Preventing Dependency in Slovenia: Healthy Ageing, Early Intervention and Long-Term Care

An older person does not usually move from independence to long-term dependency in a single moment. Functional ability can change gradually through reduced strength, falls, chronic disease, social isolation, poor nutrition, cognitive change or the cumulative effects of several smaller difficulties. It can also deteriorate rapidly after an acute illness or hospital admission. Some changes cannot be prevented. Others can be delayed, reduced or partly reversed when risks are identified early and the right support is available.

This distinction is becoming increasingly important within Slovenia’s developing long-term care system. As explored across the Slovenia Ageing, Long-Term Care & Community Support Knowledge Hub, the country has created a new social-security pillar for people who require sustained assistance with basic and supportive daily activities. Yet the reform also contains an explicitly preventive component: services for strengthening and maintaining independence are designed to reduce deterioration and help people preserve functional ability.

That creates a wider strategic opportunity. Long-term care does not need to operate only at the point where dependency has already become substantial. It can connect with public health, primary healthcare, geriatric practice, rehabilitation, municipalities, community organisations, families and age-friendly environments to support independence earlier.

The central policy challenge is to make prevention operational without making unrealistic promises. Ageing is not a disease, and significant disability or dependency cannot always be avoided. Prevention in long-term care should therefore mean extending healthy and independent life where possible, identifying reversible risks, preventing avoidable deterioration and ensuring that people receive proportionate support before smaller difficulties become larger ones.

Prevention sits across systems rather than inside one service

Slovenia already has a strategic foundation for thinking about ageing in this way. The Strategy of a Long-Lived Society places healthy, safe and independent living, participation and intergenerational cooperation within a broader response to demographic change. Slovenia’s development framework similarly treats healthy and active life across the life course as an important condition for wellbeing in an ageing population.

Long-term care reform adds another layer. Under the Long-Term Care Act, ZDOsk-1, the purpose of the system includes maintaining independence and enabling people to remain in their home environment for as long as possible where that is their preference. People who qualify for long-term care can receive services for strengthening and maintaining independence in addition to their main long-term care right.

Those services are important, but they are not the whole prevention system.

Much of the work that influences later dependency sits elsewhere: prevention and management of chronic disease within healthcare, physical activity, nutrition, falls prevention, rehabilitation, mental health, accessible housing, social participation and support for informal caregivers. Municipal environments and transport can determine whether somebody remains active. Primary healthcare can identify emerging risk before a person meets long-term care eligibility. Community organisations can reduce isolation. Rehabilitation can restore function after illness or injury.

Prevention is therefore a pathway rather than a programme.

The stronger opportunity lies in connecting these functions so that a person does not have to become substantially dependent before the system becomes interested in maintaining their independence.

Slovenia has made maintaining independence an explicit long-term care right

One of the distinctive features of Slovenia’s new framework is the inclusion of storitve za krepitev in ohranjanje samostojnosti — services for strengthening and maintaining independence.

These services are intended to prevent deterioration and reduce the need for assistance. They can include training in the safe use of medical devices, exercises to maintain mobility and functional independence, psychosocial support, post-diagnostic support for people with dementia and advice about adapting the home environment.

The professional base is deliberately broader than routine personal assistance. Depending on the intervention, services can involve social workers, occupational therapists, physiotherapists, graduates in kinesiology and social gerontologists. This matters because dependency is rarely produced by one factor alone.

A person may technically be able to stand from a chair but stop doing so because they fear falling. Another may become less independent because the bathroom environment is unsafe. Someone with early cognitive impairment may retain substantial ability if routines, communication and the home environment are adapted appropriately.

The annual entitlement is linked to long-term care category. Current arrangements provide 12 hours in category 1, 24 in category 2, 48 in category 3, 30 in category 4 and 24 in category 5. The pattern is not a simple progression in which more dependency always produces more preventive hours; the entitlement is structured around the role these interventions can play at different levels of need.

For operational teams, the important issue is therefore not simply whether the allocated hours are used. It is whether they are targeted towards meaningful functional outcomes through outcomes-focused and goal-led support.

Preventing dependency is different from preventing ageing

Language matters in this field. A policy objective of “preventing dependency” can become problematic if it implies that needing support represents personal failure or that every deterioration could have been avoided through better choices.

That is neither clinically realistic nor consistent with a rights-based long-term care system.

Progressive neurological conditions, advanced dementia, significant disability and the effects of serious illness may create increasing support needs despite excellent preventive care. Even where functional decline can be slowed, the purpose should not be to deny or delay legitimate access to assistance.

Prevention is better understood at several levels. Population health measures can reduce risks across the life course. Early intervention can address emerging frailty or loss of function. Rehabilitation can restore capability after an acute event. Long-term care can prevent secondary deterioration among people who already need substantial support.

For someone who uses a wheelchair, for example, prevention may mean protecting skin integrity, maintaining upper-body function, reducing pain and preserving opportunities for participation. For a person with dementia it may mean maintaining mobility, nutrition, meaningful activity and familiar routines rather than attempting to reverse the underlying condition.

This connects prevention with positive risk-taking and risk enablement. Independence cannot be preserved by removing every risk from a person’s life. Excessive restriction can itself accelerate loss of confidence, movement and capability.

An apparently minor fall can become a turning point

Consider a 79-year-old woman living independently in Celje. She has hypertension and mild osteoarthritis but manages her own personal care, shopping and household tasks. She falls outside her home and sustains bruising but no fracture.

Clinically, the immediate incident appears minor. Over the following weeks, however, she becomes frightened of falling again. She stops walking to local shops and uses the stairs less frequently. Her daughter begins bringing groceries. Reduced activity leads to declining strength and balance, which makes another fall more rather than less likely.

A reactive system may not respond until a second fall, hospital admission or substantial loss of daily function creates an obvious service need.

A preventive pathway looks at the trajectory instead. Relevant professionals explore whether medication, vision, footwear, balance, home hazards or another health issue contributed to the fall. Appropriate exercise supports strength and confidence. Occupational advice considers environmental risks without unnecessarily restricting activity. Her daughter is involved with consent but does not simply take over every task her mother finds difficult.

The outcome being sought is not merely “no further falls.” It is continued mobility and confidence with proportionate risk management.

If her needs later meet the statutory threshold for long-term care, the personal plan can build on this work rather than beginning from an assumption that assistance should replace activities she may still be able to perform.

Organisations examining similar situations can use the Positive Risk-Taking Planner to structure the relationship between autonomy, foreseeable risk, controls and review. It does not determine Slovenian eligibility or clinical decisions, but the underlying principle is relevant: safety and independence should be considered together.

Healthy ageing begins before long-term care eligibility

A prevention strategy confined to people already entitled to long-term care begins too late to capture the full opportunity.

Slovenia’s public-health system therefore matters to the future sustainability of long-term care. National approaches to nutrition, physical activity, mental wellbeing, screening and chronic-disease prevention operate across the life course. Health-promotion infrastructure within primary healthcare provides routes through which people can receive information and support before substantial dependency develops.

The National Institute of Public Health, NIJZ, has also strengthened the evidence base specifically around healthy ageing. Its Integration of Geriatric Care for Older People project, completed in September 2026, brought together work on clinical care, polypharmacy, oral health, nutrition, physical activity, mental health, workforce competence and more integrated treatment of older people.

The significance lies in the breadth of the model. Functional decline can be influenced by multiple interacting factors. Poor nutrition may reduce muscle strength. Reduced strength increases falls risk. Fear of falling reduces activity. Isolation can affect mental health and motivation. Polypharmacy may contribute to adverse effects. Treating each issue separately can miss the combined trajectory.

NIJZ’s subsequent healthy-ageing recommendations strengthen the case for a more coordinated and preventive approach rather than waiting for advanced need.

This aligns with the wider principle of health inequalities, prevention and early intervention: prevention has greatest system value when it reaches people before avoidable disadvantage has compounded into higher need.

Physical activity becomes an independence intervention

Physical activity is sometimes discussed as a general lifestyle recommendation rather than part of long-term care strategy. For an ageing population, that distinction is too narrow.

Muscle strength, balance, mobility and confidence influence whether people can stand, transfer, climb stairs, shop, prepare food and participate outside the home. Losing these abilities can convert a manageable health condition into dependency on another person.

Slovenia has been developing practical infrastructure around this connection. Through its integrated geriatric-care work, NIJZ developed exercise approaches including vAdBeCeDa, a programme designed for adults and particularly relevant to older people and people with chronic conditions. It addresses strength, balance, flexibility and coordination and can be accessed through health-promotion centres or through digital resources for home use.

The value of such programmes is not that an exercise intervention can prevent all long-term care need. It is that functional ability is modifiable for many people, including some who already have chronic conditions.

For long-term care providers, this changes the meaning of support. A worker completing every physical task for a person may produce an efficient visit while unintentionally reducing opportunities to maintain ability. Where safe and appropriate, just enough support and least restrictive practice can preserve participation in everyday activities.

That requires judgement. Encouraging a person to do what they can is different from withholding assistance. The personal plan should identify where participation is beneficial, where fatigue or pain limits activity, and where professional rehabilitation or therapeutic input is required.

Prevention therefore becomes part of ordinary practice rather than an additional programme delivered alongside care.

Early intervention depends on recognising change before a threshold is crossed

Long-term care eligibility necessarily requires formal assessment. Slovenia’s entry points at Centres for Social Work assess applicants using the statutory framework and place eligible people into one of five long-term care categories.

A prevention system, however, also needs to notice people whose needs are increasing but who may not yet require formal long-term care.

Primary healthcare teams, community nursing, relatives, municipal services, social organisations and the person themselves may all encounter early signals. These can include repeated minor falls, unintended weight loss, difficulty managing medication, declining mobility, withdrawal from social activity, increasing exhaustion among an informal caregiver or growing difficulty with instrumental daily tasks.

The operational challenge is not to turn every sign of ageing into a referral for formal care. It is to create proportionate routes towards the right response.

That response might involve clinical assessment, health-promotion support, physiotherapy, occupational advice, municipal social assistance, community activity or a long-term care application where dependency has become sustained.

Four questions help distinguish meaningful early intervention from indiscriminate service expansion:

• What ability or activity has changed, and over what period?
• Is there a potentially reversible health, environmental or social cause?
• What matters to the person and what ability do they want to maintain or recover?
• Does the situation require healthcare, rehabilitation, social support, long-term care or a combination?

The final question is particularly important. Long-term care should not absorb needs that properly require medical treatment or rehabilitation simply because it is the newest part of the system.

Home environment can determine whether capability becomes dependency

Functional ability is not located entirely within the individual. It is produced partly through the interaction between the person and their environment.

An older person with reduced mobility may remain independent in an accessible apartment but require substantial assistance in a home with steep stairs, an inaccessible bathroom and no suitable handrails. A relatively small adaptation can therefore change the amount of human assistance required.

This is recognised within Slovenia’s independence-strengthening services, which can include advice about adapting the living environment and safe use of medical aids.

Consider an 84-year-old man living with his wife in a house they have occupied for four decades. Following illness, he begins struggling to enter the bath and rise from a low chair. His wife responds by physically helping him, placing increasing strain on her back.

The immediate answer could be more hands-on care. A more complete assessment looks at why assistance has become necessary. Occupational input identifies changes to the bathroom and seating environment. Appropriate equipment reduces unsafe transfers. Exercises support the man’s remaining strength. His wife receives advice about how to assist without becoming the permanent manual solution.

His need has not disappeared, and future deterioration may still increase his long-term care entitlement. But environmental change has prevented a mismatch between his abilities and his home from unnecessarily accelerating dependency.

This principle connects directly with equipment, assistive technology and home adaptations. Prevention is often most effective when it changes the environment around a person rather than expecting the person alone to overcome the barrier.

Prevention must include people who already have substantial needs

There is a risk that preventive policy concentrates resources on people with relatively low needs because their independence appears easiest to preserve. That would overlook an equally important function of prevention within higher-dependency care.

A person in category 4 or 5 can still experience preventable secondary deterioration.

Reduced mobility can lead to contractures or pressure damage. Poor oral health can affect nutrition. Inactivity can worsen physical conditioning. Inadequate hydration can increase health risks. Social withdrawal can reduce quality of life. A person with advanced dementia can lose remaining abilities more rapidly if daily support routinely replaces rather than enables participation.

This explains why Slovenia’s services for strengthening and maintaining independence remain relevant across all five long-term care categories, although the annual allocation differs between them.

The objective changes with the person.

For someone with relatively low dependency, success might mean maintaining independent shopping and personal care. For somebody with advanced neurological impairment, it might mean preserving safe transfers, communication, comfort and participation in meaningful routines.

Prevention should therefore be measured against an individual baseline rather than an abstract standard of independence.

This is also why support planning and review matter. A personal plan should not become a static description of deficits. It should show what abilities remain, what outcomes are being supported and when changes require reassessment.

Dementia demonstrates why prevention needs a nuanced definition

Dementia provides one of the clearest examples of the limits and possibilities of preventive long-term care.

Once a progressive dementia syndrome is established, long-term care cannot be framed around preventing the condition through service delivery. It can, however, prevent or reduce many avoidable consequences associated with poor support.

Post-diagnostic support, which is explicitly included within Slovenia’s independence-strengthening services, can help a person and family understand the diagnosis and plan for changing needs. Communication approaches can preserve involvement in decisions. Familiar routines and meaningful activity can support wellbeing. Environmental adaptation may reduce confusion or falls. Attention to nutrition, mobility, medicines and sensory needs can prevent secondary deterioration.

Imagine a woman with early dementia who lives with her husband. She is physically mobile but has begun abandoning activities because both partners fear she may become confused outside the home. Her husband increasingly completes tasks on her behalf because it is quicker.

The apparent risk is cognitive impairment. The emerging secondary risk is avoidable loss of confidence and function.

A more enabling approach identifies activities she can continue safely, establishes routines and communication strategies, involves her in planning while she can express her preferences clearly and supports her husband to distinguish helpful assistance from unnecessary substitution.

Over time her needs may still increase. Prevention has not “stopped dementia.” It has protected autonomy and function for longer.

This is the practical connection between preventive long-term care and dementia assessment, review and changing needs.

Family caregivers need preventive support too

A long-term care system can preserve one person’s independence while quietly exhausting another.

Slovenia’s recognition of the family caregiver as a formal long-term care right acknowledges the substantial role relatives play, particularly for people with high levels of dependency. Yet prevention needs to extend to caregiver sustainability whether or not the relative holds that formal status.

A spouse may gradually take over lifting, personal care, night-time supervision, appointments and household responsibilities without identifying themselves as a caregiver. Adult children may combine support with employment and their own families. Where services are difficult to access, informal support can expand until it becomes the mechanism holding the entire arrangement together.

Early intervention should therefore notice changes in caregiver capacity as well as changes in the person receiving support.

Training, respite, replacement care, equipment, realistic personal planning and timely formal support can prevent a manageable family arrangement becoming unsustainable. This is not merely a wellbeing issue for the caregiver. If an exhausted caregiver suddenly becomes unavailable, the person they support may require urgent formal provision or institutional admission.

Prevention is therefore relational. The resilience of the care arrangement depends on both people.

Technology can detect risk, but response determines whether it prevents anything

Slovenia’s inclusion of e-care within the long-term care framework creates another route for preventive support. Technology can provide alerts, support communication and offer additional reassurance for people living at home.

The wider potential is significant. Digital systems can help identify changes in patterns, support medication routines, enable remote contact and improve information exchange between professionals. Over time, more sophisticated analytics may help services identify combinations of indicators associated with deteriorating function.

But technology does not become preventive simply because it produces data.

If an alert is generated repeatedly without meaningful review, the underlying risk remains. If a digital tool identifies reduced activity but nobody determines whether the cause is illness, pain, depression or equipment failure, detection has not become intervention.

The governance pathway therefore needs to connect information with responsibility:

• what information is collected and for what purpose;
• who reviews a meaningful change;
• what threshold prompts human contact or professional assessment;
• how consent, privacy and proportionality are maintained;
• what happens when technology fails or the person cannot use it; and
• whether the intervention improves an outcome rather than merely increasing monitoring.

This is especially important when using person-centred technology and digital enablement. Monitoring should support autonomy rather than convert a private home into an unnecessarily surveilled environment.

The Digital Transformation Readiness Assessment can help organisations explore whether governance, workforce capability, digital resilience and operational design are sufficiently mature to support technology-enabled care. The framework is not specific to Slovenian regulation, but its central question is relevant: is technology embedded in a functioning care model or merely added to it?

Prevention needs a workforce able to enable rather than only complete tasks

Slovenia’s preventive ambitions also change what the long-term care workforce needs to do.

Task completion remains important. People need reliable assistance with washing, dressing, eating, movement, household activities and other recognised needs. Yet an independence-oriented system also asks workers to notice change, encourage remaining ability and understand when specialist input may be needed.

That requires competence and time.

A worker may notice that somebody who previously walked to the bathroom now asks for assistance from the chair. The change could reflect temporary fatigue, pain, fear, infection or a more sustained decline. The worker is not expected to diagnose the cause, but the observation may be important enough to record and escalate.

Similarly, a physiotherapist or occupational therapist can recommend an enabling approach, but its value is reduced if daily support routinely works against it.

The preventive workforce model is therefore multidisciplinary and connected. NIJZ’s recent work on integrated geriatric care has deliberately focused on strengthening competencies across health and social-care professionals rather than treating healthy ageing as the responsibility of one occupation.

This connects with broader workforce skills for ageing-well services. Prevention becomes credible only when frontline practice, specialist expertise and supervision reinforce the same objectives.

Prevention has to survive the pressure for immediate productivity

One of the most difficult operational tensions is that preventive work can take longer today while reducing need tomorrow.

Helping a person dress themselves may take longer than dressing them. Supporting safe walking can require patience. Discussing nutrition or encouraging participation may appear less urgent than completing the scheduled task. When workforce capacity is tight, enabling practice can therefore be squeezed by immediate throughput.

This creates a financing and governance problem as much as a practice problem.

Slovenia’s compulsory long-term care insurance provides a dedicated funding basis for recognised long-term care rights, supported by state-budget resources. The independence-strengthening entitlement gives preventive activity an explicit place within that system rather than leaving it entirely dependent on discretionary local initiatives.

However, the value of the investment will depend on implementation. Counting the number of professional hours delivered is straightforward. Demonstrating whether those hours maintained mobility, reduced deterioration or helped someone remain safely at home is harder.

Organisations seeking to connect activity with outcomes can use the Quality Dashboard Builder to structure measures around quality, capacity and impact. For preventive care, the principle is particularly important: activity data should not be mistaken for evidence that dependency has actually been reduced or delayed.

A better evidence model starts with trajectories rather than isolated events

Preventive outcomes are difficult to measure because the event that did not happen is inherently uncertain. A person who remains independent for another year might have done so without intervention. Another person may deteriorate despite excellent support because their underlying condition progresses.

This means Slovenia should avoid judging prevention through simplistic promises of avoided admissions or reduced long-term care expenditure alone.

A stronger evidence model follows trajectories.

At individual level, records can show whether mobility, daily activities, confidence, participation or caregiver sustainability have changed against the person’s baseline. At provider level, services can examine patterns of deterioration, reassessment, falls, avoidable complications and transitions into higher-intensity support. At national level, NIJZ and other responsible institutions can analyse population trends, geographical variation and the relationship between service use and functional outcomes.

Qualitative evidence matters as well. A person maintaining the ability to prepare breakfast or walk to a neighbour may represent a meaningful outcome even if it produces no immediately measurable saving elsewhere.

The Governance Maturity Assessment offers organisations a way to examine whether evidence is reaching decision-makers and influencing action. In the Slovenian context, the wider lesson is that preventive information needs to travel from personal plans and local practice into provider, municipal and national learning.

Without that feedback loop, prevention risks remaining an attractive policy principle whose operational impact is difficult to see.

Prevention can strengthen financial sustainability without becoming rationing

Slovenia’s demographic direction makes the financial argument for prevention unavoidable. An ageing population will increase demand for health and long-term care while changing the relationship between the working-age population and those drawing on age-related support.

Maintaining independence can therefore contribute to sustainability. If some people need fewer hours of assistance for longer, avoid avoidable hospital treatment or enter high-intensity support later, the effect can accumulate across the system.

But the financial argument needs careful boundaries.

Prevention should not become a mechanism for delaying an entitlement that somebody already needs. Nor should people be required to demonstrate that they have followed a healthy lifestyle before receiving publicly funded support. Compulsory long-term care insurance is based on social protection, not a retrospective judgement about whether dependency was avoidable.

The appropriate economic question is different: where can investment improve function, wellbeing and independence while also using public resources more effectively?

Sometimes the answer will be an exercise or falls-prevention programme. Sometimes it will be timely rehabilitation, home adaptation or support for a family caregiver. Sometimes the appropriate intervention will simply be sufficient long-term care, because inadequate assistance can itself cause deterioration.

Financial sustainability and person-centred support therefore do not have to be opposing objectives. They become aligned when resources are used early enough and intelligently enough to support capabilities rather than waiting for preventable deterioration.

Prevention should become a continuous thread through the care pathway

The strongest future model for Slovenia is unlikely to be a separate “prevention service” positioned beside health and long-term care. Prevention needs to become a continuous thread through both.

Before formal dependency, healthy-ageing programmes, primary healthcare and community infrastructure can maintain health and participation. When functional change emerges, early assessment can identify reversible factors. Following illness or injury, rehabilitation can focus on recovery. Once long-term care is required, independence-strengthening services and enabling daily support can protect remaining capability. At higher levels of need, preventive practice can still reduce secondary complications and preserve quality of life.

Transitions between these stages matter because the person does not experience them as separate administrative systems.

A 76-year-old man with diabetes, reduced strength and emerging difficulty shopping may first encounter prevention through primary healthcare. Months later he may receive physiotherapy after illness. Municipal help may support some household activities. If his dependency becomes sustained, he may apply through the Centre for Social Work for long-term care.

The strategic question is whether each stage builds on the last.

If information, goals and professional understanding are repeatedly lost at organisational boundaries, the person experiences fragmented interventions. If the pathway retains a clear focus on his capabilities and priorities, prevention becomes cumulative.

This is why continuous improvement has relevance beyond provider quality systems. Slovenia’s new framework is itself still developing, and implementation evidence should shape how preventive pathways evolve.

The international lesson is to connect prevention with entitlement

Many countries promote healthy ageing while separately financing services for people who have already become dependent. Slovenia’s reform is notable because it places an explicit independence-strengthening component inside the new long-term care architecture while wider health and ageing strategies continue to operate around it.

The institutional design is specific to Slovenia and should not be treated as a universal model. Other countries have different insurance arrangements, municipal responsibilities, primary-care systems and definitions of long-term care.

The transferable principle is the connection between prevention and entitlement.

A system does not become preventive merely by encouraging older people to exercise, eat well and remain socially active. It also needs to examine whether healthcare identifies emerging functional decline, whether rehabilitation is accessible, whether homes and communities support independence, whether care workers preserve remaining ability and whether formal entitlements include interventions capable of preventing secondary deterioration.

Equally, prevention cannot replace adequate care. Its credibility depends on maintaining that boundary.

The most useful international lesson from Slovenia may therefore be that healthy ageing and long-term care should not be treated as opposite ends of a policy spectrum. They are different parts of the same life-course challenge.

Conclusion

Slovenia’s long-term care reform creates an opportunity to move prevention closer to the centre of ageing policy. The country has not simply created new rights for people who are already dependent on assistance. Through services for strengthening and maintaining independence, e-care, community-based provision and a wider emphasis on healthy ageing, it has also created mechanisms that can help preserve function and reduce avoidable deterioration.

The harder work is operational. Prevention crosses the boundaries between public health, primary healthcare, rehabilitation, long-term care, municipalities, housing, communities and families. Its value depends on those parts of the system recognising functional change early, responding proportionately and sharing a consistent objective: helping people retain meaningful capability for as long as possible.

That objective must remain realistic and rights-based. Dependency cannot always be prevented, progressive conditions cannot be wished away, and preventive language should never be used to restrict legitimate entitlement. The relevant question is not whether every person can remain fully independent, but whether avoidable loss of function is being identified and addressed.

As Slovenia’s new system matures, the strongest evidence of success will therefore extend beyond the number of services delivered. It will be visible in trajectories: people maintaining abilities, recovering after setbacks, remaining connected to their communities and receiving more intensive support when they genuinely need it rather than because earlier opportunities were missed.