Home care in Italy: a system on the move, in the opposite direction to what we expect

Abstract

For a long time, the international literature has described the Italian public system of home care for frail elderly people as underfunded and mostly cash-oriented; a system, thus, relying almost entirely on informal care provided by the family and, more recently, by migrant workers. Abroad and in Italy, most experts have long shared the expectation that, if and when, public expenditure devoted to home care was to increase, the outcome would be an expansion in the provision of services in kind. This study analyses how the provision of home care actually has changed in the last decade. The analysis reveals that indeed public expenditure has risen. However, while the system of home-care provision also has changed, it has done so in the opposite direction to that expected. In fact, most of the additional resources have funded an increase in the number of users of the companion payment [Indennità di Accompagnamento (IA)], a cash benefit of €487 per month. In this respect, the Italian welfare system is more cash-oriented than it was 10 years ago. This article discusses the reasons behind the increased uptake of the IA, namely: an increase in the needs and demands of older people; the traits of the Italian welfare system; and the peculiar features of the companion payment itself. The article then looks at why services in kind rose to a lesser degree, pinpoints the main reason as being based on the politics of social care at national level, and finally focuses on the challenges that the Italian home-care system has to face within the changed policy environment with respect to quality of care, carers' conditions and support for users with high-level needs.