Slovakia is aging, and the gulf between healthcare and social services is fully apparent in long-term care. Experts from the health and labor ministries agree that without linking the systems and new financing, it will not work. Their goal is a stable model that keeps a person at home as long as possible and pays for what they truly need.
Why integrate healthcare and social services
Life expectancy is rising, but years spent in good health are lagging; Slovakia is among the weaker performers in the EU. Social services facilities face a stark fact: about 23,500 clients do not receive healthcare because health professionals are lacking. Hospitals and facilities alike are reducing the scope of what the available staff can realistically handle. The system is thus fragmenting, and the needs of dependent people remain unmet.
The solution should not be just a set of small patches, but also a profound change, including funding. Experts point out that it is one “purse” — if a person is stabilized in the social sphere, it saves healthcare expenditures. Crucial, too, is the stability of political and management teams, so that steps already underway do not collapse with every change of leadership. Alongside systemic reform, immediate, partial measures will be needed where the need is most acute.
What the planned reform will bring
The Ministry of Labor is preparing a long-term care reform: completion by the end of the year, legislation next year, and entry into force on January 1, 2026. The centerpiece is to be a personal budget — a care allowance that the individual will manage, with part tied to services. There is discussion about whether it should also cover healthcare services alongside social ones. According to the current debate, personal assistance is to remain a separate benefit, while other allowances should be merged.
The aim is a shift from beds to the field: today, up to 70% of clients use residential services, but the direction should be toward home, community, and outpatient care. Funding is to “stick” more to the person, not to the type of facility or bed. Alongside legislation, the labor shortage and training are being addressed; bringing in workers from abroad runs into questions of competencies. While the system is being recalibrated, the ministries are announcing interim calls — for example, for caregiving or respite services.
People, competencies, and mental health
For care to work, medical and nursing tasks must be clearly separated from supportive activities, and other professionals must be involved. The social worker should be a fully-fledged member of the team with legal standing and access to documentation, even though they are not a healthcare worker. Education and competencies should be reassessed; for example, the “professional caregiver” specialization is being tested, combining the skills of an orderly and a caregiver and potentially operating in both sectors. Such a mix of roles can free up nurses and doctors for demanding procedures.
Mental health is a major challenge: according to the discussion, as many as 73% of people needing long-term care have various psychiatric diagnoses. When deciding on the personal budget, legal representatives step in, but the system must have clear rules also for those who have not been deprived of legal capacity. Community psychiatric care is being launched under the recovery plan, but it faces a shortage of specialists and results will come gradually. The hardest part will be the mindset shift — to stop “counting procedures” and see the person as a whole, across ministries.
