Unfinished welfare, Censis alarm: risk of social collapse

An unfinished, frightening welfare. In terms of health, assistance and welfare, the Italian families are increasingly vulnerable, uncertain in the management of non-self-sufficiency and aware that they must resort to their own resources. A study ("Where is welfare going? Health, assistance and welfare in the expectations of families") carried out by Censis for Assindatcolf, the National Association of Domestic Employers. The survey was conducted on a sample of 2,400 households employing domestic work.

The context: the demographic transition leads to an increased demand for long-term care, with an increase in chronic diseases and conditions related to old age, and a greater need for healthcare resources, putting a strain on the sustainability of public services. In 2022, EUR 65,991 million was invested in care by general government institutions, i.e. EUR 54,606 million in cash social benefits and EUR 12,637 million in social benefits in kind, of which EUR 1,252 million came from other institutions. Expenditure on social assistance corresponds to only 11.7 per cent of total expenditure on social protection benefits, making it the lowest investment share compared to the other areas (health and social security system).

The study shows that 45.3 per cent consider it a priority to enhance home services, assuming that the home is the best place to care for oneself, 58.7 per cent call for the introduction of deductibility of domestic work, and 49.1 per cent say they personally care, as a caregiver, for a dependent relative, in addition to the role of the carer.

According to the report, the need to intervene on public spending, the progressive change in social needs and the demographic evolution of the country have put the system under strain, leaving many issues open that have quickly become emergencies. In particular, if in 2020 7.4 per cent of GDP was reserved for public health spending, in 2026 it is expected to be 6.1 per cent; there are 12,576 active social welfare and sociomedical residential facilities, with an offer of about 414,000 beds (7 per 1,000 inhabitants), the highest availability is in the South with just over 1.000 beds for every 100,000 inhabitants; if today the over-65s are 24.0% of the population (in 1961 they were 9.5%) and 63.5% people of working age (15-64) (in 1961 they were 66.0%), in 2050 the elderly are expected to be 34.5% and the 15-64 year olds less than 55%. Furthermore, 6.8 million pensions are below EUR 1,000 per month.

49.1% declare to personally take care, as a caregiver, of a non self-sufficient relative, a figure that is not an alternative to the carer but a complementary one. For 42.4%, the most critical aspect of caring is the physical fatigue and stress of coping with the many needs of the care recipient. Very important are also the conditioning of daily life, often absorbed almost completely by caring for the assisted person, and the renunciation of a relational and autonomous life (24.7%). On the other hand, 16.4% emphasise the lack of real recognition of the caregiver's role by the institutions and the lack, therefore, of economic compensation for the work performed. Slightly above 8% are those who have had to abandon or have had to neglect work or, in any case, the activity from which the carer's income derives. On the other hand, 6.7% are worried that they might cause harm to the care recipient, since the caregiver does not have the necessary skills for the various interventions he/she is called upon to perform.