Chapter XII: Long-term care
When are you entitled to long-term care?
There is no special long-term care insurance or assistance scheme in Slovenia. However, a person dependent on the care of another person who is in need of permanent attendance and assistance with activities of daily living might be entitled to certain benefits from several social security schemes. For instance, there are special rights in the mandatory pension and invalidity insurance, mandatory health insurance, parental protection insurance and social assistance schemes.
Assistance and Attendance Allowance
Assistance and Attendance Allowance (dodatek za pomoč in postrežbo) may be claimed by the recipients of old-age, partial, invalidity, widow’s or widower’s and family pension, if they permanently reside in Slovenia and require permanent assistance to satisfy their basic needs. It may also be paid to the recipients of general Financial Social Assistance.
Supplement for Care and Assistance
Disabled persons who are not entitled to a pension from the mandatory pension and invalidity insurance may claim the Supplement for Care and Assistance (dodatek za tujo nego in pomoč). In order to be entitled to this cash benefit, the need for assistance from another person for all (or the majority of) daily needs must be demonstrated.
Special Childcare Allowance
Special Childcare Allowance (dodatek za nego otroka, ki potrebuje posebno nego in varstvo) is one of the family benefits. It is intended to compensate for extra costs which a family with a child with special needs faces.
Partial Payment for Loss of Income
Partial Payment for Loss of Income (delno plačilo za izgubljeni dohodek) is also among the family benefits. It is paid to one of the parents who has left his/her job in order to care for a child with special needs.
Benefits in kind
Prolonged hospital treatment is one of the long-term benefits in kind provided under the mandatory health insurance. Medical aids (orthopaedic, hearing and other aids intended for home care such as special beds, sanitary medical equipment, etc.) are also available. Costs of healthcare are covered in full (with no co-payments from the insured person) in cases such as disabled children, certain disabled adults, and elderly persons over 75 years of age.
Residential Care is a social service provided for example for elderly persons. A person who is entitled to the residential care alternatively has the possibility to choose the right to a Family Assistant (družinski pomočnik). The Family Assistant is awarded by the locally competent Centre for Social Work to a disabled person who requires assistance with performing all of the activities of daily living, and is paid at the level of the minimum salary. Services to enable care at the beneficiary’s home (home care) are also available.
What is covered?
Assistance and Attendance Allowance is granted to blind, visually impaired persons and persons with at least 70% reduced mobility, if due to permanent changes in their state of health, they cannot satisfy basic needs, being unable to move, feed without assistance, dress and undress or take care of their personal hygiene, and perform other basic tasks indispensable for living.
A supplement for Care and Assistance is granted to disabled persons who are incapable of performing basic life functions, requiring the constant assistance of another person. If a person needs assistance in performing all of his/her basic life functions, this supplement amounts from 20 to a maximum of 30% of national average net personal income per employee. It amounts from 10 to 20% of this basis if help from another person is required in performing a majority of basic life functions.
Entitled persons are treated according to their individual needs when granting benefits in kind. The type of residential care (care I, II, IIIA, IIIB and IV) depends on the individual assessment. For instance, care I implies that the person needs assistance in a very limited extent (mostly very basic assistance and social care), whereas care IV is required by persons with serious and long-lasting mental problems, such as dementia, who need more or less constant and special care.
How is long-term care accessed?
Benefits are granted as soon as the need for care is established. Evaluations are made by experts (invalidity commissions, medical doctors and other experts). The invalidity commission is composed of medical doctors, and experts competent in evaluating dependency, especially in the field of care and other relevant social security experts. Benefits are provided as long as the dependency persists and all other conditions (e.g. the age of a child) are fulfilled.
The Assistance and Attendance Allowance is claimed at the local office of the Pension and Invalidity Insurance Institute, or at the Centre for Social Work if it is claimed as a supplement to the general Financial Social Assistance.
The majority of other benefits should be claimed at the local Centre for Social Work, e.g. Supplement for Care and Assistance, Special Childcare Allowance, Partial Payment for
Loss of Income, and Family Assistant.
Entitlement to prolonged hospital care has to be established by the hospital physician and entitlement to Residential Care by the provider of such care (or in certain cases the Centre for Social Work).
Your right to long-term care when moving within Europe
Long-term care benefits also fall under EU social security coordination rules, in the same way as sickness benefits. Long-term care benefits in cash are paid according to the legislation of the state where you are insured, regardless of which state you are residing or staying in.∗
Long-term care benefits in kind are provided according to the legislation of the state in which you reside or stay as if you were insured in that state.
Further information about the coordination of social security rights when moving or travelling can be found at http://ec.europa.eu/social-security-coordination