Act on Elderly Care and Nursing (APG) - Purpose (APG)

1. This law establishes the basis for the demand-oriented, high-quality, and cost-effective care of non-hospitalized individuals of all age groups, as well as the care of elderly persons.

2. It regulates the responsibilities of the canton and municipalities as well as the financing of the services.

1. The personality, self-determination, and dignity of the individuals under care and receiving care must be respected.

2. Every person, regardless of their economic situation, should be able to access appropriate care and support based on their needs.

1. The municipalities are responsible for the implementation of the law, insofar as the tasks are not assigned to the canton by this law.

2. The canton fulfills its tasks through the competent directorate (hereinafter referred to as the Directorate), unless this law provides otherwise.

1. Municipalities collaborate to form supply regions for the planning and provision of services to ensure the population's access to care and nursing services under this law.

2. The municipalities determine the division of the supply regions. If they cannot reach an agreement, the executive council shall decide.

3. The supply regions organize themselves in the forms of municipal cooperation stipulated in the Municipal Act.

1. Opening and Operating Institutions Offering Care Services, such as Nursing Homes, Assisted Living Facilities, Day and Night Centers, or Organizations Providing Outpatient Nursing Care (Spitex), Including the Expansion and Modification of Services, Require an Operating License from the Directorate.

2. Nursing Professionals Practicing Their Profession with Their Own Professional Responsibility Require a Practice Permit According to the Health Act.

1. The operating license is granted upon request if the institution

a. has the required professional staff;

b. has designated at least one professional responsible for nursing care who meets the requirements according to paragraph 2;

c. has suitable premises and facilities;

d. ensures appropriate pharmaceutical care;

e. demonstrates a quality assurance system in accordance with § 11;

f. has joined the ombudsman's office in accordance with § 18;

g. possesses liability insurance that covers the risks associated with the institution's activities.

2. The professional responsible for nursing care must

a. meet the professional requirements for independent practice as a nurse and

b. be trustworthy as well as provide physical and mental assurance for impeccable professional practice.

3. The operating license is issued for a maximum term of 5 years.

4. The government council regulates the details.

1. The authority may restrict or impose conditions on the operational permit and order the necessary measures to remedy deficiencies.

2. The operational permit shall be revoked if

a. its conditions are no longer met or facts are subsequently ascertained that would have necessitated its refusal;

b. conditions are not complied with or ordered measures have been unsuccessful.

3. The revocation of the operational permit pursuant to para. 2 letter b. shall be preceded by a warning, setting a reasonable period to rectify the identified deficiencies.

4. The prior warning is waived if there is a serious danger to the supervised persons or an imminent threat thereof.

1. Oversight of the institutions requiring authorization is the responsibility of the municipality or supply region that has entered into a service agreement with the institution. This specifically includes oversight in accordance with Article 387 of the Swiss Civil Code.

2. Exemptions are those areas of oversight that fall under the purview of the canton. This particularly concerns regulatory supervision of public health, oversight of therapeutic products, and food control.

3. The canton is also responsible for overseeing those institutions requiring authorization that have not entered into a service agreement with a municipality or supply region.

1. The cantonal and municipal authorities may conduct both announced and unannounced inspections at institutions requiring permits.

1. Orders concerning the prevention of an imminent danger to health are immediately enforceable.

2. Appeals against such orders do not have a suspensive effect.

1. The municipalities shall establish one quality commission each for the outpatient and inpatient sectors, consisting of representatives from the municipalities, the service providers, and the directorate. The involved municipalities and associations shall bear the costs for their representatives themselves.

2. Upon the request of the quality commissions, the government council shall determine the quality procedure, the basic quality requirements, and the quality control office for the service providers.

3. The quality control offices must possess certification.

4. The municipalities and supply regions may establish quality requirements in the service agreement that exceed the basic requirements.

5. Service providers who have not concluded a service agreement are obligated to demonstrate a recognized quality assurance system to the directorate.

6. The service providers shall make the results of the quality controls available to the directorate as well as to the municipalities and supply regions with which they have concluded a service agreement.

7. The costs of the quality controls shall be borne by the service providers.

1. Outpatient and inpatient service providers are obligated to offer training and continuing education positions for nursing professions according to their operational capabilities and circumstances.

2. Service providers may be required to participate in a program in which the number of training positions for each facility is mandatorily specified.

3. The government council may stipulate that a compensation payment must be made if the specified number of training positions is not met.

4. The revenue from the compensation payments shall be used exclusively for the promotion of nursing professions or disbursed to facilities that create more than the specified number of training positions.

1. Service providers are obligated to provide the canton, the service regions, and the municipalities with the data that is imperative for the fulfillment of their duties.

2. The government council regulates the details. It particularly determines the content of the surveys, the deadlines for data submission, and sanctions for non-compliance.

1. The Directorate conducts monitoring regarding the cost and performance data.

2. The monitoring is based on

a. statistical data from the canton;

b. surveys on the costs and performance of service providers.

3. The Directorate periodically prepares a report on the results of the monitoring.

4. The Directorate provides the municipalities and supply regions with the necessary key figures of those institutions that hold an operating license under this law within their area, as well as comparative values for the entire canton.

5. The Government Council may issue regulations on data collection methodology as well as on accounting and performance recording.

1. Municipalities shall operate an information and advisory center within the supply region regarding questions of care and assistance for the elderly, or they shall commission an institution to manage such a center.

2. The information and advisory center shall at minimum include the following services

a. Information for residents;

b. Consultation and needs assessment by a nursing professional, particularly before initial admission to a residential care facility;

c. Referral to suitable services.

3. Municipalities may assign the information and advisory center with additional tasks, particularly in the areas of health promotion and prevention for the elderly.

4. The information and advisory center shall be managed organizationally independent from service providers.

1. The canton may promote supra-regional, specialized advisory services on issues of care and support in old age.

2. For this purpose, it may conclude service agreements.

1. The Directorate operates an information platform for questions related to care and nursing in old age.

2. The municipalities and the authorized institutions are obligated to provide information.

3. The Government Council regulates the details.

1. The municipalities ensure the operation of a central ombudsman's office for elderly issues and home care services.

2. They may delegate the task to a private individual or institution through a service agreement.

3. The consultation provided by the ombudsman's office is free of charge.

4. The institutions requiring a permit under this law jointly finance the ombudsman's office.

1. The Executive Council adopts an age policy framework in which the principles of the aging policy are established. This framework is periodically reviewed and adjusted.

1. The care regions shall develop a care concept. The directorate shall advise and support them in this process.

2. The purpose of the care concept is to ensure an adequate provision of outpatient, intermediate, and inpatient care and support services. It shall specifically include services for assisted living, palliative care, and persons suffering from dementia.

3. The care concept shall take into consideration the services available in adjacent areas.

1. The supply regions enter into service agreements with providers whose services are required according to the supply concept.

2. The municipalities may conclude service agreements with additional providers of outpatient and intermediary services.

3. With the consent of the other municipalities in the supply region, individual municipalities may also conclude service agreements for inpatient services. The statute of the supply region may stipulate a quorum for consent.

4. The Directorate concludes its own service agreements with institutions to which the canton provides contributions.

5. The service agreements are concluded for a maximum of 10 years.

1. The service agreements specifically regulate

a. the type, scope, and remuneration of the services;

b. the approval of tariffs charged to the beneficiaries of the services;

bbis. * any additional charges for special services such as dementia care or palliative care;

c. the quality requirements and quality control bodies;

d. the participation, information, and supervision of the municipalities and supply regions;

e. the sanctions for non-compliance with the service agreement.

2. The municipalities and supply regions can establish a priority for their residents in the service agreements.

3. For residential care facilities, the service agreement specifies from what level of care need admission is generally possible.

1. The care region ensures that its residents with a need for outpatient or intermediate care or support have access to an appropriate provision.

2. The provision includes at a minimum the care services reimbursable as mandatory services by social insurance, the necessary housekeeping services, support offerings, meal services, and day and night offerings.

1. The financing of outpatient care services is governed by the Introductory Act to the Federal Health Insurance Act.

2. The municipalities and supply regions can additionally compensate service providers with whom they have concluded a service agreement or who have been consulted on a case-by-case basis for special services they provide in the public interest.

1. The municipalities and service regions regulate the financing of day and night services within the service agreements with the service providers.

1. The canton contributes to the costs of supra-regional outpatient and intermediary specialized services, provided that the services are necessary for care.

2. The Directorate enters into service agreements with the respective service providers, taking particular account of services for children as well as for oncology patients.

1. The municipalities and supply regions regulate the financing of other outpatient services such as care and housekeeping services in the service agreements with the service providers.

1. Municipalities may grant contributions for the recognition and promotion of caregiving and nursing by caregivers.

2. Municipalities shall establish the conditions for granting contributions in a regulation.

3. The canton grants contributions for the implementation of basic nursing courses for caregivers.

1. Assisted Living is defined as services that meet at least the following requirements

a. An available contact person who can provide or arrange for care and outpatient nursing services as well as household services;

b. the apartments are generally barrier-free;

c. a 24-hour emergency call system is in place.

1. The care regions promote services for assisted living.

1. Municipalities and supply regions regulate the financing of assisted living services in service agreements with service providers.

2. The canton promotes innovative projects for assisted living and the development of integrated care.

3. It provides contributions to such projects in the form of temporary start-up financing.

4. The Directorate decides on corresponding applications. It may consult an expert commission for the assessment of the applications.

5. The government council regulates the details.

1. Residence in assisted living facilities does not alter the responsibility for the disbursement of contributions to care services, supplementary contributions according to the Supplementary Benefits Act for AHV and IV, as well as municipal contributions pursuant to § 40.

2. This regulation applies for 5 years from the commencement of residence in the municipality where the assisted living facility is located. After this period, the municipality of residence is responsible.

1. The Directorate establishes the need for inpatient care places per supply region with a lower and upper limit in consultation with the supply regions. It consults the service providers on this matter.

2. The Directorate plans supra-regional special services.

1. The Government Council issues the nursing home list in accordance with the stipulations of the health insurance legislation.

2. Admission to the nursing home list is dependent on

a. an operational license from the Directorate;

b. a service agreement with a supply region, a municipality with the consent of the supply region, or the Directorate, which corresponds to the needs assessment.

3. Homes that possess recognition under the Disability Assistance Act[8] can, upon request by the Directorate responsible for disability assistance, be included in the nursing home list.

1. Stationary care facilities must disclose available spaces within the supply region.

2. The supply regions are responsible for the allocation of available spaces to individuals in need of care as required, taking into consideration the needs of the individuals requiring care.

3. Within the scope of their service agreements and capacities, stationary care facilities are obliged to ensure the admission of individuals in need of care.

4. Individuals in need of care have the freedom to choose among stationary care facilities within their financial means.

1. The management may have the care classifications of residents in residential care facilities reviewed at its own expense by its own nursing professionals or by an appointed specialist agency.

1. The financing of inpatient care services is governed by the Introductory Act to the Federal Law on Health Insurance.

1. The canton may participate in covering the costs of regional inpatient specialized services, provided that the expenses for care or supervision are extraordinarily high.

1. Residential care facilities impose separate charges on residents for care, support, and accommodation.

2. A residential care facility may not impose different charges for the same service on self-payers and recipients of supplementary benefits.

1. The municipality provides refundable contributions to residents whose income and liquid assets, taking into account any supplementary benefits as well as any additional contributions pursuant to the Supplementary Benefits Act to the AHV and IV, are insufficient to cover the costs of care.

2. The municipality responsible is the one in which the resident had their domicile before entering the care facility. This is subject to the provisions of § 32.

3. Municipal contributions are subsidiary to supplementary benefits and additional contributions.

1. The municipality may reclaim the contributions allocated for covering the cost of residence, in accordance with § 40, together with interest, from the resident.

2. Contributions that the municipality has provided due to a waiver of income or asset values can be reclaimed, along with interest, from the beneficiaries.

3. If contributions are not refunded by either the resident or the beneficiaries, the municipality has a claim against the estate of the resident.

4. The rate of interest corresponds to the mortgage reference interest rate of the Federal Office for Housing (FOH).

1. Stationary care facilities are entitled to request a guarantee for potential claims from residents upon entry, amounting to a maximum of two months' worth of costs that the residents are required to pay themselves.

2. If a resident can demonstrably not pay the guarantee from their own means, the care facility may apply for a subsidiary cost guarantee from the municipality.

3. The municipality will cover a claim from the care facility up to the amount of the cost guarantee if it cannot be recovered from the resident or, in the event of death, from the heirs. The care facility must provide the corresponding proof.

4. The governing council regulates the details.

1. A fine shall be imposed on anyone who

a. engages in an activity requiring a permit under this law without possessing the necessary permit;

b. otherwise contravenes this law or regulations issued based on it.

2. A fine of up to CHF 100,000 shall be imposed on anyone who fulfills the conditions of paragraph 1 and acts in a commercial manner or endangers human health.

1. Fees covering costs shall be charged for the issuance of permits, the conduct of controls, examinations and inspections, as well as for other official acts pursuant to this law.

2. The government council shall issue a fee ordinance.

1. The municipalities shall consolidate into supply regions in accordance with § 4 within 3 years from the effective date of this Act.

2. Until the formation of the supply regions, the individual municipalities shall perform the tasks of the supply region mutatis mutandis.

1. Within 4 years from the enactment of this law, the service agreements must be renegotiated with the service providers in accordance with the requirements of this law.

2. Existing service agreements will become invalid no later than this time.

3. Service agreements that municipalities conclude based on their authority pursuant to § 45 paragraph 2 may be concluded for a maximum period of 3 years.

1. Investment Contributions under §§ 17 to 21 of the Law of October 20, 2005, on Elderly Care and Assistance are granted if a complete application for contributions, including the building permit, has been submitted before the enactment of this law.

2. The Government Council regulates the details.

1. The Obligation to Reimburse Investment Contributions pursuant to § 22 of the Act of October 20, 2005, on the Care and Support for the Elderly Remains in Effect.

1. The Interest on Investment Contributions Pursuant to § 23 of the Law of 20 October 2005 on Care and Nursing for the Elderly must continue to be paid until the expiration of 25 years from the final payment in the case of residence in a nursing and retirement home, or 10 years from the final payment in the case of residence in a nursing apartment.