Spitex (home care)

What is Spitex?

Spitex is the Swiss abbreviation for “spitalexterne Hilfe und Pflege”, meaning help and nursing care outside hospital. It refers to nurses and organisations that care for, advise and support people at home who are ill, have had an accident or need long-term care. The aim: anyone who can live at home should not have to go into hospital or a nursing home, and anyone leaving hospital should be able to go home sooner.

In everyday use, “Spitex” covers non-profit organisations, often working on behalf of a municipality (Gemeinde), as well as private Spitex companies and self-employed nurses. For health insurance, the name does not matter; what matters is authorisation. Nurses authorised under Art. 49 of the Health Insurance Ordinance (KVV) and “organisations providing nursing care and help at home” under Art. 51 KVV that meet the cantonal requirements may bill basic health insurance.

What is included and what is not

Spitex offers two types of service, which are financed differently:

• Nursing care: assessment of care needs and advice, examination and treatment (treatment care, for example wound care, injections, preparing and administering medicines) and basic care (for example help with washing, dressing, eating and moving around). Basic health insurance pays fixed contributions towards these services.
• Housekeeping and companionship: cleaning, shopping, cooking, laundry, accompanying you, meals on wheels. This is household help and not a benefit of basic health insurance. You pay these costs yourself, possibly with support from supplementary insurance, supplementary benefits or your municipality.

How it works

Registration and needs assessment

Spitex usually starts at the suggestion of your GP, the hospital when you are discharged, or your family. A nurse visits you at home, assesses your care needs and your environment, and plans the necessary measures (Art. 7 para. 2 let. a KLV). The result is a care plan listing services and the time needed. This needs assessment is the basis for billing the health insurer.

Doctor’s order

Treatment care requires a doctor’s order or instruction. In it, the doctor decides whether examination and treatment are needed and sets the duration, at most nine months; it can be renewed. For acute and transitional care after a hospital stay, the order is valid for at most two weeks. For people receiving a helplessness allowance for moderate or severe helplessness, the order for the related services is valid indefinitely.

Since 01.07.2024, nurses may provide part of the services, namely assessment, advice and basic care, at the expense of basic health insurance without a doctor’s order. This stems from the first stage of implementing the nursing care initiative.

What basic health insurance pays

Basic health insurance does not pay a full tariff but a fixed contribution per hour, billed in units of 5 minutes, with at least 10 minutes per visit:

On this contribution, the insurer charges the deductible and retention fee as for any other benefit. The actual cost of care is usually higher than the contribution. Of these uncovered nursing costs, at most 20% of the highest care contribution paid by basic insurance may be passed on to you; the Federal Office of Public Health (FOPH) puts this at no more than CHF 15.35 per day for care at home. Many cantons charge less or nothing at all. The remainder, known as residual financing, is borne by the canton and municipalities; the canton decides how this is organised. The whole system is called financing of long-term care.

Legal basis

The basis is Art. 25a of the Federal Health Insurance Act (KVG). Under Art. 25a para. 1 KVG, basic health insurance contributes towards nursing care provided on the basis of an established need for care, on an outpatient basis (including in day or night facilities) or in a nursing home: by a nurse, in organisations employing nurses, or on a doctor’s order. Para. 3 empowers the Federal Council to determine which services are possible without a doctor’s order. Para. 4 requires the contributions to be set in francs and according to the need for care. Under para. 5, at most 20% of the highest care contribution may be passed on to the insured person from the uncovered nursing costs; the cantons regulate residual financing. Acute and transitional care after a hospital stay is paid by basic insurance and the canton of residence for at most two weeks under the rules of hospital financing (para. 2).

The details are set out in the Health Care Benefits Ordinance (KLV): Art. 7 KLV describes the services (assessment, advice and coordination; examination and treatment; basic care) and who may provide them. Art. 7a KLV sets the contributions per hour and billing in 5-minute units, with a minimum of 10 minutes. Art. 8 KLV governs the doctor’s instruction and order: at most nine months for treatment care, at most two weeks for acute and transitional care, and indefinitely for people receiving a helplessness allowance for moderate or severe helplessness. Authorisation of Spitex organisations is set out in Art. 51 KVV.

For recipients of supplementary benefits, the canton reimburses documented costs of help, nursing and companionship at home under Art. 14 para. 1 let. b of the Federal Act on Supplementary Benefits (ELG), including costs that basic health insurance does not pay.

Example: one month of care at home

Elsa is 82 and returns home after a hospital stay. Her GP orders 30 minutes of treatment care a day for 30 days, for example wound care and giving medication. In addition, she receives 45 minutes of basic care a day for washing and dressing, plus a one-off one-hour needs assessment. The contributions are the statutory rates for 2026.

Service	Time	Rate	Contribution
Needs assessment	1 hour	CHF 76.90	CHF 76.90
Treatment care	30 × 30 minutes = 15 hours	CHF 63.00	CHF 945.00
Basic care	30 × 45 minutes = 22.5 hours	CHF 52.60	CHF 1,183.50
Total basic insurance contribution			CHF 2,205.40

If Elsa needs permanent care and her income is not enough, she checks whether she is entitled to supplementary benefits; these also reimburse care and companionship costs at home. She compares her basic insurance premium in the premium calculator and finds information on the insurers under health insurers.

What this means for you

If you or a family member needs Spitex:

1. Organise it early. Have Spitex arranged before you leave hospital, through the hospital’s social services or your GP.
2. Check the doctor’s order. Treatment care requires a doctor’s order. Watch the expiry date after at most nine months and have it renewed in time.
3. Keep nursing care and housekeeping separate. Ask which visits are billed to the health insurer as nursing care and which are charged privately as housekeeping.
4. Know the cantonal rules. The patient contribution and residual financing are regulated by each canton. Your municipality or the Spitex organisation can tell you more.
5. Check supplementary insurance and supplementary benefits. Some supplementary outpatient insurance policies contribute towards household help; if your income is low, supplementary benefits can help. For people who are seriously ill, palliative care at home is also an option.

Consider your deductible too: if you need Spitex on a permanent basis, you will almost certainly reach your deductible. The lowest deductible of CHF 300 is then usually cheaper. You must notify a lower deductible by 30 November for the following year; see deadlines.

Common mistakes

• Thinking the health insurer pays for everything. Basic health insurance contributes towards nursing care, not towards housekeeping or companionship.
• Letting the doctor’s order expire. Without a valid doctor’s order, the insurer does not have to pay for treatment care.
• Using private carers without authorisation. Only authorised nurses and organisations can bill basic health insurance.
• Overlooking the patient contribution. On top of the deductible and retention fee, the canton may charge up to CHF 15.35 per day.
• Forgetting supplementary benefits. If you receive supplementary benefits, you can submit costs for help, nursing and companionship at home to the supplementary benefits office.