The Future of Long-Term Care in Austria: Ageing, Technology, Workforce and System Reform

An older person living in Austria in 2050 may encounter a long-term care system that still contains many familiar elements: Pflegegeld, services organised through the Länder, mobile care, residential provision, family support and professional nursing. Yet the environment around those institutions will be profoundly different. A much larger share of the population will be older, professional care workers will remain a scarce resource, families will be smaller and more geographically dispersed, and digital systems will be woven more deeply into health, housing and everyday life.

The future challenge explored across the Austria Ageing, Long-Term Care & Community Support Knowledge Hub is therefore not simply how to expand today’s arrangements. It is how Austria can preserve the strongest principles of its Pflegevorsorge while redesigning the surrounding service system for a different demographic and workforce reality.

That distinction matters. Austria already has substantial public infrastructure: a national Pflegegeld entitlement, a growing Pflegefonds, established mobile and residential services, a distinctive 24-Stunden-Betreuung sector, professional nursing and social-care occupations, support for family carers and increasingly sophisticated digital and quality infrastructure. The strategic question is how these elements evolve together. By 2050, sustainability will depend less on any single reform package than on whether financing, prevention, workforce, housing, technology and regional planning become parts of one coherent long-term care strategy.

2050 changes the scale of the planning problem

Austria’s population is not projected simply to become larger. Its age structure is changing significantly.

Population projections indicate that people aged 65 and over, around one fifth of the population in 2024, could represent more than a quarter by 2040 and approximately 27% by 2050. At the same time, the share of the population in the principal working-age groups is expected to decline.

The operational consequence is more important than the headline percentage. More people will reach ages at which frailty, dementia, multimorbidity and functional impairment become more prevalent while the relative pool from which professional workers and family carers can be drawn becomes smaller.

Austria’s updated Pflegepersonalbedarfsprognose reinforces this point. Maintaining care and support capacity requires both replacement of workers leaving the system and additional staff for growing demand. The projection indicates an average requirement of roughly 7,000 additional or replacement Pflege- und Betreuungspersonen each year between 2023 and 2050 across nursing and other care occupations.

This makes long-term workforce planning inseparable from demographic policy. Training more people remains necessary, but Austria cannot assume that future demand can be met simply by reproducing current service models with proportionately more workers.

The future system will have to use professional time differently.

The objective should be additional healthy and independent years, not merely additional care places

An ageing society can respond to demand in two fundamentally different ways. It can concentrate primarily on expanding services once dependency develops, or it can combine sufficient long-term care capacity with systematic efforts to maintain function and independence for longer.

Austria will need both.

Prevention cannot remove dementia, disability or the need for intensive care. Nor should it become a mechanism for blaming individuals when their health deteriorates. Its strategic value lies in influencing the trajectory of need.

Falls prevention, mobility, strength and balance, nutrition, accessible housing, social participation, medication management, rehabilitation and earlier recognition of frailty can all affect whether an older person remains independent, requires limited assistance or moves more quickly towards intensive support.

This creates an opportunity to bring prevention and health inequality more explicitly into long-term care planning. The important outcomes are not simply participation in preventive programmes but whether people retain mobility, confidence, social connection and control over everyday life.

Community Nursing, primary care, mobile services, municipalities, voluntary organisations and local networks can all contribute, but the future model will need clarity about who identifies emerging risk and who coordinates a response. Prevention loses effectiveness when everybody supports it conceptually but no organisation has sufficient operational responsibility.

Operational scenario: the future pathway begins before a person is classified as needing substantial care

A 78-year-old man in Styria lives alone after his wife dies. He has diabetes and osteoarthritis but does not require intensive daily assistance. His daughter lives in Graz and visits at weekends. Over six months he becomes less active, stops attending a local social group and has two minor falls that do not result in hospital admission.

A reactive long-term care system may barely see him. He has not yet reached a point at which a large formal package is required.

A prevention-oriented system interprets the pattern differently. Primary care, a local community nursing or advisory function and municipal services can identify that mobility, isolation and confidence are deteriorating together. With his agreement, the response focuses on physiotherapy or exercise, medication and health review where appropriate, home hazards, transport and reconnection with community activity. Assistive technology may provide reassurance without turning his home into a surveillance environment.

The outcome being pursued is not avoidance of Pflegegeld at any cost. It is preserving capability.

If his needs later increase, the information gathered through earlier support can help services understand what matters to him and how his circumstances have changed. The future system therefore becomes more continuous: prevention, assessment and long-term care are not entirely separate stages.

For organisations examining comparable choices, the Positive Risk-Taking Planner offers a practical framework for balancing independence, benefits, identified risks and proportionate safeguards rather than responding to ageing through restriction alone.

Home will remain central, but the meaning of care at home must change

Supporting people to remain at home is likely to remain a major Austrian policy objective. It reflects personal preference for many people and can preserve community connection and autonomy.

By 2050, however, the sustainability of home-based care will depend on whether Austria moves beyond a model in which scheduled professional visits are layered onto extensive family support.

Some households will continue to have strong informal networks. Others will not. More people may live alone, adult children may live further away and older couples may both have significant needs. Female employment and changing expectations about unpaid care will also make it increasingly difficult to assume that relatives can absorb additional hours indefinitely.

Future home support therefore needs a broader architecture: mobile Pflege- und Betreuungsdienste, rehabilitation, household assistance, respite, day support, case and care management, primary care, Community Nursing where Länder develop it, assistive technology and appropriate alternative housing.

The distinction between a home-care visit and a sustainable home-care system will become increasingly important.

A person receiving three scheduled interventions each day may technically have formal support but still be isolated or unsafe for the remaining hours. Conversely, somebody with appropriate housing, local relationships and low-level preventive assistance may maintain independence without intensive professional input.

Future planning should therefore measure independence and community inclusion alongside service volume.

Housing may become one of Austria’s most important long-term care infrastructures

Long-term care debates often concentrate on workers and benefits while treating housing as a background condition. By 2050, that separation will be increasingly difficult to sustain.

An inaccessible home creates care demand. Stairs, narrow bathrooms, unsuitable entrances and poorly designed environments can turn manageable physical impairment into dependence. Rural isolation can compound the problem where transport and nearby services are limited.

Austria therefore has a strategic interest in housing that can adapt as people age.

This does not mean creating one standardised form of older people’s housing. The future mix could include ordinary homes that are easier to adapt, barrier-free apartments, intergenerational developments, supported housing and arrangements that sit between independent living and conventional Pflegeheim provision.

The operational advantage is flexibility. A person may need relatively little support at 75, regular mobile assistance at 82 and substantial care later. Housing that accommodates changing mobility, technology and visiting support can reduce the number of disruptive moves.

Future policy will need stronger connections between Länder care planning, municipal development, housing organisations and accessibility policy. Otherwise Austria risks investing in care capacity while leaving the physical environments that generate avoidable dependence largely unchanged.

The workforce of 2050 will need different roles, not only greater numbers

Austria cannot solve its long-term care workforce challenge by asking the same workforce to work progressively harder. Nor is it realistic to assume that every additional future task can be allocated to highly qualified nursing professionals.

The country already has a differentiated occupational structure including diplomierte Gesundheits- und Krankenpflegepersonen, Pflegefachassistenz, Pflegeassistenz, social-care professions and Heimhilfe, alongside other professional and support roles. The future opportunity lies in using that diversity more deliberately.

Highly qualified professionals should spend more time on activities requiring assessment, complex clinical judgement, coordination, supervision and specialist intervention. Other competent workers can undertake appropriate support within their scope and training. Administrative work should be reduced wherever safe automation and better information systems allow it.

This makes career design important. People need routes into the sector, opportunities to progress and reasons to remain. Training subsidies can improve entry, but sustainable workforce resilience and continuity also depend on working conditions, leadership, predictable employment, manageable workload, professional development and whether staff believe they can provide good care.

Migration will remain relevant. Austria already relies on international workers across health, nursing and particularly 24-Stunden-Betreuung. Future migration policy will need to connect qualification recognition, language development, ethical recruitment, employment conditions and integration rather than treating international labour as an unlimited external supply.

The objective should be a workforce model capable of retaining domestic and international workers while using professional competence intelligently.

24-hour care faces a long-term economic test

Austria’s 24-Stunden-Betreuung model has enabled many people with substantial support needs to remain in private homes. Its scale and institutional history make it more than a temporary response to formal service shortages.

Yet its future raises difficult questions.

The model depends heavily on migrant Personenbetreuer:innen, many of whom operate as self-employed workers and rotate between Austria and their home countries. Household payments, Pflegegeld and, where eligibility conditions are met, public subsidy contribute to financing.

By 2050, countries from which Austria currently draws care workers will themselves be older. Wage expectations and employment opportunities across Central and Eastern Europe may continue to change. Cross-border care labour cannot therefore be assumed to remain available on the same economic terms indefinitely.

Austria will need to decide what role it expects 24-hour support to play within its future care architecture.

Strengthening quality and working conditions may increase cost. Increasing household subsidy may require greater public expenditure. Moving more people into conventional professional services would create additional workforce demand elsewhere.

The strategic requirement is to make these trade-offs explicit.

A sustainable future cannot depend on preserving affordability through weak worker bargaining power. Equally, abrupt removal of a model on which thousands of households depend would create significant disruption. Gradual reform needs to improve transparency, quality and worker protection while developing alternative home-support capacity.

Operational scenario: a family’s 2040 care decision exposes the workforce dependency

An older couple in Burgenland live in their own home. The wife has dementia and needs supervision throughout the day; her husband provides much of the support but is becoming frail himself. Their children work in Vienna.

The family considers 24-Stunden-Betreuung. By this point, however, the cost of attracting rotating carers from neighbouring countries has increased substantially. The household can afford only part of the arrangement after Pflegegeld and available subsidy.

The decision cannot be solved simply by telling the family to purchase more care. The local system examines the alternatives: mobile services, day provision, respite, adaptations, support for the husband and whether a different housing arrangement could meet both partners’ needs. A live-in arrangement remains one option rather than the assumed default.

The Land also sees the case as part of a wider pattern. If many households are encountering the same affordability problem, individual advice cannot resolve a structural change in the labour market. Service-development planning must consider whether additional mobile capacity, supported housing or revised financial support is required.

This is the type of future uncertainty that the Digital Twin Scenario Modeller can help organisations explore: not by predicting Austria’s future precisely, but by testing how different assumptions about workforce availability, demand and service configuration affect capacity.

Technology will become infrastructure, but care must remain human

By 2050, distinguishing “digital care” from care may become increasingly artificial. Scheduling, records, communication, remote monitoring, assistive technologies and decision support are likely to be embedded across everyday service delivery.

Austria already has important foundations in digital health, ELGA and wider e-health development. Long-term care can benefit as systems become more interoperable and information follows people more reliably across organisational boundaries.

Technology could support future capacity in several ways. Automated administration may reduce documentation burden. Intelligent scheduling can reduce unnecessary travel. Remote consultations can extend specialist reach. Sensors and telecare can support some people living independently. Data analytics can identify capacity pressure earlier. Artificial intelligence may support drafting, pattern recognition and planning.

None removes the need for professional accountability.

A sensor does not decide whether an older person should be admitted to hospital. An algorithm cannot determine what level of risk a person values in their own life. Generative AI output still requires validation. Remote monitoring creates work because somebody has to interpret and respond to alerts.

The future challenge is therefore person-centred technology: using digital capability to extend autonomy and professional capacity rather than substituting surveillance for relationships.

Organisations planning comparable transformation can use the Digital Transformation Readiness Assessment to examine strategy, workforce adoption, information governance and resilience before technology becomes embedded in critical care pathways.

Artificial intelligence will change work before it replaces occupations

AI is likely to affect Austrian long-term care, but its most plausible near- and medium-term impact is task redesign rather than wholesale worker replacement.

Documentation assistance, translation, scheduling, demand forecasting and selected decision-support functions can change how professional time is used. More sophisticated systems may increasingly identify patterns across health and care data.

The boundary should remain clear: computational capability can support judgement without acquiring moral authority over a person’s life.

This becomes particularly important in long-term care because decisions frequently involve competing values rather than technically optimal answers. Safety, independence, privacy, family involvement and personal preference can point in different directions.

Austria will also operate within the European Union’s evolving digital and AI regulatory environment. Future implementation will therefore need appropriate risk classification, data governance, human oversight, transparency and professional competence.

The stronger productivity opportunity lies in removing work that does not require human presence. If AI reduces time spent reproducing information across documents, professional capacity can increase. If it generates additional alerts, verification tasks and defensive documentation, workload may rise instead.

Technology should consequently be judged by observable outcomes, including time released, continuity, safety, accessibility and user experience, rather than the sophistication of the system purchased.

Integration will matter most at the points where people experience fragmentation

Austria’s health and long-term care arrangements have different financing and governance histories. Those institutional boundaries will not disappear simply because the population ages.

For the individual, however, they are increasingly artificial.

An 88-year-old person with heart failure, diabetes, frailty and emerging dementia does not experience a health need on Monday and a social-care need on Tuesday. Their life crosses primary care, hospital services, medication, mobile nursing, personal support, family care and potentially residential provision.

Future integration therefore needs to concentrate on practical interfaces rather than organisational rhetoric.

Shared information, clear coordination, accessible primary care, case and care management, Community Nursing where available, discharge planning and stronger relationships between Pflegeheime and clinical services can reduce gaps without requiring all services to sit inside one institution.

Interoperability and system integration become particularly important as complexity rises. The objective is not merely technical connectivity. Relevant information must reach somebody who has the authority and capacity to act on it.

Operational scenario: the future test of integration is whether anybody owns the transition

An 89-year-old woman in Lower Austria is admitted to hospital after pneumonia. She also has moderate dementia, reduced mobility and receives mobile support at home. Before admission, her son visits several evenings each week.

Following treatment, she is medically stable but significantly weaker. The hospital can transfer information electronically, yet information exchange alone does not create a safe discharge.

A future integrated pathway establishes who coordinates the transition. Her changed mobility is assessed; medication changes are communicated; the capacity of the mobile service is confirmed rather than assumed; her son is involved without being made responsible for filling every gap; and short-term rehabilitation or increased support is considered before a permanent change of setting.

If she returns home, the pathway includes an early review because the first days after discharge are not treated as the end of the episode.

If similar discharges repeatedly stall because community capacity is unavailable, the evidence moves beyond individual case management. The Land needs visibility of the pattern so that hospital pressure can be connected with long-term care development.

This illustrates why future integration is fundamentally a governance question. Information, responsibility and capacity have to meet at the same point.

Regional flexibility will remain valuable only if Austria can see the consequences

Austria’s nine Länder will continue to face different demographic, geographic and service conditions. Vienna cannot sensibly organise long-term care exactly like Tyrol, Burgenland or Carinthia.

Federalism therefore remains a potential strength: services can adapt to local infrastructure, population density and established provider arrangements.

The future risk is not variation itself. It is variation whose consequences are insufficiently visible.

The Pflegefondsgesetz already requires Länder to submit Sicherungs-, Aus- und Aufbaupläne addressing how care and support services will be safeguarded, expanded and developed. As demographic pressure increases, these plans can become increasingly important instruments of long-term capacity governance.

The stronger future model would connect planning assumptions with outcomes. A Land could explain not only how many services it expects to fund but how projected demand, workforce availability and geography shaped that decision. National Pflegereporting and other datasets can then make persistent differences more visible without pretending that every Land should produce identical service structures.

This requires mature quality monitoring. Formal entitlement and allocated expenditure are insufficient if people cannot obtain timely support in practice.

Geographic equity should therefore be assessed through access, waiting demand, workforce distribution, continuity and outcomes as well as expenditure.

Climate resilience will increasingly intersect with care resilience

Long-term care infrastructure designed for the middle of this century also has to operate in a changing climate.

Heat is particularly important for older people, including those with cardiovascular or respiratory conditions, cognitive impairment or limited ability to regulate their environment. Care workers themselves may be travelling or working in hot homes and buildings.

Flooding, storms, snow and other disruption can affect access, power, communications, supply chains and worker travel. Alpine and dispersed communities face different resilience challenges from dense urban areas.

Climate adaptation therefore belongs inside long-term care planning rather than being treated only as environmental policy.

Residential facilities need suitable temperature management and continuity arrangements. Mobile services need plans for reaching people when transport is disrupted. Technology-dependent support requires backup arrangements where power or connectivity fails. Services need to know which people are particularly vulnerable during heatwaves or other emergencies without creating intrusive surveillance.

The relevant principle is emergency preparedness: future care systems should be designed to maintain essential support under conditions that may become more frequent or severe.

Resilience also reinforces the case for local networks. A highly centralised system can be efficient under normal conditions yet vulnerable when transport or communication is interrupted. Local knowledge and community capacity can complement professional services, provided responsibility is clear and unpaid community help is not treated as a replacement for formal care.

Quality measurement needs to move from activity towards value

Austria’s future system will generate far more data than today. The governance challenge will be deciding which information matters.

Counting Pflegegeld recipients, residential places, mobile-service hours and workers remains necessary for capacity planning. Those indicators do not reveal whether somebody experiences continuity, maintains mobility or feels in control of their support.

Future quality intelligence needs to combine structure, process and outcomes.

• Capacity evidence should show whether appropriate services are actually available where people live.
• Workforce evidence should include vacancies and numbers alongside turnover, continuity, competence and workload.
• Quality evidence should capture safety without allowing absence of incidents to become the sole definition of good care.
• Person-level outcomes should include independence, dignity, participation, experience and whether support reflects individual priorities.
• Family evidence should identify whether carers feel supported or whether formal system stability depends on increasing unpaid work.

The development of Austria’s Pflegereporting provides an important foundation because it creates greater capacity to understand workforce and quality trends across the system.

Organisations working through similar evidence challenges can use the Quality Dashboard Builder to structure balanced measures across capacity, workforce, quality and outcomes rather than allowing easily counted activity to dominate governance.

Operational scenario: a Land learns that more service does not automatically mean better outcomes

A Land substantially increases mobile-care capacity over several years. The reported number of delivered hours rises and political reporting initially presents the expansion as evidence that future demand is being addressed.

More detailed analysis produces a more complicated picture.

Some districts have substantially reduced waiting times, while others remain difficult to staff. The number of different workers visiting some high-need individuals has increased because providers are stretching rotas across larger caseloads. Family carers report that additional visits help, but some still cannot access reliable respite. Hospital discharge delays associated with unavailable home support have improved in certain areas but remain persistent elsewhere.

The response is not to conclude that expansion failed. Additional capacity was necessary.

Instead, the Land changes the evidence question from “How much care did we fund?” to “What did the additional capacity change?”

Service volume is retained as a core indicator but interpreted alongside waiting demand, continuity, workforce stability, regional access, carer experience and selected person-level outcomes. Persistent geographic differences then influence the next Sicherungs-, Aus- und Aufbauplan.

The example illustrates the future value of evidence as a feedback mechanism. Data becomes useful when it changes the next planning decision.

People and families need greater influence over the architecture, not only individual care decisions

Person-centred care is often understood at the level of individual planning: preferences, routines, goals and choice. These remain essential.

Austria’s future system also needs participation at a higher level.

People receiving Pflegegeld, residents of Pflegeheime, people using mobile services, Personenbetreuer:innen, professional workers and family carers possess different forms of operational knowledge. They can identify where formal policy and practical experience diverge.

That intelligence should inform service development.

For example, a technically successful digital portal may remain difficult for older people to navigate. A respite programme may exist but operate at times that do not help working carers. A new housing model may appear accessible while making social participation difficult. Workforce redesign may improve efficiency but reduce continuity valued by people with dementia.

Meaningful co-production and lived-experience involvement can expose these effects before they become embedded.

This does not mean every policy choice can satisfy every preference. Governments still have to make decisions about affordability, distribution and safety. Participation improves the evidence on which those trade-offs are made and helps distinguish institutional convenience from outcomes people genuinely value.

The federal-Länder relationship will determine whether reform becomes transformation

Austria’s future long-term care system is unlikely to be built through one comprehensive national law that replaces existing arrangements. Its institutional structure points towards negotiated development.

The federal government controls important financing and policy levers, including Pflegegeld and the Pflegefonds. Länder retain central responsibility for organising formal long-term care services. Municipalities, providers, health services, social insurance and families each hold other parts of the operational reality.

The 2024–2028 Pflegefonds settlement, with more than €6 billion allocated across the period, provides substantial resources and supports an expanded range of purposes. Yet the demographic horizon extends far beyond 2028.

Future reform therefore needs stable mechanisms through which Bund and Länder can make decisions using shared evidence about demand, workforce and outcomes. The Pflege-Entwicklungs-Kommission can contribute to that dialogue, but institutional forums matter only if they translate evidence into decisions.

Organisations examining comparable multi-level accountability can use the Governance Maturity Assessment to test whether responsibility, evidence, escalation and decision-making remain connected during complex reform. It is not an Austrian regulatory framework; its value lies in structuring the governance questions that fragmented systems need to answer.

Austria should plan for several futures rather than one forecast

Demographic projections provide direction, not certainty. Migration, longevity, health trends, labour-force participation, technology and family structures may all develop differently from current assumptions.

A resilient long-term care strategy should therefore use scenarios.

One future may involve stronger healthy-ageing outcomes and slower growth in high-intensity care. Another may combine greater longevity with more years of complex dependency. International migration could strengthen the professional workforce, or competition for workers across Europe could intensify. Technology may release substantial administrative capacity, or poorly integrated systems may create new workload. Informal care may remain extensive, or changing family structures may reduce its availability more quickly than anticipated.

Austria does not need to predict exactly which future will occur. It needs service models that remain viable across several plausible conditions.

This changes investment decisions. Flexible housing becomes more valuable. Workforce career structures matter because retention protects capacity under multiple scenarios. Interoperable technology reduces dependence on one organisational model. Prevention remains worthwhile because maintaining capability benefits individuals even if aggregate savings differ from forecasts.

Scenario planning also makes uncertainty governable. Leaders can identify which assumptions would materially alter capacity and monitor them over time.

The strongest future model is an adaptive care ecosystem

By 2050, the most sustainable Austrian system may be less defined by individual service categories and more by its ability to adjust support as people’s lives change.

That does not require institutional boundaries to disappear.

Pflegegeld can continue to provide nationally structured financial support. Länder can retain responsibility for service development. Professional roles can remain distinct. Residential care can coexist with home support. Families can remain important without becoming compulsory substitutes for public capacity.

What needs to improve is movement between those components.

A person should be able to receive preventive support before substantial dependency, add mobile assistance as needs increase, access rehabilitation after illness, use technology where it genuinely helps, obtain respite when family support becomes strained and move to more intensive or residential support without every transition feeling like the construction of an entirely new system.

That is an adaptive model of long-term care: one in which funding, information and professional responsibility are sufficiently connected to respond to changing need.

It also changes the definition of sustainability. A sustainable system is not simply one whose expenditure can be financed. It is one that can continue producing acceptable human outcomes despite demographic, workforce and technological change.

What Austria’s future offers as an international lesson

Austria’s institutions are distinctive. Pflegegeld, federal-Länder responsibilities and the scale of 24-Stunden-Betreuung reflect national political, social and labour-market choices that cannot simply be transferred elsewhere.

The broader strategic lesson is more widely relevant.

Long-term care systems cannot prepare for population ageing by projecting current utilisation forward and purchasing proportionately more of everything. Workforce supply, family capacity, housing, technology and public expectations will change at the same time.

The transferable principle lies in designing for adaptation.

Countries need to understand which needs genuinely require scarce professional labour, which can be delayed through prevention, which can be supported through better environments and technology, and which responsibilities society expects families to carry. They also need governance capable of recognising when assumptions change.

Austria demonstrates why national entitlements and decentralised services can coexist, but also why decentralisation requires transparent evidence if geographic flexibility is not to become inequitable access.

The future will be shaped less by whether one country possesses the perfect institutional model than by whether its institutions can learn quickly enough.

Conclusion

Austria enters the next quarter-century with significant long-term care assets: a nationally established Pflegegeld system, substantial public investment through the Pflegefonds, experienced professional and provider infrastructures, strong traditions of family support and a reform agenda increasingly attentive to workforce, community services, digitalisation and quality. Those foundations matter. They also have to operate in a demographic environment for which they were not originally designed.

The strongest future direction is not unlimited expansion of today’s care model. Austria will need to maintain independence for longer, build adaptable housing and communities, protect family carers from unsustainable responsibility, redesign professional roles, strengthen home and residential capacity, improve the sustainability of 24-Stunden-Betreuung and use technology to release rather than displace human capability. Better integration and more comparable evidence must connect those changes across Bund, Länder and local delivery.

Implementation will determine whether these ambitions become everyday reality. A national entitlement has limited value if local capacity is unavailable; digital innovation has limited value if nobody owns the response; workforce investment has limited value if people do not remain; and regional flexibility has limited value if persistent inequality cannot be seen.

Austria’s central task towards 2050 is therefore to build a long-term care system that can adapt as rapidly as the society around it changes while preserving the qualities that matter most: dignity, security, choice, relationships and the possibility of living a meaningful life with support.