The complex set of social changes in Central and Eastern European countries (CEE) which include the transformation of political, economic and welfare systems is generally named “the transition period”. In Slovenia these changes started in 1991 with the country attaining independence and continued with thorough changes to the welfare system. Together with the transformation of the welfare system, new forms of care for older people such as home care services were introduced. In this paper we present the welfare system reforms relevant to older people and the consequent development of their care in two main areas: institutional care as well as the development of social services for older people living at home.
The Slovenian welfare system today is the outcome of a series of gradual changes over the last 20 years. However, its origins can be traced to the 1950s and the development of the Yugoslav welfare system (see Kolarič, 1990 and 1992; Kolarič et al., 2009). The state socialist welfare system was based on the compulsory payment of contributions by employees and enterprises to cover risks of income loss (including old age) and all contributions for education, childcare, care for older people etc. The system had three components, namely: the public sector, the informal sector and the “gray” sector. In the public sector, a well developed and regionally dispersed network of public (state) organisations and institutions provided formally organised professional services, including numerous institutions for the care of older people (old people’s homes). The second sector — the informal sector — provided services that were lacking in the public sector. These were provided by members of close and extended families, friends and neighbours. This voluntary and unpaid provision of services, largely based on strong value orientations, normative expectations and emotional closeness within informal networks (Filipovič Hrast and Hlebec 2008 and 2009; Hlebec and Filipovič Hrast 2009; Hlebec 2009), was ignored by the state and therefore not supported by policy measures. The gray sector (Kolarič 1990 and 1992; Kolarič et al., 2009) comprised employees in public institutions and organisations who were offering services for direct (illegal) payment. The gray supply of services was tolerated by the state as it compensated for the lack of services in the public sector. Part of the third sector also comprised voluntary organisations and associations which were financially supported by the state. This part of the system was not well developed before the transition period.
Therefore, care for older people before the transition period was based on the public provision of institutional care and on informal care provided mostly by family members (Nagode et al., 2004). That is why it is important to continually observe both: (1) the development of institutional care; and (2) the development of policy measures and services for older people living at home and for their carers.
The change of the political system in 1991 was accompanied by changes in the economic system as well as gradual changes in the welfare system. Among changes to employment policy, family policy, disability and old age pension policy, health care policy, educational policy and housing policy (Kolarič et al., 2009), the old age pension reforms and health care reform had the greatest impact on care for older people. There were also several specific acts and programmes related to care of older people which we will review later.
Two pension system reforms took place in 1992 and 1999 (Kolarič et al., 2009). Changes in the pension system, although gradual, increased the retirement age, reduced differences in requirements for men and women (the full pensionable age for men is 63 and 61 for women) and emphasised the relationship between benefits and contributions. A three-pillar system of pension financing was also introduced. A new reform is in the pipeline and the proposed changes further increase the retirement age and are aimed at the pension system’s long-term financial sustainability.
The pension system changes have had an effect on the retirement age which is slowly rising, as shown in Figure 1 below.
Figure 1: Average age of new pension beneficiaries (without survivors and widower’s pensioners) under general and special regulations, by years, situation in December
Sources: Zavod za pokojninsko in invalidsko zavarovanje Slovenije, 2010; The Pension and Disability Insurance Institute of Slovenia, 2004.
However, other changes relating to the pension system reform have had a negative impact on the lives of older people, especially those who are the most vulnerable — the very oldest. The income position of retired people was improving from 1983 to 1993, although the poverty incidence of people aged 60+ was considerably above the national average (see Stropnik et al., 2003: 62-64). While the economic situation of older people was improving until 2001, their economic situation has deteriorated since 2001 as shown by Kump and Stropnik (2009; Stropnik et al., 2010) in their analysis of the economic status of older people after the pension reforms. The biggest decrease in the economic situation occurred for those aged 75+, who also faced a decrease in their absolute (not only relative) income. As emphasised by those authors, elderly women, especially women in a single household, and people living in pensioner households are in a particularly low income position. The authors relate these changes directly to the impact of the pension reforms.
Changes to the health care system were introduced by the health insurance reform of the 1990s (Kolarič et al., 2009). Basic (compulsory) health insurance (CHI) still covers almost the entire Slovenian population and therefore the health security system is accessible to all. However, several services, medicines etc. require additional voluntary health insurance (Stropnik et al., 2003). Some researchers (e.g., Javornik, 2006) claim that the growing social and economic inequalities as a result of the transition have had a greater effect on differences in health and overall wellbeing than the health security system itself. Moreover the health system and social welfare system are only slowly responding to demographic changes and the intensive ageing of the population. The long-term care system is still quite fragmented and systemic, while related policy changes are still a challenge for the near future.
Apart from overall changes to the welfare system after the transition, other policy measures were developed that relate directly to the care of older people. These measures and their consequences are presented in the following paragraphs.
The Pension and Disability Insurance Act (PDIA) prescribes means-tested transfers among the elderly such as a pension income supplement which is available to pensioners with low incomes and an incomplete contribution period. It is granted to old-age pensioners, disability pensioners and recipients of a survivor pension. 1999 also saw the introduction of a national pension granted to people who do not receive any pension and satisfy a number of conditions. In addition, assistance and attendance allowance beneficiaries are mostly given to pensioners.
The Health Care and Health Insurance Act (1992) offers an opportunity for family members to take care of a close family member. They are eligible for wage compensation for 7 days, exceptionally for 14 days, but only for people who are living in the same household. The National Health Care Programme in the Republic of Slovenia — Health for All by 2004, emphasised home care services. Although a long-term care insurance act was proposed in 2006, it is still to be passed.
The Social Security Act (MDDSZ, 2006a; Amendment to the Social Security Act, 1992) defines services for social prevention, and services meant to eliminate social distress and difficulties (first social aid, personal help, help to the family, institutional care, guidance, protection and employment under special conditions, help to workers in enterprises, institutions and other employers). One measure related to care for older people is the possibility for a family member to become a family attendant with the right to partial payment for lost income at the minimum wage level or to a proportional part of payment for lost income in the case of part-time work.
The programme for the development of care for older people in social protection in Slovenia (Program razvoja varstva starejših oseb na področju socialnega varstva v Sloveniji do leta 2005, MDDSZ, 1997) emphasised the development of institutional care and the development of services in the community.
The strategy of care for the elderly till 2010 (MDDSZ, 2006b) supports: the enlargement of capacity for care at old people’s homes; the granting of concessions to and encouragement of public-private partnerships; upgrading of the capacity network for day care; the distribution of home help services; the distribution of the sheltered housing system; the distribution of the remote help system provider so that the public access contractor network is ensured and covers the whole country. Support for family members who take care of elderly family members was also encouraged.
The National Social Protection Strategy of 2005 and the Resolution on the National Social Protection Programme 2006-2010 define new forms of mobile assistance, day care centres, care in a family other than the birth family and care in sheltered housing for the elderly. In addition, two programmes tackle social exclusion and poverty: the National Programme on the Fight against Poverty and Social Exclusion (MoLFSA 2000) and the National Action Plan on Social Inclusion 2004-2006.
As mentioned, care for older people before the transition period was based on the public provision of institutional care coupled with informal care provided mostly by family members. Policy measures since 1991 have targeted both the development of institutional care and support for older people living at home and their carers. Therefore, we focus the main part of this paper on trends already emerging in the development of: (1) institutional care; and (2) services for older people living at home.
Valentina Hlebec: Faculty of Social Sciences, University of Ljubljana, Slovenia. Kardeljeva pl. 5, 1000 Ljubljana – email@example.com .
Tags: help at home, istitutional care for older people, Slovenian welfare system