Care homes: 19,000 nurses are needed, but their roles and responsibilities remain unclear

The saga surrounding the role of the family or community nurse has now taken on the air of a ‘soap opera’, with two further episodes added to the story: on the one hand, the Agency for Regional Health Services (Agenas) has published the ‘Technical Guidelines’ on Community Care Homes; on the other, the preliminary agreement for the National Collective Agreement for the ‘Healthcare Sector’ has been signed.

Let’s start with the first one. The July 2026 issue of Agenas’s *Quaderno di Monitor* is devoted to guidelines on ‘Multiprofessional and multidisciplinary teams in community care homes’, and the document translates one of the key requirements set out in Ministerial Decree 77/2022 into practical guidance. Chapter 6 discusses the composition of the team and identifies 14 specific roles, one of which is the Family or Community Nurse (IFoC), whose professional profile is defined as follows: “A nurse who, in addition to their basic training, possesses experience and has undertaken specific training programmes in the field of community healthcare, covering health education, the management of chronic conditions and their integration with social services; preference is given to nurses holding the specific academic qualification (a Level I Master’s degree in Family and Community Nursing or a related discipline). The professional role of the IFoC is characterised by the ability to care for individuals, families and communities within their living context, promoting autonomy, continuity of care and health education.”

The adjacent column describes his role within the team. The full text of the statement set out above, notwithstanding a few typographical errors in its syntax, does not, however, specify the hierarchical and organisational structure, direct responsibilities, nor does it make any reference to the inconsistency of regional training programmes which, as is well known, are in complete disarray. Nor is there any mention of the dedicated master’s degree programme established two months ago. As has been the case previously, there is still no legal definition of the IFoC role – in terms of contractual classification and remuneration – with the term ‘key professional role’ continuing to be used. The problem lies precisely in the term ‘role’, which means nothing because, according to the National Collective Labour Agreement (CCNL), the profession or professional profile remains simply that of a nurse; however, for example, in the AGENAS document, amongst the 14 roles within the team, the IFoC is distinguished from a generalist ‘nurse’. To date, however, no legislation has yet specified ‘who’ the IFoC is, but only ‘what’ they do and ‘where’ they do it. One might argue that these matters fall within the remit of collective bargaining: quite right, and so this brings us to the other point mentioned earlier.

The negotiating parties to the contract have effectively capitulated unconditionally to the issue, as clearly highlighted in the bombastic and disheartening Joint Declaration No. 3, attached to the contract text: “The parties consider it necessary to address, in the forthcoming contract renewal, the most appropriate framework for the role of the family nurse as referred to in Law No. 77 of 17 July 2020”. Leaving aside the merits and the ‘political’ content of this decision, they have failed to be precise even on a purely formal level, given that Law 77/2020 is cited as the legislative source. The reference to Decree-Law 34/2020 – converted into the aforementioned Law 77/2020 – as the original legislative source is, to say the least, out of context, because the emergency decree introduced the role in question without specifying anything about the legal nature of the ‘role’, not even whether it involved employment or self-employment, not to mention that the provision was contextualised within the state of emergency. Returning to the recent preliminary agreement, however, the negotiating parties are not entirely to blame for the failure to formalise the arrangement in the contract, as the Sectoral Committee’s Policy Statement of 2 April 2026 makes no mention of the issues relating to the IFoC.

Healthcare organisations will therefore be able to recruit a Food Technologist or a Dental Practice Assistant – roles that may be of interest to a few dozen people – but they will not know how to classify them legally, reward them financially or integrate the 19,000 IFoC staff into their organisational structure; these staff are due to be employed in the community care homes which, since 30 June, all national and regional policy-makers have been assuring us are fully operational.