Non-self-sufficient, only 7.6 per cent in nursing homes and families pay 58 per cent
In the Cergas Bocconi-Essity Long Term Care Observatory Report the portrait of an inadequate Italy: RSAs left alone at the helm and Adi still stuck at 14 hours per frail elderly person
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Key points
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The galloping ageing of the Italian population, which unfortunately brings with it a quota of non-self-sufficient persons equal to over 4 million in 2023 (+1.7% over 2021) is not matched by an equal increase in services: On the contrary, the gap between demand and supply of care is dramatic, so much so that today the RSAs - mostly concentrated in the North of the country - meet just 7.6% of needs, while the Integrated Home Care (ADI), widespread on paper as required by the National Recovery and Resilience Plan, is planted on a 30.6% coverage rate and, as a result of the serious shortage of professionals, totals a totally inadequate actual number of hours per person, amounting to 14 hours per elderly person. Also dramatic is the figure for day care centres, which cover barely 0.6 per cent of demand. In the face of this substantial latitude on the part of the social-health services, the caretaker-pillar remains in the field: more than one million estimated in 2023 between regular and irregular carers. to be precise, 1,034,243 are hypothesised. And the families? In the daily lives of almost all households there is the experience of the hefty bill paid in terms of suffering for their loved ones, absence from work, and strictly economic outlay: in addition to the bill to be paid at the end of the month for carers, about 58% of the turnover of the RSAs' managers derives from the private expenditure of family members, mostly (44%) dependent on the share of public services that the relatives themselves bear in large percentage. Only 14% of the turnover of the facilities comes from completely private expenditure for in-patient places
The Cergas Bocconi-Essity Report
.The picture is drawn by the 7th Long Term Care Observatory Report Cergas Sda Bocconi-Essity, which denounces "a poor and inadequate performance of services compared to the demand of the elderly and families". It then raises the issue of an ever closer connection between residences for the elderly, hospital and territorial health services to improve the effectiveness and efficiency of welfare systems.
The Report returns the results of a survey conducted on 106 residences for the elderly, each of which manages an average of 113 beds, which takes a snapshot of the exchanges and connections between RSAs and other actors in the sector. Among the system's main criticalities, the first one immediately emerges when assessing the elderly person's need for assistance in order to gain access to a facility, and that despite the new rules dictated by the non-self-sufficiency reform passed by the government two years ago (law 33/2023): general practitioners (mmg), health authorities and municipal social services enter the field. "It emerges from this that the assessment of need is compartmentalised," warn the authors of the report, "and does not take into account the characteristics of the services that the elderly would need. Relationships with facilities take place through formal and administrative exchanges, fuelling the risk of offering services that are inadequate or inconsistent with the needs of individuals.
The risk of inefficiencies and duplication of services
.Not only: the RSAs are 'left autonomous' in defining the details of service delivery (38% of cases). That is to say, there is still no structured interface with other healthcare entities, creating inefficiencies and often duplication of services. A condition that also occurs in the case of the activation of emergency services such as access to emergency rooms or hospitalisation.
'The RSAs,' commented Giovanni Fosti, Elisabetta Notarnicola and Eleonora Perobelli, lecturers and researchers at Cergas Sda Bocconi, 'have become points of reference for continuing care. They offer fundamental support to families and the healthcare system, also managing end-of-life, dementia and chronic diseases. What is needed, however,' they warn, 'are innovative approaches, new specialised professional skills, and an integration of services and structures to ensure the sustainability of the long-term care sector, also by activating synergies with other parts of the welfare system. No organisation can meet these challenges alone'.
