Non-self-sufficiency, more than a reform the law on the elderly is an empty box
From the new unified multidimensional anti-bureaucracy evaluation system to targeted home care and the accreditation of the RSAs: the implementation of the framework law on care for the frail elderly is almost at year zero
Key points
An empty box, yet to be filled: the non-self-sufficiency reform intended to provide answers to the more than four million frail elderly in Italy, launched by the Meloni government in March 2023 with a good 30 years delay compared to the forerunner Austria, is waiting to be implemented in its most substantial contents. Moreover, many important innovations have been modified or cancelled by Decree 29/2024, which has largely rewritten that framework law, raising obvious questions of constitutionality.
A reform still at the stake
Translated: on the new unified multidimensional assessment system established by the reform (law 33/2023) to simplify the bureaucracy of access to services and allowances, as well as on targeted home care for the non-self-sufficient and on the accreditation of RSAs, we are almost at year zero.
And yet these are precisely the crucial issues to be addressed, in a context in which, just looking at residences, facilities cover about 2% of the elderly population, while in other EU countries they do not fall below 4%, and the lack of services is still faced with an army of a million carers. Meanwhile, the Public Accounts Observatory estimates that in Italy the proportion of over-80s will grow from the current 8% to 10% in 2040 and to 14% in 2070, and at the same time health spending on care for the over-80s will almost double, from 1.3% to 2.5% of GDP.
I passi dell'Italia
Serviva una svolta decisiva e l’Italia ci ha provato. Ma se la prima parte della riforma dedicata all’invecchiamento attivo “procede”, il Titolo II della legge pensato per mettere in piedi un’architettura di presa in carico proprio degli anziani già fragili, marca il passo. Come segnala il Patto per la non autosufficienza che il 21 ottobre organizza a Roma un convegno al ministero della Salute con Orazio Schillaci. L’obiettivo è fare il punto e uscire dall’impasse. «E’ normale che una riforma ambiziosa incontri difficoltà importanti - osserva Cristiano Gori, coordinatore del Patto – ma il problema è che arriva con decenni di ritardo, gli anziani sono sempre di più e il settore versa in condizioni molto critiche». Ecco perché la tempistica è decisiva: «C’è il pericolo di iniziare a mettere mano al settore quando l’ampiezza dei bisogni inevasi e il deterioramento dell’offerta di risposte renderanno impossibili interventi migliorativi di sostanza», avvisa ancora Gori.
Heavier bureaucracy
In fact, the reform was created to overcome the fragmentation of public measures, spread between health services, social services and national monetary transfers that were not coordinated with each other. However, the integrated governance system envisaged to plan interventions together was cancelled. As for procedures, the initial objective was to make life easier for the elderly and families, who today are forced to wander among a myriad of counters, places and locations. Instead, the decree now being prepared paradoxically designs more complicated procedures by increasing the number of steps to be taken.
