Challenges and Innovations in Digitizing Elderly Care in

Switzerland: A Single Case Study

Estelle Pfitzer

1 a

and Tobias Kowatsch

1,2,3

School of Medicine, Universität St. Gallen, St. Gallen, Switzerland

Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland

Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland

Keywords: Digital Health Technologies, Elderly Care, Care for Older Adults.

Abstract: Switzerland’s aging population, with the old-age dependency ratio reaching 32% in 2023, has significantly

increased the demand for efficient elderly care services that enable seniors to live independently for longer.

This study investigates the challenges and opportunities in digitizing elderly care in Switzerland through the

lens of the Consolidated Framework for Implementation Research. Using a qualitative single-case study

approach focused on a Swiss-based company specializing in AI-powered tools for home-based care, the study

addresses two key research questions: (1) What are the challenges in digitizing elderly care in Switzerland?

and (2) How can digital health technologies support this sector? The findings reveal key challenges, including

economic disincentives, workforce imbalances, and fragmented technology adoption, while also

demonstrating how tailored digital tools can enhance preventive care and improve operational efficiency.

Collaborative efforts among policymakers, care providers, and digital health companies are crucial for

advancing sustainable and equitable elderly care.

1 INTRODUCTION

Many developed countries are experiencing a

significant demographic shift with a rapidly aging

population (Grinin et al., 2023; Manfredi et al., 2019;

Marois et al., 2020). Switzerland is no exception, with

individuals aged 65 and over representing 19.3% of

the population in 2023, up from 15.4% in 2000

(bfs.admin, 2024). This demographic shift has led to

a narrowing ratio of working-age individuals to

retirees, as the old-age dependency ratio reaches 32%,

closely approaching the youth dependency ratio of

33% (Figure 1).

These trends greatly increase the demand for

efficient elderly care services that enable seniors to

live independently for longer. As the elderly

population grows, healthcare systems face the

challenge of addressing the rising demand for

services while managing resource constraints (Bloom

et al., 2015; Jones & Dolsten, 2024). Digitization is

an important strategy to meet these challenges,

offering innovative approaches that streamline care

https://orcid.org/0009-0006-0577-2757

https://orcid.org/0000-0001-5939-4145

delivery, enhance patient outcomes, and optimize

resource allocation (Chen et al., 2023; Lee et al.,

2023; Pekkarinen et al., 2019; Sun et al., 2020).

Figure 1: Dependency Ratios in Switzerland: Trends in the

old-age dependency ratio (persons aged 65 and older per

100 working-age individuals) and youth dependency ratio

(persons under 20 per 100 working-age individuals) in

Switzerland from 1900 to 2023.

33%

32%

10%

20%

30%

40%

50%

60%

70%

80%

1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2020 2030

Youth dependency ratio: persons under the age of 20 per 100 persons aged 20–64

Old-age dependency ratio: persons aged 65 and over per 100 persons aged 20–64

Pﬁtzer, E. and Kowatsch, T.

Challenges and Innovations in Digitizing Elderly Care in Switzerland: A Single Case Study.

DOI: 10.5220/0013395400003911

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 18th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2025) - Volume 2: HEALTHINF, pages 1077-1082

ISBN: 978-989-758-731-3; ISSN: 2184-4305

1077

This paper explores the challenges of elderly care

in Switzerland and examines how digital technologies

address these issues by addressing the following

research questions:

RQ1: What are the challenges in digitizing the

elderly care sector in Switzerland?

RQ2: What are the opportunities in digitizing the

elderly care sector in Switzerland?

2 METHOD

This study uses a qualitative single-case approach to

examine digitizing elderly care in Switzerland,

focusing on Domo Health. This company was

selected due to its position in developing AI-powered

tools for home-based care, integrating real-time

monitoring, predictive analytics, and connected

devices. Its direct involvement in addressing systemic

challenges in elderly care in Switzerland makes it

suitable for analyzing digitization opportunities and

barriers within the Swiss healthcare context. Founded

in 2012, Domo Health’s platform provides actionable

insights for early intervention and features enterprise

resource planning tools to streamline workflows, such

as visit scheduling and invoicing, for home care

organizations (domo.health, n.d.).The data was

collected through a 29-minute semi-structured

interview with Domo Health’s CEO, conducted with

prior consent and transcribed using Fireflies.ai. The

interview explored systemic challenges, policy

influences, and technological innovations in elderly

care. Thematic analysis was performed on the

transcript using the Consolidated Framework for

Implementation Research (CFIR) (Damschroder et

al., 2022), focusing on challenges to digitization and

opportunities. Secondary data from academic

literature, policy documents, and Domo Health’s

reports complemented the analysis, ensuring a

comprehensive perspective on the potential of digital

technologies in Swiss elderly care.

3 RESULTS

We examine the challenges in digitizing elderly care

in Switzerland, including financial, workforce, and

technological barriers, and explore opportunities

through enhanced care delivery and sustainable

digital business models.

3.1 Challenges in Swiss Digital Elderly

Care Adoption

First, we investigate key barriers to adopting digital

technologies in Swiss elderly care, focusing on

financial, structural, and workforce challenges and

the preference for reactive over preventive care.

3.1.1 Financial Disincentives for Preventive

and Home-Based Care

Using CFIR’s “Outer Setting” domain, particularly

the “Financing” construct, we uncovered systemic

barriers to promoting home-based care in the Swiss

healthcare system. With decentralized governance

and mixed financing structures, Switzerland's

healthcare system has historically posed challenges in

promoting preventive and home-based care for older

adults. The current Federal Health Insurance Act

(HIA) financing model combines contributions from

health insurers, cantonal residual financing, and client

copayments (Möckli et al., 2024). However, the

system has historically favored hospital-based

treatments, discouraging the adoption of cost-

effective home care services. As the CEO of Domo

Health explained: “Insurance companies prefer

funding treatments that involve hospital stays

because these are reimbursed more favorably

compared to home care services.”

This model created significant disincentives for

preventive care technologies, such as remote patient

monitoring and fall detection systems, as financial

support for these innovations was often insufficient.

Healthcare providers were consequently less inclined

to implement these cost-saving measures, leading to

higher long-term expenses and less effective care for

older adults (Kherad, 2017).

A key turning point occurred following the

November 24, 2024, national referendum. Swiss voters

approved an amendment to the HIA introducing

standardized financing of benefits. Under the new

system, cantons must cover at least 26.9% of

healthcare costs, while health insurers contribute up to

73.1%, regardless of whether care is provided in

hospitals or at home (Health Insurance Act, n.d.). This

reform balances potential financial biases against

home-based care and aligns reimbursement structures

across care settings. By leveling the playing fields, the

reform encourages the adoption of preventive care

technologies, aiming to reduce long-term costs while

promoting more effective and patient-centered care for

older adults. However, it is also argued that the reform

may inadvertently lead to a rise in health insurance

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premiums, as insurers are now responsible for a greater

share of costs (RTS, 2024).

3.1.2 Fragmentation in Service Delivery and

Technology Adoption

Applying CFIR’s “Outer Setting” domain and “Local

Conditions” construct, we found a sizable impact of

decentralized governance on technology adoption in

elderly care. The Swiss healthcare system is highly

fragmented in its structure and use of electronic

health records (EHR) and digital technologies. Each

Canton regulates healthcare independently, making it

difficult to achieve standardization and coordination

among providers (REF). This fragmentation is further

compounded by the diversity of healthcare actors,

including public and private hospitals, nursing

homes, and private practices, which operate with

differing priorities and resources. While the Federal

Act on the Electronic Patient Record mandated EHR

adoption for hospitals and nursing homes by 2020 and

2022, respectively (Federal Department of Home

Affairs (FDHA), 2017), it only encourages voluntary

participation for other providers, such as general

practitioners and ambulatory services, resulting in

low uptake outside of mandatory settings. Financial

and technical barriers, particularly for smaller

practices, hinder widespread adoption, as the law

provides only limited federal funding and no direct

reimbursement for implementation costs. As our

interviewee noted, “Switzerland is far behind

compared to other countries, like even the electronic

patient record is behind.”

This reflects the country’s lagging position in

adopting EHR systems relative to other OECD

nations. This fragmentation complicates the

scalability of nationwide digital health technologies,

as technologies must be adapted to different

technology environments and practices in each

canton (De Pietro & Francetic, 2018).

3.1.3 Imbalance in Workforce Distribution

The Swiss healthcare workforce appears more

balanced towards hospital-based specialized care,

leaving a critical gap in home-based services and

general practitioner care. This imbalance also aligns

with CFIR’s “Outer Setting” domain, and the

construct of “Local Conditions”. This imbalance

incentivizes doctors to pursue specialization,

exacerbating the shortage of general practitioners and

primary care providers (Baumann et al., 2020). As

Domo Health’s CEO pointed out:

“The whole system has shifted from a general

practitioner and specialist physician 20 years ago

receiving the same salary to a system now where you

make three times more money if you are a doctor in

the hospital as a specialist.”

This uneven distribution not only undermines the

accessibility of primary care but also impacts the

quality of care in home settings, where

comprehensive support is increasingly necessary due

to an aging population.

3.1.4 Focus on Reactive over Preventive

Care

Using CFIR’s “Process” domain, particularly the

“Engagement” construct, we highlight the focus on

reactive treatments over preventive measures due to

systemic disincentives. Domo Health’s CEO

described the challenges of prioritizing sustainable

healthcare practices: “Somehow, nobody cares about

prevention. […] the whole system is based on I am

sick, I'm being diagnosed, and I get the treatment.”

This reliance on expensive, reactive treatments

increases financial strain and undermines

opportunities to address health issues before they

escalate. Preventive measures like remote

monitoring, early detection systems, and lifestyle

interventions could significantly reduce long-term

costs while improving patient outcomes

(AbdulRaheem, 2023). However, the need for

systemic incentives for prevention creates barriers to

adopting these measures at scale. Without policy

reforms that prioritize and reward preventive care, the

sustainability of Switzerland’s long-term care system

could face risks, particularly as the aging population

drives up demand for healthcare services.

3.2 Opportunities in Swiss Digital

Elderly Care

Second, we examine how digital health technologies

can overcome structural challenges in elderly care,

enhancing service delivery while supporting

sustainable business models.

3.2.1 Digitization for Enhanced Elderly

Care

Digitization aligns with CFIR’s “Intervention

Characteristics” domain, particularly through the

constructs “Relative Advantage” and

“Compatibility”. Domo Health’s platform

exemplifies these characteristics by integrating real-

time health monitoring, predictive analytics, and

operational tools into a single solution tailored to

elderly care. By consolidating clinical data from

Challenges and Innovations in Digitizing Elderly Care in Switzerland: A Single Case Study

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multiple sources, such as medical devices, apps, and

patient-reported data, the technology provides

actionable insights to support early interventions. As

our interviewee noted:

“We are adding [...] a tool which can [...] plan which

visits they need to do, which care is reimbursed and

then connect that to insurance companies.”

Their platform is tailored to the unique care needs

of older adults across patient and home care settings,

for instance, the Domo.Go safety watch enables fall

detection, emergency response via the Swiss Red

Cross, and real-time health data tracking,

empowering seniors to remain independent while

enhancing their safety. The platform combines

enterprise resource planning tools with clinical

functionalities for home care providers, automating

scheduling, invoicing, and insurance

reimbursements. This integration helps nurses focus

on patient care while ensuring financial sustainability.

By enabling remote patient monitoring and

predictive analysis, the platform empowers

healthcare professionals to shift from reactive to

preventive care, addressing early warning signs such

as sleep disruptions or changes in respiration rates.

This approach can reduce hospitalizations and allow

seniors to stay at home longer, as Domo’s CEO

emphasized:

“The goal should be prevention […] before it’s too

late.”

The companies’ dual focus on operational

efficiency and clinical decision-making demonstrates

how digital health technologies can transform elderly

care. By overcoming barriers to preventive care and

streamlining workflows, their approach directly

addresses the needs of Switzerland’s aging

population while easing the strain on the healthcare

system.

3.2.2 Business Models for Sustainable

Digital Elderly Care

Switzerland’s reimbursement framework presents

difficulty in adopting preventive digital health

technologies, as these services are often underfunded

and not integrated into standard care practices

(Jürgens et al., 2024). To address this challenge,

Domo Health has developed a business model that

directly sells its software to nurses and home care

organizations. This approach reflects CFIR’s

“Intervention Characteristics” domain, particularly

“Innovation Design” and “Cost” constructs. By

combining clinical tools with operational features,

such as invoicing systems linked to insurance

reimbursements, the platform ensures financial

viability while incentivizing the adoption of

preventive care. As the CEO of Domo Health

explained: “Our tool is a daily tool for nurses [...]

and at the same time, it’s a clinical tool for them to

offer better care.”

Compared to countries like Germany and France,

where reimbursement policies for digital health

technologies are more advanced (van Kessel et al.,

2023), Switzerland lags in providing incentives for

innovation. However, recent policy developments,

such as adjusting co-payments for ambulatory care,

signal a shift toward more favorable conditions.

These changes align insurance incentives with the

adoption of digital health technologies, paving the

way for broader implementation of preventive care

and highlighting how CFIR’s “Outer Setting”

domain, through the construct “Policy and

Incentives”, can influence the implementation of

digital health solutions. By tailoring their business

model to the Swiss healthcare context, digital health

companies can strategically position themselves to

capitalize on these policy shifts and expand the

impact of their services, enhancing both the

sustainability and scalability of their services.

4 DISCUSSION

The findings highlight the significant challenges in

digitizing elderly care in Switzerland, including

fragmented service delivery, financial disincentives

for preventive care, and workforce distribution.

Additional challenges identified in related work, such

as the limited adoption of technology by elderly care

workers (Baudin et al., 2020) and the low digital

literacy of older adults (Östlund, 2021), further

compound the difficulty of implementing digital

solutions. Addressing these challenges requires

comprehensive policy reforms (Nicolet et al., 2023;

Tynkkynen et al., 2022), collaborative efforts to

facilitate the widespread adoption of digital

technologies, and alignment in stakeholders’ goals

(Pfitzer et al., 2024). Such advancements hold

promise for mitigating the pressures of a rapidly

aging population and enhancing the quality of life for

older adults (Chen et al., 2023; Ienca et al., 2021;

Nikou et al., 2020). While Domo Health served as the

focus of this case study, the opportunities discussed

can be abstracted to emphasize broader implications

for global healthcare systems. For instance,

digitization strategies like integrating predictive

analytics and real-time monitoring have universal

relevance for elderly preventive care, making them

applicable to diverse contexts beyond Switzerland.

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This study is limited by its single-case focus,

which may not capture the variation in healthcare

delivery models and policies across Switzerland.

Additionally, the reliance on the perspective of Domo

Health’s CEO provides only one viewpoint, omitting

insights from other key stakeholders such as

policymakers, healthcare providers, and patients. The

absence of quantitative data also limits the ability to

assess measurable outcomes, such as cost reductions

or improvements in care quality.

Future research should address these limitations

by incorporating perspectives from multiple

stakeholders, conducting comparative studies across

elderly care-focused digital health companies, and

including quantitative assessments to evaluate the

impact of digitization in elderly care. Longitudinal

studies could also provide a better understanding of

these technologies' long-term effects on the

healthcare system and patient outcomes.

5 CONCLUSIONS

Care for older adults in Switzerland faces critical

challenges, including fragmented service delivery, a

lack of incentives for preventive care, and barriers to

digitization. However, novel innovations demonstrate

how integrating clinical data, predictive analytics,

and operational tools can help transform the care

landscape. Empowering healthcare professionals and

supporting preventive care measures can help older

adults remain independent and reduce the burden on

hospitals. Collaborative action among policymakers,

healthcare providers, and technology companies will

be crucial to overcoming current challenges and

ensuring the sustainability of elderly care. Through

these efforts, Switzerland has the potential to

establish a more efficient, patient-centered system

that enhances the quality of life for its aging

population.

CONFLICT OF INTEREST

EP and TK are affiliated with the Centre for Digital

Health Interventions (CDHI), a joint initiative of the

Institute for Implementation Science in Health Care,

University of Zurich, the Department of

Management, Technology, and Economics at ETH

Zurich, and the Institute of Technology Management

and School of Medicine at the University of St.

Gallen. CDHI is funded in part by CSS, a Swiss

health insurer, the Swiss growth-stage investor MTIP,

and the Austrian health provider Mavie Next. TK is

also a co-founder of Pathmate Technologies, a

university spin-off company that creates and delivers

digital clinical pathways. However, CSS, Mavie

Next, or Pathmate Technologies were not involved in

this research. EP works at MTIP, a Swiss healthtech

growth equity firm that helps founders scale up

successful and sustainable digital health businesses.

MTIP was not involved in this research.

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