Dependent elderly, ongoing crisis weighing on families and public healthcare
The model outlined by the reform recalls the universalist architecture of the NHS, but the asymmetries between health and social care remain marked: the role of the public system in providing appropriate services must be clearly defined
Italy is ageing and non-self-sufficiency is already one of the main social and health emergencies. A quarter of the population is over 65, more than 4 million people live in conditions of non-self-sufficiency, and the lengthening of life implies an average of 13-15 years of progressive loss of autonomy.
However, only a minority of elderly people receive structured public support, while most of the care burden falls on families: more than 2.5 million dependent elderly people are cared for by informal caregivers and more than 1.1 million carers make up for the absence of a professional and organised offer.
This systemic fragility also falls on the SSN, with an increase in improper accesses and ineffective management of chronic illnesses. The result is a system that chases after emergencies.
Reform does not close the gap
With Law 33/2023 and Legislative Decree 29/2024, Italy has taken an important step forward, recognising non-self-sufficiency as a priority of the welfare system and introducing tools such as the Essential Levels of Social Benefits, the Universal Benefit, the Single Points of Access (PoA) and Individualised Care Plans.
However, the gap remains wide. Resources are limited and access criteria selective: the new Universal Benefit - an experimental economic contribution with a budget of EUR 250 million per year - reached only 2,000 beneficiaries in 2025. In fact, the burden of care continues to fall largely on family caregivers and private expenditure.
