Slovenia is one of the most rapidly ageing countries in the EU, and health spending as a share of GDP is forecast to increase in the coming years. In the period 2013-2060 the share of people aged 80+ in the Slovene population is expected to grow from 4.5% to 12.3% (EU-28: 5.1%-11.8%), i.e. to more than double with most of the growth happening before 2045. At the same time the share of people 85+ will expand by more than a factor 3.5 from 1.9% to 6.9% (EU-28: 2.3%-7.0%), and the share of people aged 80+ and 85+ among the people above 65+ will rise noticeably from 26.4% to 41.9% (EU-28: 27.8%-41.5%), and from 11.0% to 23.6% (EU-28: 12.9%-24.6%), respectively.
Over the same period of 47 years the old age dependency ratio measured as 65+ as percentage of the 20-64 year olds will rise from 26.9% (EU-28: 29.9%) to all of 58.3% (EU-28: 55.3%).
The health of the Slovenian population continues to improve, although gaps in life expectancy by gender and socioeconomic groups persist.
The country also faces a major challenge with the projected growth of long-term care expenditure and the need for a shift in care models. These are projected to pose fiscal sustainability risks in the medium to long term. Under an assumption of no policy change, the Ageing Report scenario suggests that public expenditure as share of GDP would rise from 0.9% to 1.9% (EU-27: 1.6%-3.1%) by 2070. The impact of a progressive shift from the informal to the formal sector of care in Slovenia would entail an estimated increase by 137% in the share of GDP devoted to public expenditure on long-term care (128% on average for the EU27).
At present, long-term care (LTC) is the responsibility of the Ministry of Health and is regulated under different sets of legislation, including pensions, health care, as well as social and family care This means that, as it stands, there is no single overarching regulation on long-term care and its financing. Discussions regarding a new Long-term Care Act, drafted in October 2017, are indeed still ongoing. While a two-year pilot project was initiated in 2018, the government plans to deal with legislation on long-term care only after the adoption of a new Health Care Act. Therefore, a legislative proposal on long-term care is expected mid-2020, at the earliest. These delays are a setback in implementing reforms in health and long-term care that ensure quality, accessibility and long-term fiscal sustainability.
Due to population ageing, the number of elderly needing LTC has been increasing. In 2017, there were 64,433 long-term care recipients in the country – i.e. a 3% increase compared to the previous year.
Institutional care is traditionally well developed in Slovenia, with a trend towards privatisation in the last 15 years.
Home care for the elderly consists of community nursing and home help. Community nursing is carried out on instructions from a family physician. It covers the medical care of a patient at home (or in a social institution), like wound care, injections, taking samples for laboratory examination, etc. Community nursing services are fully covered by compulsory health insurance. Community nurses are employed by healthcare centres that are geographically spread across Slovenia. Currently, there are 57 public healthcare centres at the primary level.
Persons entitled to home help are those whose psycho-physical capabilities enable them to function at home and keep in satisfactory mental and physical condition, with occasional organised help from another person(s). This group also includes persons over 65 who are − due to age or age-related factors − incapable of fully independent living. The person in need fills out a special request form for home help and submits it to the relevant local Centre for Social Work. Upon receipt of the application, a social worker visits the person in need to make an assessment of his/her situation, and then together they define the services needed. Home help is financed from the user’s own funds and municipality budgets. The user fees are income related, with 10 income brackets. The local Centre for Social Work may grant partial or full exemption from payment for long-term care services to users of institutional and community-based services. Full or partial exemption from payment is determined on the basis of a cap on spending and the ability of users (or their families) to pay for the services. Where the user payment does not cover the cost of the long-term care provided, the remaining amount is paid by the municipality or central government.
The only cash benefit relevant for the elderly (65+) is the assistance and attendance allowance. It is granted to, among others, retired residents of Slovenia who need assistance in meeting their basic needs. These are assessed by the Disability Committee of the Disability Insurance Institute of the Republic of Slovenia, to whom the request for assistance and attendance allowance is submitted by the general physician or the person in need. Beneficiaries must be residents of Slovenia. The allowance is not means tested; there are three different rates of assistance and attendance allowance, ranging from EUR 292.11 to EUR 418.88 per month.
The burden of informal care for dependent relatives is high in Slovenia and falls primarily on women. The number of people depending on others to carry out activities of daily living will increase significantly over the coming 50 years.
Number of carers
Traditionally, the family plays a very strong role in ensuring good living conditions − not only in terms of care and finances, but also with regard to the housing issue (Cirman, 2006). Hence, there is a very strong tradition of multigenerational households in Slovenia. As regards informal care, the family is the main provider of care for older people in Slovenia. Most Slovenes (60%) consider it the children’s responsibility to care for older people; this figure is higher than the EU average (48%) (EC, 2007). A Eurobarometer study has shown that almost 40% of Slovenes see cohabitation with an old, disabled family member as the solution to a family care-provision issue.
Survey data on informal carers in the Slovene population, aged 50 years and over, show that about 220,000 inhabitants of Slovenia regularly care for their closest persons. Women are overly represented in among both carers and care recipients (over two thirds).
There is a clear need for training of, and more support to, informal carers, like respite services, an allowance compensating for (a part of) the cost of respite services, social security insurance of informal carers, etc. More flexible employment arrangements are also needed for employees with long-term care obligations.
Social inclusion of carers, access to education and employment
There is no care leave system for long-term care of the elderly. Adequate workplace arrangements for informal carers are not available.
The parent (or other person fulfilling the parental role) who is taking care of a child below the age of 18 years with a severe physical disability or a moderate or heavy mental disability, has the right to work part time. The number of caring hours must nevertheless amount to at least a 50% part-time equivalent. The employer may not reject such a request.
In some specific cases, partial financial compensation for the loss of income is available to a person involved in caring tasks. To be eligible, the informal carer should be one of the parents (or other person performing the parental role) who drops out of the labour market or starts working part-time in order to care for:
- A child with a serious mental problem or physical disability, or
- Two or more children with a moderate or serious mental problem or a moderate or heavy physical disability.
The right is universal and lasts until the child is 18 years old. In 2016/2017, the full benefit amounted to €734 per month (or a proportion of it according to the hours of care). Social security contributions have to be paid from this amount.
An allowance for the care of a child needing special care is also available. It seeks to compensate for a part of the increased costs of maintenance and care of a child requiring special care. The benefit amounts to between €100 and €200 per month depending on the severity of the mental health problem or disability. Eligibility is defined on the basis of the opinion of a medical commission and is received as long as the reasons persist or until the child reaches 18 years of age (up to the age of 26 if the child continues his/her education).
Recognition and definition of carers
There is no national policy regarding informal care in Slovenia. Informal care mainly includes instrumental activities of daily living, while basic activities of daily living are provided as a combination of formal and informal care. The proportion of care provision divided between formal home care services and informal care depends on whether users live alone or with a family. Those who live alone receive more home care services from formal carers (Hlebec et al. 2014). In other words, access to formal home care and the prevalence of informal care seem to be interrelated.
Access to information and advice
The Anton Trstenjak Institute of Gerontology and Intergenerational Relations has developed and implemented a community-based training programme for informal carers. The contents include social and health aspects of caring such as understanding of and communication with the care receiver, skills for home care, care for carers’ own health, knowledge on prevalent age-related diseases, palliative care, death and grieving, information about respite care possibilities and institutional care, and psychosocial situation management. During the training, participants have the opportunity to learn from local and national experts and institutions related to caregiving. Some topics are presented by local community nurses, physiotherapists, doctors, formal carers from the local home care centre etc.
Training for family and other informal carers consists of ten weekly learning sessions that are attended by 15-25 family carers and carried out with a method of active peer learning from shared experience and expertise. In the course of the training programme, participants develop personal relationships. At the end of the training programme they are therefore encouraged to continue with monthly meetings in “local relatives’ groups”, which based on the principle of self-help groups. The Anton Trstenjak Institute provides expert support to leaders of these self-help groups. Furthermore, it organizes regular meetings of leaders from all over Slovenia where they exchange experiences and discuss topics such as: awareness raising, informal carers’ rights and equal opportunities. In 2018, the Anton Trstenjak Institute, together with informal carers, organized the first national conference on informal care in Slovenia.
The programme is co-financed by Ministry of Labour, Family, Social Affairs and Equal Opportunities and by Municipalities as part of the Network of intergenerational programmes for quality ageing.
The Social Protection Institute of the Republic of Slovenia (SPIRS) also organises courses for informal carers (a course is organised at least once a month; each lasts 8 weeks and takes up 2 hours per week). These are free of charge for participants. The courses are financed by company donations. There are also many local initiatives and projects to arrange education and training courses, a telephone line to support informal carers, etc. So far, no initiative to support informal carers has come from the state.
Discussions regarding training and skills validation for informal carers to assist them in becoming LTC professionals is lacking.
- State of Health in the EU – Slovenia Country Health Profile, OECD and WHO Observatory of Health Systems and Policies, 2019
- The 2018 Ageing Report, Economic and Budgetary Projections for the EU Member States (2016-2070), EC, 2018
- ESPN Thematic Report on Challenges in Long-Term Care, Slovenia, EC, 2018
- ESPN Thematic Report on work–life balance measures for persons of working age with dependent relatives, Slovenia, 2016Joint Report on
- Health Care and Long-Term Care Systems and Fiscal Sustainability, EC, 2016
- Adequate social protection for long-term care needs in an ageing society, European Commission, 2014
- AGEING IN SLOVENIA – Survey on the needs, abilities and standpoints of the Slovene population aged 50 years and over, Anton Trstenjak Institute, 2013