With four million older adults needing long-term care, assistance is changing forever

The number of older adults requiring long-term care (LTC)in Italy has surpassed the symbolic threshold of four million people. This milestone, which was reached in 2023, marks the transition to a new phase in which LTC needs have become a structural phenomenon, one that is expected to proliferate in the coming years.

This phenomenon emerges at a time when financial, organizational, and professional resources are limited and unlikely to multiply appreciably, creating an increasingly evident mismatch between supply and demand. Although public services have expanded, they are able to meet only part of the need: Home care reaches about 30% of cases, while residential care covers a much smaller share.

This imbalance signals a structural strain. In practice, care continues to be the burden of families and an informal care system that, while widespread, is still only lightly regulated and highly uneven.

Responding to new needs

The first section of the 8° Rapporto Osservatorio Long Term Care ( The 8 ^th Observatory on Long-term Care Report, published in Italian) by CERGAS SDA Bocconi and Essity examines the Italian system. The long-term care sector is currently undergoing a period of transformation in which providers are reconsidering both service volumes and approaches to meeting care needs.

The Italian system was built around several well-defined features: the central role of the family, a separation between health and social care, a preference for cash benefits over services, and considerable fragmentation of information. This model has proven resilient, but its limitations are becoming increasingly apparent.

The research goes beyond simply describing the current situation. In addition to measuring the scale of need and the system's ability to meet it, the study explores how those needs are changing, and which models of care may prove most effective in light of these changes. How can services be designed to adapt to needs that are more diverse and dynamic than ever before?

Changing demand, traditional supply

The four million plus older adults requiring LTC represent a highly diverse population with varying levels of frailty, although the greatest concentration is found in the oldest age groups. In fact, among people aged 85 and over, nearly two-thirds have severe functional limitations. This means that care needs are not only augmenting; they are also becoming more complex.

On the supply side, the system remains largely anchored to traditional models. The service network has historically focused on integrated health and social care services, while the social care sector remains comparatively weaker. In recent years, home care has expanded significantly, driven in part by Italy's National Recovery and Resilience Plan (PNRR), whereas the capacity of residential care facilities has remained essentially unchanged.

Comparing demand with supply, coverage rates clearly illustrate the limits of the current system:

• Home care fulfills approximately 30.6% of total need.
• Residential care covers just 7.6%.
• Semi-residential services remain marginal, at around 0.6%.

These limitations are compounded by substantial regional variation, reflecting very different organizational models and policy choices across Italy.

In this context, informal care continues to be the true backbone of the system. The number of paid caregivers exceeds one million and accounts for a sizeable share of care needs, confirming that the public system alone is unable to provide an adequate response to the situation.

Looking at providers tells a similar story. Although the sector's largest organizations are showing signs of diversification, they remain heavily concentrated in residential care, which continues to generate most of their revenue. This suggests that service delivery models are still relatively slow in adapting to changing patterns of demand.

Flexibility and integration

These findings suggest that long-term care can no longer be managed through standardized, rigid models; instead what’s needed are more flexible, integrated solutions that can evolve over time.

For policymakers, this means shifting the focus from simply amplifying capacity to improving the quality and configuration of services. The current expansion of home care, for example, risks boosting the number of people served while reducing the intensity of care provided. This approach improves the numbers, but not necessarily the system's ability to deliver comprehensive care.

Managers across the sector will need to rethink service design and delivery. The Report's findings suggest that the most promising paths forward lie in the ability to build new models over time through incremental change, experimentation, and continuous adaptation.

From this perspective, several development priorities become central:

• Developing hybrid solutions that move beyond the traditional distinction between home care and residential care.
• Strengthening the community dimension as a care infrastructure.
• Using technology as a lever to redesign services.

The most interesting experiences, including those from other countries, are deeply rooted in local contexts and evolve over time through adaptive processes.

Overall, the Report portrays a sector marked by acute structural tensions but also by notable opportunities for change. In a context where the mismatch between needs and resources is likely to persist, sustainable development pathways need to be built that create value for individuals, families, and the system as a whole.

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.