Cergas Bocconi-Essity Observatory

Older dependent elderly, public spending down for over 4 million over 65 and families pay

Direct transfers such as the accompaniment allowance rarely translate into services and innovation while one million carers cope with the decline in integrated home care per patient: the demand for new models on housing and technology

by Barbara Gobbi

6 May 2026

4' min read

Translated by AI

Versione italiana

4' min read

Translated by AI

Versione italiana

A constantly growing demand for care, a public supply that often struggles and a traditional welfare model that 'shows all its structural limits'. The classic perfect storm, which calls for innovation throughout the entire Long Term Care chain.

The eighth report of the Sda Bocconi-Essity Cergas Observatory on care for the non-self-sufficient elderly over 65 takes stock. Which first of all recounts a datum that must continue to be monitored carefully, in the coming months and years when the exploit of the ageing population may seriously jeopardise public accounts and those of families: the non-self-sufficient elderly are over 4 million, but public spending on LTC destined for this segment of the population falls from 1.43% of GDP recorded in 2020 to 1.18% in 2024. "A trend," comment the experts, "that reflects an increasingly selective welfare system, concentrated on highly complex cases and leaving families with an increasing share of care responsibilities".

And despite the fact that large direct economic transfers to families such as the accompaniment allowance - never revised despite the promise of the non-self-sufficiency reform launched by the government in 2023 - continue to represent the majority item of LTC public expenditure with 51.7 per cent, these monies 'rarely translate into organisational and innovative services'.

The Adi Paradox

The paradox of a still inadequate network is to be found in the update on integrated home care (ADI): while it grows by 11 per cent compared to 2022, this mini-increase does not translate, at least for the time being, into greater care intensity. On the contrary: average hours per patient have dropped from 18 (2019) to 14 (2023). In parallel, more than 1 million carers continue to represent an irreplaceable pillar of the informal care system.
In contrast, the number of places in RSAs remains stable.

Gaps between regions

The territorial gap remains marked and represents one of the system's most structural criticalities: RSA coverage exceeds 29% of the over 75 non-self-sufficient in the Autonomous Province of Bolzano, while it stops at 1% in Campania and Sardinia. On the home care front, some regions in the Centre-North (Latium, Veneto, Tuscany) have already reached the Pnrr target of 10 per cent of the over-65s with ADIs; the regions in the South are recording increases, but they are still significantly behind.

RSA patients

Among the 24 major players in the sector surveyed by the Observatory, the profile of the RSA guest is increasingly complex: average entry age of 83.8 years, average stay of 340 days, and 60% of guests with cognitive disorders certified or detected by staff. Data that tell how residential facilities today must respond to increasingly articulated needs, requiring professional and organisational approaches that are up to the task.

Housing and Technology

Starting from this consolidated scenario, the Report chooses to flank the analysis of the Italia system with a look at 79 international cases - selected from among the most mature and documented experiences in Europe - with the aim of identifying the levers of transformation that have enabled other systems to respond more effectively to the needs of the elderly. "It is not a question of indicating a model to be replicated, but of understanding what conditions enable innovation: regulatory, organisational, cultural and governance," is the observation. As Elisabetta Notarnicola, Research Area Coordinator Social Policy & Service Management at Cergas SDA Bocconi, explains, 'we chose to explore not only what the system is today, but also the conditions that make change possible. The experiences analysed show that it is possible to innovate in the Long Term Care sector: the starting point is not necessarily the availability of resources, but the ability to rethink models, build partnerships and put the person at the centre. In Italia there are already energies and skills to go down this road. What is needed now is a context - regulatory, organisational and cultural - that supports and enhances them'.

There are two trajectories of analysis: on the one hand, housing models; on the other hand, the integration of digital technologies. The first one concerns housing models for ageing: from senior housing with integrated services to multigenerational communities, from small-scale models for people with dementia to cooperative neighbourhood spaces. On the technology front, solutions oriented towards relational management, proactive health and more flexible and data-driven services were considered.

New Models

The Report's findings also offer clear indications for the Italia context. The most innovative systems," the report's authors go on to observe, "are not based on a simple relationship between a public purchaser and a private provider: they are built through forms of co-design between different parties, capable of generating shared value in the long term. This requires working on enabling conditions that have yet to be consolidated in Italia, but on which encouraging signs can be seen: the growing interest of operators in senior housing solutions, assistive technology and proximity care models testifies to a vitality in the sector that public policies could better support. The key word is 'redesign' and the rethinking of housing as well as the integration of digital technologies are the two strategic levers. For Massimo Minaudo, Country Manager of Essity Italia, "the Long Term Care sector needs real innovation - in care models, in the use of technology, in housing solutions - and this innovation is possible when the various players work together towards shared goals".