Non-self-sufficiency

Frail elderly, assessment for access to services postponed to 2027

The implementation of the new simplified and hi-tech instrument crucial for municipalities and local health authorities to take care of dependent persons starts 'on schedule' with an initial trial in 2026

by Barbara Gobbi

29 April 2025

3' min read

Key points

Changes in the field
How the experimentation takes place
The demands of the Pact on non-self-sufficiency

3' min read

The Council of Ministers has given the final go-ahead to the legislative decree that entrusts to a twelve-month trial, for the whole of 2026, the new Unified Multidimensional Assessment required for access to social and socio-sanitary services through the PUAs, the Single Access Points at the Community Homes in the territory.

The changes in the field

In detail, the new decree launched by the Cdm, in addition to a series of other changes, corrects Article 27 of the maxi implementing decree (Legislative Decree 29 of 15 March 2024) of the reform on the elderly, i.e. Law 33 of 2023 put in the pipeline by the Draghi government and approved by the Meloni executive.
It will be up to the Ministry of Health, in agreement with Labour and Social Policies and Disability, and subject to the agreement of the Unified Conference, to adopt by 30 November 2025, and therefore no longer within six but twelve months, the decree that will define the modalities and the territories involved in the first twelve-month experimentation of the Unified Multidimensional Assessment, starting from 1 January next.

The legislative decree passed by the Council of Ministers 'also specifies the exclusive medical-legal competence of the Inps (Italian National Social Security Institute) as regards the assessment process aimed at ascertaining the conditions of disability with respect to the different competences of the team operating the multidimensional assessment at the Single Points of Access (PUA) aimed, inter alia, at ascertaining non-self-sufficiency'.

How the experimentation takes place

The one-year trial will be launched on a sample basis - according to the principle of geographic differentiation North, Centre, and South - with the participation of one province per region, as sanctioned by the agreement in the Unified Conference on 17 April. For the purposes of this first test, the Ministry of Health will rely on the support of the Higher Institute of Health and the National Agency for Regional Health Services (Agenas).

But what is the Unified Multidimensional Assessment? In fact, it is one of the most innovative pieces of the reform and this is one of the reasons why the Ministry of Health has reportedly decided to take its time, especially to write the decree on criteria and modalities more accurately. The experimentation will then serve to adjust the focus before launching the new instrument throughout the country.

The demands of the Pact on non-self-sufficiency

"We hope that this extra time that the State is giving itself to refine the assessment tool will serve to comply with the dictates of law 33: if so it is time gained, otherwise it is time lost'. Thus Cristiano Gori, coordinator of the Pact for Non-self-sufficiency, which has been among the promoters of law 33 from the outset and which closely monitors the implementation of the law.

In short, when drafting the criteria for the Unified Multidimensional Assessment, the ministry should stick strictly to what is written in the original Reform, which has been partially amended and smoothed by the implementing decree. 'Ideally, we would like to create a single assessment tool for all national benefits,' Cristiano Gori continues. 'For us, the cornerstones should be a single national assessment for state benefits such as accompaniment, to be realised with a quality, state-of-the-art tool capable of providing complete and clear information to municipalities and regions thanks to the interoperability of information flows. This mechanism will lead to an enormous simplification of access to benefits, from the current five to six to only two assessments of the person. The state must create a context in which it can offer the regions a whole series of quality data on the elderly, so as to facilitate care projects'. In a context of minimal resources, by the way, this is the most powerful tool that can be realised 'without money': having an important national tool makes it possible, for example, to train all the geriatricians in Italy to disseminate the criteria.

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