The Canton of Zürich has overhauled the framework governing family members employed by home care organisations to look after their own relatives, reducing the municipal subsidy rate for this type of care by nearly half and introducing mandatory training and supervision requirements. “Perverse incentives in the financing of these care services were eliminated, and the quality of care provided by family members was subject to stricter requirements,” the health authority of the Canton of Zürich said.
The reforms come as the cantonal health authority reports a steady and accelerating rise in supervisory complaints across the entire healthcare system since the Covid-19 pandemic.
Both developments are the work of the cantonal health authority, the AFG, and together paint a picture of a healthcare system under growing scrutiny, from regulators tightening financial frameworks, and from patients increasingly willing to make their concerns heard.
A 2019 Court Ruling Changed Everything
The story of family caregiving reform begins with a Federal Supreme Court decision of 18 April 2019, which ruled that basic care services provided by family members (such as personal hygiene or putting on compression stockings) can be billed to mandatory health insurance (OKP) within certain limits.
Since that ruling, the Canton of Zürich has seen a notable increase in the number of home care (Spitex) institutions and a significant rise in billed basic care hours, particularly among organisations without a service agreement with a municipality. The AFG identified the need for action on two fronts: financial incentives and care quality.
From 2026, the canton has introduced a separate, lower standard deficit for family caregiver services: CHF 15.75 per hour (minus the patient’s contribution), compared with the previous standard deficit of CHF 30.30 per hour (as of 2025) applicable to all home care, a reduction of 48% in the municipal contribution for this category.
The full financing structure now works as follows:
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OKP pays CHF 52.60 per hour for basic care
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The municipality covers the remaining deficit, now CHF 15.75/hour for family caregiver services
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The patient contributes a share deducted from the municipal payment
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The family caregiver typically receives CHF 30–40 per hour; the employing Spitex organisation receives additional compensation for its oversight role
From 2026, home care organisations must itemise separately on their municipal invoices the hours of care provided by family members, distinct from hours delivered by professional staff.
New Quality Requirements
Alongside the financial reforms, the AFG has tightened the quality framework:
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Family caregivers must complete a nursing assistance course or equivalent training within one year of starting employment
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Every home care organisation must have its own registered nurses on staff
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Those nurses must contact each family caregiver by telephone at least every two weeks and visit them in person at home at least once a month
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The number of family caregivers per registered nurse is capped to ensure supervision is meaningful
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Rising Healthcare Complaints Across The Healthcare System
The AFG reports that the number of supervisory complaints and reports is steadily increasing, with a marked acceleration since the Covid-19 pandemic. Patients and other individuals are now increasingly contacting the AFG directly, rather than going through intermediaries.
The AFG attributes the increase to several factors:
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Population growth and a greater number of service providers
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A lowered complaint threshold, people are more willing to raise concerns than before
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Higher control density, more proactive monitoring by authorities
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More consistent procedures to protect patients
The complaints span the full range of healthcare professions and institutions. Among healthcare professionals, data covers doctors, dentists, nurses, pharmacists and a wide range of other professions including osteopaths, midwives, naturopaths, speech therapists, neuropsychologists, podiatrists and others. Among institutions, complaints cover hospitals, nursing homes, Spitex organisations, birthing centres, rescue and transfer services, polyclinics and organisations for psychological psychotherapy, among others.
The AFG notes a slight distortion in dentist data due to a change in data collection methodology through end of 2024.
The authority says it will continue to monitor the family care sector closely, in consultation with municipal and home care associations, and will consider further measures as needed.
