In another thread,
https://www.englishforum.ch/introduc...s-ca-zh-2.html there was some mention of nurses or carers/assistants working for depressingly low pay. I'd like to describe a scenario in which this happens in Switzerland, while making it clear that a proper nursing job should be legal, with a proper contract and all the right social security deductions, by nurses who are legally in the country, registered correctly and properly remunerated.
The following is an outline of a very low-paid nursing or caring/assisting option, used for frail patients who live at home .
Scenario
A patient needs home-nursing and is visited by a nurse, typically by a team of nurses of varying qualifications. The costs of this, with the exception of a small self-pay slice, is covered by the mandatory Swiss medical insurance. As the patient's illness or aging progresses, the need for nursing at home increases, and at some point that quantitiy of nursing exceeds what the medical insurance company agrees to pay.
The family, if there is one, and friends, if there are some, rally around and try to care for the person (for free) as best they can, up until the point of exhaustion (or they stop before then, if the relationships are poor, anyway, or if they are busy). This can easily lead to a crisis.
Ways out of the Crisis of Insufficient Nursing Services at Home The easiest way forward is for the frail person to use up their savings, if any, to pay for the nursing hours not covered by the medical insurance. Possibly, the family and friends might also contribute towards the nursing bill.
Another way is to do battle with the medical insurance company: some are more generous, others shirk their responsibility. There is a commonly held, but inaccurate , notion that the medical insurance company need not cover home-nursing costs in excess of what it would have cost the medical insurance company had the patient submitted to moving into an nursing home.
However, in 2019, Frau Stephanie Burger (83), took the case of the costs of her husband's home-nursing all the way through all the levels of Court, until the Swiss Supreme Court ruled in her favour . https://www.beobachter.ch/familie/al...-bundesgericht
This judgment confirmed that, if it can be shown that the overall well-being of the patient would be significantly better at home than in a nursing-home, this artificial ceiling can be exceeded.
If no-one has the nerves, energy or money for the above, the patient is either moved to a nursing-home (which may, or may not, be better for the patient), or the family then typically hires a nurse or carer/assistant from Eastern Europe.
Hiring a low-paid Nurse, typically from Eastern European countries in the EU (and illegally from non-EU countries)
If the hiring is done directly, it is by personal recommendation. In some cases, an Eastern European woman who does speak some German, is hired to be with the frail person, and live in their home with them, on duty 24-hours a day, for 6 days. The family covers one day, so the poor woman can get a breath of fresh air and be alone for a while, and go out in her own time.
Clearly, under such conditions, the employer is not acting legally, and the nurse/carer is not working legally. Officially she is visiting Switzerland as a tourist, and that does not allow employment. In addition, it is illegal to employ someone at a radically exploitative (so-called "dumping") wage, relative to the going market rate, and also illegal not to insure them properly for accidents and social security contributions.
This scheme has become significantly easier as more countries have joined the EU, since now a much larger pool of people from economies where Fr. 10 feels like a princely sum, may enter Switzerland legally, at least as tourists, for at least for 3 months. Their potential employers in Switzerland could go the proper route of hiring and registering them, but that would also lead to having to pay them a fair wage, so many avoid this by pretending that the woman is just here on holiday.
If the patient's need of care is ongoing, such an employee leaves Switzerland before her tourist stay is over, and her sister comes to work, in her stead, for the next 3-months-minus-one-day tourist stay. In this way, one unregistered job can be shared by a family, with two or three or four women enduring such circumstances, each for a phase, in order to bring home money from Switzerland.
Although a lot of such deals are done illegally, there are also agencies which claim to provide a similar service, but doing everything legally.
As far as we read about it, such staff are formally employed by an agency in their home country (at a wage that seems reasonable there, but is very low for Switzerland) and merely "sent to work abroad" in Switzerland. In this way, the agencies avoid the reproach of paying a dumping wage. Those agencies say that their staff are insured properly, and that they are contractually entitled to more hours off-duty per week.
In any case, the option of hiring in such a nurse or carer is available, at all, only to those who can afford her salary, whether adequate or exploitatively low.
Options for Patients who Need many Hours of Nursing at Home
Those who need a lot of nursing but do not have the money to pay for it properly in Switzerland, have the following options open to them: move into a nursing-home (the costs are covered in part by the patient themselves until their assets have been depleted, in part by the medical insurance company, and any amount beyond that is covered by the municipality) emigrate to a country where the carer wages are low, and there enter a nursing-home or employ [more affordable] home-nursing capitulate and become dependent upon their families, if those families can/will support them capitulate and have insufficient nursing, with their condition worsening commit suicide. This latter may sound dramatic, and it is a testimony to the inadequacy of the Swiss network of care, yet it is a decision taken by some chronically ill and some aging people. The main organisations which are involved in providing a framework are called Exit and Dignitas, and there are a few smaller organisations, too.