The elderly and the disabled, Italy lags behind in the EU for spending on assistance: the weight of the private sector is growing, while the state is retreating. “Problems already present emerged with Covid”

Insufficient. These are the resources that Italy invests inassistance of the elderly and people with disability: 2.5% of GDP, one point below the average of 3.5% of the most developed OECD countries and two less than Germany (4.5%) which is in first place, closely followed by Great Britain (4,3%) e France (4.1%). And while the public service continues to decline, falling from 30% to 25%, the private sector is advancing, now at 26% from 23%. Furthermore, the key role of non-profit organizations is growing significantly – which also includes social cooperatives – and which covers almost half of the total supply of beds for the elderly and disabled (49%), compared to 42% ten years ago.

The data is contained in the report Elderly and disabled: a new model of assistance made by Foundation for Subsidiarity (FPS), in collaboration with Cesc – University of Bergamo, Crisp – University of Milan, Polytechnic of Milan and University of Parma and with the participation of Don Gnocchi Foundation e Holy Family Foundation. Statistics updated to the data available up to 2018, which photograph the Italian framework of assistance and care for elderly people who are not self-sufficient and severely disabled. The research (120 pages), edited by Alberto Brugnoli e Antonello Zangrandi, is the result of a process of comparison and in-depth work with researchers, university professors and representatives of other public, private and non-profit organizations in the social-health sector, and contains analyzes and concrete proposals for the reform of the sector.

Change system – Starting from the proposal for the establishment of a National Service for the elderly and disabled who are not self-sufficient to be understood as a “place of integration and orientation of expenditure in search of a higher quality of service and enhancement of the skills present in it”. Therefore a “catalyst of resources that today are divided between different actors (INPS, Municipalities, SSN, …) in order to build an answer that is able to satisfy such a complex need, generating a value that would be higher than the single summation of the actions implemented by the various actors “.

The idea of ​​revolutionizing the reporting basing it on results rather than sui requirements that “can create the organizational and conceptual space within which to seriously introduce the theme of Health budget, overcoming the rigidity of entrusting, taking over and pricing systems based more on “containers” (and their relative costs) rather than on people and their needs “.

In this regard, the report notes that “measure the results of a composite intervention on a fragile person is one of the most interesting challenges that lie ahead: it is therefore necessary to go beyond mortality and morbidity, beyond the levels of severity of individual pathologies and reach autonomy“. For example if the guest of a residence enters with a certain level of autonomy and after three months he lost a third – not because of the degeneration of his pathology – “it is necessary to reflect oneffectiveness of actions put in place ”to understand any areas for improvement.

“With the pandemic, problems have emerged in the care and assistance of elderly and disabled people who have been present for some time”, says a Giorgio Vittadini, president of the Foundation for Subsidiarity. “First of all, the need to recognize the diversity of needs: there is the self-sufficient elderly person and the non self-sufficient elderly person; there is a family that can take care of the person at home and there is a family that does not have the possibility – he underlines – there is a type of disability that opens up to the world of Paralympics, and one that requires assistance h24; there are poor families and rich families, who have access to the information they need, and others who are less aware. We are in a new phase. The territorial articulation of social assistance and health services must be reformed because needs increase significantly and because possibilities of cure grow”.

An example among all. The evidence, the report points out, is that the more the number of hours of assistance that the structure is able to guarantee on average for each resident, the more it improves the performance and, in the case in question, yes reduces mortality. However, the average rates per resident allocated in Italy they do not allow to guarantee a quality level of the offer such as to have similar standards to other European countries or the rest of the world.

A few statistics – With 13.8 million seniors, Italy has one of the highest levels in the world of population over 65 years, about 23% of the total (20% in the European Union). A quota destined to rise in the future, foresees the FPS Report. The disabled with severe limitations in their usual activities are about 3.1 million, 5.2% of the population. The expense for the Long Term Care (LTC) in the Peninsula amounts to about 0.7% of GDP, half that of OECD countries (1.5%), far lower than the main European partners, such as France (2.4%), Great Britain (2.4%) and Germany (2.2%). Interventions to support people with disabilities represent approximately 1.8% of the Italian GDP, compared to the average of 2% in the OECD. In this specific case we are in line with France (1.7%) and Great Britain (1.9%), but still far from Germany (2.3%) which invests more than all in the disability sector in the EU.

Valuing the results – The bodies that carried out the research have drawn up precise proposals for institutions: moving from the current model of care based on afragmented offer to a proposal more sensitive to variations in demand and to real needs, through i personalized care projects, review the mechanisms of accreditation, today exclusively linked to organizational and structural criteria, and to introduce a flexible system that knows how to measure and enhance the results. They also state that it is necessary to introduce the “supply chain budget”, Abandoning the logic of remuneration of the single service to face in a flexible way the new needs that have emerged within the RSA and RSD. And again: investing in training of health professionals e socio-sanitary introducing courses on territorial medicine, disability and the social and relational dimension of treatment courses in university courses.

Costa: “The fund for the assistance of the severely disabled has been increased but more is needed” – “The attention of the Draghi government and the Ministry of Health towards the needs of the elderly and disabled is high and constant, especially during this health and economic emergency”, said the Undersecretary of Health. Andrea Costa, on the occasion of the presentation of the Report. “Together with General Figliuolo – he added -, in organizing the vaccination campaign first and with the third dose then, we have included these subjects among the priority categories to be protected and safeguarded. I fought hard to allow the relatives of guests of the RSA to return to greet and embrace loved ones in the structures, aware that the affection of a family member is the best cure “. Unfortunately, however, how he wrote there are still many critical issues in place.

“The State-Regions Conference”, Costa then announced, “has approved an increase of 20 million euros of the Fund for assistance to people with severe disabilities without family support. However, there are still many steps to be taken: the Pnrr it will be an opportunity, which we cannot miss, to invest in proximity and onHouse assistance. It will be necessary to strengthen the territorial social services promoting a synergistic collaboration, a structured integration, between associations of the third sector and the National Health Service. This network of solidarity that knows them needs to be consolidated problems of the different territories and knows how to intervene effectively to respond to the needs of the fragile population“.

The primary and growing value of non-profit – With the pandemic crisis, the problems relating to assistance for the elderly and disabled people have worsened. “The scenarios that the statistics are outlining underline the rapid increase in the elderly population and show how this is accompanied by a progressive weakening of family networks“, He notes Gian Carlo Blangiardo, president of Istat. “The figure of the lonely elderly person, who needs assistance outside the family network, risks becoming more and more accredited in Italy in the coming decades”, warns the Istat number one.

“The FPS report”, he points out Don Vincenzo Barbante, president of the Don Carlo Gnocchi Onlus Foundation, “invites us to consider the important contribution offered in the social-health sector by the non-profit world of Christian inspiration. A world that, in designing the future scenarios of assistance capable of responding to care needs, expects to be valued for the experience and services it can offer to the country in a renewed spirit of subsidiarity “. Finally, Don Marco Bove, president of Holy Family Foundation Onlus, observes how “today it is necessary to move from a model of assistance based on the offer to a integrated orientation based on demand, on the real needs of frail people – elderly and disabled – even if complex “.

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