In short

In Geneva, home help and home care rest mainly on IMAD (the Geneva home-maintenance institution), a public body. The most common — and most expensive — confusion is about reimbursement.

Contrary to a widespread belief, LAMal does not "reimburse 90%" of home care. It pays a flat contribution per hour, set at federal level, which in practice covers roughly 50 to 60% of the real cost of care. The rest is met by a capped patient co-payment (CHF 10/day in Geneva) and by the residual funding of the canton and municipalities.

And crucially: care is only one part of staying at home. Practical help (cleaning, shopping, laundry) is not covered by LAMal — it is billed at an hourly rate that depends on income. 24/7 presence, meanwhile, is the heaviest cost and is rarely covered.

Care vs. practical help: the distinction that drives the bill

Everything starts with a simple but decisive distinction: what counts as prescribed medical care on one side, and what counts as practical help on the other. The two are not funded in remotely the same way.

IMAD service On prescription? Who pays / how it's funded
Nursing care Yes Flat LAMal contribution/hour (OPAS art. 7a) + patient co-payment (CHF 10/day) + cantonal residual
Occupational therapy Yes Same (LAMal contribution + co-payment + residual)
Hospital-at-home Yes Same (LAMal contribution + co-payment + residual)
Practical help (cleaning, shopping, laundry) No Not covered by LAMal — hourly rate based on income (RDU)
Home-delivered meals No Paid by the beneficiary (ordered through IMAD)
Help-call system (telealarm) No Subscription (flat fee) — the "Croix-Rouge alarm" product distributed via IMAD
Temporary respite unit (UATR) — Stay of 5–45 days/year: LAMal care (contribution + co-payment); accommodation at own cost

💡 The rule of thumb: what is medical and prescribed enters the LAMal circuit (contribution + co-payment + residual); what is domestic is billed by income and largely stays with the family.

The LAMal share of care, in plain terms (and why not "90%")

The care-funding mechanism is federal (LAMal art. 25a, OPAS art. 7a) — identical across Switzerland. It is not a percentage, but a fixed contribution per hour according to the type of care.

All amounts in CHF, current federal contributions.

Type of care LAMal contribution per hour
Assessment, advice and coordination 76.90
Examinations and treatments 63.00
Basic care 52.60

(Billed in 5-minute increments, 10-minute minimum.)

Three concrete consequences:

  1. The contribution is capped; the real cost is not. The insurer pays its hourly lump sum; because the real cost of an hour of care is higher, the contribution covers only about 50 to 60% of it in practice.
  2. The patient pays a co-payment — but a capped one. At most 20% of the highest contribution, i.e. a federal maximum of CHF 15.35/day for home care. In Geneva, the co-payment is set at CHF 10/day, below the federal cap.
  3. The canton and municipalities pay the rest. The difference between the real cost and (contribution + co-payment) is covered by residual funding at cantonal/municipal level. This is what makes home care financially bearable — provided you are correctly steered.

⚠️ Don't confuse the two co-payment caps: CHF 15.35/day at home and CHF 23/day in a nursing home (Geneva applies CHF 10/day in both cases). It's one of the most frequent errors when comparing home care and an EMS.

Practical help: billed by income

This is the cost families often discover along the way. Cleaning, shopping, laundry, non-medical support: none of it is covered by LAMal.

IMAD bills practical help at an hourly rate that depends on the beneficiary's income, calculated via the RDU (unified determining income — the same notion used for health-insurance subsidies and supplementary benefits). The lower the income, the lower the rate.

Two levers worth knowing:

  • Get the RDU calculated. It drives the rate of practical help — and access to subsidies and PC. Without an up-to-date RDU, you often pay the full rate by default.
  • PC can reimburse part of the costs. Recipients of supplementary benefits can have cleaning and laundry costs reimbursed by the SPC, within the limits of the current scale. The SPC can also cover practical help up to a capped hourly rate.

The real heavy cost: 24/7 presence

Keeping a parent at home is rarely expensive because of the care — LAMal and the canton absorb most of it. The cost explodes the moment continuous presence is needed: nights, weekends, constant supervision (dementia, fall risk).

This enhanced presence usually falls to private Spitex organisations or live-in carers, and is generally not reimbursed (only the prescribed "care" portion is). This is exactly the tipping point where home care becomes more expensive than a nursing home — a trade-off best weighed early, with the figures in hand.

IMAD or private Spitex: who does what

IMAD (public) Private Spitex
Status Public Geneva institution Private organisations
Prescribed care Yes (LAMal funding) Yes (LAMal funding)
Practical help Yes (RDU-based rate) Yes (private rate)
Enhanced presence / 24/7 Limited Core of the offer
Meals, telealarm, UATR, day centres Yes Variable

In practice, many situations combine the two: IMAD for care and basic practical help, a private Spitex or a live-in carer for the presence IMAD does not cover.

How it works on the ground in Geneva

  1. Trigger: hospital discharge, loss of autonomy, return home after a fall. The GP or hospital prescribes the care.
  2. Assessment: IMAD assesses needs at home and draws up a care plan.
  3. Billing: care goes through LAMal (hourly contribution + CHF 10/day co-payment + cantonal residual); practical help is billed at the RDU-based rate.
  4. Enhanced presence: for what IMAD does not cover (nights, 24/7, support), you bring in a private Spitex or a live-in carer — usually at the family's cost.
  5. Carer respite: support and respite options (UATR, day centres); Pro Senectute Geneva offers support for relatives and home accompaniment.

Common pitfalls

  • Assuming everything IMAD does is reimbursed. Only the prescribed care portion is — and even then, via a flat contribution, not "90%". Practical help stays out-of-pocket.
  • Banking on a "90% reimbursement". The figure does not exist in the legal mechanism. Count instead on ~50–60% of the real cost of care covered by the LAMal contribution.
  • Underestimating the cost of 24/7 presence. It is the heaviest cost of staying at home, and rarely covered.
  • Not getting the RDU calculated. It drives the rate of practical help and access to subsidies/PC.
  • Forgetting the telealarm and safety adaptations. Cheap, they often delay entry into a nursing home.

Useful resources (Geneva)

  • IMAD — switchboard: 022 420 20 00 · home-delivered meals: 022 420 20 20 — imad-ge.ch
  • IMAD service tariffs: imad-ge.ch — tariffs (detailed scale to download for exact amounts)
  • Pro Senectute Geneva — free social consultation, support for relatives: 022 807 05 65 — ge.prosenectute.ch
  • Supplementary-benefits office (SPC) — PC and cost reimbursement: ge.ch — SPC

We handle it for you

Understanding who pays what — LAMal contribution, co-payment, cantonal residual, the RDU-based rate for practical help, entitlement to PC — takes time, and the wrong steer is expensive. Our Family Care & Admin Review maps out your parent's situation, checks their entitlements and organises the right contacts (IMAD, GP, SPC, Spitex), so that staying at home is both safe and financially under control.

Sources

  • IMAD — Nursing care (on prescription): imad-ge.ch — accessed 2026-06-24
  • IMAD — Practical help (not LAMal, income-based rate): imad-ge.ch — accessed 2026-06-24
  • IMAD — Service tariffs 2026: imad-ge.ch — tariffs — accessed 2026-06-24
  • FOPH — Care services (LAMal art. 25a, OPAS art. 7a contributions, CHF 15.35/day home-care co-payment cap): bag.admin.ch — accessed 2026-06-24
  • Canton of Geneva — Home care: residual funding: ge.ch — residual funding — accessed 2026-06-24
  • Pro Infirmis — Funding of care by health insurance (the contribution covers ~60% of cost): proinfirmis.ch — accessed 2026-06-24