Insights on Long-Term Care Policies in Italy: National Reforms to Local Changes
Research presented at the 4th International Conference on Evidence-based Policy in Long-term Care delves into the evolution of Long-Term Care (LTC) policies in Italy from national debates to local innovations. It covers the impact of economic crises, trends in LTC across Europe, and the interplay between national frameworks and local care delivery. The study aims to provide a comprehensive overview of LTC reforms and practices at various levels in Italy from 2014 to 2016.
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CeRGAS Centre for Research on Health and Social Care Management LTC REFORM TRENDS BETWEEN NATIONAL AND LOCAL POLICIES: INSIGHTS FROM ITALY Giovanni Fosti*, Elisabetta Notarnicola giovanni.fosti@unibocconi.it 4th International Conference on Evidence-based Policy in Long-term Care London School of Economics and Political Science (LSE), London, 4 - 7 September 2016. 1
LTC accross Europe LTC Key Policy Priority across Europe: Demografic / socioeconomic changes Significant growth in the need for LTC Long run increases in service unit costs Reduction in the availability of unpaidcare Rising political voice of key LTC consumer groups General pressure on public service budgets (Fernandez and Gori, 2015) 2
LTCnational trends accross Europe The tsunami of the 2008 economic crisis hit particularly hard most of the southern European countries, which at a certain point had been making efforts to catch up by providing more services and resources addressed to old age welfare, looking toward the more successful northern and central European welfare states as reference points in their own LTC policies wind of reforms and changes in the European countries Refamiliarization Privatization Deinstitutionalization Subsidiarity Restructuring National policies and reforms had different impact at the local level: If the national debate is concentrated on framework policies, what is happening at the local level, where care is delivered to families? (Deusdad, B. A., Pace, C., & Anttonen, A.; 2016) 3
Our research: from national reforms to local changes Objective: Our work offers a picture of what is going on in Italy in terms of LTC innovation and reforms at the local level. Period 2014 - May 2016 Steps: We first provide an overview of the recent national public debate about Long Term Care. We then provide a synthesis of trends in the care sector, reviewing the contents of regional policy making about Long Term Care Finally we provide an insight on innovation going on at the local level. 4
A method to understand trends at the national, regional and local level (1) Focus of analysis Target Objective Method Procedure Understanding which policies concerning LTC have been under discussion in the 2014-2016 period. Review of existing literature and official documents from the ministries 1.Identification of main trends at the national level. 2.Check through official documents and articles. TRENDS AT THE NATIONAL LEVEL Italy 1.Identification of keywords 2.Scanning of the 2014-2016 legislation including the keywords and classification of the initiatives. 3.Checking and expanding the research through a keywords driven search in the sectorial press and the Italian scientific literature, Scanning the press, the italian scientific literature, regional legislation and official documents and the press. Lombardy Emilia Romagna Liguria Understanding which policies concerning LTC have been under discussion in the 2014-2016 period. TRENDS AT THE REGIONAL LEVEL Local authorities and care providers in the north of Italy Questionnaire asking if new projects or field test about long term care have been performed in the period 1.Submission to the questionnaire to private and public managers participating to executive education initiatives (around 90 people) 2.Classification of the initiatives. Understanding what is going on at the local level, especially concerning new projects and field test TRENDS AT THE LOCAL LEVEL 5
A method to understand trends at the national, regional and local level (2) Looking for trends and innovation at the national, regional and local level: 1. Once scanned the official sources 2. Classification of the initiatives and experiences: Newness of the contents Contents Funding and Financing Confirmation of existing (annual) intervention Governance Change of an existing intervention. Care standards Service features Radical innovation Access criteria Need evaluation 6
The national level 3 main themes explicitly concerning LTC have been under discussion at the national level: theme contents classification Annual allocation of the fund. The fund is destinated to region Criteria and destionation is strictly defined at the ministerial level. Trend of an orientation towards serious disability (such as ALS) not LTC. Annual confirmation of the National Fund for dependant people Confirmation of annual intervention. Change of an existing intervention. Concern access criteria to public social care. Considered more inclusive by some professionals, less inclusive by others. Operational from 2015. Review of the existing requirements (both personal and income based requirements). Relevant for every social care target, not specific for LTC. Approval of the ISEE Reform, concerning personal requirements to access public social care Political debate about the opportunity af a re-allocation of the funds dedicated to the cash for care scheme (Indennitt di Accompagnamento) Radical innovation under political discussion but still Discussion of a possible reform of the LTC cash for care scheme 7
The regional level (1) 3 regions, chosen for their relevance and importance among regional welfare systems in Italy. Sources that have been analyzed: Regional legislation and official documents Scientific literature concerning the regions 2014-2016 Specialized press 13 citing LTC keywords Lombardia 11 citing Lombardia 3 citing Lombardia 12 citing LTC keywords 8 citing Emilia Romagna 1 citing Emilia Romagna Emilia Romagna 8 citing LTC keywords Liguria 2 citing Liguria None citing Liguria Websites and professional press dedicated to LTC or social care Strategic plans, annual and multi year legislation Italian journal dedicated to LTC or social care 8
The regional level (2) Regional legislation and official documents, what s going on? Confirmation of existing (annual) intervention 3 Change of an existing intervention 5 2014-2016 Radical innovation 5 Lombardia Emilia Romagna 5 5 2 2 2 4 Liguria Service features Access criteria Need evaluation Governance Access criteria Need evaluation Care standards Funding and Financing Funding and Financing Confirmation of existing rules and standards year after year Updating of existing rules for the current year Next slide 9
The regional level (3) Which radical innovation in the official documents? Access criteria Need evaluation Funding and Financing Service features 2014-2016 Introduction of new vouchers and cash for care interventions dedicated to elderly Introduction to cash for care interventions dedicated to indipendent living Continuity of care Introduction of a new funding mechanism for residential care based on service rating Lombardia Introduction to counselling and training for care givers Continuity of care Introduction of new need assessment tools Emilia Romagna Introduction of a new regulation for personal carers at home Introduction of public intervention dedicated to active aging Liguria 10
The regional level (4) What s more? Specialized press confirmed the same evidences found in official documents Scientific literature concerning the regions confirmed the same evidences found in official documents Add some insights on innovation going on in care homes and within home care services providers that emerge from the local level 11
The local level (1) 90 questionnaires filled in by public and private managers operating in the LTC sector in the 3 regions. Gate question: Has your organization been working on something you considered innovative about LTC in the last two years? NO: 66 YES: 24 Next slide 12
The local level (2) Which innovation from the local level? 24 experiences collected: TARGETS CONTENTS Home Care Home and personal living Sharing economy Counselling Need assessment Care pathways Active elderlies Families Mental health Dependent elderlies LTC 13% 13% 4% 42% 21% 46% 12% 12% 8% 12% 17% 13
The local level (3) Which innovation from the local level? 24 experiences collected: OBJECTIVES AND NEEDS THAT ARE PURSUED NEED OF INFORMAL CARE BOTH FOR THE FAMILY AND THE DEPENDENT PERSON Different from what is promoted at the national and regional level NEED OF INCREASING CARE INTENSITY FEELING OF SAFETY AT HOME AND IN ALL THE ASPECTS OF THE PERSONAL LIFE NEED FOR THE FAMILY TO FIND A CARE - LIFE BALANCE MORE SOCIAL RELATIONS AND ACTIVE LIFE FINDING NEW RESOURCES THROUGH SHARED INTERVENTIONS MORE PSYCHOLOGICAL COUNSELLING BUILDING A SAFETY NET FOR THE ELDERLY 14
Conclusions (1/2) National Focus: Existing intervention/access criteria Regional Focus: Changes of existing intervention and radical innovation Local Focus: Targeting on caregiver and families Regional and local level are more active and innovative than the national level. 15
Conclusions (2/2) Main issues: Continuity of care/ Active ageing Public Sector as enabler and promoter not only focused on financing and regulation From service production to connection 16
Selected references Gori, C., & Fernandez, J. L. (2015). Long-term Care Reforms in OECD Countries. Policy Press. Lechevalier, A., Giraud, O., & Kumpers, B. (2013). Policy learning and innovation in local regimes of home-based care for the elderly: Germany, Scotland and Switzerland (No. halshs-00788968). Deusdad, B. A., Pace, C., & Anttonen, A. (2016). Facing the Challenges in the Development of Long-Term Care for Older People in Europe in the Context of an Economic Crisis. Journal of Social Service Research, 42(2), 144-150 Autosufficienza, N. N. (Ed.). (2015). L'assistenza agli anziani non autosufficienti in Italia. Maggioli Editore. 17
