Slovenia’s Long-Term Care Workforce: Recruitment, Retention and Capacity Pressures

For Slovenia’s new long-term care system, workforce capacity is where statutory ambition meets operational reality. An entitlement can be defined nationally, an individual can be assessed through a Centre for Social Work and funding can be available through compulsory long-term care insurance, but none of those elements can substitute for the worker who helps someone get out of bed, the nurse who undertakes an appropriate nursing intervention, the coordinator who turns an entitlement into a workable personal plan or the team that keeps a residential service operating safely through the night.

This workforce question has become more important as Slovenia has moved from designing long-term care reform to implementing it. The wider Slovenia Ageing, Long-Term Care & Community Support Knowledge Hub examines how the country is building its new settlement around national rights, dedicated financing and a stronger home-care offer. The workforce is the delivery infrastructure underneath that settlement.

Slovenia entered the reform with staffing pressures already affecting social-welfare services and older people’s institutions. The new system does not make those pressures disappear. In some respects it increases the importance of resolving them because long-term care at home, institutional long-term care, coordination and other statutory rights require sufficient people with the right competencies in the right places.

The central challenge is therefore not simply recruitment. Slovenia needs to retain experienced workers, develop new skills, integrate people recruited from abroad, improve working conditions, use technology intelligently and distribute capacity across urban and rural communities. It also needs workforce information capable of distinguishing an isolated vacancy from a structural threat to service continuity.

A new care system is being built on an existing workforce

Slovenia did not create its long-term care workforce from zero when the Long-Term Care Act, ZDOsk-1, introduced the new system. Much of the relevant expertise already existed within homes for older people, social-welfare institutions, home-help services, healthcare and other community provision.

This provided an important foundation. Workers brought established relationships with people using services, knowledge of local communities and experience of supporting older and disabled people with complex daily needs. Existing institutions also brought management, premises, equipment and organisational infrastructure.

But transferring existing capability into a new statutory framework is not the same as creating additional capacity.

Long-term care at home creates demand for workers who can move between households while delivering support within the defined long-term care framework. Institutional long-term care requires sufficient staffing throughout the day and night. Coordinators have to develop and review personal plans. Centres for Social Work require advisers capable of supporting the eligibility and entry process. Nursing-related long-term care activities require appropriately qualified personnel.

At the same time, established social-welfare and healthcare services continue to need workers. Recruitment into one part of the system can therefore redistribute scarcity rather than resolve it.

This is why workforce planning needs to look beyond the number of people formally employed in long-term care. It needs to understand the labour market from which those workers are drawn and whether growth in one service is creating pressure elsewhere.

The broader principles of workforce planning are particularly relevant during this transition. The key question is not simply how many posts exist, but what capacity those posts create after vacancies, turnover, sickness, supervision, travel and skill mix are considered.

Long-term care requires different levels of competence

The Slovenian framework recognises that long-term care is not one undifferentiated activity. Different services require different competencies.

Assistance with basic activities of daily living is subject to defined qualification and training requirements. Support with instrumental or supporting daily activities can be undertaken within a different qualification framework. Nursing activities connected with basic daily living require personnel qualified within the relevant healthcare requirements and operate with professional nursing oversight.

This matters operationally because a provider cannot treat every worker as interchangeable.

A service may appear adequately staffed overall while lacking enough people capable of performing particular activities. The problem becomes more pronounced when users have combinations of personal care, mobility, cognitive and nursing needs.

Skill mix therefore becomes as important as headcount. Providers need to understand:

• which activities each worker is qualified and competent to undertake;
• where nursing and other professionally led interventions are required;
• how much supervisory capacity is needed to support less experienced staff;
• whether workforce deployment matches the actual needs of users rather than historical staffing patterns;
• how training and competency are maintained as roles develop; and
• where specialist knowledge is too scarce to provide resilient cover.

This becomes especially important in home-based services. A residential institution can bring several professional groups into one building. Home care disperses those workers across a geographic area, making scheduling and skill matching more complex.

A provider may have enough workers to cover the total number of allocated hours yet still struggle to place the right worker in the right household at the right time. The workforce problem is therefore partly numerical and partly organisational.

Recruitment pressure begins with the attractiveness of care work

Recruitment difficulties in long-term care cannot be understood separately from the conditions of care work. Slovenia is competing for workers in a broader labour market in which physically and emotionally demanding care roles must attract people who have alternatives.

Care work can involve personal support, lifting and mobility assistance, exposure to illness and death, emotional relationships with users and families, irregular schedules and substantial responsibility. Home-based workers may also spend significant time travelling alone between households.

Pay matters, but attractiveness is wider than pay. Predictable working arrangements, supportive management, training, progression, adequate staffing, equipment and respect for professional contribution all influence whether people enter and remain in the sector.

This distinction matters because recruitment campaigns have limited value if newly recruited workers encounter the same conditions that caused experienced employees to leave.

Slovenia has recognised workforce conditions as a policy issue rather than leaving individual providers to solve the problem alone. Temporary measures introduced across social-welfare and long-term care services have included financial support intended to improve staffing and working conditions, develop capacity and support recruitment.

By September 2026, the government had gone further. Temporary intervention measures adopted during the implementation of long-term care include a monthly gross supplement for employees undertaking direct long-term care, basic or social care, nursing or rehabilitation work, with a lower supplement for other eligible employees supporting these services. The measure is intended to operate during the system’s stabilisation period through the end of 2027.

The significance lies not only in the amount. It represents an acknowledgement that workforce retention is part of implementing the statutory system itself.

Retention is a continuity-of-care issue, not simply an employment metric

Turnover affects more than recruitment cost. Long-term care is relational work.

A worker who regularly supports the same person learns how that individual communicates, how their mobility changes during the day, what causes anxiety, which routines preserve independence and when a small change may indicate deterioration. Much of this knowledge can be documented, but not all of it can be reproduced instantly when staff change.

Consider an 86-year-old woman living at home near Celje with moderate mobility limitations and early cognitive impairment. Her long-term care plan provides regular assistance with personal activities and everyday tasks. Two workers usually share most of her visits and have developed a stable routine with her.

One worker leaves. The provider initially fills the rota using several different employees. Every worker is appropriately qualified, so formal staffing compliance remains intact. Yet the woman becomes increasingly anxious because she does not recognise who will arrive. She begins refusing some support and telephones her daughter more frequently. Visits take longer because each new worker has to establish trust and understand the household routine.

What appears on the provider’s workforce report as one vacancy has become a quality and capacity issue. The remaining visits require more time, the daughter carries more informal responsibility and the risk of service breakdown increases.

This is why staff retention needs to be connected with continuity and outcomes rather than monitored as an isolated human-resources indicator.

Organisations examining these relationships can use the Predictive Workforce Risk Module to structure analysis of turnover, vacancy and continuity signals. It does not prescribe Slovenian staffing requirements, but it illustrates the value of identifying workforce deterioration before it becomes visible through missed or disrupted care.

Home-based long-term care changes the workforce equation

Slovenia’s expansion of long-term care at home is strategically important because it gives eligible people a stronger opportunity to remain in familiar surroundings. Operationally, however, home-based support creates a different workforce model from institutional care.

Workers are distributed rather than concentrated. Travel becomes part of productive capacity. Demand clusters around particular times of day. Workers operate with greater autonomy between visits. Managers and coordinators need visibility of services that are taking place across dozens or hundreds of separate homes.

This means a nominal staffing establishment tells only part of the story.

Suppose a provider serving several municipalities has 30 frontline workers. If each person could spend an entire shift providing care, that workforce would represent one level of capacity. If significant time is required to travel between remote settlements, attend supervision, complete records and respond to unplanned changes, the amount of care that can actually be delivered is lower.

Morning and evening demand makes the equation more difficult. People cannot all receive support with getting up, washing and breakfast at midday simply because that would make the rota easier. Home care therefore requires scheduling around human routines rather than maximising theoretical utilisation.

The issue connects directly with workforce scheduling and rota management. Efficient deployment matters, but efficiency cannot be defined only as minimising travel or maximising visits per worker. Continuity, punctuality, worker wellbeing and the user’s preferred routine also have value.

A provider that compresses schedules too aggressively may initially appear productive while creating lateness, rushed care and employee dissatisfaction. Over time, the resulting turnover can reduce capacity further.

Home-based long-term care therefore needs workforce planning that reflects geography, peaks in demand and the real time required to provide dignified support.

Rural Slovenia exposes the importance of workforce distribution

National workforce numbers can conceal significant geographic differences. Slovenia’s settlement pattern includes Ljubljana and other urban centres alongside small towns, villages, mountainous areas and dispersed rural communities. The same number of workers does not produce the same service capacity in each environment.

A provider covering a compact urban area may schedule several visits within a small radius. In a rural territory, a worker can spend substantial time travelling between two people with identical entitlements.

Imagine an older couple living in a remote settlement. The husband has significant physical limitations and receives long-term care at home. His wife provides some informal support but cannot safely undertake transfers. The provider has appropriately skilled staff, yet only two workers regularly cover their part of the municipality.

One goes on extended sick leave. The provider can send workers from another area, but each replacement journey adds travel time and disrupts other schedules. The couple’s entitlement has not changed, and there is no question about their eligibility. The risk comes entirely from the thinness of the local workforce.

A sustainable response may involve reorganising routes, recruiting nearer to the community, sharing capacity across neighbouring areas or developing a more resilient deployment model. Technology can help with scheduling and coordination, but it cannot eliminate the physical distance between households.

The Digital Twin Scenario Modeller can help organisations explore how staffing, geography and demand interact under different scenarios. Again, it is not a Slovenian regulatory instrument. Its relevance lies in moving workforce planning from static headcounts towards testing what happens when sickness, vacancies or demand alter real service capacity.

For national policy, the lesson is equally important. Workforce sufficiency should be examined geographically. A national increase in care workers can coexist with persistent local shortages if recruitment is concentrated in areas that were already easier to staff.

Recruitment from abroad can add capacity but requires integration

International recruitment is one part of Slovenia’s response to workforce shortages in social welfare and long-term care. It can widen the available labour pool, particularly where domestic recruitment cannot meet demand.

Yet recruiting a worker from another country is not equivalent to creating immediately usable care capacity.

Language is fundamental. Long-term care workers need to understand people whose speech may be affected by dementia, stroke, sensory impairment or distress. They need to communicate with relatives and colleagues, understand instructions and records, and recognise subtle information about risk or changing health.

Integration also involves housing, administrative processes, orientation to Slovenian services, workplace culture and professional expectations. A worker who has relocated internationally may need considerably more support than a conventional induction programme provides.

Slovenia has recognised this operational reality through measures supporting providers with the integration costs associated with newly employed foreign nationals. That is important because successful international recruitment depends on retention after arrival, not merely on the number of employment contracts signed.

Consider a residential long-term care provider that recruits a small group of workers from abroad. Their previous care experience is valuable, but their Slovenian language skills vary. The provider could place them immediately into understaffed units and regard the vacancies as filled. A more sustainable approach combines supervised practice, language development, cultural orientation and gradual assumption of responsibilities.

Initially, that approach consumes experienced staff time rather than releasing it. Six months later, however, it may produce a more stable workforce with stronger communication and confidence.

The operational lesson is that integration capacity should be planned alongside recruitment capacity. Existing workers need enough protected time to support new colleagues without making their own workload unsustainable.

This is closely connected with staff training, but the requirement goes beyond a course. Competence develops through induction, supervision, practice and feedback.

Working conditions determine whether additional recruitment becomes lasting capacity

Slovenia’s workforce policies increasingly recognise that retention depends on the environment in which care is delivered. Temporary pay measures can improve attractiveness, but sustainable workforce capacity requires attention to workload and working conditions as well.

An understaffed service can create a self-reinforcing cycle. Vacancies increase pressure on existing employees. Overtime rises. Workers have less time for supervision and development. Sickness may increase. Experienced staff leave, making the service still harder to stabilise.

The reverse is also possible. A service with manageable workloads and effective supervision can retain expertise, support new recruits more successfully and build a reputation that assists future recruitment.

This makes staff wellbeing and engagement an operational variable rather than an optional employment initiative.

Providers need evidence capable of showing when pressure is accumulating. Useful signals include persistent overtime, agency or temporary cover where applicable, sickness, turnover, unfilled shifts, supervision delays and increased complaints about continuity. None should be interpreted alone, but together they can reveal whether staffing remains resilient.

The strongest workforce governance also listens to workers. Frontline employees often recognise unsustainable routes, unrealistic workloads or recurring skill gaps before these appear in formal performance information.

Listening does not mean every staffing preference can be accommodated. It means treating workforce experience as operational intelligence rather than waiting for resignations to demonstrate that a problem existed.

Coordination roles are part of the workforce challenge

Much public discussion about care workforce capacity focuses understandably on frontline workers. Slovenia’s long-term care architecture also depends on coordination.

The long-term care coordinator working with a provider has a different function from the adviser involved at the CSD entry point. Once a person enters the relevant form of long-term care, coordination helps translate entitlement into an individual personal plan and supports review as circumstances change.

This role becomes particularly important where needs cross boundaries. A person may receive long-term care while also requiring healthcare, rehabilitation, social-welfare services or substantial support from family members. Someone living at home may need changes in the mix of long-term care activities without necessarily requiring an entirely different statutory category.

Coordination requires time. If coordinators carry workloads that allow only administrative processing, the system loses an important mechanism for making care genuinely individual.

A 79-year-old man returning home after hospital treatment illustrates the issue. Before admission he already received long-term care. He now has reduced mobility and additional short-term rehabilitation needs. His daughter assumes that the existing care package will automatically expand. The home-care team knows that some tasks have changed, while healthcare professionals remain responsible for other interventions.

The coordinator’s value lies partly in making those boundaries workable: reviewing the personal plan within the long-term care framework, identifying what requires reassessment, ensuring the person understands the available options and helping prevent responsibilities from being silently transferred to the family.

That work is part of capacity. A system with adequate frontline hours but insufficient coordination can still produce fragmented care.

Effective support planning and review therefore depends on both professional capability and realistic coordinator workloads.

Technology can release capacity, but it cannot replace the care relationship

Workforce shortages naturally increase interest in technology. Slovenia has been supporting investment in modern technologies and equipment within social-welfare and long-term care services, including technology intended to automate or assist aspects of work.

The strongest opportunity is not to treat technology as a substitute for human care. It is to identify activities where technology can reduce avoidable physical or administrative burden.

Appropriate equipment can make some physical tasks safer. Digital records can reduce duplication where systems are well designed. Better scheduling can reduce unnecessary travel. Remote technologies may support safety or reassurance for some people at home. Automation may remove repetitive processes from administrative teams.

Each gain can release workforce capacity, but each also creates requirements of its own.

Workers need training. Equipment must be maintained. Digital systems need reliable data. People using care must understand what technology does and retain appropriate privacy and choice. A poorly implemented digital system can consume more worker time than the process it replaced.

This is particularly important where technology involves monitoring within someone’s home. Efficiency does not override autonomy. A sensor or remote support arrangement that helps one person feel safer may feel intrusive to another.

The wider principle of digital skills and workforce adoption therefore matters as much as purchasing technology itself.

Organisations exploring similar change can use the Digital Transformation Readiness Assessment to examine whether workforce skills, governance and operational processes are ready for digital change. Technology creates sustainable capacity only when people and workflows change with it.

Temporary workforce flexibility needs strong safeguards

The workforce pressures exposed during implementation have also prompted Slovenia to introduce greater flexibility in how providers can secure qualified personnel.

Temporary measures adopted in September 2026 allow long-term care providers, under specified circumstances, to use contractual cooperation with individual self-employed professionals where required personnel cannot be secured through employment. The measure is intended to operate during the transitional stabilisation period through the end of 2027.

Importantly, flexibility does not remove qualification requirements. People undertaking long-term care work through these arrangements remain subject to the relevant education, competence and other conditions applying to the services they perform.

This distinction matters. Flexible staffing can help a provider maintain access when conventional recruitment cannot fill a critical gap. It should not become a route for weakening professional standards or creating a permanently fragmented workforce.

Providers therefore need to consider continuity, induction, information access, supervision and accountability alongside contractual status. A qualified professional who works intermittently across several organisations may still need local orientation to individual users and provider procedures.

There is also a strategic question about what happens when temporary measures expire. If a service becomes structurally dependent on exceptional staffing arrangements, the underlying recruitment problem remains unresolved.

That is why workforce risk and mitigation should distinguish between short-term resilience measures and a sustainable workforce model. Temporary flexibility can create breathing space; it is not in itself a long-term workforce strategy.

Quality assurance needs to connect workforce evidence with user outcomes

Staffing information becomes most useful when it is connected with what happens to people receiving care.

A provider can meet a numerical staffing requirement while experiencing poor continuity. Training completion can be high while employees lack confidence applying new skills. Vacancy rates can fall because posts have been filled by inexperienced staff who still require substantial supervision.

Workforce assurance therefore needs several layers of evidence.

At operational level, managers need to know whether shifts and home visits can be covered safely. At professional level, they need confidence that staff have the competencies required for the activities they undertake. At service level, they need to understand whether workforce changes are affecting timeliness, continuity, incidents, complaints or personal outcomes.

National oversight has a different purpose. It needs to identify whether staffing requirements and workforce policies are supporting the long-term care system across Slovenia and where recurring shortages may threaten equitable access.

Consider an institutional provider where headline staffing numbers remain broadly stable. Over six months, however, experienced nursing personnel leave and are replaced gradually by less experienced colleagues. Care assistants report increasing difficulty obtaining timely clinical guidance, sickness rises and families begin raising concerns about communication.

No single indicator establishes that care is unsafe. Together they justify closer review of skill mix, supervision and workload.

This is where the Quality Dashboard Builder offers a useful transferable framework. It can help organisations bring workforce, quality and outcome evidence into the same view rather than treating staffing as a separate human-resources dataset. It does not certify Slovenian regulatory compliance; its value is analytical.

The broader workforce assurance principle is straightforward: sufficient staffing should ultimately be evidenced through reliable care, not only through establishment figures.

Family care should not become the invisible workforce reserve

Where formal workforce capacity is constrained, families often absorb the difference. This can happen gradually and without an explicit decision.

A visit moves later, so a daughter helps her mother dress before work. Weekend support becomes difficult to schedule, so a spouse provides it. A family member attends every appointment because continuity between professionals is inconsistent.

Slovenia’s long-term care system formally recognises the role of family care through the right to a family caregiver for eligible people meeting the relevant conditions. That recognition is significant because it brings some family caregiving within the formal long-term care settlement rather than treating all unpaid care as an unlimited private resource.

But family involvement remains wider than the formal family-caregiver right.

Imagine an older man with substantial long-term care needs whose adult daughter lives nearby. He prefers home care and his daughter wants to remain involved. A provider vacancy temporarily reduces continuity, and she begins covering several tasks herself.

For a few weeks this feels manageable. After several months, she has reduced her working hours and is arranging her life around uncertain visit times. The formal care record may still show that most allocated services are being delivered, while the family has quietly absorbed the system’s lack of resilience.

This is why family partnership and carer support must remain part of workforce governance. Families can contribute knowledge, relationships and support, but they should not become an unmeasured staffing contingency.

Questions about workforce capacity should therefore include what has changed for families. Rising unpaid care can be an early signal that formal services are not providing the continuity originally intended.

Workforce policy needs a longer horizon than the implementation period

Slovenia’s temporary workforce measures are understandable during the establishment of a major new system. Supplements, integration support, flexible staffing mechanisms and investment in technology can help stabilise services while new entitlements become embedded.

Demographic ageing, however, makes the workforce challenge structural rather than temporary.

Future planning will need to consider how many workers are required, which roles should undertake which activities, how career pathways can make long-term care attractive and how productivity can improve without making care more task-driven.

There is also an opportunity to redesign roles around the strengths of the new system. Long-term care does not need to reproduce every historical division between social support and health-related care. Within legal and professional boundaries, clearer competency frameworks and multidisciplinary working can help workers operate at the appropriate level of skill.

Training will become increasingly important as the population’s needs change. Dementia, multimorbidity, frailty, disability, rehabilitation and end-of-life needs require different combinations of knowledge. Digital systems and assistive technologies add further competencies.

Career development matters here. A worker who sees no route beyond an entry-level care role may leave the sector even if they value the work. Structured development into specialist, supervisory, coordination or professional roles can strengthen retention while building capability.

Workforce strategy therefore needs to connect recruitment with education, professional development, working conditions, technology and service design. Treating each as a separate initiative risks solving one constraint by creating another.

The international lesson is to treat workforce as system infrastructure

Slovenia’s experience offers a wider lesson for countries expanding long-term care entitlements. Funding reform and workforce reform cannot be sequenced independently.

A new insurance mechanism can make care financially accessible. National eligibility can strengthen fairness. Home-based rights can increase choice. But each reform changes demand for labour.

If workforce capacity grows more slowly than entitlement, rationing can reappear in operational forms: delayed service starts, reduced continuity, constrained choice or greater reliance on families. The statutory right remains, but its practical value becomes uneven.

The transferable lesson is not that another country should reproduce Slovenia’s qualification framework, employment measures or institutional structure. Those arrangements reflect Slovenia’s own legislation, labour market and welfare system.

The transferable principle is that workforce evidence should be designed into reform from the beginning.

Governments and service systems need to know whether new demand is being met through genuine additional capacity, redistribution from existing services, increased worker intensity or greater unpaid family care. These outcomes are not equivalent.

They also need to distinguish temporary implementation pressures from structural shortages. A short-term vacancy can be managed operationally. Persistent inability to recruit particular professions or serve particular regions requires a policy response.

This turns workforce intelligence into a core part of long-term care governance rather than a supporting employment function.

Conclusion

Slovenia’s long-term care reform has made workforce capacity one of the clearest tests of whether a statutory care entitlement can become a dependable everyday service. The country has created national rights, dedicated financing and a stronger framework for home and institutional long-term care, but those structures ultimately rely on enough skilled people being available where and when support is needed.

The challenge extends well beyond filling vacancies. Slovenia needs a workforce with the right skill mix, effective supervision and sustainable working conditions; sufficient coordinators and professional capacity; successful integration of workers recruited from abroad; and deployment models capable of serving both urban and dispersed rural communities. Technology can release capacity and reduce physical or administrative burden, but it cannot replace relationships, judgement or competent human support.

The temporary measures being used during the system’s stabilisation period show that workforce constraints are being treated as an implementation issue at national level. Their longer-term value will depend on whether they create lasting capability rather than temporary cover.

For people receiving long-term care, the decisive outcome is not the workforce establishment on paper. It is whether a familiar and competent person arrives when expected, whether changing needs are recognised, whether support protects independence and whether families can remain partners rather than becoming an invisible substitute workforce. Slovenia’s next workforce challenge is therefore to convert recruitment activity into resilient care capacity — and to make that resilience measurable across the whole system.