DEVELOPMENT DYNAMICS OF HEALTH AND SOCIAL INFRASTRUCTURE 
FOR THE LONG-TERM CARE – THE CASE OF THE POSAVJE REGION
David BOGATAJ1,2, Marija BOGATAJ1*, Marta KAVŠEK2 
1University of Ljubljana, Faculty of Economy, Kardeljeva pološčad 17, 1000 Ljubljana, Slovenia
2Institute INRISK, Kidričeva 1, 8210 Trebnje, Slovenia
Received: Feb 24, 2021
Accepted: Sep 2, 2021
Original scientific article
*Corresponding author: Tel. + 386 41 670 572; E-mail: marija.bogataj@ef.uni-lj.si
10.2478/sjph-2021-0036 Zdr Varst. 2021;60(4):269-277
269
DINAMIKA RAZVOJA ZDRAVSTVENE IN SOCIALNE INFRASTRUKTURE 
ZA DOLGOTRAJNO OSKRBO – PRIMER POSAVSKE REGIJE
© National Institute of Public Health, Slovenia. 
Bogataj D, Bogataj M, Kavšek M. Development dynamics of health and social infrastructure for the long-term care - the case of the Posavje region.  
Zdr Varst. 2021;60(4):269-277. doi: 10.2478/sjph-2021-0036.
ABSTRACT
Keywords: 
ageing, social 
infrastructure, 
gerontology, built 
environment, long-term 
care, silver villages
IZVLEČEK
Ključne besede: 
staranje, socialna 
infrastruktura, 
gerontologija, 
arhitekturno okolje, 
dolgotrajna oskrba, 
srebrne vasi
Background and purpose: The populations of rural areas across Europe, especially Slovenia, are ageing 
rapidly and the areas themselves are becoming depopulated. Therefore, this study aims to contribute to our 
understanding of the population dynamics and provide a method for forecasting housing and other long-term 
care needs.
Method: The surveys questioned those responsible for long-term care, the caretakers in institutional care, and 
current and potential homecare users in rural areas of Slovenia. We wanted to discover what they considered 
as crucial in the process of long-term care deinstitutionalization. Our 2020–2050 projections are based on the 
surveys conducted across 38 municipalities in the Eastern Slovenian region and an in-depth empirical study in 
Posavje. The results are embedded in the demographic projections and the multistate transition model of the 
declining functional capacities to forecast the needed housing facilities and human resources.
Results: The results are the time series of required capacities. Around 60% of respondents in Slovenian rural 
areas believe that even a better organization of homecare would not allow them to stay at home until death 
due to inadequately built housing and the absence of a continuous presence of caregivers. These findings were 
included in the projections. Therefore, community care in the network of Smart Silver Villages was proposed. 
Discussion: Investments are needed to renovate the housing stock of older adults and construct sheltered, 
assisted living housing and specialized households in the community. Moreover, proper education and training 
of human resources would increase the output. In addition, financial solutions are advised to develop Smart 
Silver Villages.
Motivacija in namen: Podeželska območja po Evropi in v slovenskih regijah se hitro starajo in vse bolj praznijo. 
Zato je naš cilj prispevati k razumevanju te dinamike in podati metodo za projekcije potreb po nastanitvi in 
dolgotrajni oskrbi starejših na podeželju ter s tem revitalizacijo slovenskih pokrajin.
Metoda: Anketirali smo oskrbovalce in druge osebe v podeželskih občinah, odgovorne za dolgotrajno oskrbo, 
oskrbovance in potencialne uporabnike dolgotrajne oskrbe in jih povprašali, kaj je v procesu deinstitucionalizacije 
najpomembnejše. Naši zaključki temeljijo na raziskavah, opravljenih v 38 občinah vzhodnoslovenske regije, 
in poglobljeni empirični raziskavi v regiji Posavje, kjer smo na temelju demografskih projekcij prebivalstva 
in aktuarskega modela pojemanja mnogoterih padajočih funkcionalnih zmogljivosti, kakor tudi iz želja 
prebivalstva, ki izhajajo iz anket, napovedali dinamiko potrebnih prostorskih kapacitet in človeških virov za 
dolgotrajno oskrbo.
Rezultati: Za primer Posavja smo izpeljali časovno vrsto potrebnih zmogljivosti, upoštevajoč tudi, da je kar 
60 % anketirancev na slovenskem podeželju prepričanih, da jim tudi boljša organizacija oskrbe na domu ne bi 
omogočila bivanja doma do smrti zaradi neustrezno zgrajenih stanovanj in nezmožnosti zagotavljanja stalne 
navzočnosti negovalcev, kar smo upoštevali v projekcijah.
Razprava: Potrebne so naložbe v obnovo obstoječega stanovanjskega fonda ali izgradnjo oskrbovanih stanovanj 
oziroma varovanih stanovanj ali gospodinjskih skupnosti kot samostojnih enot v skupnostni oskrbi, zagotoviti 
pa je treba tudi več oskrbovalcev, torej povečati obseg izobraževanja in usposabljanja na tem področju. Dane 
so tudi usmeritve v iskanje ustreznih finančnih virov, predvsem v sklopu evropske iniciative pametnih ekovasi.
1 INTRODUCTION
1.1 Ageing and long-term care
The proportion of people aged over 80 years is forecasted 
to triple in the next 50 years, driving demand for more 
intensive long-term care (LTC) and housing solutions. 
This demographic development drives the growth of the 
health care and LTC expenditures, and puts pressure on 
LTC delivery. However, we consider demographic changes 
as new and exciting opportunities for rural residents 
and rural social entrepreneurship (1-4). The question is: 
“What would be the optimal construction dynamics of the 
assisted living facilities and the projection of staff needed 
for eldercare? What are the useful methods that can help 
develop optimal decision-making procedures at given 
constraints?” Due to their purchasing power, older adults 
in Europe constitute a potentially significant market of the 
silver economy (5). Knowing ageing dynamics is essential 
for the health and LTC sector, leisure industry and logistics, 
the housing market, and insurance industry (5-8). While 
it is assumed that people’s ageing may positively impact 
social science and technology, it is necessary to accurately 
study the economic potential of older people in rural 
areas. Moreover, educational innovations in LTC still pose 
a significant challenge (6-9). Globally, four basic types of 
housing for older adults are available: (a) for independent 
living, (b) for assisted living, (c) for memory care, and (d) 
nursing homes (in Slovenia, the homes for older adults—
DSO), also nursing hospitals (NH) as accommodation with 
better medical equipment and appropriately skilled nursing 
staff. These facilities can be organized (a) in a single 
building such as that in Slovenian cases of nursing homes 
(we shall use the acronym DSO for the Slovenian cases); (b) 
as campus-like continuous care retirement communities 
(CCRC), or (c) like continuous care of dispersed smaller 
units of independent and assisted living, with higher 
spatial standards or in cohabitation in a functional region 
as proposed in this paper, where the information and 
communication platform makes overcoming distances 
cheaper (3). There are three reasons for the third choice: 
(a) older adults prefer to stay as close as possible to their 
communities and relatives; (b) they wish to feel safe, and 
(c) modern digital technologies enable cheaper managing 
of such dispersed provision of care. 
Slovenia has developed an “Active Ageing Strategy” 
(10). The strategy’s fundamental goal is to live (a) 
active, (b) healthy, (c) independent and safe, and (d) in 
an intergenerational cohabitation, as stated in (10-14). 
Based on these documents and the initiative of the smart 
eco-social villages, as initiated by MEP Bogovič and MEP 
Szanyi in the European Parliament (15), as well as on the 
social farming and green care initiatives (16-20), we (a) 
studied discrepancies between the official documents 
and the wishes of the older adults explained in more 
than 500 interviews, from where we collected qualitative 
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and quantitative data, (b) calculated the demographic 
projections in the local action groups (LAGs—Slovenian 
LAS) as the non-profit-making composition made up of 
public and private organizations from rural municipalities, 
having a broad representation from different socio-
economic sectors in Eastern Slovenian region (21), and 
(c) developed a Multistate Transition Model (MTM) for 
the projections of required housing and human resources 
as an upgrade of the actuarial model (6). In the paper, 
implementation was considered in LAG as a non-profit 
group composed of local communities, like municipalities 
of a compact territory that manage LEADER projects in 
European rural areas (21). The composition of Slovenian 
LAGs is presented in Figure 1. Based on our surveys, the 
details of which are presented in (3), we realized that 
more than 60% of older adults in rural areas assume that 
they do not live in safe and accessible housing units and 
do not believe that they can receive care in their homes 
due to construction barriers and loneliness. They assume 
that they do not live in enough safe and accessible housing 
units and have no relatives nearby willing even to offer 
partial help. Additionally, up to 20 hours per week of care 
is not intensive enough to provide for their needs at home 
when their care category falls in level 2 or 3 of care (he 
details of this categorization can be seen in Article 24 
of Regulation (22)). However, they would like to receive 
care close to their social networks. Therefore, we need 
more smaller units also for institutional care or care in the 
community. Dispersed development of a larger number 
of smaller sheltered housing units and greenhouses 
(cohabitations) in a functional region of a LAS could offer 
more activities in the less populated areas. This provides 
greater independence and autonomy to older adults than 
living in a DSO and ensures higher security than a poorly 
adapted old family home.
Figure 1. Composition of Slovenian municipalities in 
LAGs we studied.
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In Section 3, we present the projections of housing 
needs, based on the actuarial methodology of healthy 
life projections (2, 6), where also the respondents’ wishes 
from our survey are considered. Additionally, projections 
of required human resources for LTC are calculated 
based on the constraints of norms and standards of care 
in DSO. Section 4 discusses the method that supports 
the decisions on optimal construction dynamics of some 
assisted living facilities and projects the staff needed for 
eldercare, hence complementing an education plan. From 
the general description of these procedures, we turn 
our attention to the quantitative methods suggested for 
Slovenian long-term planning in LTC (22, 23). 
2 METHODS
2.1 Multistate transition model 
We raised a question about the optimal construction 
dynamics of assisted living facilities and the projection of 
staff needed for eldercare. Therefore, we need: 
(a) to consider the projection of the number of older 
adults who would need an adapted housing because of 
their declined functional capacities;
(b) to study what kind of facilities they would prefer; 
(c) to find what is the expected intensity or structure of 
care needed for each cohort.
From these basic answers, we can develop the optimal 
construction dynamics and find other related needs of 
older adults. Our article is based on the MTM, developed 
further from (6), and considered in the spatial planning 
context (3). The impact of moving among different 
environments and intensity levels of care depends on the 
built environment, the culture and wishes, the health of 
the older adults and their functional capabilities, and 
their financial capacity. The living options are (a) to stay 
at their conventional home (FH: i=0), (b) to adapt their 
home/adapted family house (adFH: i=1), (c) independent 
living housing/sheltered housing (SH: i=2), or (d) housing 
units with care (HwC); HwC facilities could be made 
available in totally independent housing units, with 
all housing rights and outsourcing services, including 
healthcare OS (i=3), or in the green care, in the context 
of social farming, and other forms of cohabitation, which 
we named greenhouses GH (i=4). They could also move 
to a nursing home. In Slovenia, such a nursing home is a 
residential facility DSO (I=5). Then, they move to a health 
facility like a nursing hospital (Slovenian: “negovalne 
bolnišnice”- NH: i=6). Due to the reversibility, the multiple 
decrement model, as developed in (6), can be remodelled 
into the MTM. The last state (i=7) is to be dead.
We denote the initial state in the family home as state 0, 
and the probability of transitions from the environment 
representing the parent node i to the child node j of a 
transition graph at various ages by
where Mx
(i,j) is the number of residents that move from 
environment i to j, and Sx
(i) is the total number of residents 
who were previously living in i<j. The final allocation of 
residents by type of housing environment for each cohort 
(x) in the year τ is described in the matrix [2], modifying 
the model in (6). Vector Ex,τ represents the structure of 
various settings where residents in the cohort x years old 
live in the year τ.
The allocation of residents in the year τ+1 is given by
2.2 Methods of determining transition probabilities 
The empirical study of 38 municipalities, joined in five 
different LAGs: LAG Posavje, LAG Goričko, LAG Pri dobrih 
ljudeh, LAG Obsotelje and Kozjansko, and LAG Prlekija is 
presented in this article. We have conducted an inquiry 
among the institutions responsible for the care and two 
groups of interviews among those in institutional care 
and those whose functional capacities allow them to stay 
independent in a community. 
According to the population projections considering a “no 
migration” scenario (2), the share of the oldest layer of 
the population in Slovenia (80+), including in the Posavje 
region (3), is expected to triple in the next 30 years (see 
Figure 2a). For forecasting the expected number of LTC 
users of various housing options and services in the next 
30 years:
(a) we made an actuarial investigation on the age structure 
of inhabitants and their projected age structure;
[3]
[2]
[1]
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(b) from the history, we studied the structure of older 
adults who needed the care of first, second, third, and 
fourth category of care (unpublished sources of The 
Health Insurance Institute of Slovenia);
(c) after knowing the relative frequency of cohorts, 
with inhabitants being expected to be in one of the 
care categories, we have conducted interviews among 
the institutions. These institutions are responsible for 
care at the municipality level (38 representatives of 
municipalities, 38 representatives of centres for social 
work, and representatives of all institutional care 
facilities). We conducted two groups of interviews among 
those with housing in institutional care and those whose 
functional capacities allow them to stay independent in a 
community or are in a form of homecare. 
Because many older adults find it difficult to answer a 
survey in writing, based on the pre-prepared questionnaire 
as a form consisting of a series of written multiple-
choice questions, interviews were set up between the 
interviewer (nurse) and respondents. They answered 
the multiple-choice questions and explained their choice 
where necessary (semi-structured), which gave us better 
insight into these topics. The number of people who 
wanted to use one of the housing and care modalities 
was calculated. Probability as the relative number of 
inhabitants age x in each mode was calculated and used 
in the MTM.
3 RESULTS OF THE CASE STUDIES
3.1 The case study in the Posavje region
Due to the age of the interviewees, short interviews 
replaced previously planned surveys. Over 60% of the 
respondents (among over 500 older adults) believe that 
even a better homecare organization would not allow them 
to stay at home until death. 85% of them answered that 
due to inadequately built housing and the absence of a 
continuous presence of caregivers, they think that the best 
solution is to transfer to a DSO in lieu of better solution. 
Around 71% of those still living in the community will shift 
to a DSO only if they have difficulty overcoming vertical 
obstacles (stairs, elevators). Because of their desire to 
stay close to relatives, they would prefer community care 
in an assisted living housing or greenhouses that are less 
than 5 km from their family home. Such arrangements 
would provide opportunities for better intergenerational 
coexistence and allow them to be close to their dearest 
relatives and friends. Therefore, affordable housing 
arrangements in sheltered, assisted living housing and 
greenhouses of integrated care are the desired option of 
97% of residents in DSOs and 67% of older persons still 
living at home. From this, we can roughly conclude that 
more than 90% of those living in DSO in Slovenia, in care 
category I or II, and more than 60% of those still living at 
home would opt for community care arrangements in the 
Smart Silver Village (SSV) network when their functional 
capabilities fall below the category II threshold (p<0.001). 
Silver Village is assumed as a village where the built 
environment does not place physical barriers for older 
adults to socialize and communicate in space. Since such 
networks can be improved with new ICT solutions, we 
are talking about “smart” silver villages. The details are 
described in (3). Based on the population projections for 
these areas and the surveys mentioned above, the optimal 
dynamics of housing for older adults and required human 
resources are calculated for Posavje. 
Figure 2a shows the population projection for the 80+ 
cohort and the ratio between the active population and 
the 80+ cohort for the Posavje region (Figure 2b). The 
results in other LAGs are similar or worse.
Figure 2a. 
Figure 2b. 
Demographic projections for 2019–2070 of cohort 
80+ in the Posavje region.
The ratio between the active population and the 
population 80+ in the Posavje region.
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Table 1. The projection of LTC demand in five LAGs given today’s structure of housing and services based on the no-migration 
demographic projections.4
1At the same standard of number of nurses per population
2Note that demand is more than 50% higher than existing capacity today in nursing homes- NHs
3Waiting line in LAG Pri dobrih ljudeh and LAG Prlekija is registered in LAG Goričko
4The calculations by authors based on the European population projection 2018 data – no migration scenario.
5Estimate of demand by 2050 (number of persons) assuming the same structure of applicants: 1/4 of the care recipients in the cohort 
65-79 and 3/4 among the population 80+ (based on the no migration scenario)
3.2 Projections of needs in five LAGs
Projection results for the population and categorization 
of needed care provided the following forecast of needed 
capacities of LTC, based on the MTM, as presented 
in Table 5. The projections in Table 5 are made under 
the assumption that no new solutions for community 
care will be developed. Therefore, there is assumed 
home care proportionally to people who will need the 
care category I or II only and those who will have an 
accessible environment tailored to their needs and safety. 
Additionally, we assumed that they would have the 
financial resources to enter nursing hospitals and a DSO 
when needed or categorized into care III.
Based on the demographic projections for each LAG, 
the given structure of care categories in LAGs, and the 
interviews, the forecast of LTC demand is presented 
in Table 1 if new facilities for community care are not 
developed (4). A more in-depth study was later conducted 
in the Posavje region. Based on the no-migration scenario 
(Figure 1), surveys, and the MTM, the projections of the 
LTC demand in the case of Posavje was studied in detail, 
keeping in mind that this LAG has been prepared for the 
development of community care, especially to build GHs 
immediately; the expected expenditures for a GH of 24 
inhabitants are provided in Table 2. Based on this and 
the methodology of EUROSTAT, (already available in May 
2021), as improved in (2), Tables 3-6 were constructed. The 
assumption was that the structure of intensity of care from 
category I to III would stay the same as the structure of 
categories of care for residents of nursing homes in 2019.
3.3 Projected needs in the Posavje region
The rapid development of adequate housing and care 
capabilities is necessary to move some category I and II 
residents from a DSO to community care in Silver Villages 
and provide proper facilities for the most vulnerable older 
adults in waiting lines. 
Table 2 presents the expenses of the greenhouses for those 
included in the national insurance plans (ZN); they would 
cover the salaries of one nurse and two medical technicians 
in integrated care (morning/afternoon/night) at 24 homes. 
In this case, we assume only two social caregivers, needed 
in the morning and one in the afternoon, who are to be 
paid by the municipality and the users.
LAS Posavje 
 
Growth rate 2050/2019
LAS Goričko 2020 
 
Growth rate 2050/2019
LAS Obsotelje in Kozjansko 
 
Growth rate 2050/2019
LAS Pri dobrih ljudeh 2020 
 
Growth rate 2050/2019
LAS Prlekija 
 
Growth rate 2050/2019
2019 
2050 
2019 
2050 
2019 
2050 
2019 
2050 
2019 
2050
 
11.149 
9.210 
-17
6.053 
5.036 
-17
4.682 
3.873 
-17
4.097 
3.411 
-17
5.054 
4.187 
-17
48.958 
34.888 
-29
29.925 
19.387 
-35
20.333 
14.651 
-28
19.948 
13.115 
-34
23.855 
15.984 
-33
11.273 
14.019 
24
8.034 
8.893 
11
4.348 
5.907 
36
5.012 
5.937 
18
6.312 
7.034 
11
4.179 
10.066 
141
2.538 
6.376 
151
1.477 
4.151 
181
1.484 
4.144 
179
1.975 
5.059 
156
75.559 
68.184 
-10
46.550 
39.692 
-15
30.840 
28.582 
-7
30.541 
26.607 
-13
37.196 
32.264 
-13
34 
551 
23 
351 
12 
221 
13 
211
 
15 
231
317 
515 
62
156 
235 
51
115 
208 
81
64 
105 
64
68 
104 
53
1.398 
2.960 
112
9353 
2.0203 
116
419 
1.026 
145
323 
771 
139
813 
1.787 
120
Year
<15 15-64 65-79
Cohorts
80+ Sum
Patronage 
nurses  
employed
Included  
in 
homecare
Demand
In
 NH2,5
AG
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10% of housing units are assumed to be for married couples. 
This follows from the structure of our respondents in the 
5 LAG field surveys and interviews. The demanded and 
needed capacities forecasted in Tables 3-6 based on the 
MTM extended from (6).
Table 2.
Table 3.
Table 4.
Table 5.
Expenditure of municipalities and users in 24 housing 
units of greenhouse facilities.
Optimal construction dynamics of facilities in 
Posavje in terms of number of beds.
Projections of the structure of needs for providers in 
the Posavje region.
Notation
U-users
adFH-homecare
OS-sheltered-assisted living housing
GH-greenhouses and daily living-assisted living
DSO-Nursing home organised as today
NH-Nursing hospital for long-stay there 
Staff/user norms in healthcare and the required 
number of staff per user per unit for OS, GH, and NH.
*The calculated values are derived from the expected structure 
of categories of care as given in the studied LAGs. Source: ZZZS 
[18]
*According to the currently valid norms of homecare (see (3) 
and (22-23)). 
**Possible reduction also in the case of the category of care 
III with the partial help of relatives and volunteers. A high 
percentage of relatives and volunteers are willing to participate 
(3).
 *** We assume that all patients are members of the health 
insurance scheme. From the expected structure of care 
categories and norms in DSO, we summarize the minimum 
requirements: 1 nurse and two medical technicians, each in 
their 8-hour shift.
**** Well-organized integrated care with partial help from 
relatives and norms in the NH for health-insured patients:
a: morning; b: afternoon; c: night: a/b/c.
A*
B**
ZN***
Integrated care
2025
2030
2035
2040
2045
2050
Nursing technician
Senior physio-therapist
Graduate of senior nurse
B.Sc. Work therapist
Nurse-caregiver
Server
Specialist doctor
Total
2020
2025
2030
2035
2040
2045
2050
5/5/3
3/2/1 
1/1/1 
2/1/0+1/1/1
1964
2201
2466
2764
3099
3457
1.98
0.18
0.54
0.19
3.12
0.57
0.02
6.6
0.42
0.44
0.43
0.43
0.43
0.44
19.74
1.32
6.58
1.98
27.72
0
0.1
57.42
0.18
0.17
0.17
0.16
0.15
0.15
1.59
0.15
0.43
0.15
2.5
0.45
0.01
5.28
0.39
0.35
0.33
0.34
0.35
0.36
0.02
0.05
0.08
0.07
0.06
0.06
322
348
377
407
440
476
515
286
323
365
412
465
525
592
100
113
128
144
136
184
207
1046
1180
1332
1503
1696
1915
2161
735
830
936
1057
1193
1346
1519
697
787
888
1002
1131
1276
1441
457.6
176
0
88
36,608
14,080
0
7,040
25,626
9,856
0
4,928
Variants Year
Staff
Year
Number of 
employees 
per shift 
a/b/c****
U
In OS per 
30 users
Health care staff per facility
OS+GH
In DSO  
per 200 
users
adFH
In GH per 
24 users
Cat. I:II:III= 39%:14%:47%
DSO NH
Home-
care
Cat.I Community
OS+GH
Cat.II Nursing
home
DSO+NH
Cat.III
User 
monthly 
30% in  
€/month
Total
Without community care With community care
Municipality 70%
Yearly for 528 h/month 
at 16€/h in €/year
Nursing facilities
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According to some professionals working in the DSO 
of these LAGs, older adults in need of category I or 
II care would be better off living in community care. 
The construction dynamics also follow based on this 
opinion, as shown in Tables 3-6. Given the increase in 
the population aged 65+ cohort and 81+ even in higher 
dynamics, there will also be a significant increase in the 
need for nursing hospitals. Hence, Silver Villages should 
start with constructing LTC facilities for community care 
as soon as possible. In addition, the state should provide 
an extension of capacities of DSOs and nursing hospitals at 
least in the next five years. In line with the demographic 
trends, it is generally necessary to ensure that the health 
system has adequate capacity to maintain its current level 
of services and that standards must be aligned with the 
changing age structure.
As given in Subchapter 3.1, more than 60% of the 
respondents in Slovenian rural areas claim that even a 
better organization of homecare would not allow them to 
stay at home until death due to inadequately built housing. 
They are missing a more prolonged presence of caregivers; 
therefore, only a relative increase in caregivers will not 
adequately cover the needs. Moreover, due to the large 
dispersion of older people’s homes in rural areas, this 
problem is even more pressing than home care in cities. 
Therefore, based on the MTM, we propose building with 
higher dynamics of DSO and NH capacities, as presented 
in Table 6. In such a rapidly ageing population, questions 
arise regarding the standard of care provided by the 
national insurance schemes and what would be considered 
above that standard. For investments, the public sources 
available are European and national, with more significant 
support from the European Investment Bank, the European 
Social Fund, and the European Regional Development Fund. 
The development of innovative financial products and 
social entrepreneurship programs is of great importance.
Table 6. The construction dynamics of the assisted living units and the projection of staff needed in the Posavje region.
* Limit is 30 apartments with one or two beds. We consider that in each group, there are at least 10% of those with two beds (married 
couples)
**Article 8 of PRAV10060 stipulates that the maximum possible number of care recipients in one unit is 24.
***Max. for 20 hours weekly/U
4 DISCUSSION 
We attempted to answer questions regarding the proper 
methods that can help in developing optimal decision-
making procedures in Slovenia at given constraints, 
considering (a) how to approach the organization of SSV, 
(b) how to organize the financial sources to reduce the 
waiting lines of the older adults for the LTC, and (c) how 
to find jobs for younger cohorts in the villages, attracting 
them to stay in rural areas. A network of SSVs as nodes 
of facilities for older adults who need LTC services 
is considered. It is assumed to be a platform for the 
effective use of social resources to raise the quality of life, 
which would be a part of the modern silver economy (5). 
There are possibilities to organize and structure financial 
resources available from (a) European Structural and 
Investments (ESI) funds, (b) national and local resources, 
and (c) contributions of older people and their families in 
LTC, in public-private partnerships, identifying challenges 
and constraints (3). We highlighted the following question, 
given in the introduction: “What would be the optimal 
construction dynamics of the assisted living facilities and 
the projection of staff needed for eldercare? What are the 
useful methods that can help develop optimal decision-
making procedures at given constraints?” These would be 
essential questions in the European silver economy. The 
European initiative of the silver economy (5) and the smart 
eco-social villages (18, 24-27) supports the idea of faster 
development of ambient assisted living technologies. 
These results can be ingredients of an innovative platform 
of the SSVs, ensuring that the increased needs of the older 
adults for safety, comfort, and environmentally friendly 
living is met easily, even though the dynamics of ageing 
is high. The technologies of SSVs will ensure that the 
members stay well connected and served by the health 
and social caregivers. The greenhouses would allow them 
2025
2030
2035
2040
2045
2050
348
377
407
440
476
515
103
121
132
149
168
190
202
236
259
292
330
372
76.7
82.9
89.4
96.9
104.8
113.3
22.7
26.6
29
32.8
37
41.8
44.4
51.9
57
64.2
72.6
81.8
188
204
220
238
257
278
25.8
30.3
33
37.3
42
47.5
5
5
6
7
7
8
99
115.6
126.9
143.1
161.7
182.3
7
8
8
9
10
12
Year
U UU
Homecare: Number of users 
(U), The health care staffs 
(HS) and primary + social 
care (P+SC) staff
Number of users (U),
the health care staffs (HS) 
and primary + social care 
(P+SC) staff in GH
Max no. of 
studios in 
GH is 24
Number of users (U),
The health care staffs (HS) 
and primary + social care 
(P+SC) staff in OS
Max no. of 
flats in OS 
is 30
HC HCHCP+SC***
0.54/U
P+SC***
0.54/U
No. of GH**P+SC***
0.59/U
No. of OS*
to remain dispersed in small villages and hamlets, with 
travel costs of caregivers reduced. European Smart Village 
development strategy highlights the issue of innovative 
approaches to optimal utilization of resources. The plan 
articulates that the ‘Green Care’ initiative should be 
included in the programs as a range of activities “that 
promotes physical and mental health and well-being 
through contact with nature” (24-28). Greenhouses could 
be a part of this mission. Therefore, based on the MTM, 
we propose to build DSO and NH capacities with higher 
dynamics, as presented in Table 6. At least for those in 
category III b of care, DSO and NH should be available, 
which would provide the opportunity to stay there longer 
than three months. Posavje needs 30 beds now in NH 
under the constraint that no one can stay there more 
than three months. If this restriction no longer existed 
and those of category III b stayed there as long as needed 
because this kind of care will keep gradually rising until 
2050, at least up to 200 beds will need to be provided in 
the next 30 years (the optimum would be 308 beds, but a 
third of them from DSO could still return to DSO if it were 
adequately adopted, but for those from home care and 
community care, staying in nursing hospital is the primary 
option). According to the demographic projection of 
population ageing at the unchanged longevity of healthy 
living by age cohorts, the projections follow from the 
categorization of care needs to be given in (22-23).
Construction of SSVs as an ICT-supported network of 
dispersed housing and other LTC facilities would retain 
the older adults in such villages and provide jobs to 
younger cohorts in the housing construction industry, 
facilities management, transportation, logistics services, 
and, especially, in the core LTC activities. Young people 
who wish to stay in the countryside could contribute to 
landscape conservation and the rapid population decline. 
The number of needed employees will rise to more than 
800 people in the next 30 years only in the core social 
care sector, in the Posavje region. The number of persons 
in healthcare will also grow at least up to 400 employees. 
In the integrated arrangements, there will be a need 
for additional training and education and specialization 
programs. Additionally, younger respondents of our survey 
have shown great willingness to engage in such cooperation 
for free, provided that they are equally catered for when 
they need such assistance in the future; in this case, at 
least a short training module should be provided. 
Consequently, all these projections show the requirement 
for more intensive educational and training programs for 
social, nursing, and integrated care. According to our 
survey of other LAGs, most municipalities in the LAGs 
under consideration do not implement an active land 
policy to follow the national housing program needed to 
achieve the housing stock as projected. Spatial planners 
have rarely placed LTC facilities in long-term plans of 
municipalities. Because they have missed the spatial plans 
for LTC facilities, municipalities cannot apply today for 
funding from accessible public funds, such as the National 
Housing Fund and other resources.
5 CONCLUSION AND FURTHER DIRECTIONS OF 
ACTIVITIES
We presented how the Multistate Transition Model, 
as developed here, helps us forecast the structure of 
population dynamics and the required capacities of 
housing and human resources for LTC. Because of the 
ageing population, as also presented for the Posavje 
region, which is among the youngest, the ratio between 
active population and population aged 80+ will fall from 
12 to 3 in the next 40 years. In such a rapidly ageing 
population, questions arise regarding the standard of care 
provided by the national insurance schemes and what 
would be considered above that standard. When setting 
up LTC systems in the Slovenian countryside, we must 
include the decisions in LTC insurance schemes. 
In this context, programs for the development and 
operation of supply networks and integrated social and 
health infrastructures can be financed from various public 
and private sources. The public sources available are 
European and national. The development of innovative 
financial products and social entrepreneurship programs 
is of great importance. 
The LAGs should develop appropriate rural development 
programs; additionally, adequate education programs for 
such development should be designed. 
These activities can be financed substantially by the 
European Social Fund, the European Fund for Regional 
Development, the European Cohesion Fund, and the 
European Agricultural Fund for Rural Development. These 
financial flows combined from pension and the health 
insurance sources may revitalize the rural areas and 
provide jobs for young cohorts who will be engaged in 
providing these services. 
It is necessary to engage citizens in community-led local 
development actions as soon as possible. The LAGs should 
support them to co-create SSVs with the integrated 
provision of eldercare services. They should learn how 
judiciously utilize financial resources from the ESI funds 
and European Investment Bank. As stated before (24-
27), “social policy should encourage the development 
of formal services in rural areas and elaborate policy 
measures for informal caregivers,” also in greenhouses, 
which can be a more effective and efficient organization 
of LTC, as already shown by Hlebec et al. (28).
10.2478/sjph-2021-0036 Zdr Varst. 2021;60(4):269-277
276
CONFLICT OF INTEREST
The authors declare that no conflict of interest exists.
FUNDING
The theoretical study was financed by the Slovenian 
Research Agency research project J6―9396: Development 
of social infrastructure and services for community based 
long-term care, while the implementation of these results 
was partly financed by the European Agricultural Fund for 
Rural Development.
ETHICAL APPROVAL
The principle of informed consent to participate was 
applied. In addition, ethical principles have been verified 
by the internal commission.
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