimensions that underpin such relationships: ethical, theoretical and practical. Based on our analysis, we provide two recommendations to inform policymaking on how to support care needs of the elderly and set an ethically acceptable balance between formal and informal care when familial generations are involved.
Book
Five years after the first Review of Switzerland’s health system, the OECD and the World Organization combined their expertise again to report on progress and implementation of health reforms in the Swiss health system. In addition to taking stock of the good overall performance of the Swiss health system, the two organizations propose concrete ways to help the system be more efficient and prepare for the future health needs of the Swiss population. The report focuses on three important issues: health insurance markets, health workforce planning and management and governance of the health system.
SwissAgeCare-2010 Forschungsprojekt im Auftrag von Spitex-Schweiz: Pflegende Angehörige von älteren Menschen in der Schweiz
  • Perrig-Chiello
  • François Pasqualina
  • Brigitte Höpflinger
  • Schnegg
Perrig-Chiello, Pasqualina, François Höpflinger, and Brigitte Schnegg (2010), 'SwissAgeCare-2010 Forschungsprojekt im Auftrag von Spitex-Schweiz: Pflegende Angehörige von älteren Menschen in der Schweiz.' (Bern: Spitex Schweiz).
Pflege durch Angehörige
  • Andrea Zumbrunn
  • Lucie Bayer-Oglesby
Zumbrunn, Andrea and Bayer-Oglesby, Lucie (2015), 'Pflege durch Angehörige', in Willy Oggier (ed.), Gesundheitssystem Schweiz, 2015-2017 (Bern: Hogrefe), pp. 311-18.
Familiale Pflege-ein näherer Blick auf eine komplexe Realität
  • Pasqualina Perrig-Chiello
Perrig-Chiello, Pasqualina (2012), 'Familiale Pflege-ein näherer Blick auf eine komplexe Realität', in Pasqualina Perrig-Chiello and François Höpflinger (eds.), Pflegende Angehörige älterer Menschen: Probleme, Bedürfnisse, Ressourcen und Zusammenarbeit mit der ambulanten Pflege (Bern: Hans-Huber), pp. 111-210.
  • Iren Bischofberger
Bischofberger, Iren, et al. (2014), 'Betreuungszulagen und Entlastungsangebote für betreuende und pflegende Angehörige: Schweizweite Bestandsaufnahmen', (Zürich/Bern: Bundesamt für Gesundheit (BAG)/Careum/BASS).
Zeitlicher Umfang und monetäre Bewertung der Pflege und Betreuung durch Angehörige
  • Melanie Rudin
  • Silvia Strub
Rudin, Melanie and Strub, Silvia (2014), 'Zeitlicher Umfang und monetäre Bewertung der Pflege und Betreuung durch Angehörige', (Bern: Büro Bass).
Kompetenz-und Aufgabenteilung Bund -Kantone -Gemeinden
  • Gerhard Kocher
Kocher, Gerhard (2010), 'Kompetenz-und Aufgabenteilung Bund -Kantone -Gemeinden', in Gerhard Kocher and Willy Oggier (ed.), Gesundheitssystem Schweiz, 2010-2012 (Bern: Hans Huber), pp. 133-44.
Unterstützung pflegender Angehöriger in den Kantonen
  • Christine Moor
  • Andreas Aemisegger
Moor, Christine and Aemisegger, Andreas (2011), 'Unterstützung pflegender Angehöriger in den Kantonen. Zusatzanalyse zum Bericht "Kantonale Alterspolitiken in der Schweiz', (Zürich: Zentrum für Gerontologie).
Pflegebedürftigkeit und Langzeitpflege im Alter: Aktualisierte Szenarien für die Schweiz
  • François Höpflinger
  • Lucy Bayer-Oglesby
  • Andrea Zumbrunn
Höpflinger, François, Bayer-Oglesby, Lucy, and Zumbrunn, Andrea (2011), 'Pflegebedürftigkeit und Langzeitpflege im Alter: Aktualisierte Szenarien für die Schweiz' (Bern: Verlag Hans Huber).