2005: Home care
Background information about dementia and home care services
In 1978, the National Health System was set up in Italy. In the same year, Local Health Authorities (USL) were created which were controlled by the municipalities. However, it was not until 2000 that a legal framework and financial basis for a national development of social services was established. Meanwhile, care for the elderly was entrusted to general practitioners, community care services organised by municipalities and associations. According to Nesti et al. (2003), “at least until the 1990s, Italy had no clear concept of the problems inherent to elderly people with care needs, nor was it clear which services were required to maintain their health.”
There is still a strong emphasis on support from the family. Care of the elderly is traditionally considered as a kind of “social duty” by the family, especially the women on whom the main burden of care falls. According to Auser (2001), “it is generally accepted as normal and legitimate that the community and institutions should become involved in caring for elderly family members only after the family resources – often interpreted in a very extended sense (up to the third degree of kinship) have run out (in Polverini et al. 2004).
Demand for home care services has nevertheless increased significantly but supply has been fairly limited. The percentage of over 65 year-olds using home care services in Italy is very low (i.e. 1% of the population) compared to other countries e.g. 5.5% in the United Kingdom, 6.5% in Germany and almost 10% in Scandinavia (Minguzzi in Polverini et al. 2004). Moreover, there have been considerable differences in the development and distribution of home care services, particularly between the north and south of the country. There are also differences between the populations. For example in the north, elderly people tend to live in better conditions; on the islands, such as Sicily and Sardinia, there is a higher percentage of chronic diseases and disability (Nesti et al. 2003). Services tend to be fragmented and public expenditure on health services is fairly low.
Legislation relating to the provision of home care services
Reform of the National Health System began in 1992 with the Health Care Decree no. 502/1992, followed by the “Objective: Ageing Persons” project (the National Plan for Welfare), Law no. 328/2000 relating to the creation of an integrated care and social services system and finally the Guidance and Coordination related to Health and Social Integration Act of 2001.
The objective of the National Plan for Elderly People was to better coordinate medical and social services so as to ensure their integration within the home care services system. Related services are intended to promote the well-being of elderly people and to help them to maintain their autonomy.
Every person in Italy, with insufficient financial resources, irrespective of age, can ask for “alimony” from his/her family. According to articles 433, 438 and 443 of the Civil Code, relatives can fulfil this obligation either by paying money every month or by accepting and supporting the person in their own home (Polverini et al., 2004).
Financing of home care services
In Italy, citizens must purchase a ticket in order to have access to services within the National Health Service. People who are over 65 years old and those suffering from an officially recognised chronic and disabling disease do not have to pay.
The regions have legislative powers over health and welfare but home care services are financed entirely by Local Councils. Such services are generally rendered to people on low incomes. Elderly people may have to contribute towards costs using their pensions, vouchers and care payments. Those with extremely limited financial resources may be exempt from making these partial payments. According to Dogliotti et al. (1999), there is a die-hard cultural misconception in Italy that care is not considered as a right to be claimed by each and every citizen, but rather as a concession from above, similar to some sort of ‘charity’ (in Polverini et al., 2004, p.57).
According to Nesti et al. (2003), national surveys have revealed that 15% of families caring for an elderly relative employ informal carers on a private basis for more than 20 hours per week. These carers are often immigrants and the amount paid per month ranges from approximately EUR 500 in the South to EUR 800 in the North (Salvini, 2006). In some cases, families use the vouchers that they are given for services to contribute towards the cost of private care.
Kinds of home care services available
A care system was set up in the framework of the National Plan for Elderly people which includes:
Home Care (community care): with social importance (home help, meals and personal care); with health importance (medical, rehabilitative and/or nursing care); integrated.
Integrated Home Care Services: is a combination of integrated and coordinated health and social activities which seek to keep an elderly person at home as longer as possible. Health services are medical care (Geriatric, Psychiatry), nursing, rehabilitation, medicines and prosthesis supply. Social services are: personal care, meals, house work, laundry, administrative services.
Day Centres: semi-residential structure, within the District, which hosts disabled elderly people for a short-term period (they are open during the day, 5 days a week, 7 hours a day, and admit 20 elderly persons). They provide healthcare services (prevention, therapy, and rehabilitation), and social care services (personal care and promotion of personal autonomy, entertainment, job therapy, and social activities).
Nursing homes: residential structure, organised into small groups (“nuclei”), which provides healthcare, social care, and functional rehabilitation for people with disabilities. Patient care can be extensive or intensive. The first area comprises temporary accommodation for long-term care and rehabilitation (while hospitalisation is limited only to the acute stage). The second area comprises intensive rehabilitation, with high medical importance, plus a hospice for terminal patients which provides palliative care (reduction of pain; social protection for patients and their family; family support). Doctors, nurses, social workers and psychologists are available at the Nursing Home.
- European Foundation for the Improvement of Living and Working Conditions (EFILWC) (2002), Italy – http://www.eirpfpimd.ie/living/socpub_cstudies/de3.htm (accessed 31/5/2005)
- Information provided by Gabriella Salvini (2006)
- Nesti, G. et al. (2003), Providing integrated health and social care for older persons in Italy, Procare (http://www.imsersomayores.csic.es/documentos/documentos/procare-providingitaly-01.pdf)
- Polverini, F., Principi, A., Balducci, C., Melchiorre, G., Sabrina Quattrini, M., Gianelli, V. and Lamura, G. (2004), National Background Report for Italy, EUROFAMCARE. http://www.uke.uni-hamburg.de/extern/eurofamcare/documents/nabare_italy_rc1_a4.pdf
 Extract from the report “Providing integrated health and social care for older persons in Italy” (Nest et al., 2003)
Last Updated: Wednesday 15 July 2009