{"id":9176,"date":"2025-06-13T15:16:47","date_gmt":"2025-06-13T13:16:47","guid":{"rendered":"https:\/\/www.rivistaeco.com\/?p=9176"},"modified":"2025-06-13T15:16:47","modified_gmt":"2025-06-13T13:16:47","slug":"who-bears-the-cost-of-elderly-care","status":"publish","type":"post","link":"https:\/\/www.rivistaeco.com\/en\/2025\/06\/13\/who-bears-the-cost-of-elderly-care\/","title":{"rendered":"Who Bears the Cost of Elderly Care"},"content":{"rendered":"

Population aging presents a major challenge for our healthcare system and social services. Today, the financial resources available for the care of non-self-sufficient elderly people are not enough. But it’s not just a question of money. For example, services are not the same across the country, as availability and quality differ greatly from one area of Italy to another. All this has inevitable consequences: the elderly struggle to afford age-related costs, and the burden of care falls largely on families\u2014which mainly means women. A detailed overview of the situation is provided by the Age-It study, funded by the PNRR. The conclusion is that a radical reform of the system is needed to ensure equal access to services and adequate, sustainable care over the long term.<\/em><\/p>\n

 <\/p>\n

\u201cWill you still need me, will you still feed me when I\u2019m sixty-four?\u201d asked the Beatles in 1967 in When I\u2019m Sixty-Four<\/em>. Nearly sixty years later, the question remains relevant.<\/p>\n

Looking at our country, additional questions arise: how many men and women now reach the age of sixty-four and beyond? Who will feed whom, and who will need feeding? And more: will society be able to keep pace with this process? In other words: how does the aging of the Italian population relate to health status and potential problems of non-self-sufficiency?<\/p>\n

This is what we aim to answer here, anticipating that it is not an individual issue, nor one to be resolved within couples, but a true social and economic alarm for Italy. First, we must clear away the incorrect perception that the elderly population is a problem. Rather, we must adapt to transformations through policies that accompany change and enhance people over 65 as a resource\u2014which, in fact, they are.<\/p>\n

Aging of the Italian Population: A Challenge for the Future<\/strong><\/h3>\n

The first fact to consider is that Italy is facing a rapid population aging: in 2024, 25% of Italians have reached or surpassed the age of 65. The percentage of \u201cover 65s\u201d will rise to 36.8% by 2050, and\u2014an even more significant figure\u2014the population over 85 will increase from 4.1% in 2024 to 8.4% in 2050 (see chart below).<\/p>\n

 <\/p>\n

\"\"
Source: United Nations, Department of Economic and Social Affairs, Population Division (2024). World Population Prospects: The 2024 Revision.<\/figcaption><\/figure>\n

 <\/p>\n

Good news? Certainly, increased longevity\u2014due to medical advances, services provided by the National Health Service, and improved living conditions\u2014places us at the top of international rankings. But there is another side of the coin: a very large number of senior citizens require care and assistance.<\/p>\n

The analysis of long-term care needs has revealed a serious mismatch between supply and demand in Italy, according to a study by Ca\u2019 Foscari University of Venice in collaboration with the U.S. National Institutes of Health (NIH). Care for non-self-sufficient elderly people relies heavily on families, particularly wives, daughters, and daughters-in-law, and on unqualified personnel. Worsening the situation are the fragmentation of the public system, the limited financial capacity of elderly and vulnerable people, the restricted spread of private insurance, and the increasing incidence of multi-morbidities over time (i.e., the presence of more than one chronic illness in a person). Legislative Decree no. 33\/2023 and the recent Legislative Decree no. 29\/2024 aim to reform the long-term care system, but the effectiveness of the reform will depend on the specific content of the implementing decrees.<\/p>\n

How Long-Term Care Works in Italy<\/strong><\/h3>\n

The system of care for non-self-sufficient elderly people in Italy is a complex mosaic of monetary transfers and care services, characterized by significant fragmentation of responsibilities. The distribution of funding, management, and governance among central, regional, and local authorities adds to this complexity.<\/p>\n

The main form of economic support is the attendance allowance (indennit\u00e0 di accompagnamento<\/em>), provided by INPS, which requires 100% disability and limitations in daily activities. While crucial, it often does not cover the actual costs of care.<\/p>\n

Care services, ranging from home to residential care, are managed by various entities, such as local health authorities and municipalities, with considerable regional differences in availability and access criteria.<\/p>\n

Elderly People Needing Formal and Informal Care<\/strong><\/h3>\n

The study shows that among people over 65, 26.5% receive some type of care\u2014formal (i.e., paid) or informal, at home or in institutions. The percentage rises to 57.8% for individuals over 85. The majority of care recipients (55%) receive only informal care at home, while 21.3% receive only formal home care. A significant share receives mixed care, both formal and informal.<\/p>\n

Access to care is strongly linked to the economic conditions of elderly individuals. Among over-65s with limitations in daily activities, higher poverty rates (20.5%) and lower incomes are observed, along with poorer health and higher prevalence of depression. This vulnerability calls for targeted policy interventions to ensure access to care and improve quality of life for these seniors.<\/p>\n

Nursing Homes and Family Help<\/strong><\/h3>\n

Italy\u2019s more than 12,000 nursing homes, offering about 300,000 beds, struggle to meet growing demand: bed occupancy rates approach 95%. Availability varies significantly between regions, with the number of beds per 100 elderly people ranging from 0.6% in Campania to 4.6% in Trentino-Alto Adige.<\/p>\n

Another noteworthy aspect: the long-term care sector rests on the shoulders of a precarious and predominantly female workforce (among 260,000 registered workers, the majority are women, joined by 800,000 informal workers).<\/p>\n

The real cornerstone of care, however, is the family\u2014particularly women. Informal care provided by wives, daughters, and daughters-in-law far exceeds formal care: 83.8% of those over 65 receive it, compared to 34.7% who rely on public services. Daughters in particular provide twice as much care as sons, often at the expense of their work and private lives.<\/p>\n

Users and Costs, Public and Private<\/strong><\/h3>\n

How much does long-term care cost? In 2015, Italy spent \u20ac7 billion on care for 288,000 non-self-sufficient elderly people in nursing homes and another \u20ac4.63 billion for home services to 1,444,410 users. The real challenge, however, is quantifying the value of informal care provided by family members. The study within the PNRR framework estimates the annual economic value of this form of care at between \u20ac11.2 and \u20ac22.91 billion\u2014significantly higher than that of formal care.<\/p>\n

From a financial perspective, over 70% of formal long-term care spending is funded by the state, while the remainder is borne by users. In terms of facility availability\u2014formal home care and residential care\u2014public funding covers 63.28% of facility costs, while the individual (or their family) pays the remaining 36.39%. For home care, public contributions rise to 92.77%.<\/p>\n

In conclusion, Italy today faces an unprecedented demographic challenge. Public decision-makers are called upon to consider an expansion of public care services; recognition and support for informal care; and the strengthening of the private insurance market\u2014it is estimated that among those over 65, only 4.19% have private long-term care insurance. Only a radical reform of the system can ensure equal access to services and a credible response to the needs of a rapidly changing society.<\/p>\n

 <\/p>\n

Agar Brugiavini is Professor of Economics at Ca\u2019 Foscari University of Venice. She coordinates Spoke 6 \u201cSilver economy: work, participation, retirement and welfare\u201d of the PNRR research program \u201cAge-It.\u201d<\/em><\/p>\n

Gloria Moroni is a fixed-term researcher at Ca\u2019 Foscari University of Venice. She was previously a postdoctoral researcher at the Erasmus School of Economics, Rotterdam. Her research interests include family, labor, and health economics.<\/em><\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

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