The most innovative and effective long-term care (LTC) experiences are shaped by designing services around people's needs, rather than by adapting existing service structures.
This is especially true for the older population, as highlighted in the cases analyzed in the 8° Rapporto Osservatorio Long Term Care (The 8 th Observatory on Long-Term Care Report, published in Italian) by CERGAS SDA Bocconi . Loneliness and social isolation, the need for guidance and support in accessing services, and the desire to maintain independence for as long as possible in familiar living environments: these factors often contribute to the onset of dependency.
But such needs do not fit neatly into either the "health care" or the traditional "social care" category, and for this very reason they often fall through the cracks of a system that, both in Italy and abroad, is still organized in silos. For healthcare providers, this calls for a shift in focus: from individual services to the broader support ecosystem.
Housing, for example, is no longer simply a physical setting. Instead, it can become a platform on which to build relationships, communities, and integrated services (including traditional public and private, health and social care services). Much of the innovation we see across Europe is taking place in this intermediate space between home-based care and institutional residential care.
The report in numbers
The 8° Rapporto Osservatorio Long Term Care analyzed 79 European case studies reflecting innovation in support for older adults with care needs, focusing on housing solutions and home-based services enabled by digital technologies. The objective was to come up with insights that could be useful to the people responsible for designing and managing services in Italy. The resulting picture is not intended to provide a model to replicate but rather a framework for guiding the strategic and organizational decisions of the professionals working in the sector.
Community and hybrid roles
One of the frequently recurring themes across the cases concerns the community dimension. In the most effective models, relationships among people are not a byproduct but an intentionally designed component of the service. Shared spaces, a diverse mix of residents or users, and mutual support mechanisms form a genuine "care infrastructure" capable of generating well-being while at the same time alleviating pressure on formal services.
This approach to LTC also requires new skills. The case studies, in fact, spotlight hybrid professional figures (variously referred to as community managers, hosts, or coordinators) who connect people, services, and local communities. These positions do not readily match the sector's traditional professional profiles, yet they are often critical factors in the success or failure of a model. For providers of services for older adults, investing in these roles also means rethinking recruitment, training, and staff development processes.
Innovating through adaptation
Another valuable lesson centers on how innovation takes place in this sector. Contrary to what we might expect, the most successful models do not emerge from detailed up-front planning. Instead, they evolve through incremental processes, local experimentation, and continuous adjustment. Co-design, with the participation of users and stakeholders, is the mechanism through which services take shape and become embedded in the local context. This approach also has salient implications for organizations in the sector, necessitating a degree of tolerance for ambiguity, the ability to learn from experience, and organizational structures that are flexible enough to adapt over time and even accommodate failure. Rigid control systems and overly short planning horizons fit poorly into this picture.
Alongside these positive elements, the report also points out critical issues that are consistent with what has been observed in other contexts, including Italy. Scalability is perhaps the most common: Many models that perform well in limited settings, due to local conditions, cannot always be reproduced elsewhere. More broadly, financial sustainability remains an unresolved challenge, often addressed through hybrid combinations of public funding, private resources, and user contributions. Another problem is the risk of a mismatch between the service's intended target population and the users it actually reaches. This misalignment is vital to monitor because it can undermine the effectiveness of models that prioritize prevention, primarily designed for people who are still relatively independent.
An agenda for LTC managers
Taken together, the evidence from the international case studies outlines a possible agenda for managers in the Italian long-term care sector:
- Needs: Recognizing unmet needs and placing them at the center of service design is a prerequisite for innovation.
- Housing: Living environments can be reimagined as service platforms to prevent them from turning into yet another silo.
- Skills: As social needs become more pressing, it is essential to invest in hybrid professional roles capable of connecting services, users, and communities.
- Partnerships: Governance requires multi-stakeholder systems that integrate formal services with informal support networks.
- Time horizon: Healthcare providers can anticipate frailty by reaching people before their needs become acute.
- Resources: The key to achieving sustainability is combining user contributions, public funding, and private investment.
None of these directions can be pursued without tackling organizational challenges and expending sustained effort. Yet the cases in our study show that, even in contexts facing constraints similar to Italy’s, there is real room for innovation. The key is to build programs patiently over time, starting with communities and the needs of the people they serve.
Giovanni Fosti , Elisabetta Notarnicola , Eleonora Perobelli (eds.), Long Term Care
in trasformazione: casa, servizi e comunità. 8° Rapporto Osservatorio Long Term Care , (in Italian), EGEA, 2026.
