Opinion on the draft recommendation to address the worrying situation in residential care homes

The Government adopted its draft response based on the recommendations to address the worrying situation in residential care homes, submitted by a group of deputies, with Jelka Godec being the first to sign. The Government has examined the proposed recommendations and provides the following explanations.

The Government is aware of the staffing problems in residential care homes and other social care institutions. Staff shortages are a Europe-wide problem and the Government has already taken various measures to improve the current situation.

The Ministry of Health has clarified that staffing standards for health care workers are based on the nature of the work, the process, the division of work and tasks within the health care team and the characteristics of the population concerned, and therefore, they cannot be harmonised. There is no international standardisation or practice for staffing standards with a normative basis in this form or for this purpose. Setting a minimum staffing standard plays a crucial role in regulating the emergency and intensive care sector. Staffing levels are not adjusted to current needs but are based on a national needs assessment.

It is envisaged that the effects of the Long-Term Care Act (ZDOsk-1) will also extend to residential care homes, so that harmonisation of staffing standards is not expected to be achieved until 1 March 2024. The Government is set to carry out an assessment of the situation, which will serve as a basis for subsequent action in this area.

Harmonisation must be fundamentally guided by the sustained workload and achieved staff efficiency in providing quality care for both hospital patients and care home residents.

The pricing of services in hospitals and care homes is determined by the Decree on the compulsory health insurance service programme, the resources required for its implementation and the amount of funding for services such as

• one day of care in residential care home and
• non-acute hospital care.

The draft Act determining urgent measures to improve the staffing, working conditions and capacities of providers of social assistance and long-term care services encompasses eight key measures. These include:

• Providing staff grants for final-year secondary school and university students enrolled in study programmes for social assistance and long-term care professions;
• Supporting the involvement of volunteers in social assistance and long-term care services. This initiative aims to recognise the valuable contribution of volunteers in improving the quality of life of service users, while reducing the workload of staff within their working environment;
• Training of new staff supports the systematic induction of new employees in social and long-term care providers in order to speed up the transfer of knowledge and skills within the organisation, to familiarise them with the provider's concepts and working methods, and to ensure a higher quality of service provision;
• Guidelines for streamlining and modernising work processes are aimed at providers of full-time institutional care, such as care homes for older persons. These guidelines include co-financing support for the integration of modern technology and equipment to ensure higher quality and safety of services for users. This, in turn, will reduce the workload of existing staff and minimise the need for additional staff;
• In many cases, the recruitment of foreign workers can also be a solution to staff shortages, which is why the Act provides for an increase in the staffing of the information points for foreigners.

In order to facilitate the integration of foreign workers into professional and social life, the Act provides for the development of integration programmes when foreigners are employed by providers of social assistance and long-term care services.

Previously, changes to staffing standards in residential care homes and special social care institutions were adopted in April 2022 and will gradually be increased until 2030. It is envisaged that one fifth of the mandatory additional staff will be provided every two years (September 2022, March 2024, March 2026, March 2028 and March 2030). By 2030, staffing levels in care homes are expected to increase by 46% compared to the standards prior to the adoption of the amendment to the Rules. In addition, staffing levels in specialised social care institutions are expected to increase by 30% compared to current staffing levels. In total, the expected growth by 2030 suggests an increase of over 2,200 staff within the current network of providers.

The state budget also provides for the co-financing of additional labour costs arising from changes to the sectoral collective agreement for the period from the entry into force of the Long-Term Care Act (ZDOsk-1) until 31 December 2024 for providers of home-based family support services. The estimated amount of disbursements in 2024 is €20 million.

The Government agrees that the digitalisation of both care homes and other social service providers is very important. We will therefore set up a single information system for long-term care providers (for both institutional care and in-home long-term care) and other social care institutions. As each provider now has its own information system and databases are not interconnected, which makes it impossible to quickly retrieve quality data (e.g. on bed occupancy, waiting lists, applications for admission and applications filed with more than one provider), the initial phase of the project to establish a single information system will focus on reviewing the existing systems and finding good solutions for all stakeholders. In the second phase of the project, a single information system will be set up and put in operation for providers. The Cohesion Fund is providing €6.8 million for the project of a single information system. In parallel with the digitalisation of social care and long-term care providers, the necessary human resources, such as IT staff, will be strengthened.

Investment in institutional care for older persons and the ensuing improvements of the conditions for the work of these institutions, which has a significant impact on the well-being of staff and users, included, also thanks to the European funds, the launch of a number of investment projects over recent years. Some have already been completed. The projects co-financed by REACT-EU, except one project, were completed by the end of 2023. The available grants (non-repayable funds) earmarked for the period 2021-2023 totalled just over €93 million. Funds for different types of construction works (reconstruction, extensions or new structures) were allocated to 16 public institutions.

The construction of new facilities for institutional care of older persons financed by the Recovery and Resilience Plan will start this year. It includes the construction of new infrastructure for 539 additional beds in smaller, independent living units. To this end, €59 million in refundable funds is earmarked for the period 2024-2026. An additional €6.7 million for the payment of VAT is earmarked in the budget of the Republic of Slovenia. The final deadline for completion and opening of all the facilities is 30 June 2026.

For investment in residential care homes for older persons, €13.5 million is earmarked in the state budget for 2024 and €25 million for 2025. These funds will be used for reconstruction, which will subsequently improve the conditions for users, and for the construction of new facilities. The budget funds will be used to provide additional 154 beds by the end of 2025.

Furthermore, providers who were awarded a concession for the provision of institutional care for older persons in the tenders for concessions in 2021 and 2022 but have not yet started work will become operational in the next years. The deadline by which concession services, i.e. institutional care for older persons, must be provided has been extended for 927 beds until 31 December 2024 and for 722 beds until 31 December 2025.

The Government recently approved a programme for the repair of direct damage to property in public social care institutions caused by the floods of 4 August 2023. The funds for the reconstruction of state owned property will be provided from the state budget: €2,207,341 in 2024. The funds will be used to repair damaged buildings, draw up investment and project documentation, repair damage to installations and equipment in buildings, restore land, execute geotechnical works and conduct studies. Ten buildings and associated land in the regions of Koroška, Gorenjska, Osrednjeslovenska and Pomurska were included in this programme prepared by the Ministry of a Solidarity-Based Future. The adopted programme for the repair of direct damage to property also covers the stabilisation and rehabilitation of land affected by landslides.

Source: Ministry of a Solidarity-Based Future

Government approves amendments to the Act Regulating the Implementation of the Budgets

The Government today approved the proposed amendments to the Act Regulating the Implementation of the Budgets of the Republic of Slovenia for 2024 and 2025.

The amendments were drafted on the basis of comments provided by the Legislative and Legal Service of the National Assembly. The revised EU de minimis Regulation laying down the conditions for de minimis aid also warranted an amendment to Article 133 of the Act on Reconstruction, Development and Provision of Financial Resources (the Reconstruction Act).

Following the adoption of the Reconstruction Act, the European Commission adopted Regulation 2023/2831/EU which entered into force on 1 January 2024, repealing the previous Regulation that served as a basis for the Act. The draft amendment brings the Reconstruction Act into line with the conditions laid down by the revised Regulation for granting de minimis aid.

Source: Ministry of Finance