Caring for our seniors: what we can learn from others

The Italian population is aging, which inevitably means there’s a greater need for long term care (LTC). In fact, over-65s accounted for 23% of all Italians in 2021, and 4 million were functionally dependent (almost a third of the people in that age range). By 2030, projections show that 30% of the population will be 65 or older.

And yet the LCT system in this country is still fragmented, underfunded, and lacking in qualified personnel, according to the recently released 6^th Report of the Long-Term Care Observatory (OLTC) CERGAS SDA Bocconi, depicting a sector in need of structural interventions.

Italy: moving in the right direction, but not yet far enough

The Italian Reform regarding dependency (Law no. 33, dated 23 March 2023) is a step in the right direction, but it doesn’t tackle future challenges in a structured way. Specifically, what seems to be missing is an overarching vision that integrates the three pillars of sustainability, linked to economic parameters, staffing, and service models.

• Economic sustainability: The Reform doesn’t call for either an increase in LTC dedicated resources, or an integration of public and private funding. A missed opportunity to guarantee long-term stability for the system.
• Sustainability of personnel: The staffing shortage problem is not addressed. With no concrete measures to attract and retain qualified professionals, service quality is compromised.
• Sustainability of service models: The Reform doesn’t clearly delineate the relationship between homecare and residential care, nor does it map out the evolution of the range of care services. This ambiguity could hinder the effectiveness of relevant interventions.

An analysis of the models used in other European countries like France, Germany, and Sweden, can provide an interesting starting point in the search for effective, sustainable solutions for the future of Italy’s LTC system.

Looking beyond our borders: comparing models

We can look to France, Germany, and Sweden for virtuous examples, drawing on different aspects of their approaches to LTC.  Here are some of the strengths of the three systems.

• France: Flexibility and support for caregivers (usually family members who care for dependent relatives).  A care allowance offers beneficiaries the freedom to choose services and hire caregivers. What’s more, measures such as the “substitute caregiver subsidy” and additional work leave are ways to recognize the fundamental role played by the people who provide care for their loved ones.
• Germany: Multidimensional evaluation and incentives for homecare. A complete system that factors in both the health and the social network of the beneficiary to offer personalized assistance. Germany also offers incentives for at-home services thanks to insurance coverage and flexibility in combining services, alleviating the pressure on senior care facilities.
• Sweden: Focus on active aging and prevention. This model promotes homecare and active aging, encouraging seniors to remain at home as long as they possibly can. Hefty investments in LTC personnel and simple, clear governance complete the picture.

Lessons learned and food for thought

A comparison of the French, German, and Swedish models can give us invaluable insight for Italy, beginning with the realization that to finance the LTC system in an adequate, sustainable way, we need to diversify funding by integrating public and private resources.

We must recognize how invaluable the role of caregiver is. Acknowledging the indispensable contribution that caregivers make, and supporting them with concrete measures: these are moral duties and investments in the future.

Investments are needed in training and professionalizing personnel. Improving working conditions and creating fulfilling career paths are the keys to attracting and retaining qualified staff in the LTC sector.

Homecare and active aging should be encouraged more assertively. Investing in flexible, high quality in-home services and encouraging active aging and prevention are ways to take some of the pressure off senior care facilities and improve the quality of life for users.

Needs assessment should be based on a multidimensional approach. Considering both the health and the social network of the beneficiary is essential to guaranteeing personalized, effective care.

The bottom line is that no model is perfect, and there’s no guarantee that a model developed in one context will work in another. But the fact is that other European countries have begun rolling out reforms in response sustainability issues linked to economic aspects, personnel, and service models, while the Italian system still has a long way to go in actioning changes in this direction.