Skills for a Changing Care System: Workforce Development in Slovenian Long-Term Care

A worker arriving at an older person’s home in Slovenia may now be operating within a long-term care system that expects much more than completion of a series of practical tasks. The person may need assistance with washing and dressing, support to preserve mobility, observation of changing health needs, sensitive communication with relatives and accurate recording within a formal personal plan. Another member of the team may provide nursing-related care, while a coordinator connects those interventions with the person’s wider long-term care entitlement.

That changing practice environment makes skills a central part of Slovenia’s reform. The Slovenia Ageing, Long-Term Care & Community Support Knowledge Hub examines the wider transition towards statutory rights, compulsory insurance and stronger community support. Within that transition, workforce development determines whether new organisational structures produce genuinely different care or simply place new administrative arrangements around established practice.

Slovenia has therefore combined statutory qualification requirements with training, supervision and publicly supported routes through which existing employees can gain the education or vocational qualifications needed for emerging roles. It is also developing a national approach to strengthening competencies and assessing quality in long-term care.

The central policy challenge is to avoid treating workforce development as a one-off mobilisation exercise. Ageing, dementia, multimorbidity, disability, digitalisation and the expansion of home-based care will continue to change what workers need to know. Slovenia’s stronger opportunity is to build a learning system in which qualifications establish the entry threshold, while supervision, practice development and evidence about outcomes continually improve capability.

The new system defines skills around different types of long-term care

Slovenia’s Long-Term Care Act, ZDOsk-1, does not treat the long-term care workforce as a single occupational group. The legislation distinguishes between different types of activity and establishes corresponding qualification requirements.

Assistance with basic activities of daily living requires a worker who meets the specified educational threshold and is appropriately trained within social care or nursing, or who holds a relevant national vocational qualification. Supporting activities of daily living can be undertaken within a different educational threshold. Nursing activities connected with basic daily living must be delivered by personnel competent under healthcare rules and operate under graduate nursing leadership.

The system also creates a multidisciplinary dimension through services intended to strengthen and maintain independence. Relevant professional groups include social workers, occupational therapists, physiotherapists, kinesiologists and social gerontologists, with requirements around the composition of the provider team.

Coordination has its own professional requirements. A long-term care coordinator needs an appropriate professional background, experience where required and specific preparation for the role. Advisers working at the Centres for Social Work entry points have separate requirements because they assess eligibility rather than coordinate the subsequent delivery of an individual’s long-term care.

The distinctions are important because they establish that competence should follow function. A provider cannot assume that one generic care-worker role can safely absorb every activity created by the new system.

This gives workforce development several interconnected purposes:

• enabling employees to meet formal educational and qualification requirements;
• building practical competence for the activities they actually undertake;
• developing multidisciplinary working around independence and changing needs;
• preparing coordinators and assessors for new statutory responsibilities;
• strengthening supervision and reflective practice; and
• building digital, communication and person-centred capabilities alongside technical skills.

The wider principle of workforce skill mix and practice competence is therefore especially relevant to Slovenia. The reform is not simply changing how care is financed. It is creating a more explicit architecture around who can undertake particular work and how different professional contributions should connect.

Qualifications establish a floor, not the full definition of competence

Formal qualifications matter because people receiving long-term care should be able to expect minimum levels of preparation from those undertaking personal, nursing and professional activities. They also give providers clearer parameters for recruitment and deployment.

But qualification and competence are not identical.

A worker can hold the required educational credential while being unfamiliar with a particular person’s communication style, a new digital recording system or the practical complexities of supporting someone with dementia at home. Conversely, an experienced employee may possess substantial practical knowledge while needing an additional qualification to undertake a role within the new statutory framework.

Slovenia’s implementation arrangements have recognised this transition problem. Public funding has been made available to support social-welfare and long-term care providers with the costs of employees gaining required education, while separate support has been offered for workers obtaining relevant national vocational qualifications.

This is an important workforce intervention. Without transition routes, a new qualification framework can unintentionally remove experienced workers from available capacity at precisely the moment demand is increasing. Supporting existing staff to gain recognised qualifications can preserve their experience while bringing practice into the new framework.

Imagine a residential service in eastern Slovenia employing a care worker who has supported older people for many years. She understands residents extremely well and is trusted by families, but the provider identifies that her existing qualification does not give her the clearest route into a role required within the new long-term care structure.

Simply replacing her with somebody who already possesses the qualification would discard valuable relational knowledge. A supported education or national vocational qualification pathway creates a different option: retain the experienced employee, give her protected development opportunities and assess whether she can meet the formal requirements for the relevant work.

That approach is not about lowering standards in recognition of experience. It is about connecting experience with recognised competence rather than treating the two as alternatives.

Assessment skills have become a specialist capability

The creation of a common entry route into long-term care has generated a distinct skills requirement within Slovenia’s Centres for Social Work. The adviser for long-term care, or svetovalec za dolgotrajno oskrbo, is not simply processing an application. The role involves applying the national eligibility assessment to a person’s functional circumstances, normally through assessment in the person’s home.

That requires consistency as well as professional judgement.

By 2026, advisers undertaking eligibility assessments were required to complete initial preparation comprising theoretical training and practical assessments before carrying out the function, followed by periodic refresher professional education. The training framework is nationally specified and supports use of the common assessment scale.

The operational significance is substantial. A statutory assessment tool can promote consistency only if different professionals understand and apply it in sufficiently comparable ways.

Consider two people with similar physical limitations but very different living circumstances. One lives with a spouse who provides substantial assistance; the other lives alone. The adviser needs to understand functional capability without allowing the presence of an unpaid family member to obscure the individual’s underlying care needs. Cognitive and communication difficulties may also be less visible than physical impairment.

Assessment training therefore needs to address more than scoring mechanics. It requires interviewing skills, observation, professional reasoning, understanding of functional need and awareness of how household circumstances can influence what is visible during a home visit.

Ongoing review of assessment patterns is equally important. If unexplained variation develops between entry points, the appropriate response may include calibration, further training or clarification of practice rather than assuming that every difference reflects different populations.

This illustrates why continuous professional development is relevant even to tightly specified statutory processes. Training prepares a professional to use an assessment framework; learning from its application helps the system use it consistently.

Coordination requires a different professional skill set

Once a person enters long-term care, the coordinator’s work shifts the emphasis from determining eligibility to making the entitlement operational. That distinction creates its own development needs.

The coordinator works with the person to develop the personal plan, organises and supports team working, and helps ensure that long-term care is delivered coherently and professionally. This requires knowledge of the statutory framework, but also negotiation, communication, care planning and multidisciplinary coordination.

A person’s life rarely fits neatly into administrative categories. Someone receiving long-term care may also have healthcare treatment, rehabilitation, family support, housing needs and community connections. The coordinator needs to understand the boundaries between these arrangements without allowing those boundaries to fragment the person’s experience.

For example, an older woman returning home after treatment for a fractured hip may already be eligible for long-term care. Her immediate priorities include personal support, mobility, safe transfers and rehabilitation. Her daughter wants to help but lives 40 kilometres away.

The coordinator cannot personally provide every intervention. The skill lies in constructing a workable personal plan, understanding which activities belong within long-term care, recognising where healthcare or rehabilitation professionals remain responsible and ensuring that the woman’s own goals remain visible.

If the coordinator approaches the task primarily as allocation of service hours, the plan may technically fit the entitlement while missing the rehabilitation opportunity. If the coordinator understands outcomes-focused support, the same entitlement can be organised around restoring confidence, maintaining mobility and reducing unnecessary dependency.

Coordinator development should therefore include the relational and analytical skills needed to turn formal rights into individualised support, not only knowledge of administrative procedures.

Community-based care requires workers to exercise judgement more independently

The expansion of long-term care at home changes where work takes place and therefore changes the skills required to undertake it safely.

In an institution, colleagues and managers are physically closer. A worker can often seek immediate assistance when circumstances change. Equipment and records are concentrated within the service. At home, the worker may be alone with the person and encounter situations that were not evident when the personal plan was developed.

A home may be difficult to navigate. A relative may be distressed. The person may suddenly appear less mobile or more confused. Medication may be present even where the worker is not responsible for administering it. Environmental risks can change between visits.

Competence therefore includes recognising the limits of one’s role and knowing when and how to escalate concerns.

Take a worker supporting an 82-year-old man in a village outside Novo Mesto. The planned visit includes assistance with personal activities and preparation for the day. During one visit, he is unusually breathless and struggles to stand. His formal long-term care entitlement has not changed, but the situation in front of the worker has.

The critical capability is not to diagnose the cause. It is to recognise a material change, communicate appropriately, follow the relevant escalation arrangements and document what has happened so that the right healthcare or long-term care response can follow.

This combines observation, communication, professional boundaries and risk awareness. A training programme focused only on the mechanical completion of daily-living activities would miss the most important decision the worker makes that morning.

As Slovenia expands community care, decision-making and escalation therefore become practical workforce competencies. Providers need employees who can work confidently without confusing autonomy with unsupported practice.

Organisations examining similar questions can use the Positive Risk-Taking Planner to structure thinking about independence, risk and proportionate support. It is not a Slovenian practice standard, but it can help distinguish risk enablement from unmanaged risk when developing workforce capability.

Skills for independence change the purpose of care

One of the more significant features of Slovenia’s long-term care framework is the inclusion of services for strengthening and maintaining independence. This moves the workforce conversation beyond compensating for what a person cannot do.

The multidisciplinary team for these services brings together professional expertise that can include occupational therapy, physiotherapy, social work, kinesiology and social gerontology. The statutory composition requirements reinforce the idea that preserving function and participation requires more than routine personal assistance.

This creates an important practice question for the wider workforce: does everyday care maintain capability or unintentionally replace it?

Completing a task for someone can be faster than supporting them to participate. Under workforce pressure, that creates a natural tension. Helping a person dress independently may take longer than dressing them. Supporting someone to walk safely to the kitchen may initially require more attention than bringing breakfast to their chair.

Yet repeated substitution can gradually reduce confidence and ability.

Consider a 76-year-old man with Parkinson’s disease receiving long-term care at home. On difficult mornings, workers understandably want to make the visit manageable by completing most activities for him. His occupational therapist, however, has identified techniques and environmental changes that allow him to undertake parts of his routine himself.

The value of the specialist assessment is lost if the frontline team does not understand and consistently apply it. Workforce development therefore needs mechanisms through which specialist knowledge changes everyday practice.

That may involve joint working, practical coaching, concise guidance within the personal plan and review of whether the approach is producing the intended outcome.

The distinction is fundamental. A multidisciplinary team does not create person-centred care simply by existing. Its expertise has to travel into the routines of the workers who spend the most time with the person.

This is where strengths-based approaches can connect Slovenia’s formal service architecture with the practical goal of preserving independence.

Dementia and complexity demand relational as well as technical competence

Slovenia’s ageing population means that long-term care workers will increasingly support people whose needs cannot be understood through physical assistance alone. Dementia, sensory impairment, frailty and multiple long-term conditions can interact in ways that make communication and observation central to safe practice.

Dementia illustrates the point particularly clearly.

A worker may need to support a person who does not understand why someone has entered their home, cannot easily describe pain or becomes distressed during personal care. Technical competence in the care task remains necessary, but the quality of the interaction determines whether the task can be completed with dignity.

Effective development therefore includes communication, recognition of distress, adaptation of routines and understanding how environment and familiarity influence behaviour.

A woman with moderate dementia living with her husband near Koper provides a useful example. She usually accepts support from two familiar workers. Following sickness and rota changes, several unfamiliar employees begin visiting. She increasingly refuses personal care and becomes distressed when workers approach quickly.

The immediate interpretation could be that her dementia has worsened. A more informed review identifies that unfamiliarity and inconsistent communication are contributing to the change.

The provider responds by restoring greater continuity where possible, giving replacement workers concise information about her communication preferences and asking an experienced colleague to coach staff during initial visits. The response is not a new clinical treatment. It is better application of relational knowledge.

This is why dementia workforce competence needs to be integrated into wider long-term care development rather than reserved only for specialist dementia settings.

Supervision turns knowledge into safer practice

Training is easiest to measure through attendance. Competence is harder because it becomes visible in practice.

Slovenia’s regulatory framework recognises supervision as part of the staffing conditions surrounding long-term care. That is important because a worker may understand a principle during formal training but encounter much more ambiguous situations in someone’s home or within an institution.

Good supervision creates space to examine those situations. It can identify uncertainty before it becomes error, support employees after difficult events and help managers distinguish an individual development need from a recurring problem in service design.

Suppose several workers report difficulty supporting a resident who has become increasingly distressed during evening care. Treating each incident separately may lead to repeated reactive responses. Supervision can bring the pattern together: what happens before the distress, how different staff respond, whether communication is consistent and whether the personal plan needs review.

The learning then becomes collective rather than remaining with the worker who happened to be present.

This matters particularly as Slovenia brings new employees and internationally recruited workers into long-term care. Initial training cannot anticipate every situation. Structured support from experienced colleagues helps new workers understand how formal standards translate into local practice.

Supervision also protects against the opposite problem: experienced practice becoming unquestioned simply because it is familiar. Long-standing routines may need to change as long-term care becomes more person-centred, home-focused and outcomes-oriented.

The Governance Maturity Assessment can help organisations examining similar systems consider whether learning, accountability and oversight are embedded rather than dependent on individual managers. It does not replace Slovenian supervision requirements; its relevance lies in testing whether development is supported by organisational governance.

Digital competence is becoming part of care competence

Digital development creates another layer of workforce capability. Long-term care increasingly depends on information moving between assessment, personal planning, delivery, review and system oversight. Workers may also encounter e-care, remote technologies and digital equipment supporting people at home.

Digital competence cannot therefore be confined to administrative employees.

Frontline workers need enough confidence to record information accurately, access what they need and understand their responsibilities around privacy. Coordinators need to interpret digital information rather than merely collect it. Managers need to distinguish useful indicators from poor-quality data. Employees supporting e-care need to understand how technology fits alongside human support.

The challenge is especially important for an ageing workforce and for employees whose previous roles relied heavily on paper processes. Introducing a digital system without adequate preparation can increase workload and reduce data quality precisely when the technology is intended to improve both.

There is also an ethical dimension. Remote monitoring and assistive technology can support independence, but workers need to understand consent, privacy and the limits of what technology can establish. An alert can indicate that something happened; it may not explain why.

The strongest approach is therefore to connect digital skills and workforce adoption with the actual care pathway rather than treating digital training as software instruction.

The Digital Transformation Readiness Assessment offers organisations a way to examine whether workforce skills, processes and governance are ready for technological change. Its wider relevance to Slovenia lies in a simple principle: technology becomes useful care infrastructure only when employees understand how to use it within their professional responsibilities.

International recruitment creates a two-way development requirement

Slovenia’s use of workers recruited from abroad can help widen the labour supply, but international recruitment also changes the workforce-development task.

New employees may bring valuable qualifications and experience from other health or care systems. Their development needs should not therefore be framed as though they arrive without expertise. The challenge is to connect that expertise with Slovenian language, legislation, professional boundaries, service structures and expectations.

Language development is especially important in long-term care because communication is itself part of care. Understanding a person with cognitive impairment, responding to colloquial language or recognising an indirect expression of discomfort requires more than basic transactional vocabulary.

At the same time, established teams may need support to integrate colleagues from different professional and cultural backgrounds. Successful integration is a two-way organisational process rather than a test imposed only on the incoming worker.

A residential provider recruiting experienced employees from another country might therefore combine Slovenian language development, supervised orientation, explanation of ZDOsk-1 roles and gradual familiarisation with residents. Existing staff may act as mentors, but their workload must reflect that additional responsibility.

Public support for the integration costs associated with newly recruited foreign workers acknowledges that creating effective workforce capacity involves more than completing recruitment.

The quality test comes later: whether those employees remain, develop, communicate confidently and become integrated members of stable teams.

Slovenia is beginning to connect workforce competence with national quality development

A particularly important development is Slovenia’s work on a model for assessing quality and employee competence in long-term care. The ongoing Kakovostna dolgotrajna oskrba — Quality Long-Term Care — project is intended to strengthen professional support, develop workforce competencies and establish foundations for monitoring long-term care quality.

The programme is significant because it connects workforce development with the quality of services rather than treating training as a separate employment activity. Its work includes education to strengthen competencies, development of working methods and a methodology for monitoring long-term care delivery.

The quality-assessment model is being developed during 2026, with pilot testing planned for 2027 and 2028. It should therefore be understood as an emerging national quality-development approach rather than an already established nationwide assessment regime.

That distinction matters. During a reform of this scale, there is a temptation to design a comprehensive quality framework and immediately treat its indicators as definitive. Piloting creates an opportunity to test whether measures actually distinguish meaningful quality and whether data can be collected without creating disproportionate administrative burden.

Competence assessment presents the same challenge. Completion of training is easy to count. Demonstrating that learning has changed practice requires richer evidence.

A useful evidence picture may connect several levels:

• formal qualification and mandatory training;
• supervision and observed practice;
• confidence and competency in the activities assigned to the worker;
• incidents, complaints and recurring practice concerns;
• continuity and experience reported by people using services; and
• outcomes such as maintained independence, participation and safety.

The wider principle of quality data and performance metrics is useful here. No single measure establishes workforce competence. The stronger assurance comes from connecting development activity with evidence about practice and outcomes.

Organisations exploring that connection can use the Quality Dashboard Builder to structure workforce, quality and outcome information together. It is not an official Slovenian quality methodology, but the underlying approach can help prevent training data from becoming detached from the experience of people receiving support.

Learning needs to travel from individual workers to the wider system

A mature workforce-development model does more than improve individual competence. It identifies recurring learning needs across organisations and feeds them into service and policy development.

Suppose providers in several regions repeatedly report that workers struggle with the boundary between long-term care activities and healthcare interventions. The immediate response may be additional local training. If the pattern persists nationally, however, the issue may indicate unclear guidance, a difficult service interface or a competency framework that needs refinement.

The same applies to assessment. If CSD advisers repeatedly encounter difficulty applying part of the eligibility framework, national training bodies and the responsible ministry need visibility of that experience.

This creates a learning loop:

practice generates evidence; supervision and quality processes identify patterns; providers and public institutions interpret those patterns; training and guidance are adjusted; and subsequent evidence shows whether the change improved practice.

Without that loop, professional development can become repetitive. Workers attend new courses while the system leaves the operational conditions that generated the problem unchanged.

Slovenia’s current implementation period provides a valuable opportunity to establish these feedback mechanisms because the system is still adapting. Temporary measures adopted in September 2026 to make long-term care more responsive and reduce administrative burden show that implementation experience is already influencing national arrangements.

That responsiveness should extend to workforce development. If particular skills become consistently difficult to recruit, if qualification routes create bottlenecks or if workers report that new procedures are unnecessarily consuming care time, those signals should inform system design rather than being treated solely as provider problems.

The next skills agenda will be shaped by ageing and complexity

Slovenia’s current training requirements are being developed during the implementation of a new long-term care system, but the capability agenda will continue changing long after implementation stabilises.

Population ageing is likely to increase the number of people living with combinations of frailty, dementia, chronic disease and functional limitation. More support at home will require workers who can operate independently while remaining connected with professional teams. Expectations around autonomy and participation will increase the importance of communication and supported decision-making.

Technology will add new competencies rather than removing the need for existing ones. Digital records, e-care and assistive technologies may reduce some workload, but they also require information governance, digital confidence and the ability to judge when technology is helping or constraining the individual.

Climate and environmental pressures may also influence future practice. Workers supporting people at home need to recognise the implications of extreme heat or severe weather for people who are frail, isolated or dependent on electrically powered equipment. These are not reasons to create a separate specialist role for every emerging risk. They demonstrate why the care workforce needs adaptable foundational competence.

Career pathways will matter as well. Slovenia will be competing for employees with healthcare and other sectors. Development needs to offer workers a credible route from entry-level support towards greater expertise, coordination, supervision or professional roles.

That makes learning part of retention. Employees are more likely to see long-term care as a sustainable career when new skills bring meaningful responsibility, recognition and progression rather than simply additional tasks.

The international lesson is to build capability alongside entitlement

Slovenia’s experience highlights a challenge shared by countries formalising or expanding long-term care: legislation can define a right much faster than a workforce can develop the competence required to deliver it.

Formal educational requirements are necessary, but they are only one layer. Existing employees may need supported qualification routes. New professional roles require dedicated preparation. Home-based services increase the need for judgement and escalation. Multidisciplinary approaches require specialist knowledge to influence frontline practice. International recruitment creates language and integration needs. Digitalisation changes what competence means again.

The transferable lesson lies less in Slovenia’s specific qualification levels or occupational categories than in the way workforce development can be connected to implementation.

A system introducing new rights should be able to answer not only whether enough workers exist, but whether they can perform the work the new model expects. It should know which competencies are scarce, where they are geographically concentrated, how existing workers can progress and whether training is changing outcomes.

There is also a broader governance principle. Skill shortages should not automatically be interpreted as failures of individual workers or providers. Repeated gaps can indicate structural problems in education, career pathways, funding, role design or the interface between different parts of the care system.

The strongest workforce strategy therefore combines individual professional development with system learning.

Conclusion

Slovenia’s long-term care reform is changing the meaning of workforce competence. The new system still depends on fundamental care skills, but it increasingly requires those skills to operate alongside statutory assessment, personal planning, multidisciplinary support, nursing competence, digital systems, risk judgement and a stronger emphasis on maintaining independence.

The country has begun building the infrastructure needed for that transition. ZDOsk-1 establishes differentiated qualification requirements; advisers and coordinators have defined professional expectations; public support is helping existing employees gain required education and vocational qualifications; and the emerging Quality Long-Term Care project is connecting workforce competence with wider quality development. These are important foundations, but the decisive test will be what happens in everyday practice.

A qualification can establish that someone is prepared to undertake a role. It cannot by itself ensure that an older person with dementia feels understood, that a home-care worker recognises deterioration, that specialist rehabilitation advice changes daily routines or that a coordinator brings fragmented support into one coherent personal plan. Those outcomes depend on supervision, practice development, team learning and organisational conditions that allow workers to use what they know.

For Slovenia, the strongest forward direction is therefore a workforce-development system that learns continuously: retaining formal standards while using experience, quality evidence and the voices of people receiving care to refine competence over time. As long-term care matures, skills will not be a supporting component of reform. They will be one of the principal ways in which the reform becomes real.