For five years, caregivers have been able to be paid, but this model is frowned upon by most French-speaking cantons, which put obstacles in place. In the canton of Vaud, the dispute will be decided by the Federal Court, RTS learned.
In 2019, the Federal Court ruled that compulsory health insurance (LAMal) must remunerate the activity of caregivers up to 52.60 francs per hour. The latter do not need to be health professionals, but they must be employed by a home care structure – public or private – to be able to receive this remuneration.
Only structures authorized to operate have the right to employ caregivers. In fact, the cantons therefore have the power to prohibit the remuneration of caregivers, which is what Vaud and Jura, the cantons most reluctant towards this system, do. The State of Vaud has refused to issue authorizations to two private companies, AsFam and Solicare, which seek to employ caregivers, reveals the RTS.
Additional requirements
These refusals give rise to a legal battle. The cantonal court ruled in favor of the companies, but the case was brought before the Federal Court.
To justify this position, Sandra Gaillard Desmedt, director of community health in the canton of Vaud, underlines the complexity of home care in her canton. “For several years, the canton of Vaud has favored a policy of keeping seniors at home. This implies a high level of professional skills and knowledge, which is difficult to guarantee with untrained caregivers,” she explains.
We also have other requirements, such as the presence of a referring doctor and documentation in French, which has prevented, for the moment, the files from being completed.
In Jura, the deputy head of the Public Health Service, Sophie Chevrey-Schaller, shares this concern. She emphasizes the need for caregivers to have training equivalent to the Red Cross certificate to join a care organization. According to her, this is one of the main reasons explaining refusals of approval.
“We also have other requirements, such as the presence of a referring doctor and documentation in French, which has prevented, for the moment, the files from being completed,” she explains.
Critical insurers
Beyond the question of training, other challenges make this model complex. The cantons are wondering how to apply labor law rules to these special employees, who often live with the person they care for. How can we ensure that they take leave or respect rest periods?
Insurers, too, have reservations. They consider it abnormal to pay non-professionals the rate of nurses. They also believe that it is not up to health insurance to finance this remuneration, but rather to the State.
“Doubtful margins”
In the Federal Parliament, the remuneration of caregivers also raises concerns. Elected officials denounce the “questionable margins” that certain intermediaries practice, accused of keeping the majority of the 52.60 francs paid by the LAMal. The Federal Council must soon assess the risks of abuse.
Alexandre Momy, member of the AsFam management, rejects these accusations. According to him, the margins of companies like his are used to cover social charges, training costs and operating costs. “If we were there only to make money, we would have left French-speaking Switzerland a long time ago,” he says.
While German-speaking Switzerland sees no taboo in the remuneration of caregivers by private companies, French-speaking Switzerland is moving towards a public approach. Trying to entrust the remuneration of caregivers to public home care organizations would be a way for cantons and municipalities to benefit from the margin, between the 52.60 francs per hour paid by the LAMal and the amount received directly to the caregiver. The windfall from caregivers seems to arouse the desires of both businesses and the State.
Radio and TV subject: Romain Carrupt and Mathias Délétroz
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