Long Term Care

The fundamental question posed in the monograph, to which we found only partial answers, was how to design a system of long-term care services, and in particular health care as one of its components. We developed a model for the economic valuation of long-term care expenditures that includes basic care, housing-related care, social care, and health care. Lifetime long-term care expenditures were evaluated using the criterion of the actuarial present value of lifetime care. We also examined whether lifestyle affects the present value of lifetime care.

Within the framework of the research conducted for the monograph, we found that lifestyle influences the population’s ability for self-care and that financial capacity also affects the choice of housing and care when self-care abilities change.

We arrived at two important results that, to our knowledge, have not previously been identified in the literature in this field. Existing literature does note that certain factors affect population health, but it does not address whether, or to what extent, they affect the ability for self-care. The type of activity at the workplace—most notably heavy physical labor—has a significant impact on the age at which an individual becomes dependent on the assistance of others or acquires the right to institutional care, a finding not previously reported in the existing literature. While the effects of lifestyle factors (smoking, prolonged sitting at work, and alcohol consumption) on health have been examined in thousands of studies, the impact of heavy physical labor as a factor leading to an earlier need for entry into long-term care has not yet been investigated by anyone. There are several studies on the effects of such work on lower back pain, spinal injuries, and similar consequences, but there are no findings from research examining how it affects the age at which the right to long-term care is acquired. We argue that heavy physical labor significantly contributes to earlier entry into institutional care, and that it is not true that the majority of older people wish to age at home once they reach a state in which they can no longer care for themselves. As they approach or reach such a decline in functional capacity, they desire different forms of care—either in community settings or in assisted living facilities, and, in the worst case, institutional care in nursing homes.

We believe that Eurobarometer 283, which was later echoed by the European Commission in its proposals on the deinstitutionalization of long-term care, was based on a survey that included all age cohorts of the population. Based on our own experience and field surveys, we concluded that many older people, when they are no longer able to care for themselves in their own homes, would prefer community-based care, which is not developed in Slovenia. In our field observations, we included older people who were already receiving care in the sample, from which it can be inferred that 44.4% of older people would, in any case, wish to remain in their “old” home. They hold this view either because they see no alternative solution (other than institutional care in a nursing home) or because, due to financial constraints, they cannot afford any other option. As many as 39.7% of older people wish to live in assisted living apartments, while 1.6% would prefer community-based care for older people (such communities do not exist in Slovenia and are therefore unfamiliar to them, but respondents believe that such communities would allow them to better preserve their independence and dignity). A total of 12.7% of respondents wish, in any case, to remain completely independent, meaning that they would not join any community, but would require more services, comfort, and an accessible ground-floor apartment. Only 1.6% of respondents would opt for institutional care in a nursing home.