1. REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY AND SOCIAL AFFAIRS REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY, SOCIAL AFFAIRS AND EQUAL OPPORTUNITIES LONG - TERM CARE POLICIES AND REFORM IN SLOVENIA LJUBLJANA, November 2013

2. REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY AND SOCIAL AFFAIRS REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY, SOCIAL AFFAIRS AND EQUAL OPPORTUNITIES EUROPOP 2010 - Slovenia Population aged 0-14 (%) Population aged 15-64 (%) Population aged 65 or more (%) Population aged 80 or more (%) Old-age dependency ratio (%) 201014.069.416.53.923.8 202015.265.019.85.230.4 203013.762.224.26.338.8 204012.959.627.59.246.1 205013.955.530.610.955.0 206013.754.831.612.757.6

3. REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY AND SOCIAL AFFAIRS REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY, SOCIAL AFFAIRS AND EQUAL OPPORTUNITIES

4. REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY AND SOCIAL AFFAIRS REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY, SOCIAL AFFAIRS AND EQUAL OPPORTUNITIES Present System of Long-Term Care in Slovenia Slovenia does not have a uniform system of long- term care for elderly, chronically ill, disabled and other persons who need help in performing ADL and IADL.

5. REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY AND SOCIAL AFFAIRS REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY, SOCIAL AFFAIRS AND EQUAL OPPORTUNITIES LTC is currently provided in different ways Services within the social (care) system: different forms of institutional care, home care services, the right to a home care assistant, care in sheltered housing, various forms of personal assistance for disabled. Services within the health care system: non-acute hospital treatment for intermediate care (nursing departments and prolonged hospitalisation), long-term care at home is provided within the community nursing care. Different cash benefits for LTC to be used for informal help or to (co)pay the formal services. Entitled are: beneficiaries of old-age and disability pensions, beneficiaries of social assistance, persons who are unemployed due to high disability, war-disabled persons and war veterans (all in cases of need), but not all who are in need of LTC.

6. REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY AND SOCIAL AFFAIRS REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY, SOCIAL AFFAIRS AND EQUAL OPPORTUNITIES Current financing of the LTC services and benefits Partly from taxes (from the national and municipal budgets). Partly from social security contributions (provided from compulsory health insurance and compulsory pension and disability insurance). Partly from the users (private) contribution (long-term care services are covered fully by public sources only if the user or his/her relatives are unable to pay obligatory contribution).

7. REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY AND SOCIAL AFFAIRS REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY, SOCIAL AFFAIRS AND EQUAL OPPORTUNITIES Formal LTC services in Slovenia -2011 Type of long-term care service Number of users Institutional care of elderly17.386 Institutional care of dissabled3.486 Non-acute hospital treatment 6.138 Home care and personal assistance 6.618 753 Home care assistant779 Total35.160

8. REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY AND SOCIAL AFFAIRS REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY, SOCIAL AFFAIRS AND EQUAL OPPORTUNITIES LTC benefits - 2011 Type of cash benefit for long- term care Number of beneficiaries Attendance allowance according to the PDI regulations 30.731 Attendance allowance to the CSA beneficiaries 343 Assistance and aid allowance according to the ACSCMPHP 4.011 Attendance allowance according to the regulations on war- disabled persons and war veterans 412 Total35.497

9. REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY AND SOCIAL AFFAIRS REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY, SOCIAL AFFAIRS AND EQUAL OPPORTUNITIES Structure of expenditure for LTC in RS 2003-2011 Index 2011/2003 20032005200720092011 Total costs (mil EUR)255317351437477187 public expenditure193247272333355183 private expenditure627079104122198 Share of GDP (in %) 1,011,101,011,231,32130 public expenditure0,770,860,790,940,98128 private expenditure0,250,240,230,290,34138 Share of total costs (in %) 100 public expenditure767877767498 private expenditure2422232426106 Source: SORS 2013

10. REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY AND SOCIAL AFFAIRS REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY, SOCIAL AFFAIRS AND EQUAL OPPORTUNITIES What is hindering accessibility of LTC? Inadequate financing of LTC. The existing services and benefits are not integrated into an uniform system. A lack of co-ordination between social and health service providers. Inadequate regional distribution and lack of providers of LTC (urban versus rural). Relatively undeveloped services in home (local) environment. Undeveloped prevention, rehabilitative care and use of IT.

11. REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY AND SOCIAL AFFAIRS REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY, SOCIAL AFFAIRS AND EQUAL OPPORTUNITIES Starting point of the LTC reform Recognition of the need for LTC as a new social risk that people should be protected against. Proposal for the introduction of a new compulsory insurance scheme, similar to the protection of entire population against sickness or injury, disability and old age (pension insurance), unemployment and other social risks.

12. REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY AND SOCIAL AFFAIRS REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY, SOCIAL AFFAIRS AND EQUAL OPPORTUNITIES The main elements of the Draft Act on LTC Integration of health and social part of the long-term care in to an uniform system Introduction of one entrance point (one-stop-shop) for claiming all long-term rights (independent bodies at the local - regional level) Introduction of an uniform system of needs assessment Free choice of the type of service by the users More individualised treatment of users and emphasis on services in home and local environment (community forms of LTC have priority to institutional forms)

13. REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY AND SOCIAL AFFAIRS REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY, SOCIAL AFFAIRS AND EQUAL OPPORTUNITIES Financing according to the Draft Act on LTC Solidarity financing according to the principles of social insurance by introduction of the compulsory social insurance for LTC. OPTION: Introduction of private insurance to cover part of the costs, (personal payment, higher standard and »hotel costs within institutional care«) Part of expenses would be covered through compulsory insurance and part through private insurance or out-of-pocket.

14. REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY AND SOCIAL AFFAIRS REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY, SOCIAL AFFAIRS AND EQUAL OPPORTUNITIES KEY DILEMMAS The key question is what type of private founding ? Out-of-pocket payment? Obligatory or voluntary private insurance? Co-payment or additional payment? Private insurance combined with health insurance? Independent private insurance?

15. REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY AND SOCIAL AFFAIRS REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY, SOCIAL AFFAIRS AND EQUAL OPPORTUNITIES Planned activities regarding preparation of the new LTC ACT Starting points adopted by the Slovenian government in September 2013 Proposal of the NEW LTC ACT beginning of 2014 Adoption in the Parliament mid-2014 Implementation of the new LTC Act 2016

16. REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY AND SOCIAL AFFAIRS REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY, SOCIAL AFFAIRS AND EQUAL OPPORTUNITIES THANK YOU! davor.dominkus@gov.si