Safeguarding Older People in Slovenia: Rights, Risk and Accountability in Long-Term Care

An older person receiving long-term care may depend on another person for intimate personal care, meals, medication-related support, mobility, communication or access to money. That relationship can be supportive and enabling, but dependency also creates vulnerability. Harm may be obvious, such as physical violence or financial exploitation. It may also emerge gradually through neglect, coercive control, poor practice, isolation, inappropriate restriction or the repeated failure to provide agreed support.

These risks take on particular significance as Slovenia establishes long-term care as a distinct pillar of social security. The Slovenia Ageing, Long-Term Care & Community Support Knowledge Hub explores the wider reform of entitlements, financing, home care, institutional support and family caregiving. Within that architecture, protection from harm cannot sit at the edge of quality assurance. It has to operate through assessment, personal planning, workforce practice, inspection, healthcare interfaces and the everyday ability of people to express concerns.

Slovenia’s framework is still developing. Long-term care providers must meet statutory conditions and be entered in the national register, while the Inspectorate for Social Affairs and Long-Term Care oversees long-term care providers, entry points and e-care alongside its social-welfare responsibilities. Healthcare delivered within institutional settings remains subject to the relevant healthcare oversight arrangements. At the same time, Slovenia is developing a national model for assessing long-term care quality and workforce competence, with the model being developed in 2026 and pilot testing planned for 2027 and 2028.

The central challenge is therefore not simply to create more controls. It is to make safety visible across a system in which responsibility is distributed among individuals, families, providers, Centres for Social Work, health professionals, inspectors and national institutions. Strong protection also has to preserve the autonomy of the person receiving care. Safety without rights can become restriction; autonomy without adequate protection can leave serious harm unchallenged.

Protection begins with rights, not simply incident response

The language of safeguarding is widely used internationally, but Slovenia’s arrangements should be understood through its own legal, social-welfare, healthcare and long-term care structures rather than imported wholesale from another country.

At its core, the issue concerns protection of dignity, physical and psychological integrity, autonomy, privacy, property and access to appropriate support. These principles matter throughout the long-term care pathway: when eligibility is assessed, when a personal plan is agreed, when services enter somebody’s home, when a family member becomes a recognised caregiver and when a person moves into institutional long-term care.

This makes protection broader than investigating allegations after something has gone wrong. Good practice also involves identifying conditions in which harm becomes more likely.

A person who cannot communicate easily may struggle to disclose mistreatment. Somebody dependent on one relative for all daily support may fear the consequences of complaining. An older resident with cognitive impairment may show distress behaviour rather than make a clear allegation. A home-care worker visiting for a limited period may see only fragments of a difficult household situation.

Effective protection therefore combines prevention, recognition, response and learning. This connects naturally with wider approaches to prevention and early intervention: risk is easier to manage when changes are recognised before they become entrenched harm.

For Slovenia, the opportunity is to embed this thinking into the new system while its operational culture is still being formed. A statutory entitlement to long-term care is important, but a right is meaningful only if the support delivered under it respects the person who holds it.

The long-term care pathway creates several points of protection

Slovenia’s long-term care system does not rely on one organisation to see everything. Instead, different actors encounter the person at different stages.

Entry points within Centres for Social Work assess entitlement. Once a person has received a decision, they choose an appropriate provider within the available network and work with the provider’s long-term care coordinator to establish a personal plan. The provider delivers the agreed support. Where circumstances change, reassessment can be initiated. The Inspectorate for Social Affairs and Long-Term Care has oversight responsibilities for long-term care providers and entry points, while other authorities retain responsibilities within healthcare and other relevant fields.

This distributed model can strengthen protection because several people may have opportunities to recognise risk. It can also create gaps if each assumes that somebody else holds responsibility.

A robust pathway therefore needs clarity about:

• who notices and records a concern;
• who takes immediate action where somebody may be unsafe;
• which organisation has legal or professional responsibility for the issue;
• how information is shared where another service needs to act;
• how the person is involved in decisions wherever possible; and
• how recurring concerns become visible beyond the individual case.

The purpose is not to make every difficulty an inspection matter. Many problems should be resolved through good frontline practice, supervision, care review or service management. The governance requirement is that staff know when ordinary problem-solving is no longer sufficient.

Organisations examining similar accountability questions can use the Governance Maturity Assessment to test whether responsibility, escalation and assurance are sufficiently clear. It is not a Slovenian legal framework, but the underlying governance question is directly relevant: can an organisation demonstrate who is responsible when a serious risk crosses operational boundaries?

Home-based care makes the private household part of the protection environment

Long-term care at home can preserve independence, relationships and familiar routines. It also moves formal care into a private environment where circumstances are less visible than within an institution.

A worker may notice unexplained bruising, inadequate food, unsafe living conditions or a marked change in behaviour. Another person in the household may control conversations or insist on remaining present. The older person may appear frightened about spending money or may repeatedly report that possessions have disappeared.

None of these observations automatically proves abuse. Bruising may result from frailty or medication. A relative may attend because the person wants assistance communicating. Financial arrangements may have been agreed willingly.

The operational requirement is neither to ignore signs nor to treat suspicion as established fact. Workers need enough competence to recognise indicators, listen without leading, record accurately and seek appropriate advice.

Consider an 82-year-old woman receiving long-term care at home near Maribor. Her son lives with her and manages shopping and household bills. A care worker notices that the woman has become unusually anxious when money is mentioned. She privately says that her pension card is held by her son but immediately asks the worker not to cause trouble because she depends on him.

A simplistic response would either dismiss the concern because the woman does not want intervention or immediately assume financial abuse. A rights-based response needs more care. The worker records what was observed and said, follows the provider’s escalation arrangements and ensures that the concern reaches somebody with the authority and competence to assess it. Immediate danger, possible criminal conduct, decision-making ability, the woman’s wishes and her dependency on her son all affect what happens next.

Her voice remains central, but confidentiality cannot mean that a serious protection concern simply disappears inside a case note.

This illustrates the importance of proportionate information sharing. Good protection requires enough information to reach the right people while avoiding unnecessary circulation of sensitive personal details.

Family care needs support and oversight without treating families as a risk category

Family care occupies an important place in Slovenia’s long-term care settlement. The formal right to an oskrbovalec družinskega člana, or caregiver of a family member, recognises intensive caregiving as part of the system rather than leaving it entirely informal.

That recognition can strengthen protection. Formal status brings the relationship into contact with assessment, personal planning, training, professional support and ongoing coordination. It can make previously hidden caring responsibilities more visible.

But formalisation does not remove risk, and it would be wrong to approach family care primarily through suspicion. Most relatives provide care because they are committed to the person. The more constructive question is whether the arrangement remains safe and sustainable for both.

Exhaustion can alter behaviour. A spouse providing near-continuous support to somebody with advanced dementia may become overwhelmed. A son who has given up employment may experience serious financial strain. Family conflict can intensify around money, inheritance or decisions about institutional care. An older person may also behave aggressively towards the family member supporting them.

These circumstances require an understanding of carer support and family partnership that recognises risk in both directions.

Early support can itself be protective. Training, planned absence, access to professional advice and realistic contingency arrangements reduce the likelihood that a demanding care arrangement becomes unsustainable. Where there are indicators of abuse, neglect or exploitation, however, family status cannot shield the situation from appropriate scrutiny.

The principle is straightforward: supporting family care and protecting the person receiving care are complementary responsibilities, not competing ones.

Institutional care concentrates responsibility as well as support

Institutional long-term care provides a more structured environment, with staff present around the clock and organisational systems for care delivery. That creates opportunities for oversight that are less readily available in private homes. It also concentrates power.

Residents may depend on the institution for personal care, food, mobility, social contact and access to everyday activities. Some may have cognitive impairment or difficulty communicating. A resident who fears retaliation or worries about being seen as difficult may hesitate to complain.

Protection in institutional care therefore extends beyond preventing deliberate abuse by individual workers. Organisational conditions can themselves create harm.

Repeatedly leaving people waiting for essential assistance, routinely ignoring preferences, using unnecessary restrictions, failing to respond to pain or allowing persistent intimidation between residents can all affect safety and dignity even where no single dramatic incident occurs.

Workforce pressure matters here. Low staffing resilience, weak supervision or excessive turnover can reduce observation and continuity. Staff who do not know residents well may miss changes that an experienced colleague would recognise.

A strong institutional model consequently needs to connect quality, safety and governance rather than treating protection solely as an incident-management function.

Restrictions can protect people, but they can also become harm

Some of the most difficult long-term care decisions arise where safety and autonomy point in different directions.

An older person with cognitive impairment may want to leave an institution alone despite becoming disoriented. Someone living at home may repeatedly refuse assistance that professionals believe is necessary. A person at high risk of falling may still value walking independently. Technology may make monitoring possible, but monitoring itself can affect privacy.

The aim cannot be to remove all risk from adult life.

Consider an 87-year-old man with dementia living in an institutional setting in Celje. He walks independently and repeatedly approaches an external door because he believes he needs to go to work. Staff are concerned that he could become lost outside.

Simply preventing him from approaching the door may reduce one immediate risk but increase distress, restriction and loss of autonomy. Leaving him entirely unsupported may expose him to foreseeable harm.

A proportionate response begins by understanding the behaviour. Staff may explore when he tries to leave, what he is communicating, whether meaningful activity reduces anxiety and whether accompanied outdoor access can preserve mobility and freedom. The personal plan can document the approach, and changes in behaviour or risk can trigger review.

Where restrictive measures engage specific legal requirements, those requirements must of course be followed. The broader operational principle is that restriction should not become an automatic substitute for thoughtful support.

This is where positive risk-taking with older people becomes relevant. Protection should help people live as safely as reasonably possible while retaining meaningful choice, rather than defining safety as the absence of all uncertainty.

The Positive Risk-Taking Planner offers organisations a practical way to structure similar reasoning around benefits, foreseeable harms, controls and review. It does not determine Slovenian legal authority for restrictive measures, but it can help prevent risk decisions from becoming informal, inconsistent or excessively defensive.

Consent and communication determine whether rights are real

Rights can exist formally while remaining difficult to exercise in practice. Communication is therefore central to protection.

An older person with hearing loss may appear to agree because they have not understood the question. Somebody with aphasia may need more time or alternative communication methods. A person with dementia may be able to express clear preferences about daily routines even where more complex decisions require additional support.

Workers need to distinguish communication difficulty from absence of preference.

This becomes especially important when relatives are involved. Families can provide valuable context and help professionals understand a person’s history. But convenience should not allow the relative’s voice automatically to replace the individual’s.

Imagine a 79-year-old woman receiving home-based support after a neurological illness. Her daughter attends every discussion and answers questions before her mother has time to respond. The daughter is attentive and genuinely believes she is helping.

The coordinator notices that the woman can answer when given additional time and short, clear questions. A different approach reveals that she wants help with morning personal care but does not want her daughter managing all of her appointments.

No abuse has necessarily occurred. Yet failing to create space for the woman’s own voice would gradually erode control over her life.

Protection therefore includes accessible communication, privacy and supported participation. These are not softer additions to safety; they are mechanisms through which coercion, misunderstanding and unnecessary dependency can be reduced.

Workforce competence is one of Slovenia’s strongest preventive controls

Long-term care workers encounter situations that cannot be managed through procedures alone. They need judgement.

A worker must know when bruising is concerning, when a change in behaviour may indicate pain or fear, how to respond to a disclosure, when confidentiality has limits and how to avoid contaminating evidence through inappropriate questioning. They also need to understand professional boundaries and recognise risks associated with money, gifts, relationships and access to personal information.

Supervision matters because difficult situations are rarely resolved by a single frontline worker. Staff need a credible route for discussing uncertainty without fearing that raising a concern will automatically be interpreted as failure.

Slovenia’s current development of a quality and workforce-competence assessment model is therefore significant. The national project is intended to strengthen professional support, develop methods of working, build competence among long-term care staff and staff at Centres for Social Work, and create a methodology for monitoring long-term care. The assessment model is being developed during 2026, with pilot testing planned for 2027 and 2028.

That distinction is important. Slovenia should not yet be described as operating a mature national quality-assessment model that is still under development.

The direction nevertheless creates an opportunity to make protection competence observable. Training attendance alone is weak evidence. Stronger assurance asks whether staff can recognise concerns, record them accurately, escalate appropriately and apply learning in practice.

This connects with wider safeguarding training and competency: knowledge matters, but its practical application matters more.

Workforce pressure can become a protection risk without anybody intending harm

Not all unsafe care originates in malicious behaviour. Capacity constraints can produce neglect through accumulation.

A worker is late because the rota contains unrealistic travel time. A resident waits too long for toileting support because several colleagues are absent. Supervision is repeatedly postponed. Temporary staff do not know individual communication needs. Managers spend so much time filling shifts that emerging quality patterns receive insufficient attention.

Each event may appear operational rather than protective. Repetition changes the picture.

Slovenia’s workforce pressures are therefore directly relevant to the protection of older people. On 18 September 2026, the National Assembly supported temporary intervention measures intended to improve implementation of the long-term care system. Among the measures is a temporary monthly supplement for employees working within long-term care and home-help provision, alongside greater flexibility around workforce capacity. The measures are time-limited and form part of the effort to stabilise implementation through the end of 2027.

Temporary workforce measures may help services manage immediate pressures, but sustainable safety also depends on recruitment, retention, competence, supervision, skill mix and manageable deployment.

Consider a rural provider covering dispersed communities. No individual visit is deliberately omitted, but persistent vacancies mean that workers regularly arrive later than planned and different staff cover intimate personal care. One older person stops drinking after early afternoon because she cannot predict when evening toileting support will arrive.

The immediate indicator may be rota instability. The human consequence is dehydration risk and a shrinking daily life.

Connecting workforce risk with mitigation helps leaders see why vacancies and continuity are safety evidence rather than simply human-resources metrics. The Predictive Workforce Risk Module can similarly help organisations examine how workforce instability may translate into continuity and service risk, although it is not a Slovenian statutory assurance instrument.

Inspection provides external accountability, but responsibility remains with services

Slovenia has established a clearer external oversight structure for the new long-term care system. The Inspectorate for Social Affairs and Long-Term Care supervises implementation of long-term care regulations and has responsibilities covering long-term care providers, long-term care entry points and e-care, as well as areas of social welfare.

This matters because protection requires an authority capable of looking beyond an individual provider’s own explanation.

Institutional settings also demonstrate why regulatory boundaries need to be understood accurately. Social and long-term care functions can coexist with healthcare. Oversight of healthcare practice, including areas such as medical treatment and nursing, may fall within healthcare-specific structures rather than the social and long-term care inspectorate.

For an older person or relative, those jurisdictional boundaries may not be obvious. They experience one service environment.

Providers therefore need enough internal governance to route concerns appropriately rather than expecting the person raising the issue to understand the architecture of the state.

External inspection should also not become the provider’s primary safety mechanism. Inspectors cannot observe every interaction. Day-to-day responsibility remains with organisations and professionals delivering support.

A mature system uses inspection as one layer within regulation and oversight, supported by provider controls, professional responsibility, user feedback, complaints, workforce evidence and national monitoring.

A registered provider network creates a foundation for accountability

Long-term care providers operating within Slovenia’s public network must meet the relevant statutory conditions and be entered in the Register of Long-Term Care Providers, known as RIDO. The register is maintained by the National Institute of Public Health and provides a public record of providers meeting the legal conditions for carrying out long-term care activities.

Registration is an important baseline control. It creates visibility over who is formally operating within the system and helps distinguish authorised provision from informal arrangements.

It should not, however, be confused with continuous assurance of everyday quality.

A provider can satisfy entry conditions and later experience deterioration in staffing, management or practice. A service can meet formal requirements while individual people experience poor communication or inconsistent support.

Protection therefore needs a dynamic evidence model. Registration establishes that an organisation may provide long-term care. Ongoing quality information needs to show how that care is actually being delivered.

Useful evidence includes complaints, incidents, continuity, staffing patterns, user experience, supervision, training competence and the quality of personal-plan reviews. No individual metric proves safety. Patterns across several indicators are more informative.

This is one reason the development of Slovenia’s national quality model matters. The stronger opportunity is to connect entry requirements, ongoing service evidence and external oversight so that assurance does not become a sequence of disconnected controls.

Complaints and concerns are intelligence, not simply problems to close

A complaint can reveal something that routine performance data cannot.

An older person may report that staff speak over them. A daughter may complain that her father repeatedly receives support from unfamiliar workers. Several residents may separately describe long waits for assistance in the evening. Each concern may initially appear minor when considered alone.

Repeated patterns can indicate something more significant: weak staffing, poor culture, ineffective supervision or a service model that no longer matches dependency levels.

Strong organisations therefore distinguish resolution from learning. Resolving the immediate complaint matters, but governance should also ask whether similar concerns have occurred elsewhere and whether the underlying cause remains.

Consider a care home where three families complain over two months that residents are found wearing other people’s clothing. Staff initially treat each incident as an isolated laundry error. A broader review reveals that high turnover among support staff has weakened knowledge of residents and that the system for managing personal belongings is inconsistent.

No dramatic protection incident triggered the review. Yet the pattern concerns dignity, personal property and organisational control. Correcting the process, improving induction and monitoring recurrence provides a more meaningful response than apologising three times.

This is the connection between learning from incidents and protection. The purpose of reporting is not simply to produce records; it is to reduce the likelihood that preventable harm repeats.

Quality dashboards need to show weak signals as well as serious events

Serious incidents demand attention, but a safe system cannot rely only on events that have already reached a high threshold.

Weak signals often appear first: rising sickness absence, missed or shortened visits, increasing complaints, repeated falls, staff turnover, delayed personal-plan reviews or unusual patterns of restrictive practice.

Individually, these measures may have benign explanations. Together, they can show that a service is becoming less stable.

This creates an important governance requirement for providers and, at an appropriate aggregated level, national institutions. Information needs to be brought together in a way that supports questions rather than generating false certainty.

A useful dashboard does not display a green status simply because there has been no formally recorded abuse. It asks whether the conditions associated with safe care are changing.

For example, a provider may report no serious protection incidents while experiencing rapid staff turnover, declining user satisfaction and a rise in missed visits. Those indicators warrant attention before a severe event occurs.

Organisations examining this type of assurance can use the Quality Dashboard Builder to structure indicators and escalation questions. It does not define Slovenian reporting requirements, but it illustrates an important governance principle: performance information should help decision-makers identify changing risk, not merely confirm that reports have been submitted.

Technology introduces both protective capacity and new forms of vulnerability

E-care is part of Slovenia’s developing long-term care offer and can support people to remain at home. Sensors, alerts and communication technologies can make it easier to obtain assistance and may provide reassurance to people and families.

Technology can also introduce new protection questions.

Who has access to the information generated? Does the person understand what is being monitored? Could relatives use monitoring technology in a way that becomes intrusive? What happens if connectivity fails? Does an alert create an assumption that human contact is no longer required?

Consider an 85-year-old woman living alone who uses e-care after several falls. Her daughter would like additional monitoring because she worries constantly. The woman values the emergency function but does not want continuous observation of her daily routine.

The safest technological option is not necessarily the one collecting the greatest quantity of information. A proportionate solution should reflect the woman’s needs, preferences and ability to understand the arrangement while providing an appropriate response to foreseeable risk.

This illustrates the relationship between protection and technology-enabled safeguarding risk. Digital systems can reduce some vulnerabilities while creating others involving privacy, data security, surveillance and dependency.

Slovenia’s inspection arrangements explicitly include e-care within long-term care oversight, providing an important external accountability layer. As digital provision expands, governance will also need to keep pace with technology rather than assuming that a technically functioning system is automatically a safe one.

Protection must cross the boundary between long-term care and healthcare

Older people receiving long-term care frequently also use healthcare. In institutional settings especially, social support, long-term care and healthcare can operate around the same individual while remaining subject to different professional and oversight structures.

This can create uncertainty when harm crosses boundaries.

A pressure injury might involve mobility support, nutrition, nursing assessment and clinical treatment. Repeated medication problems may require healthcare investigation while also revealing wider organisational weaknesses. Behaviour interpreted as a long-term care issue may actually reflect untreated pain, infection or delirium.

The person should not bear the consequences of administrative fragmentation.

Effective protection therefore requires professionals to recognise when a concern sits outside their own authority and to transfer or share information appropriately. It also requires follow-through. Passing information to another organisation is not the same as knowing that the risk has been addressed.

The principle is particularly important during transitions. Hospital discharge, return home, movement into institutional care and changes in entitlement can all create temporary gaps in knowledge and responsibility.

Clear records, communication and named responsibility reduce the risk that important information is lost during these transitions.

National learning will matter as much as individual enforcement

Slovenia is implementing a new long-term care system at scale. That makes local problems valuable sources of national learning.

A repeated difficulty may indicate poor practice by one provider. If the same difficulty appears across multiple organisations, the cause may sit partly in workforce supply, regulation, information systems, financing or the design of the national framework.

The temporary intervention legislation adopted in September 2026 illustrates this feedback process. The measures respond to practical experience during early implementation and include changes intended to reduce administrative burden, increase workforce flexibility, support continuity and accelerate certain transitions and reassessments. They are temporary measures designed to help stabilise the system rather than evidence that implementation is complete.

The same learning principle should apply to protection.

If inspections repeatedly identify similar weaknesses, training may need revision. If complaints show that people do not understand how to raise concerns, information needs to improve. If workforce instability repeatedly precedes neglect, workforce policy becomes part of the safety response. If technology generates recurring privacy concerns, digital governance needs adjustment.

This is how continuous improvement should operate at system level: not by eliminating accountability for individual failures, but by asking what repeated events reveal about the design of the wider system.

Slovenia can build protection around visibility rather than bureaucracy

The expansion of long-term care inevitably generates more information: assessments, decisions, personal plans, service records, workforce data, complaints, inspection findings and quality indicators.

The temptation is to equate greater documentation with greater safety.

Records matter. They establish what was known, what was decided and what action followed. But paperwork cannot substitute for professional curiosity or human relationships.

A worker who knows an older person well may notice that they have become unusually quiet. A coordinator may recognise that a previously sustainable family arrangement is deteriorating. A manager may see that several apparently unrelated complaints originate from one shift pattern.

The strongest protection system makes those observations visible without burying them under excessive reporting.

That means designing escalation proportionately. Minor service issues need rapid local resolution. Significant concerns need structured review. Immediate threats require urgent action. Recurring patterns need governance visibility even where each individual event falls below a severe threshold.

The aim is not zero risk. No long-term care system can promise that. The aim is a system capable of seeing risk, responding proportionately and learning when its controls prove insufficient.

What the Slovenian experience can offer internationally

Slovenia’s long-term care reforms are taking place within a particular social-insurance, social-welfare and municipal context, so its institutional arrangements cannot simply be transferred elsewhere.

Its current development nevertheless highlights several principles with wider relevance.

First, protection works best when built into system architecture rather than added after services are established. Provider registration, assessment, personal planning, coordination, workforce competence, inspection and quality monitoring can reinforce one another if their information flows are designed coherently.

Second, formalising previously less visible care relationships can improve accountability. Slovenia’s recognition of family caregiving demonstrates how support delivered within households can be connected more closely to training, planning and professional contact without devaluing the family relationship.

Third, quality and protection cannot be separated from workforce policy. A service may have excellent procedures but still become unsafe if staffing instability prevents those procedures from being applied reliably.

Finally, rights and safety should not be framed as opposites. Protecting an older person does not mean removing every risk from their life. The more transferable principle is to combine proportionate protection with meaningful autonomy, accessible communication and clear accountability when intervention is necessary.

Slovenia’s quality model is still being developed and its long-term care system remains in an implementation period. That makes it too early to claim that these mechanisms have produced a mature national protection framework. It also makes the present period especially important: operational habits established now may shape how the system understands safety for years to come.

Conclusion

Protecting older people in Slovenia’s long-term care system requires more than detecting severe abuse. Safety is created through thousands of ordinary decisions: whether somebody is listened to, whether a worker recognises a change, whether a family caregiver receives support before exhaustion becomes dangerous, whether staffing problems are escalated and whether an organisation learns from apparently minor concerns.

The emerging Slovenian framework provides important foundations. Long-term care providers operate within a registered public network, personal plans connect entitlements with delivery, coordinators provide ongoing points of contact, inspection extends across providers, entry points and e-care, and a national quality and workforce-competence model is under development. The challenge is to make those elements work as a connected protection system rather than separate administrative controls.

That system must also remain rights-based. Older people should not lose autonomy merely because they require support. Family involvement should be valued without making dependency invisible. Technology should enhance safety without normalising unnecessary surveillance. External oversight should provide accountability while providers retain responsibility for everyday practice.

As Slovenia moves from establishing long-term care entitlements towards stabilising their delivery, the strongest protection will come from visibility: making concerns speakable, risks reviewable, responsibilities clear and recurring patterns difficult to ignore. A system that can combine those qualities with dignity, choice and proportionate risk will protect people not only after harm occurs, but throughout the ordinary experience of receiving long-term care.