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Objective: The aim of this research is to analyze aging population demographics compared to the current demand of long-term care services available in the Slovak Republic. Methods: This paper is a secondary source research study augmented by person to person conversation with Slovak Doctoral Students at Trnava University. Original Article 93 Original Articles Clinical Social Work and Health Intervention Vol. 8 No. 4 2017 Introduction Almost every country in the world is experiencing an aging population. The increasing share and proportion of people aged 65 years or older is drastically changing the social sphere of every country. Population aging includes implications for nearly all sectors of society. Preparing for a dramatic social change is essential to ensure a country’s continuous development. This causes a need to identify specific impacts and propose solutions to respond to the changes. Countries all over the world are experiencing shifts in long-term care due to an aging population. This shift is inevitable and known as a “demographic revolution, characterized by low birth and death rates respectively to prolong human life” (Pavelek, Eidenmueller, 924). Aside from an aging population, technological and scientific advancements have also contributed to mortality decline, ultimately  influencing better health and longevity. The elderly population as  a  whole  is  defined  as  persons  aged  65 years or older. People aged 65-74 are known as “young-old,” while those aged 75 or older are known as “old-old” (Pavelek, Eidenmueller, 925). This is causing long-term care to become one of the fastest growing sectors in healthcare today. Demographics The Slovak Republic, like many Central European countries, is experiencing an aging population. Currently, there are approximately 5,433,381 people living in the Slovak Republic. According to Eurostat: Population Structure and Aging, in 2015, persons aged 65 years or older accounted for approximately 14% of the total population. By 2025, that %age will rise to 18.1%, and by 2050, 24.8% of the population. Currently among the top five youngest countries in Europe, the Slovak Republic will become the oldest country in Europe by 2080. According to Eurostat: Population Structure and Aging, the median age of the Slovak Republic in 2016 was 40.1 years old, while in 2080, the median age is expected to rise to 53.7 years, a 13.6-year difference. An old age dependency ratio is a ratio of elders, or those not currently active in the workforce, to the working age population, which  is often defined as ages 15-64. This ratio  is  defined  as  the  amount  of  persons aged 65 years or older for every 100 working age persons in a given population. According to Eurostat, in 2010, persons aged 15-64 accounted for approximately 73% of the population. By 2050, that %age is expected to decrease to 57% of the population, a 16%age point decline. As of 2015, there were 19.8 persons aged 65 years or older per 100 working age persons, or a 1 to 5 Results: The Slovak  government  should  increase  efforts  to  integrate both the social and medical healthcare spheres. Conclusion: The study indicated that the Slovak Republic is experiencing an aging population and may not be able to accommodate elders in the future due to an increased demand for services. There is opportunity for growth within the informal caregiving sector by increasing support and education. Increasing preventative and ambulatory care services can ensure accessibility and more medical staff educated in the field of Geriatrics. There is an opportunity to conduct more research on future long-term care trends. 94 Clinical Social Work and Health Intervention Clinical Social Work and Health Intervention Vol. 8 No. 4 2017 ratio. By 2060, there will be 57.2 persons aged 65 or older per every 100 working age people, or a 1 to 2 ratio. With this increase, there will be greater pressure placed on the productive part of the population to provide goods for themselves and also the older portion of the population (Eurostat). Currently, out of the Slovak Republic’s population, approximately 770,000 people are aged 65 and older. Of those 770,000 people, approximately 200,000 people require long term care services. Of those, approximately 38,000 receive formal, institutional medical care, 70,000 receive formal, homebased social services, and 61,000 receive informal care provided by informal caregivers. Thus, approximately 31,000 elders, or 15.5% do not receive the proper care they need (The Long-Term Care System for the Elderly in Slovakia, 11). Long-Term Care Services The current array of long-term care services in the Slovak Republic is represented by two main spheres social care services and healthcare services. Social care services aim to rehabilitate a dependent person to live a more independent life. These services are concerned with alleviating unfavorable social situations for a dependent person. Social care services consist of outpatient, inpatient, and home care, including supported living facilities, nursing care facilities, facilities for seniors, social housing, day care facilities, community care, social rehabilitation, retirement homes, and informal home care (The Long-Term Care System for the Elderly in Slovakia, 6-7). Healthcare, also known as institutional medical care, is provided for people who need care for twenty-four hours per day or longer. These services include inpatient and outpatient care such as medical facilities, ambulatory care, mobile hospice care, nursing homes, hospitals, long-term care departments, and sanatoriums (The Long-Term Care System for the Elderly in Slovakia, 4-5). Another category, which stems from social care services, is known as informal care. Informal care is provided by informal caregivers who are typically relatives, close friends, or neighbors of a dependent person. These services are paid on a monthly basis depending the elder’s level of dependency. There are approximately 59,000 informal caregivers caring for 61,000 elders receiving informal care. 52% of informal caregivers are between the ages of 51 to 64. Women account for about 84% of caregivers, while men only account for a mere 16%. There is a lack of men in informal caregiving (The Long-Term Care System for the Elderly in Slovakia, 3). To determine which services are provided to a dependent person, an assessment of their level of dependency and level of needs is addressed. Their level of disability is determined by their activities of daily living (ADL). A six-grade scale is assessed by an advisory committee comprised of Physicians and Social Workers. Act No. 448/2008 defines  12  criteria  for ADLs,  such  as  eating, drinking, sitting, walking, personal hygiene, washing, and orientation. The dependent person is then scored from zero to ten on their assessment of needs. The higher the degree of dependency, the more likely a person will be provided with institutional medical care. Due to limited capacity, the preferred outcome is providing the dependent person with social service needs or informal caregiving (Long Term Care of the Elderly, 96). Barriers to Long-Term Care There are four potential barriers to the long-term care system in the Slovak Republic. There are governmental barriers, organizational barriers, financial pressures, and increasing pressure on informal caregivers. 95 Original Articles Clinical Social Work and Health Intervention Vol. 8 No. 4 2017 There are governmental barriers to longterm care. There are legislative issues that arise when elders are using both spheres social care and healthcare in long-term care. Both systems are regulated by different acts, regulations, and legislature, which may not always be linked together, nor cover all services provided. Some acts have been prepared to combine both systems, but these acts were not approved (The LongTerm Care System for the Elderly in Slovakia, 17). Several acts have been put in place, however, social care and healthcare is not systematically regulated. Since 2000, the Slovak Government has made  efforts  towards  improving  the  legislature for long-term care. In August 2000, the National Action Program for the Protection of Elderly People, or NAPPEP, was approved (OHCHR). The aims of this program were to help elders live an independent life, inclusion in social participation, integration into society, and autonomy. The goal of the program was to prepare society for an aging population. This program addressed five  key  principles  for  elders—the  principle of independence, participation, caring, self-realization, and dignity (OHCHR). In November 2000, the State Policy of Health in the Slovak Republic was approved. This policy defined  three  long-term care  priorities: enhancing healthy aging, developing and increasing palliative care, and improving mental health (Government of the Slovak Republic, 2000). Although improvement efforts were gaining headway in the early 2000s, much of the government’s success efforts ended by 2005. A legislative act to support long-term care and disabled persons was prepared in 2004 but was never approved by the government. In 2005, the Slovak government approved the Strategy on Healthcare for Geriatric Patients and Long-term Patients and the Conception of Social and long-term Care in the Slovak Republic, but the proposals for the acts stopped by the end of 2005 (The Long-Term Care System for the Elderly in Slovakia, 16). There are also efforts  to create “amendments and reparations that aim to equalize providers of Social Services, but lack of financial resources in budgets of self-governing regions and municipalities creates a non-equal environment for private social care providers” (Long-Term Care of the Elderly, 88). There are also organizational barriers within the long-term care system. With two separate sectors providing care to elders, there is little coordination between the two. In the early 2000s, the Slovak Republ

How an Aging Population in Slovakia Impacts the Utilization of the Current Array of Long-Term Care Services (Review)