Introduction: politicising and gendering the long-term care regulation

In Slovenia, care for older people entered the policy agenda and public discussion as a salient political topic relatively late, only in the first decade of the new millennium, when the ageing of the population started to show its effect on the care deficit, labour market, and public budget. The state is now rushing to find policy solutions for the care of older people, primarily within the long-term care (hereafter LTC) system. Indeed, it was through the policy regulation of the LTC system that care for older people, including its gendered consequences, has been transformed into a political problem and become the subject of political party programmes, election campaigns, and the topic of political struggles over the design of regulation. Although LTC is a broader concept, as it addresses all persons aged 18+ who are dependent on the help of others because of illness, frailty, injury, disability, and lack or loss of intellectual capacity, it has become synonymous with care for older people in policy debates.

Political pressure from international organisations, in particular the European Commission and the OECD, who estimated that Slovenia is poorly prepared for ageing, has raised the political profile of older people’s care as an issue of the LTC regulation, too. The OECD estimated that “long-term care spending covers 11.5% of the older population, well below perceived needs. The supply of long-term care is fragmented, with different legislation and eligibility criteria” (OECD, 2020: 5–6).

The LTC system has also been the subject of vibrant politicising in civil society in the last decade. Employers’ organisations, trade unions, and the Union of Pensioners’ Associations of Slovenia organised several public discussions on LTC’s systemic financing and type of service provision. NGOs such as Amnesty International Slovenia and the Silver Thread Association – an association for a dignified old age – warned of the dangers of the mixed economy, privatisation, and limited access to services. Evidence about introducing the social work approach and innovation in the medicalised model of care homes for older people was provided by academia (Flaker et al., 2008; Mali et al., 2018; Mali, 2019). The Association of Social Institutions highlighted poor working conditions. Care workers’ trade unions struggled with the government regarding the improvement of normative standards in care work (Hrženjak, 2017, 2019).

The general belief within policy-making in Slovenia that gender equality has already been achieved, which is supposed to be evident from a high share of women’s full-time employment and the comprehensive public network of childcare, has for a long time made the gender effects of LTC polices (or their absence) irrelevant for policy-makers. However, this has changed, at least on the rhetorical level, in the last decade of intense public debate. In 2018, Women’s Lobby Slovenia founded the Long-Term Care Coalition, an alliance of civil society organisations, including trade unions. In addition to advocating for an urgent adoption of an LTC Act that establishes care as a universal right provided by public services, the Coalition has drawn the attention of policy-makers and media to the gender impact of LTC regulation. With these messages, the Coalition engaged in the 2018 election campaign, publicly commented on the LTC Act drafts, communicated their views to relevant ministries and media, etc. The last two LTC Act drafts, including the adopted one, explicitly addressed the impact of LTC regulation on the situation of women as constituting the majority of informal and formal caregivers in the Act’s preliminary assessment, yet, as we argue, this was not done in the design of the policy measures.

The LTC Act, which has been under preparation since 2002, was shaped by different governmental coalitions and different actors, most notably by the Ministry of Labour, Family, Social Affairs and Equal Opportunities (MoLFSA), and the Ministry of Health. A decisive push that made the right-wing government finally adopt the LTC Act in 2021 was the COVID-19 pandemic and the related European Union Recovery and Resilience Plan. The European Commission has conditioned the use of grants for post-pandemic recovery on the adoption of the LTC Act (Zakon o dolgotrajni oskrbi, 2021).

In this chapter, we focus on the analysis of the implications of three core care services, i.e. institutional care, family carer, and cash benefit, offered to older people by the LTC Act as the outcome of long political struggles. We reflect on them through three key concepts, i.e. (de)familisation, (de)institutionalisation, and public provision. The LTC Act’s preliminaries emphasise deinstitutionalisation as an important principle of care of older people, which stresses their right to live at home for as long as possible. The gendering of care is recognised by the principle of defamilisation and the provision of universal, formal, public care services to prevent burdening women with informal care as a necessary condition for their integration into the labour market and gender equality. The Act’s preliminaries also pay attention to market anomalies in care work, such as precarious work and the grey economy. In this way, the Act’s preliminaries explicitly emphasise the responsibility of the state over the responsibility of the family and the market in the provision of care and the importance of social care innovation in care homes for older people with the aim to support deinstitutionalisation. Our aim is to critically discuss inherent controversies and contradictions of the LTC Act’s specific policy solutions for strengthening the public network, deinstitutionalisation, and defamilisation in care for older people, which are established as the guiding principles of the modern organisation of care for older people in the Act’s preliminary assessment.

Our discussion is based on an analysis of the adopted LTC Act and its previous versions, as well as on the related national and international policy documents, reports, and current research. The authors have also been actively engaged in public discussion over the different versions of the LTC Act drafts and have argued against privatisation, for social innovation, and for considering the gender impact of the concrete policy solutions for care of older people within the framework of the LTC system regulation.

First, we briefly outline the historical and contextual features of the Slovenian regime of care of older people and how the LTC Act intervenes. In what follows, we analyse the three main care services as designed in the new Act in such a way that we first discuss the relevant concept for the analysis of a particular service and then reflect on the concrete service arrangements. We analyse the institutional service through the concept of deinstitutionalisation, the family carer service through the concept of defamilisation, and the cash benefit through the concept of cash-for-care. In the conclusion, we point to potentially controversial effects of the design of these three policy measures for the principles of deinstitutionalisation, defamilisation, and public services.

Contextualisation of care for older people in Slovenia

As in most Eastern European countries and despite the normatively public and universalistic principles, the Slovenian regime of care for older people can be, in practice, described as familialist by default (Gábriel, 2022), in which the state provides low financial support for care and does not offer a wide variety of publicly available services. With the motive of ‘free choice and plurality’ of services, and because the state estimated that it could not cover the growing needs through the public network, a mixed economy of care provision was introduced in 2000 without extensive public discussion (Hrženjak, 2019).

In contrast with the comprehensive public childcare system, in Yugoslav socialism, care for older people complied much more with the traditional pattern of intergenerational solidarity within the family, which was complemented by institutional care based on the social-gerontological model provided by the state (Mali, 2008). When the burden of care becomes severe, the families turn to residential services, which provide institutional care for 4.5% of older people (Community of Social Institutions of Slovenia, 2021a). While in the last decade the health profile and dependency of residents has worsened, demanding more intensive care, the standards regarding the number and skills of care workers have remained unchanged over the past 30 years. This accelerates high work intensity and poor working conditions, which, accompanied by low pay, contribute to staff shortages (Hrženjak, 2017).

After the disintegration of Yugoslavia and at the beginning of the transition from socialism to capitalism, in the 1990s, home-based care services were launched as a form of public work, due to the high unemployment rate among women caused by the transitional restructuring of the economy. In 2000, the service was professionalised and subsidised by the municipalities, but its expansion remained limited, relatively expensive,¹ and regionally uneven (Hlebec et al., 2014a, 2014b). In 2019 only 1.8% of seniors aged 65+ received this service (Kovač et al., 2019), while the EU average was already between 8 and 12% in 2010 (Bettio et al., 2010).

The bulk of informal care is placed on women, but due to a dual-breadwinner family model, family care is not sustainable. Families are pushed to organise home-based care as a ‘care puzzle’ (Widding Isaksen and Näre, 2019) in which care is provided by a diversity of actors that can change over time, and in which care is constituted by parts that can fit well or less well together. Members of the extended family, mostly women, alternate in care provision. Public homes for older people and social work centres provide home delivery of food, transport services, and socialising in day centres. The informal care market is flourishing, where primarily local early-retired women, but also migrant women from former Yugoslav countries, mostly from Bosnia and Herzegovina and Serbia, offer casual services of cleaning and respite care (Hrženjak, 2019).

One of the salient problems in the existing system of care for older people is that while seniors are the most vulnerable group for living under the poverty threshold in Slovenia (Leskošek, 2019), the LTC insurance is not yet in place and care costs put a huge strain on the family budget as well as on the service providers. The Act was intended to finally introduce LTC insurance and regulate care provision in a comprehensive and systematic way. However, the adopted Act has postponed a regulation of systemic financing to 2025 and to a future government, which was a major disappointment and the most important reason why it was strongly criticised by all stakeholders. In addition, the Association of Social Institutions of Slovenia (representing the views of 86 out of 102 care homes), the Social Chamber of Slovenia, the Union of Pensioners’ Associations of Slovenia, and many other civil society organisations publicly declared that they do not support the LTC Act due to its “many shortcomings, ambiguities and because it does not bring better and more accessible services to users” (Community of Social Institutions of Slovenia, 2021b).

The Act was due to enter into force in 2023 and to be fully in force in 2024. However, in the meantime, elections and a change of government took place. The new left-wing government has postponed its implementation, arguing that it was flawed. It announced a revision of the Act and sustainable financing based on progressive property taxation and other budgetary resources. It promises to increase funding for the expansion of the public network of home-based care services and care homes for older people as well as periodic independent assessment of the quality of life in care homes for older people. In parallel, a modernised system of professional social and community care services is foreseen as well as the promotion of the use of ICT to make care more efficient and help older people to live independently (Government of the Republic of Slovenia, 2022). While the previous right-wing government is calling for a referendum to prevent the postponement of the LTC Act’s implementation, the majority of citizens support it. The regulation of care for older people remains an open space for political struggles. However, criticisms about the lack of regulation regarding the financing of LTC and general criticisms about the Act’s vagueness have overshadowed more specific reflections on the potential dilemmas raised by the concrete measures that the law brings.

Controversial policy solutions

In its preliminaries, the Act recognises that too much emphasis placed on institutional and family care is a problem in the current system, and promises deinstitutionalisation, defamilisation, and a comprehensive public network of formal service provision.

To reduce familisation and institutionalisation and strengthen the public network of care services, the LTC Act offers publicly co-financed care services of institutional or home-based care, family carers, and cash-for-care benefit, which are mutually exclusive, i.e. the user may choose only one and cannot combine them. In the following, we discuss the proposed policy solutions in terms of their controversial potentials for strengthening the public network, deinstitutionalisation, and defamilisation in care for older people.²

Backlashes in institutional care

One of the reasons for the emergence of LTC is the process of deinstitutionalisation – that is, the closure of large institutions and the restructuring of their services into different community-based services, which has fundamentally changed the way care is delivered (Flaker et al., 2008; Leichsenring et al., 2013; Rafaelič, 2015; Flaker and Ramon, 2016). This has changed the long-established models of care provision and focused attention on people’s right to live outside of institutions, within a community, and their right to make independent decisions about their lives.³ The paradigm of care has also changed accordingly – the focus is now on the person and their needs, and assistance is considered effective when it meets a person’s needs according to their expectations and levels of distress.

Institutional care remains an integral part of LTC under the new Act. In 2008, Slovenia reached the target of 5% of people aged 65+ in institutional care (Community of Social Institutions of Slovenia, 2021a). The highest share of people aged 65+ in institutional care was in 2012 (5.2%), but today this share has decreased to less than 4.5% because of the increase in the number of older people, especially those aged 80+, who are potential users of institutional care. Their number has increased by 72% in the last decade (Mervic et al., 2021).

Homes for older people are part of both the public and private sectors, but are absent from the non-governmental sector. The number of homes has doubled in 20 years, and in the private sector their number has been increasing rapidly since 2008 (see Table 6.1). There are inequalities in access to institutional care between small rural and larger urban municipalities (Hlebec and Mali, 2013: 375; Community of Social Institutions of Slovenia, 2022). The LTC Act encourages the trend of increasing the private sector witnessed over the last 16 years. In this way, the state has reduced geographic distances and increased the geographic coverage of homes. However, financial barriers to accessing institutional care have increased, as care in private homes is more expensive. Since 2008, co-payment for institutional care by municipalities and family has been increasing (Mervic et al., 2021: 229). Until the adoption of the new LTC Act, private homes were bound to provide institutional care according to the same rules and standards as public homes (Hlebec and Mali, 2013). The new Act, however, does not explicitly define such a similarity between the content and type of services.

The LTC Act does not significantly change access to institutional care. What has changed is the possibility for municipalities to establish homes by strengthening the presence of the private sector. According to the Slovenian Institute of Health Insurance (2022), by the beginning of 2023, the capacity of institutional care would increase by 1,129 places, all in the private sector and owned by an Austrian private company.⁴ However, for users, this does not mean an improvement in accessibility of services. Financial barriers to accessing institutional care have increased in past years as private care is more expensive, and this trend will continue in the future as the poverty rate among older people increases (Mervic et al., 2021: 229). An additional problem is that in the last three years interest in working in homes has decreased because of bad working conditions. Over one-half of job announcements did not receive a single application in 2019. Due to staff shortages, some homes are not accepting new residents despite vacancies. Some workers leave the care sector entirely; however, many seek better-paid jobs in neighbouring Italy and Austria where home-based care is supported by the state with generous cash-for-care benefits. Homes strive to fill the care deficit with migrant care workers from former Yugoslavia countries, where the pool of available care jobs is limited and the working conditions even worse (Hrženjak and Breznik, forthcoming).

The concept of Slovenian homes for older people has taken the form of medical hospitals since the 1990s, visible in the employment of mainly medical staff. However, since 2005, homes have been systemically integrated into the social care system, and most homes have begun to introduce elements of social orientation with a special role for social work. They employ social workers too, but only one social worker per 150 residents. The emphasis in social orientation is on an individualised approach to the person, the development of individualised care plans, and the development of opportunities for equal collaboration between health and social care given the importance of the concept of long-term care. For institutional care, this approach opens up the possibility of working more flexibly with residents, developing services tailored to users’ needs, and beginning the process of deinstitutionalisation (Mali, 2008).

Social orientation in homes has been at the forefront of the integrated development of care for older people in the community, including those still living at home. Homes not only provide institutional care in the narrow sense (residential and institutional care), but also support older people in their home environment and in the community by organising day-care, home-based care services, social services, assisted living, respite care, etc. Mali et al. (2018) note that homes are implementing a number of innovations in LTC that have the character of a paradigm shift in care, as the focus is on exploring the needs of users and finding the type of support that effectively meets their needs.

The social orientation of the homes was shaken by the COVID-19 pandemic. Mali and Penič (2022) note that social work strengthened its autonomy in some homes and developed new practices and areas of work, while its role was not recognised in other homes, which created many ethical dilemmas for social work. In the crisis situation, social work in some homes, especially those with a paradigm of social orientation (Mali, 2010), proved to be able to react quickly and act efficiently, for the benefit of the residents.

However, the LTC Act does not encourage social orientation and the development of an innovative approach to homes. Instead, it introduces the transformation of existing social care homes into ‘nursing homes’, whose operation is not precisely defined. The Act only stipulates that they must devote at least 80% of their capacity to the care of the neediest users and that they may carry out curative health activities (LTC Act, 2021: Art. 58, fourth paragraph). The Act introduces another type of home, the care home. These are smaller homes where care like that in assisted living facilities is provided; however, the question is whether social workers will be allowed to work in these homes. Given the current norm of one social worker per 150 residents, it is highly probable that the legislature will not provide for social workers in these homes, nor will it provide for a social care model.

It can be concluded that the LTC Act promotes the medical model of nursing homes and ignores the specificity of social orientation and the development of community forms of care in which social work has its place. This makes the role of social workers in the homes unclear. From the perspective of supporting deinstitutionalisation and developing innovation in care for older people, the LTC Act’s regulation of homes represents a backlash for innovative, community-based and social forms of care, as it has been the profession of social work that has initiated most of the innovations so far (Mali et al., 2018).

Cash-for-care benefit: towards a marketisation of care

Although the LTC Act defines care for older people as a public concern, to be guided by the principle of universality, what is important is not only the extent to which the state takes over the responsibility for care, but also the form in which it carries out its responsibility. Meagher and Szebehely (2013) showed that the neoliberal restructuring of the universalistic welfare state involves processes of marketisation, i.e. a turn towards markets as the source of welfare instead of the state. They argue that these processes typically involve the implementation of cash-for-care models in the public care system.

Studies observe many controversial effects of the cash-for-care policy mechanism (Ungerson and Yeandle, 2007). Depending on how cash payments are regulated, they can have different effects on the formal–informal division of care and on its (de)familisation (Macdonald, 2021). The rules range from cash benefits paid to the user with no control over whether the money is spent on care services at all (Austria, Czech Republic, Germany, Italy), to the market or family carer signing a formal employment contract with either the user (France and the Netherlands) or with the municipality (Sweden) (Da Roit and Le Bihan, 2010; Da Roit, 2010).

Although it is recognised that, overall, the emphasis of cash-for-care benefit reinforces family obligations to provide care, when strictly regulated, the use of cash benefits may encourage a formal care market and the complementary use of formal care services. On the other hand, research shows that favouring unregulated cash-for-care benefit promotes the development of a particular form of home-based, often 24/7, low-paid, precarious, and commodified care accessed privately through informal care markets, including migrant care work (Williams, 2011; Van Hooren, 2014). Alternatively, unregulated cash-for-care benefit which permits payment of relatives may also create ‘incentive traps’, where family carers, often women, are encouraged to take over care work (León, 2014). In both cases, cash-for-care enlarges the pool of care labour at very low cost, because it enables the state to reduce the employment and organisational costs by shifting them to the users or their families. Hybridisation of work and care, as well as deprofessionalisation, are two further controversies, as distinctions between formal and informal, paid and unpaid, skilled and unskilled care are becoming increasingly blurred in cash-for-care schemes (Macdonald, 2021).

Like in most Eastern European countries, cash-for-care benefit is a novelty in the Slovenian system of care for older people and contains all the above-mentioned controversies. The LTC Act does not specify how the cash-for-care benefit is to be used, but only provides for monitoring its use with periodic visits by the LTC coordinator (LTC Act, 2021: Art. 43 and 66). However, monitoring is intended only to check the adequacy of care, while it does not involve the protection of care workers who provide care through the social security systems and employment law. The cash benefit can be used to pay a family member, or to buy services on the grey or formal market, or not be used at all if unpaid care can be obtained. Such regulation sets the conditions for the informalisation and familisation of care, or, alternatively, the precarisation of care in the irregular market.

The Slovenian cash benefit is also controversial from the perspective of the principle of equality laid down in the Act stipulating equal access and quality of services for equal needs. Namely, its value is only 38% of the value of in-kind public and formal home-based or residential care services (compared to, for example, Germany, where cash benefit reaches approximately 70% of in-kind services (Zigante, 2018)). On the one hand, the legislator claims that the Act eliminates inequalities in care between diverse care arrangements and makes it possible for those who want to stay at home to do so. On the other hand, it explicitly allocates less resources to those who prefer home-based private care arrangements. The low value of cash benefit indicates a devaluation of care work provided within the privacy of the family domain and stimulates its use to purchase cheap services in the irregular market, where care workers compensate with their precarity for the low price of services compared to formal markets or public services.

While one might guess that the intention of the legislator in setting up the low value of cash benefit is to discourage its use and encourage instead the take-up of formal, public, in-kind services, Article 34 raises doubts about this. Article 34 stipulates that even if a user chooses formal home-based or residential care services, but they are not available in the public network, a cash benefit shall be granted as compensation. In the context of the existing shortage of public services and the state’s vague commitments to expanding the public network, this lays the ground for transforming cash benefit from a ‘free choice’ into a ‘forced choice’. There is a risk that a large share of users will have no other option than to settle for a low cash benefit and organise the needed care privately, either within the family or on the (grey) market, due to the lack of public services. In this way, the state in effect establishes a legal basis for not expanding the existing public network despite increasing demand. Given the low value of cash benefit compared to co-financing formal home-based or residential services in the public network, this could indeed provide for cost containment in LTC. The key danger of the cash-for-care benefit mechanism as set out in the Act is that it effectively opens the door to informal, low-paid, family, or (grey) market care, expansion of precarious forms of care work, pressure to lower wages, and the deprofessionalisation and informalisation of care work. Given that informal and formal care work is feminised, it will be mostly women who will bear the effects of these potentially negative developments.

Family carer: towards the familisation of care

The concept of defamilisation reveals the contradictions of the service of family carer as regulated in the LTC Act. The concept closely relates to the welfare state, specifically to the care regime established in a particular cultural and social framework according to historically constructed gender order (Connell, 1987). It is used as an analytical tool to study social policies, more specifically the arrangements of care in the context of relations between state, market, and the family (Hobson et al., 2002; Bettio and Plantenga, 2004). These relations are built on an ideological assumption of what care is, how it should be organised, and who should manage it (Sevenhuijsen, 1998). Despite the change in employment patterns towards greater involvement of women in paid work, equality policies, and the involvement of men in caring responsibilities in Europe, there is a growing tendency for current care regimes to be based on women’s unpaid or paid but precarious work (Hrženjak, 2010; Daly 2001). This points to re-familisation policies that are based on the expectation that women will respect the traditional caring roles assigned to them in the past, which reinforces gender inequalities (Rune et al., 2015). The family carer can also be understood in the context of the right to care, but we argue that in Slovenia the intention was merely the reduction of state responsibilities and costs for care.

Domestication policies (Allen, 2012) are a response to the care deficit that began to emerge in Slovenia in the late 1990s and early 2000s. The lack of space in homes for older people, combined with a weak network of home-based care or other more innovative forms of care, has led to the idea that the family should take on the bulk of care, with the state stepping in only when the family cannot, for legitimate reasons, shoulder the burden. The most visible measure of this policy was the introduction of the service of the family assistant, which was enacted through disability care in 2004 by the Social Assistance Act (hereafter SAA). In the adopted LTC Act this service was expanded under the modified name family carer to also include care for older people (LTC Act, 2021: Art. 19 to 30).

The service of family assistant was primarily intended for persons with disabilities who believe that institutions cannot offer adequate intimacy, individuality, solidarity, homeliness, and conviviality (OHCHR, 2022). The family assistant was a service provided by a family member or other person that permanently resided with a disabled person. A person can become a family assistant if she/he has left employment with the intention of becoming a carer or is a part-time employed person for the same purpose (Act Amending the Social Assistance Act, 39/2016). The service is paid primarily by the municipality as partial payment for lost income, and amounts to below the minimum wage (751.77 euros per month in 2022, that is around 522 euros net per month (MoLFSA, 2022a)), but family members, including the disabled person, must remunerate the costs according to their income or property ownership (MoLFSA, 2022b). The family assistant must contribute to the adequate care or appropriate satisfaction of the needs of the person with disability by carrying out the tasks of personal care, medical care, social care, and domestic help (European Commission, 2021).

The SAA is gender-neutral, which is in line with the declared gender equality legislation in Slovenia. But in practice, in 2016 there were 166 male and 711 female family assistants (Leskošek, 2016). Their number has declined in recent years, with only 429 family assistants in 2022 (MoLFSA, 2022a), not least because of the precarity of the status. The most obvious effect of the family assistant status is the impoverishment resulting from low income, which is further reduced because family assistants cover the costs of the person they care for, such as transport, additional physiotherapy, medical devices, special diets, and leisure activities. Family assistants are also likely to experience poverty in old age because they will receive a low pension. The exclusion from the paid labour market is a measure of female domestication and the most obvious reflection of familisation policies. It is also irrational in the context in which the employment of both partners is important for the survival of families (Leskošek, 2016).

The service of family assistant was problematised in academia and in public discussion based on an empirical study that pointed to the multiple precarisation of family assistants (Leskošek, 2016). The study showed that due to being poorly paid, the status often leads to the pauperisation of the carer. Due to exemption from labour rights, such as paid leave, sick leave, and defined working time, the status often results in work overload and social isolation. The study pointed to its gendered and class controversy too, as mainly low-income women exit the labour market and take over the status of family carer (Leskošek, 2016; Hrženjak, 2017). Despite that, in the new LTC Act, the service of family assistant has been extended to the care of older people under the amended name of family carer. Some positive developments can be noted. The partial payment for lost income will increase to 1.2 times the minimum wage, which will be paid from the newly introduced compulsory LTC insurance. An annual leave of 21 days is guaranteed, during which the care recipient is provided with institutional care. Under the LTC Act, the family carer is also entitled to unemployment insurance benefits in case of lost status.

However, a close reading of the Act also shows several controversies. The Act stipulates that only persons in categories 4 and 5 of LTC beneficiaries, i.e. those who are no longer able to care for themselves and are totally dependent on the care of others, have the right to a family carer (LTC Act, 2021: Art. 12). This provision seems irrational, as care for the most dependent care receivers is physically and mentally exhausting for carers, and it also demands professional skills. Family carers will have to attend 30 hours of training, and 20 hours of refresher training every five years, and the process of their professionalisation should be supervised by the coordinator of the long-term care who is also in charge of making the care plan. Family assistants will also have to keep a care diary recording all daily services, observed changes, and peculiarities in care and the way in which they manage them. This can be seen as a quasi-professionalisation reinforced by the Act as well as an additional bureaucratic burden for carers. The basic intention of the legislator is to merge or meliorate the family care with institutional rules and institutional standards and norms, as this is needed to justify public spending. All public spending has to be controlled and objectified to be seen as just and rational.

We can conclude that the service of family carer enables cost containment because it is much cheaper than the potential cost of care for the most dependent in formal care settings. Family carers are thus becoming part of the market of services and are normalised in the system because they are proving to be the most cost-effective version of care. The care provided by the family is institutionalised with the new LTC Act and becomes part of a system which is increasingly marketed and monetised. What matters is cost-effectiveness regardless of gender equality and personal consequences for carers themselves.

Conclusion

In this chapter, we have shown how care for older people has been politicised and gendered within the framework of 20-year-long processes of policy regulation of LTC in Slovenia. Gendered consequences of policies for the care of older people are closely linked to the issues of deinstitutionalisation, defamilisation, formal/informal care, public/private provision, provision of services/cash benefits, and working conditions in care. We point out that the legislator recognises these connections at the level of the Act’s preliminary assessment; however, it does not translate this recognition into concrete policy measures. Moreover, the LTC Act formulates concrete policy solutions in a way that is controversial in relation to the principles of deinstitutionalisation, defamilisation, and the establishment of a formal, public network of services and, at the same time, raises several new dilemmas.

Concerning deinstitutionalisation, we argue that the Act does not promote innovative forms of care that homes for older people have used in the past to demonstrate the potential for the development of community-based LTC. The LCT Act itself does not contain specific provisions for the development of community-based care, which calls into question the prospects for realising the deinstitutionalisation of LTC for older people and the further development of community-based forms of assistance previously referred to as home-based care. The introduction of the low and uncontrolled cash-for-care benefit opens the door to informal, low-paid, family, or (grey) market care, expansion of precarious forms of care work, pressure to lower wages, and the deprofessionalisation and informalisation of care work. The service of family carer, while recognising the right to care, simultaneously contributes to gender inequality in care and to the domestication of women. Introducing defeminisation measures and improving working conditions in care, support for social innovation in care homes for older people, and expanding the public network of home-based formal care services as an alternative to institutional, family, and informal care are largely absent from the politicising and gendering of the LTC Act.

We see one of the reasons for such a situation in the tensions and contradictions that are inherent to each form of organisation of care, which represents an arena where the conflicting aspirations of different actors collide. To name but a few of these aspirations: older people’s right to quality and plural care, care workers’ demands for good working conditions, the state’s intention to contain costs, and women’s claims to justice in sharing care burdens. This turns the principles of deinstitutionalisation, defamilisation, and public services into potentially mutually controversial and contradicting trends. Deinstitutionalisation may strengthen the role of the family and informal care, as states tend to reduce the costs of care. Instead of providing public and formal services, they offer cash benefits, which may stimulate irregular care markets and migrant care. The states may outsource the services to private non-profit or for-profit providers chosen through competitive tendering, thus creating a quasi-market which puts downward pressure on wages etc. (Ungerson and Yeandle, 2007; Macdonald, 2021). The first step towards resolving inherent contradictions in the organisation of care is precisely to politicise them, i.e. to openly discuss them in a broad public debate.