Post-stroke rehabilitation in crisis: Regions in disarray, private sector on the rise

Following a stroke or a traumatic event, in-hospital rehabilitation is the phase that, more than any other, determines a patient’s chances of regaining independence, social relationships and quality of life. Yet the figures show that the system is facing structural difficulties. In 2024, the number of patients discharged fell to 290,711, compared with 314,715 in 2014 (-7.6 per cent). The number of bed-days, at around 7.66 million, remains approximately 6.5 per cent lower than in 2019. Yet the number of beds – nearly 24,000 dedicated to rehabilitation – has almost returned to pre-Covid levels (-1.1 per cent). Consequently, accredited private care is becoming the backbone of the system: almost four in five discharges take place in private facilities, and accredited private care homes alone account for 57.6 per cent of these.

This picture of the situation is provided by the first national report on in-hospital rehabilitation, “Analysis of In-Hospital Rehabilitation”, commissioned by the Gianfranco Salvini Foundation, supported by A.L.I.Ce Italia, the Association for the Fight against Stroke, and presented to the Ministry of Health. The public sector has borne the brunt of the pandemic and shows a longer average length of stay (27.2 days compared with 26.1 in the private sector), whilst the national hospitalisation rate stands at 3.96 admissions per 1,000 inhabitants (4.59 in 2014), but this ranges from 8.10 in Valle d’Aosta to 1.79 in Tuscany. The number of beds for convalescence and functional rehabilitation per 1,000 inhabitants also varies greatly: 0.72 in Piedmont, 0.16 in Sardinia – more than four times fewer.

Neuro-rehabilitation is even scarcer, concentrated in just a few centres and virtually non-existent in several regions of the South. The Autonomous Province of Trento accounts for 46.5 per cent of admissions from outside the region, followed by Emilia-Romagna (42.0 per cent). Conversely, 42.3 per cent of hospital admissions for residents of Basilicata and 39.2 per cent in Friuli-Venezia Giulia take place outside the region. Lombardy, Veneto and Emilia-Romagna are the main destinations. It is worth noting that Lazio and Molise have above-average bed capacity but negative mobility balances, whilst Emilia-Romagna, Veneto and Umbria achieve positive balances with fewer beds.

For A.L.I.Ce. Italia, all this means that opportunities for recovery continue to depend, in part, on one’s postcode.

“This report shows that these differences are not merely perceptions, but a reality documented by official data,” says Andrea Vianello, president of A.L.I.Ce. Italia Odv. “It is a situation we can no longer consider acceptable. Saving a life is essential, but it is not enough: we must offer everyone the same opportunities for recovery. That is why our Association will continue to call for post-stroke rehabilitation to become a genuine priority in national healthcare planning.”