Abstract
In Italy, the supply of long-term care (LTC) services for dependent people is traditionally characterized by a very low level of public provision, if compared with other European countries. A highly selective public system, which provides social assistance for a small portion of dependent people, has been set against a considerable capacity of family to internalize caring functions. These two elements have constituted the principal traits of what has been termed the Italian “familist model”. In spite of its limitations, for many decades this model did not constitute an urgent public problem thanks to the strength of family ties. New phenomena are occurring today which greatly weaken the established system. The main facts are: (a) a large increase in the need for LTC, which has occurred with a progressive reduction in the caring capacities of families; (b) a strong inertia of the public welfare system, as opposed to the developments and reforms introduced in this field in most other European countries; (c) the growth of a private care market, strongly fostered by the increasing presence of “low cost” immigrant workers, which now meets a substantial proportion of caring needs. This chapter is aimed at describing this critical situation and the long-standing inertia that characterizes Italy. First, the main social changes causing the crisis of the traditional familist model are described. The traits of the public system of health and social service delivery are then presented in order to explain the strong inertia that has characterized it in the last decades. Subsequently an analysis is made of the emergence of the private care market as a specific “Italian” way of reducing the widening gap between the social needs of the population and the capacity of public policies to respond to them. Finally, this chapter seeks to identify the central challenges currently facing public policy-makers.
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Notes
- 1.
As shown by Groppi (2010), this assumption is historically constructed: the “ideology of blood” is the outcome of a continuous negotiation between family and collective responsibilities with the intervention of the State or tribunals throughout the Modern Era.
- 2.
See how the responsibilities towards relatives stated in the Civil Italian Code are heavier as compared to other countries (Millar and Warman 1996).
- 3.
Typically, migrant care workers come from a relatively limited number of countries and geographical areas, which have changed over the last 15 years due to different migratory waves. Most of those nowadays working in Italy come from eastern Europe (mostly Ukrainians, Moldavians, and Rumanians). They are largely middle-aged women, often highly educated and ready to live at the home of the cared person in order to save money.
- 4.
Author’s own calculation, based on the data provided on the INPS website.
- 5.
This is particularly crucial for social assistance policies because most of the regional resources are used to finance their health services. In any case, it is important to know that from 2001 onwards, the central State had systematically limited the mentioned Region’s fiscal autonomy.
- 6.
The only exceptions are the funds related to the National Fund for Dependency (see later) and the Plan for preschool services, both implemented with the general annual budget law of the State of 2007.
- 7.
From 2011 onwards, the INPS imposed the presence of their own doctors in the Commissions to assess the needs of applicants in order to control the whole process from IdA applications to their payment.
- 8.
Italy has a quite long story of patronage practices in the use of public benefits (see Paci and Ascoli 1984).
- 9.
As stated by Kingston and Caballero (2009), “existing institutions can affect the configuration of interest groups and their bargaining power, and groups with a vested interest in the status quo may attempt to block subsequent institutional change” (p. 173).
- 10.
Interviewed for this research.
- 11.
According to the present legislation, these regular fluxes are defined at national level by a decree every year (but based on a 3-year timeframe), with the help of local institutions and according to market needs.
- 12.
In the Conference State/Regions, there are nowadays some proposals to separate fluxes for personal assistants from those devoted to other sectors applicants. This can be considered as another attempt to support what is considered to be a fundamental component of the Italian welfare system.
- 13.
The Regions that have activated special cash allowances to support the regularization and qualification of personal assistants are Abruzzo, Emilia-Romagna, Friuli-Venezia Giulia, Veneto, Sardinia, and Valle D’Aosta. Their amount, duration, and economic eligibility criteria are very different.
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Costa, G. (2013). Long-Term Care Italian Policies: A Case of Inertial Institutional Change. In: Ranci, C., Pavolini, E. (eds) Reforms in Long-Term Care Policies in Europe. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-4502-9_11
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