Welfare Policy Lags Behind the Care Needs of an Aging Population

ITALIAN SOCIAL POLICY HASN'T EVOLVED TO DEAL WITH A GREYING POPULATION, SO THAT TO CARE FOR THEIR ELDERLY, FAMILIES HAVE TO RELY ON THE EVERGROWING NETWORK OF PERSONAL CAREGIVERS IN ONE OUT OF THREE CASES

by Elisabetta Notarnicola, SDA Bocconi School of Management
Translated by Alex Foti

Between 2013 and 2016, the number of non-self-sufficient (i.e. having a functionally disabling condition) elderly people (over 65 years) has inexorably increased, from 2.7 million to 2.9 million citizens (+7%). This is happening as part of the general trend towards aging of the Italian population, brought by improved life expectancy, but also by a higher incidence of chronic degenerative diseases. How is the Long-Term Care (LTC) sector dealing with this challenge? The Second Report of the Long-Term Care Observatory compiled by CERGAS, the research center for health management and social policy of SDA Bocconi School of Management, provides an updated overview of the sector in Italy, investigating the level of public and private response to family needs and current trends.

Let's start with public welfare. Making a survey of public services dedicated to the senior citizen target (from nursing homes of various types of day centers) it was found that in 2016 these were capable of providing answers to only 10.2% of non-self-sufficient citizens over 65 (in 2013 the figure was 10.4%). The diffusion of home care promoted by Local Health Organizations and Municipalities (ADI) is a different story, since it reached 26.8% of the target population in 2016 (up from 19.8% in 2013). But this growth hides a disheartening element: in 2016 the average hours of care provided per senior were only 16 per year, compared to a service that should guarantee a home stay on a daily basis. The public welfare services for LTC are therefore still weak, to the point that some unmet demand goes towards medical and hospital services (e.g. rehabilitation facilities, hospital wards, etc.), which act as a buffer when families fail to find answers in public LTC sector. Then, private welfare intervenes in various forms, such as the work of family members providing care to their elderly, the use of standardized paid services that are still scarce in the national territory, and, especially, the hiring of one or more carers (badanti, in Italian) often living in the household.

The Long Term Care Observatory of CERGAS estimates that in 2018 there were in Italy over one million formal and informal carers, with an increase of about 10% with respect to 2013. Hired family caregivers are increasingly the most widespread solution in the country, catering to the needs of one third of non-self-sufficient senior citizens. Thus the limited ability of public welfare to provide structured answers and the prevalence of self-organization in households were confirmed by the study.

If we consider aging trends, it is clear that public welfare policies have to rise to the challenge of innovation. However, the signs are not promising. Health management companies recognize the need for new services, but even among the largest ones investments are limited. Only 50% of health firms have research and development organizational units, and devote very limited budgets (1% of turnover) to innovation and only in 30% of cases invest in applications for public grants to finance ad hoc projects. On the public policy front, in the recent past (between 2015 and 2019) a great effort was devoted to regulate the work of carers, although much remains to be done: of about 400 legislative acts produced by Italian regions on the matter, only 10% are dedicated to innovation in family care, while 90% is oriented to regulating the existing situation. In other words, there are signs of movement but not yet of real change. The future of the LTC sector remains to be written.