Home care for 1.7 million elderly people, but the number of hours is falling

To complete the reform of care for older people launched by Law 33/2023 and increase the level of care provided at home, focusing more on services than on simple cash payments. These are two challenges that remain unresolved following the National Recovery and Resilience Plan, which laid the foundations for innovative measures and achieved some of its intended objectives, but did not fully address the needs of older people. These needs are set to grow, given that in Italia there are 4.6 million people aged over 80, who now outnumber children under the age of ten, and whose numbers could double by 2050 (reaching 13.6 per cent of the population).

Demographic trends are also reflected in public spending. The carer’s allowance, i.e. the financial benefit granted to people with total disability who therefore require assistance with all activities of daily living (€551.53 per month in 2026), had one million recipients in 2002, but now stands at 2.18 million (source: INPS). Expenditure on this benefit, which is paid to everyone regardless of their care needs, has reached 15 billion per year (0.7 per cent of GDP). The allowance can be used to pay a carer (at least for part of the annual costs), and there is no incentive in Italia to invest it in care services.

The NRRP has brought with it Delegated Law 33/2023, namely the framework rules for reforming care for the elderly, based primarily on simplification and the integration of healthcare interventions and services. The reform is still awaiting a series of implementing measures, for which the latest Milleproroghe Decree (Decree-Law 200/2025) has granted more time, with the aim of having the new system fully operational from 2028.

Following the experience of the Covid-19 pandemic, which had tragic consequences for many elderly people in care homes, the National Recovery and Resilience Plan (PNRR) has allocated four billion to strengthening home care as the primary setting for care and to telemedicine. Indeed, the target of extending integrated home care (ADI) to 10 per cent of the over-65s has been achieved. According to the latest data available from the Ministry of Health, the number of people receiving home care provided locally by nurses, doctors, rehabilitation therapists, number 1.645 million (11.3 per cent of those aged over 65), whereas historically, in the pre-pandemic years, the figure stood at 650,000 (5 per cent).

However, each beneficiary receives, on average, 15 hours of care per annum, compared with the 18 hours provided in 2019.