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Long-Term Care Benefits and Services in Italy

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Abstract

Among EU countries Italy is second—after Germany—in terms of population ageing. About 13.2 million (or 21.7%) of the population were over 65 years old in 2015, and their number is expected to increase to more than 20 million people in 2060. Despite the significant ageing of the population and the growing number of persons likely to become dependent on long-term care, Italy is a latecomer in activating care policies and in responding comprehensively to long-term care needs linked to demographic transformations. In particular, uniform social services securing long-term care are still missing. Major target groups of public interventions are either adult persons with severe disabilities below the retirement age, or senior persons beyond retirement age with specific functional impairments.

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Notes

  1. 1.

    INPS (2016), p. 73. The number of the elderly aged 85+ will even triplicate, from about 1.7 million in 2010 to more than 6 million in 2060.

  2. 2.

    The term “badanti” is considered inappropriate as it was originally applied to persons looking after animals in the farming sector.

  3. 3.

    Veshi (2013), p. 377; Centre for Economic and International Studies (CEIS) (2013), p. 47; for the specific poverty risks cf. Luppi (2015), p. 87 ff.

  4. 4.

    The “Commission for the analysis of macro-economic sustainability of social expenditure” (Commissione per l’analisi delle compatibilità macroeconomiche della spesa sociale) was appointed in 1997 under the chairmanship of economist Paolo Onofri to elaborate reform proposals for the Italian welfare state.

  5. 5.

    Legge 27 dicembre 2006, n. 296 “Disposizioni per la formazione del bilancio annuale e pluriennale dello Stato (legge finanziaria 2007)”, Art. 1 (1264).

  6. 6.

    The proposal for a delegated law on long-term care of 2007 (“legge delega al governo in materia di protezione e cura sociale delle persone non autosufficienti” of 16 November 2007) provided, among other things, for the introduction of core social services and core social healthcare services in order to support the development of a network of in-home, inpatient and semi-outpatient social services as well as so-called single access points (Punti Unici di Accesso, PUA). Non-governmental reform initiatives presented by members of the Italian Senate (A.S. n. 2827 of 13 July 2011) or by Parliament (A.C. 5319 of 27 June 2012) also failed; for various unsuccessful reform initiatives cf. Caruso et al. (2013), p. 147, table 2. For reform proposals concerning cash benefits (“dote di cura”) cf. Istituto per la Ricerca Sociale (IRS) (2013, 2016).

  7. 7.

    Costa (2013), p. 221. The 2007 collective agreement for domestic workers expired in February 2011, and was renewed in 2013. The renewed contract foresees a salary increase, remuneration for holidays and annual leave; extension of the right to paid leave to undergo training for migrant domestic workers; and the right to leave the house during the mandatory daily 2-hour break for live-in workers. The renewed agreement is set to expire in December 2016.

  8. 8.

    See the various acts legalizing the status of foreign nationals employed as family assistants, most recently D.Lgs. No. 109/2012, cf. Pasquinelli and Rusmini (2013), pp. 97–99.

  9. 9.

    Decree Law of 30 September 2005 No. 203 on tax evasion, Art. 11-quaterdodies (12), as amended by the Law of 2 December 2005, No. 248, cf. Long (2011), pp. 207–226 (215).

  10. 10.

    Approximately 43% of the public expenditure on long-term care is spent on the national attendance allowance and only 11% on other public benefits and services, cf. Veshi (2013), pp. 373 f.

  11. 11.

    Art. 117 Italian Constitution, as modified by Constitutional Law No. 3/2001; cf. Pioggia (2014), p. 45 ff. Frego Luppi (2011), pp. 29 ff.

  12. 12.

    Art. 117 (2) lett. m) of the Constitution.

  13. 13.

    D.Lgs. No. 502/1992 defined the “essential levels of healthcare” as all the benefits guaranteed by the National Health Service, subsequently specified in more detail by the Decree of the President of the Council of Ministers (D.P.C.M.) of 29 November 2001, confirmed by Art. 54 of Law No. 289/2002 (legge finanziaria 2003); for details see Pioggia (2014), pp. 59 ff. 67 ff. After several unsuccessful attempts to revise the LEAs in 2008 and 2010 an updated version has been finally approved in July 2016, and the new D.P.C.M. of 12 January 2017 will replace the D.P.C.M. of 2001.

  14. 14.

    Cf. Decree of the Minister for Labour and Social Policies and other Ministers (decreto interministeriale) on dependency of 4 August 2016 (Art. 7).

  15. 15.

    Law n. 112 of 22 June 2016 (“Disposizioni in materia di assistenza in favore delle persone con disabilità grave prive del sostegno familiare”) pursues the objective to support social inclusion and autonomy of persons with a severe disability, namely to avoid institutionalisation and to further independent living arrangements. To a limited extent, support programmes to assist severely handicapped people had been addressed by law No. 162 of 1998, but they were not confined to persons deprived of family assistance.

  16. 16.

    INPS (2016), p. 81. Most recipients (64%) are women, and six out of 10 beneficiaries are older than 75 years. A similar, but more generous benefit is available for the totally blind.

  17. 17.

    So-called “Home Care Premium” programme, available only in a limited number of municipalities and in case of special contracts stipulated by INPS. For details see INPS (2016), p. 99 f.

  18. 18.

    Framework Law No. 328 of 8 November 2000 on the implementation of the integrated system of social interventions and services (legge quadro per la realizzazione del sistema integrato di interventi e servizi sociali).

  19. 19.

    INPS (2016), p. 76.

  20. 20.

    Costa (2013), p. 223.

  21. 21.

    INPS (2016), p. 79.

  22. 22.

    Art. 33 (3) Law No. 104/1992, Art. 42 (5-ter) D.Lgs. No. 151/2001 as modified by D.Lgs. No. 119/2011.

  23. 23.

    Regions as political entities enjoy increased autonomy in social policy legislation following the constitutional reform of 2001. Strong regional disparities persist due to diverse socio-economic structures and administrative traditions dating back to the Italian unification in 1861 and the inability to implement a sturdy, unitary public administration.

  24. 24.

    For the elaboration of these different cluster models cf. Barbabella et al. (2013b), pp. 30 ff.

  25. 25.

    Framework Law No. 104/1992 on the social support and integration and on the rights of persons with handicap (legge-quadro per l’assistenza, l’integrazione sociale e i diritti delle persone handicappate).

  26. 26.

    This approach has been adopted in the Decree of the Ministry of Labour and Social Affairs of 14 May 2015 on the territorial allocation of the funds available under the National Dependency Fund (FNA) which gave priority to persons with most severe disabilities (“disabilità gravissima”). It refers to persons in condition of vital dependency that require continuous assistance at home and social and healthcare monitoring for 24 h a day, in view of complex needs due to severe pathological conditions, susceptible to compromise respiratory functions, nutrition, the state of conscience, and who lack autonomy in moving around and/or at any rate require watchful assistance by a third party in order to safeguard their physical and psychical integrity. 40% of FNA resources should be allocated to interventions for persons in such most severe conditions.

  27. 27.

    See the decree of the Minister for Labour and Social Affairs and other Ministries of 4 August 2016 on long-term care interventions, including the allocation of the resources of the FNA in 2016 and later on.

  28. 28.

    Art. 66 Consolidated Law on the Social Insurance on Work Accidents and Occupational Diseases No. 1124/1965 (Testo unico delle disposizioni per l'assicurazione obbligatoria contro gli infortuni sul lavoro e le malattie professionali).

  29. 29.

    Cf. Annex to T.U. No. 1124/1965.

  30. 30.

    Assegno mensile per l’assistenza personale e continuativa (Art. 5 Law No. 222/1984).

  31. 31.

    Law No. 296 of 27 December 2006, Art. 1 (1264) (Legge finanziaria 2007).

  32. 32.

    ISVAP (2003).

  33. 33.

    Rebba (2006), p. 411. The same criteria are used in occupational healthcare funds based on collective agreements that cover the risk of loss of personal autonomy: Cf. e.g. the National Healthcare Fund FASCHIM established by collective agreement for the chemical industry sector, (CCNL) of 12 February 2002.

  34. 34.

    Cf. Banchero (2009), pp. 108 f., table 1.

  35. 35.

    Cf. the examples cited by Tediosi and Gabriele (2010), 1.2.

  36. 36.

    Art. 2 (1) Provincial Law (Legge Provinciale, LP) No. 9 of 12 October 2007 of the Autonomous Province of Bolzano in connection with Resolution No. 73 of 28 January 2014 of the Provincial Government on criteria concerning the acknowledgement of long-term care dependency, the payment of care allowance and the administration of the long-term care fund.

  37. 37.

    Art. 2 Resolution No. 73 of 28 January 2014 of the Provincial Government.

  38. 38.

    Daily long-term care needs in level 1 = 2–4 h, in level 2 = 4–6 h, in level 3 = 6–8 h, in level 4 = more than 8 h.

  39. 39.

    Art. 8 (2) of LP (Bolzano) 9/2007; the minimum benefit has been increased to 555 € as of January 2016.

  40. 40.

    The Friuli region care benefit requires the condition of severe dependency defined as the impossibility to perform at least 2 Activities of Daily Living (ADL), based on the ADL score of Katz; the case of severe dementia is defined as “the condition of dementia of at least second degree, assessed according to the Clinical Dementia Rating Scale (CDR)”, Presidential Decree of the Region No. 7/2015, Art. 5.

  41. 41.

    For the legal foundations of different regional approaches cf. Banchero (2009), p. 108 f., table 1, p. 110.

  42. 42.

    ISTAT thus follows the modernized concept of disability and the approach adopted by the WHO with its International Classification of Functioning, Disability and Health.

  43. 43.

    ISTAT (2014b), p. 2f.

  44. 44.

    Figures from ISTAT (2017), and Pasquinelli et al. (2016), p. 49.

  45. 45.

    ISTAT (2015a; 2017); for more differentiated estimations cf. Chiatti et al. (2011), p. 17.

  46. 46.

    Bosco (2017), p. 202.

  47. 47.

    Gori and Lamura (2009), p. 25; N.N.A. (2015), p. 31. However, different sources provide different figures based on the types of benefits and services included. INPS (2016), p. 75, reports a 1.8% share of long-term care expenditure in GDP (2013), based on European survey data, whereas INPS institutional data underpin a 2.19% share in GDP in 2014/2015, the latter including expenditure for paid care leave under social security (in general disregarded by European sources), cf. INPS (2016), p. 77.

  48. 48.

    Barbabella et al. (2013a), p. 23.

  49. 49.

    Barbabella et al. (2015), p. 28; Barbabella et al. (2013a), p. 24.

  50. 50.

    For a detailed analysis of long-term care policies in 5 regions—Liguria, Lombardy, Veneto, Emilia-Romagna and Tuscany—that managed to develop and extend coverage in different areas of this policy sector cf. Gori and Rusmini (2015a); for the regional disparities in usage and expenditure cf. Banchero (2015), p. 193 ff.

  51. 51.

    Barbabella et al. (2015), p. 21 f.; Carrino (2015), p. 137 ff.

  52. 52.

    All northern regions attain coverage rates above the national average (with peaks between 4.38% and 3.5% in Trentino-South Tyrol, Piedmont, Aosta Valley and Friuli), while 12 out of the 20 Italian regions, including all southern regions, range below the national average. For details on the disparities cf. Carrino (2015), p. 139 ff.

  53. 53.

    Barbabella et al. (2015), p. 23 ff.

  54. 54.

    An invalidity is considered to be “civilian” if it does not result from service, war, or work, and therefore does not enjoying protection under any other social security scheme.

  55. 55.

    Art. 1–3 of Law No. 18 of 11 February 1980 (“Indennità di accompagnamento agli invalidi civili totalmente inabili”), modified by Art. 1–2 of Law No. 508/1988 (“Norme integrative in materia di assistenza economica agli invalidi civili, ai ciechi civili ed ai sordomuti”), and Legislative Decree (D.Lgs.) No. 509/1998. For details s. Mesiti (2014), p. 400.

  56. 56.

    The prerequisites do not have to be cumulative. Also persons who are able to perform the activities of daily living in their own surroundings but who cannot leave the house independently are entitled to the attendance allowance, cf. Cass. sentence (sent.) No. 8060/2004. With respect to the incapacity to perform the activities of daily living, entitlement to the allowance has also been recognized in the case of persons with Down Syndrome.

  57. 57.

    Costa (2013), p. 230.

  58. 58.

    Cass. Sez. Un., sent. No. 11329/1991; No. 1377/2003; No. 11525/2006.

  59. 59.

    Cass. sent. No. 21761/2004.

  60. 60.

    Cass. sent. No. 25569/2008; Cass. sent. No. 20003 and 21281/2010.

  61. 61.

    Cass. sent. No. 667/2002; No. 1268/2005.

  62. 62.

    Corte costituzionale, sent. No. 346/1989; Cass. sent. No. 14339/2001.

  63. 63.

    This restriction generally only applies in the case of inpatient accommodation for a period of at least 30 days. Under certain conditions, entitlement to the allowance may exist also in the case of accommodation in public care institutions, Cass. sent. No. 25764/2008. Accommodation in a day-care centre does not conflict with the receipt of the national attendance allowance.

  64. 64.

    See Cass., sent. No. 2270 of 2.2.2007.

  65. 65.

    For option rights cf. Ministerial Decree (D.M.) of 31 October 1992, No. 533; Art. 12 Law No. 412/1992.

  66. 66.

    A differentiated cash benefit (“dote di cura”) at three levels (300, 600 or 800 € per month) has been reproposed in 2016 as part of an ambitious welfare reform project, cf. Pasquinelli et al. (2016), p. 49 ff. for past reform debates s. Arlotti (2012), p. 555; Costa (2011), p. 69.

  67. 67.

    Law No. 508/1988; Law No. 289/1990.

  68. 68.

    Art. 1 of Law No. 508/1988 (Norme integrative in materia di assistenza economica agli invalidi civili, ai ciechi civili ed ai sordomuti). For totally blind minors affected by multiple disabilities the allowance is increased by 45% (Art. 5-bis of Law No. 508/1988). The amounts of all benefits related to civilian invalidity as well as any income limits that may apply are published annually in a circular by INPS; for 2017 s. circular no. 8 of 17 January 2017, annex No. 3, p. 26 ff.

  69. 69.

    Law No. 295/1990, Art. 1, as modified by Art. 20 Law No. 102/2009. However, on 1 January 2012, the obligation for a physician from the social insurance authority to be present was not observed in more than 50% of the cases. Cf. Corte dei Conti, Determinazione 91/2012. The average waiting period regarding the first appointment with the classification committee is 8 months.

  70. 70.

    Art. 20 of Law No. 102/2009.

  71. 71.

    As to the problems regarding the assessment criteria within the context of civilian invalidity from a medico-legal viewpoint see Cembrani et al. (2007).

  72. 72.

    Gori and Pelliccia (2013), p. 53 (esp. fn 9). In 2013 coverage rates ranged from 7.2% of beneficiaries aged 65+ in the Trentino-South Tyrol provinces to 17.9% in Calabria (and excessively 16.8% in the central region of Umbria), cf. Barbabella et al. (2015), p. 16 ff.

  73. 73.

    Linee Guida operative in invalidità civile, Internal Communication of INPS, 20 September 2010.

  74. 74.

    Amendment presented during the debates on the “anti-crisis” interventions of Decree Law (D.L.) No. 78/2010, converted into Law No. 122/2010.

  75. 75.

    Cf. Barbabella et al. (2013a), p. 23, table 5.

  76. 76.

    Persons who are dependent on long-term care due to a mental or psychological impairment are exempt from that requirement for lifetime on presentation of an appropriate medical certificate, cf. Art. 1 (254) of Law No. 662/1996.

  77. 77.

    INPS (2016), p. 216.

  78. 78.

    For pensions and allowances for the civilian disabled or invalids cf. Laws No. 118/1971, No. 18/1980 and No. 508/1988.

  79. 79.

    Law No. 289/1990.

  80. 80.

    Creches (asili nido) have been recognized as relevant educational services for the purpose of the benefit by the Constitutional Court, sent. No. 467/2002.

  81. 81.

    Law No. 382/1970.

  82. 82.

    Law No. 508/1988.

  83. 83.

    The right to this aggregation has been introduced by Law No. 429/1991.

  84. 84.

    Law No. 107/2010, in force since 14 July 2010.

  85. 85.

    Cf. Cinelli (2015), pp. 490 ff.; the injury must have occurred at work by a violent cause in connection with a risk related to the performed activity. Accidents at work that do not meet eligibility criteria of the work accident scheme may be covered by the statutory pension insurance, cf. Hohnerlein (1998), pp. 234 ff., pp. 247 ff.

  86. 86.

    Assegno per l’assistenza personale continuativa, Art. 66, 76 and 218 of Consolidated Law on Work Accidents (T.U.) No. 1124 of 13 June 1965, as amended by D.Lgs. No. 38/2000.

  87. 87.

    Art. 1 (782) Law No. 296/2006.

  88. 88.

    Cass. sent. No. 4069/1990; Cass. No. 12215/1998.

  89. 89.

    Corte costituzionale, sent. No. 216/1991.

  90. 90.

    INAIL, decision of 10 April 2014.

  91. 91.

    Assegno mensile per l’assistenza personale e continuativa.

  92. 92.

    DPR 1092/1973; Law No. 9/1980.

  93. 93.

    On the development of the victim compensation systems cf. Hohnerlein (2011), pp. 57 ff.

  94. 94.

    Assegno di superinvalidità pursuant to Presidential Decree (Decreto del Presidente della Repubblica, DPR) No. 915/1978. The benefit replaces the formerly existing supplementary benefits provided for care and attendance services to “major invalids.”

  95. 95.

    Art. 3 (2) of Law No 13/1987, Art. 8 of Law No. 656/1986.

  96. 96.

    As modified by Law No. 44/2006, and subsequent modifications.

  97. 97.

    Ministerial Decree (D.M.) of 14 September 2010 in connection with Law No. 44/2006.

  98. 98.

    Art. 15 (1) lett. i-septies of DPR 917/1986.

  99. 99.

    Art. 10 (1) lett. b) of DPR 917/1986.

  100. 100.

    The Regional Government of Lazio decided in 2016 that 50% of the RSA fees are linked to specific health assistance and therefore susceptible of this fiscal benefit, thus following the example given by Lombardy some years ago, cf. Decree of the Regional Government (Decreto della Giunta Regionale, DGR) No. 3540 of 30 May 2012.

  101. 101.

    Lamura and Principi (2009), p. 75.

  102. 102.

    Art. 16 (3) lett. d) of Law No. 328/2000.

  103. 103.

    Cf. the regional care benefits in Veneto (impegnativa di cura domiciliare – ICD – since 2013, replacing the former assegno di cura of 2007), Emilia-Romagna (assegno di cura anziani, 2006/2007), Liguria (misura economica del Fondo regionale per la non autosufficienza, 2008), Friuli (assegno per l’autonomia, but a 2015 reform introduced an obligation of accountability for 50% of the benefit); Lombardy (buono sociale, 2008); Autonomous Province of Trento (sussidio per la cura domiciliare di un anziano non autosufficiente, 2006; assegno di cura 2012); Umbria (assegno di cura, 2005); Tuscany (ADI indiretta, 2006), Piedmont (Assegno di cura, 2006). Even southern regions adopted this benefit: Sicily and Calabria in 2003, Abruzzo in 2006, Apulia in 2007, and Sardinia in 2008. Coverage rates among the elderly vary widely (0.2% in Piedmont; 3–4% in the Autonomous Province of Bolzano. Cf. Lamura and Principi (2009), p. 77, table 3.

  104. 104.

    The Veneto region was one of the pioneers in introducing an allowance for family assistants (asssegno badante) in 2002, DGR 4135/2006; DGRV 1338/2013 on the new cash benefit “Impegnativa di cura domiciliare”, limited to cases with low care needs. See also Abruzzo, Decree of the Regional Government (DGR) 121/2007; Emilia-Romagna, DGR 1206/2007; Aosta Valley, DGR 690/2007; Friuli: “Contributo per l’aiuto familiare”, Presidential Decree of the Region (D.P.Reg.) No. 7/2015, Art. 6; Sardinia: DGR 44/13 of 2007; Umbria: LR No. 28/2007; Lazio: DGR 890/2008; Autonomous Province of Trento, Legge Provinciale (LP) No. 15/2012. Lombardy introduced a so-called “Buono badanti” (2006) and a new system of vouchers to support home care on an experimental basis under the new “Family Fund” (DGR 116/2013; DGR 856/2013, DGR 2942/2014) and adopted new legislation for various aspects of private care and family assistants in LR No. 15 of 25 May 2015. For the typology of cash-for-care benefits cf. Pasquinelli and Rusmini (2009), p. 84 ff.

  105. 105.

    Cf. for instance Autonomous Province of Trento, Art. 10 LP No. 15/2012 and Deliberazione of the Giunta Provinciale (G.P.) No. 1233 of 14 June 2013.

  106. 106.

    Cf. in the Autonomous Region of Friuli the financial support for independent living, with a yearly minimum of 5000 €, Legge Regionale (LR) of Friuli-Venezia Giulia, No. 6/2006 (Art. 41), Regolamento 35/2007.

  107. 107.

    In the regions of Emilia-Romagna and Tuscany the benefits are granted as individual, subjective legal rights, cf. Fargion (2012), p. 52. By contrast, the interventions financed from the care fund of the Friuli region to support independent living of adult persons with severe disabilities (progetti di vita indipendente) are limited by the resources assigned to the local social administration for that purpose, a fact which goes against the concept of a subjective right to those benefits.

  108. 108.

    Cf. Autonomous Province of Bolzano, LP No. 9/2007; Resolution of the Provincial Government No. 73 of 28 January 2014 on criteria regarding the acknowledgement of long-term care dependency, the payment of care allowance and the administration of the long-term care fund. The Autonomous Province of Trento extended the use of care benefits to paying professional, accredited private care services and to contributing to co-payments to public long-term care services (Art. 10 LP No. 15/2012, DGP No. 1233/2013).

  109. 109.

    These services generally involve co-payments.

  110. 110.

    Cf. Apulia, Autonomous Province of Trento, Aosta Valley as of 2014, Lombardy LR No. 15/2015; see Rusmini (2013), pp. 156 ff. 159.

  111. 111.

    Art. 18 (2) lett. (a) LR No. 23 of 23 July 2010 (Aosta Valley) – T.U. in materia di interventi economici di sostegno e promozione sociale.

  112. 112.

    For instance in Friuli, Basilicata, Lazio. In practice however, families prefer to rely more on personal recommendation than on official registers, cf. Rusmini (2013), pp. 159f.

  113. 113.

    Provincial Law (LP) No. 9 of 12 October 2007; Resolution No. 73 of the Autonomous Province of Bolzano of 28 January 2014 on criteria concerning the acknowledgement of long-term care dependency, the payment of care allowance and the administration of the long-term care fund.

  114. 114.

    Rusmini (2013), pp. 155 ff., table 1, pp. 157–158. In the course of the financial crisis the income criteria were tightened so that the number of beneficiaries decreased.

  115. 115.

    Lamura and Principi (2009), p. 77: Emilia-Romagna: 246 €; Liguria: 330 €; Friuli: 375 €; Autonomous Province of Trento: 354 €; Umbria: 418 €.

  116. 116.

    The following benefits were granted in 2014: in care level 1 with a monthly need of support of more that 60–120 h, the care benefit amounts to 547 €, in level 2 (more that 120–180 h of need of support per month) it amounts to 900 €, in level 3 (more than 180–240 h of need of support per month) to 1350 € and in level 4 (more than 240 h of need of support per month) to 1800 €. In the region of Piedmont the monthly care benefit amounts up to a maximum of 1650 €, in the Autonomous Province of Trento up to 1100 €, in Friuli up to 1092 €.

  117. 117.

    Benefit amounts vary between 160 € (Emilia-Romagna) and up to 260 € (Veneto), depending on the duration of long-term care. Cf. Pasquinelli and Rusmini (2009), p. 87. In the Autonomous Region of Friuli the contribution to family assistance (contributo per l’aiuto familiare, CAF) varies between an annual minimum of 3144 € and a maximum of 10,920 €. The financial support assumes an employment contract for at least 20 h a week; several employment contracts can be cumulated. If more than two family care assistants are employed and total working hours exceed 54 h a week, the care allowance is increased by 20%.

  118. 118.

    Pasquinelli and Rusmini (2009), p. 89. In the case of regular employment contracts, families may deduct the social security contributions for care workers from their income tax to a limited extent.

  119. 119.

    Grazioli (2012), p. 286.

  120. 120.

    In the Region of the Aosta Valley, for instance, the monthly care benefit for care assistants was reduced by 250–300 € to an amount of 700–300 € while care benefits for family caregivers were reduced to a monthly fixed amount of 300 €, cf. Legge Regionale (LR) No. 23/2010 (T.U. in materia d’interventi economici di sostegno e promozione sociale) as amended by DGR No. 1553/2011.

  121. 121.

    Cf., for example, the Autonomous Province of Bolzano, Emilia-Romagna and the Region of Veneto that tried to solve the problem by creating a uniform basket of benefits to promote in-home care as of 2014, cf. on this Gori and Pelliccia (2013), p. 52, at fn 7.

  122. 122.

    Art. 19 (1) lett. g) of Decree Law (D.L.) No. 95/2012, converted into Law No. 135/2012. The main sources used in the section on general aspects of the provision of long-term care services, both healthcare and personal social services, are Pioggia (2014); Molaschi (2008); Morzenti Pellegrini and Molaschi (2012).

  123. 123.

    Corte cost. sent. No. 10/2010; see also sent. Nos. 282/2002, 248/2006, 387/2007 and 50/2008. For details see Pioggia (2014), pp. 56 f.

  124. 124.

    The Decree (D.P.C.M.) of 12 January 2017, (Definizione e aggiornamento dei livelli essenziali di assistenza, di cui all'articolo 1, comma 7, del decreto legislativo 30 dicembre 1992, n. 502), G.U. (Official Journal) Serie Generale n.65 del 18-03-2017—Suppl. Ordinario n. 15 was based on an agreement convened by the Conference of the State and the Regions. The novelties of 2017 comprise a more stringent integration of social services and healthcare services (Art. 21), and home care services defined by 4 different degrees of support needs (Art. 22).

  125. 125.

    Chapter IV of the new Decree replaces annex 1, part C of the D.P.C.M. of 2001.

  126. 126.

    Cf. the definition contained in Art. 3-septies D.Lgs. No. 502/1992, introduced by D.Lgs. No. 229/1999.

  127. 127.

    Art. 44 D.P.C.M of 12 January 2017. For details see Pioggia (2014), pp. 66 f.

  128. 128.

    “Atto di indirizzo e coordinamento in materia di prestazioni socio-sanitarie”. This decree distinguishes between three levels for the combination of healthcare and social services: high level of integration in which the healthcare aspect is predominant, health services with social components, and social services with healthcare components.

  129. 129.

    According to Art. 3-septies (5) of D.Lgs. No. 502/1992, social healthcare benefits with a predominant level of healthcare (prestazioni socio-sanitarie ad elevata integrazione sanitaria) are guaranteed by the local health authorities (ASL) and are part of the essential levels of healthcare. For the essential levels of benefits in the area of integrated social and healthcare see Molaschi (2010), p. 479 ff.; Albanese (2012), pp. 129 ff.

  130. 130.

    Art. 3-septies (6) of D.Lgs. No. 502/1992. The 2017 D.P.C.M. defines the essential levels of healthcare in case of long-term care needs according to intensity, complexity and duration of healthcare interventions needed. Whether the implementation of the 2017 Decree will entail changes in cost sharing arrangements is yet unclear.

  131. 131.

    Cf. Tribunale di Firenze, No. 1154; Regional Administrative Tribunal (Tribunale Amministrativo Regionale = TAR) of Piedmont, sent. No. 609/2012; No. 141/2013; TAR of Lombardy, sent. No. 459/2012 and 461/2012.

  132. 132.

    See TAR of Lombardy, sent. No. 1584/2010: services provided in residential care for an elderly patient in a persistent vegetative state are to be qualified as social healthcare services with elevated intensity of healthcare integration and are therefore entirely at the expense of the healthcare system; Cassazione, sent. No. 4558/2012: health services in residential care provided to a patient affected by Alzheimer’s disease is also to be borne exclusively by the healthcare system, as any non-healthcare services involved are of a purely marginal character.

  133. 133.

    Art. 22 (2) Law No. 328/2000.

  134. 134.

    Art. 22 (4) Law No. 328/2000.

  135. 135.

    See Art. 2 (1) of Decree of the President of the Council of Ministers, D.P.C.M. No. 159 of 5 December 2013 (Regolamento concernente la revisione delle modalità di determinazione e i campi di applicazione dell’Indicatore della situazione economica equivalente).

  136. 136.

    Corte Costituzionale No. 296/2012, sentence of 11.12.2012 concerning the regional law of Tuscany No. 66/2008.

  137. 137.

    Yet a minority of five regions claimed cost participation only from the beneficiary and limited income testing to the beneficiary.

  138. 138.

    Cf. Giacobini (2015), p. 103 f. The new system became operative only as of January 2015, according to the Decree of the Ministry of Labour and Social Affairs of 7 November 2014.

  139. 139.

    Cf. TAR of Lazio, Sect. I. sent. No. 2454/2015, No. 2458/2015 and 2459/2015 of 11 February, 2015. The sentences claimed that considering allowances granted to meet care-related needs as “income” in the ambit of means-testing was unlawful as they were not aimed at providing income support but at compensating for specific disabilities and care needs. By deliberation Nos. 838, 841 and 842 of 29 February 2016 the Highest Administrative Court (Consiglio di Stato) confirmed the TAR decisions.

  140. 140.

    Cf. Art. 2-sexies of D.L. No. 42/2016, as modified by Law No. 89/2016, which exempted disability-linked allowances from any ISEE calculation under D.P.C.M. No. 159/2013.

  141. 141.

    For example, Regional Law (LR) of Emilia-Romagna No. 3/2003; LR of Apulia No. 17/2003; LR of Tuscany No. 41/2005, LR of Basilicata No. 4/2007.

  142. 142.

    So-called LEA Committee, established by agreement between the State and the Regions of 23 March 2005.

  143. 143.

    For details see Pioggia (2014), p. 99 f.

  144. 144.

    E.g. the “Società per la salute” (“societies for health”) created in Tuscany, cf. Fargion (2012), p. 58.

  145. 145.

    For details see Pioggia (2014), pp. 162 ff.

  146. 146.

    The former “Istituzioni pubbliche di assistenza e beneficenza” (IPAB). For the regional legislation of the ASP see e.g. LR of Emilia-Romagna No. 12/2013.

  147. 147.

    Art. 5 of D.Lgs. No. 207/2001.

  148. 148.

    Pioggia (2014), pp. 169 ff.

  149. 149.

    Art. 3-septies (4) and (5) of D.Lgs. No. 502/1992 as modified by D.Lgs. No. 229/1999.

  150. 150.

    On the different orientations of regional legislation cf. Albanese (2012), pp. 146 ff.

  151. 151.

    Cf. the examples presented by Fargion (2012), pp. 37 ff., 57 ff. (Lombardy, Tuscany, Emilia-Romagna, Piedmont, Apulia).

  152. 152.

    Like Piedmont, Lombardy, Veneto, Friuli-Venezia Giulia, Liguria, Emilia-Romagna, Marche, Basilicata, Sardinia, Aosta Valley, Tuscany. Cf. Pioggia (2014), p. 137.

  153. 153.

    D.Lgs. No. 502/1992, as amended by D.Lgs. No. 299/1999.

  154. 154.

    Ministry of Health (2011), p. 246.

  155. 155.

    This particular model of participation and cooperation has been introduced on an experimental basis at the national level, but as its implementation concerns the organization of services, current regulation falls completely under the legislative powers of the Regions. See Pioggia (2014), pp. 129 ff.

  156. 156.

    Art. 8-ter D.Lgs. No. 502/1992.

  157. 157.

    Pioggia (2014), p. 126.

  158. 158.

    For accreditation in the field of integrated social healthcare as compared to the field of social services cf. Bellentani (2010).

  159. 159.

    Lombardy: Art. 9 LR No. 33/2009; for details see Pioggia (2014), p. 126.

  160. 160.

    Cf. Art. 8-quinquies of D.Lgs. No. 502/1992 and subsequent modifications and regional legislation. The contractual arrangements are called “accordi” in case of public providers, and “contratti” in case of private providers.

  161. 161.

    Art. 8-quinquies (2) of D.Lgs. No. 502/1992, as amended by Law No. 133/2008.

  162. 162.

    Bellentani (2010).

  163. 163.

    Art. 3 (4) of Law No. 328/2000.

  164. 164.

    Patronati are institutions established by trade unions, offering assistance and protection to members of the labour force, pensioners and residents in general, and are funded by social security contributions.

  165. 165.

    Art. 1 (4) of Law No. 328/2000. Cf. also D.P.C.M. No. 31/2001; Law No. 266/1992 (on the institutions for volunteers), Law No. 383/2000, Art. 2 (1) (on associations of social utility); Law No. 381/1991 (on social cooperatives).

  166. 166.

    Art. 1 (5) of Law No. 328/2000. For-profit providers are not involved in the planning and organization of the service system. See Pioggia (2014), p. 174.

  167. 167.

    The national definition is contained in Decree of the Ministry for Social Solidarity No. 308 of 21 May 2001. The standards for facilities deal with easy public accessibility, spaces dedicated to collective activities, qualified professional staff and a responsible coordinator for the services, and the planning of services according to an individual care programme. Regional legislation may add further standards.

  168. 168.

    Except for the Autonomous Province of Bolzano and the Region of Aosta Valley.

  169. 169.

    D.Lgs. No. 163/2006.

  170. 170.

    See Liguria, LR No. 57/2009, cited by Pioggia (2014), p. 181.

  171. 171.

    The expenditure for invalids and persons needing long-term care amounted to 26 billion € in 2011, which was 7.5 billion € below the average expenditure in Europe taking into account the population, cf. Baldini (2014). Expenditure was reduced during the the economic and financial crisis in Italy.

  172. 172.

    Cf. Law No. 42/2009, D.Lgs. No. 68/2011 and D.Lgs. No. 23/2011.

  173. 173.

    Starting with 100 million € in 2007, later oscillating between 400 million € in 2009/ 2010 and zero in 2012. For 2015 see the Stability Law (legge di stabilità), Law No. 190/2014, Art. 1 (159). A second national fund providing financial resources for long-term care services at regional level is the general social policy fund.

  174. 174.

    The Decree of the President of the Council of Ministers (D.P.C.M.) No. 159 of 5 December 2013, replaced the previous ISEE system established by D.Lgs. No. 109/1998.

  175. 175.

    Home-help: household activities, shopping; personal care: assistance with washing, dressing, eating, going to the bathroom, etc.

  176. 176.

    Stair lifts, wheelchair ramps, rollators, personal alarm or telephone alert, etc.

  177. 177.

    For the characteristics of home care in Italy, cf. Melchiorre et al. (2013), p. 153.

  178. 178.

    Art. 22 (4) Law No. 328/2000.

  179. 179.

    Ministry of Health (2010), QMS, pp. 97 f.

  180. 180.

    Del Favero (2011), p. 30. According to recent reforms in the region of Lombardy special support services for family members assisting senior patients with dementia or other psycho-geriatric disorders are to be supplied by providers of residential care, as a form of “open” residential care.

  181. 181.

    Amyotrophic lateral sclerosis (ALS), a severe neuromuscular degenerative disease.

  182. 182.

    As in the Autonomous Province of Bolzano, which offers services for personal hygiene (assisted bathing, showering, hair washing), laundry services, pedicure.

  183. 183.

    Besides the elderly needing long-term care services, social care services can be activated in favour of other beneficiaries, like persons with disabilities, families with children or adults in specific conditions.

  184. 184.

    Art. 15 of Law No. 328/2000.

  185. 185.

    Grazioli (2012), p. 270.

  186. 186.

    Art. 21 of D.P.C.M 12 January 2017.

  187. 187.

    Gori and Casanova (2009), p. 41. The inspiration comes from the three levels of long-term care needs presented in the document on standards for home care health services, proposed by the Commission for the revision of the essential levels of healthcare benefits in 2006, cf. table 1 in Gori and Casanova (2009), p. 43. Cf. also the three levels of integrated ADI services defined as essential levels of healthcare in Art. 22 (3b–3d) of D.P.C.M. 12 January 2017. On the persisting regional disparities cf. Vetrano and Vaccaro (2017).

  188. 188.

    For details see Pesaresi (2010), pp. 151 ff.

  189. 189.

    Pesaresi (2010), p. 154.

  190. 190.

    Pesaresi (2010), p. 155, expressly referring to Campania, Marche, Umbria; Friuli, Piedmont, Apulia, Sardinia, Autonomous Province of Trento, Veneto, etc.

  191. 191.

    What is essential is the power to engage the municipalities in financial obligations (potere di spesa). The Region of Marche has not delegated this power to the representative of the municipality within the assessment unit, cf. Pesaresi (2010), p. 155, table 7.

  192. 192.

    Pesaresi (2010), p. 161.

  193. 193.

    E.g. home care services in the Autonomous Province of Bolzano.

  194. 194.

    For ISEE, see supra fn. 135.

  195. 195.

    In 2011–2012, the decline in coverage rates extended to six regions (Liguria, Lombardy, Tuscany, Marche, Latium, and Basilicata), and to one of the Autonomous Provinces, for details cf. Barbabella et al. (2015), p. 21.

  196. 196.

    Barbabella et al. (2015), p. 21 (table 1.2); in general, higher intensity is correlated with a lower number of beneficiaries, Barbabella et al. (2013a), p. 17, table 1.

  197. 197.

    The mix between coverage and service intensity varies greatly between regions, cf. Gori and Rusmini (2015a), p. 150 f.

  198. 198.

    Average expenditure ranged from 4626 € (Aosta Valley) to 1119 € (Molise), for details cf. Barbabella et al. (2015), p. 22, table 1.3.

  199. 199.

    Barbabella et al. (2013a), p. 18 f.

  200. 200.

    Pesaresi (2007), p. 1 ff.

  201. 201.

    Tediosi and Gabriele (2010) p. 5.

  202. 202.

    For details see Fosti et al. (2012), pp. 59 f.

  203. 203.

    E.g. home help services provided in the city of Bolzano.

  204. 204.

    Grazioli (2012), p. 270.

  205. 205.

    Barbabella et al. (2013b), pp. 38 f.

  206. 206.

    For Tuscany, see LR No. 60/2008, introducing the “societies for health” as a new model of joint governance of medical and integrated social and healthcare activities, composed by public consortia between the health units ASL and the municipalities; for details see AGENAS (2012), p. 192 ff.

  207. 207.

    Gori and Casanova (2009), p. 41.

  208. 208.

    Barbabella et al. (2013b), pp. 36 ff.

  209. 209.

    Tediosi and Gabriele (2010); Vetrano and Vaccaro (2017).

  210. 210.

    Art. 23 of D.P.C.M. of 12 January 2017; Vetrano and Vaccaro (2017) p. 12.

  211. 211.

    E.g. Abruzzo, Basilicata, Emilia-Romagna, Liguria, Molise, Tuscany, Umbria, Veneto etc., while Lazio, Apulia, Sardinia are regions without such legislation, see Pesaresi (2010), pp. 160 f.

  212. 212.

    On the use of vouchers in the context of long-term care needs cf. Beltrametti (2013), pp. 191 ff.

  213. 213.

    “Voucher socio-sanitario”, introduced by deliberation of the Regional Council of Lombardy, DGR No. 12902 of 9 May 2003. Vouchers are granted for three different levels of care intensity and the corresponding economic value varies between 362, 464 and 619 € per month. In addition, a new service entitlement (“credit”) was introduced in 2003 for the purchase of health services of a lower intensity than the first level voucher for integrated care, but in 2008 this type was made available under the same conditions than the traditional voucher. For details see Giunco (2011).

  214. 214.

    The municipal “voucher sociale” is based on Law No. 328/2000 and consists in an economic contribution for a prepaid professional service (ticket restaurant, laundry service, transport service), cf. Circolare No. 6/2004 of the Regional Council of Lombardy. For care provided not by professional staff but by informal family caregivers a different type of economic support (“buono sociale”) can be granted.

  215. 215.

    Pesaresi (2010), p. 158 ff.; Region of Lombardy, DGR X/1185 of 2013.

  216. 216.

    Cf. Art. 13 (2) of Law No. 328/2000. The Charter is a necessary condition to obtain accreditation.

  217. 217.

    See the quality standards in the Charter of Services of the Autonomous Province of Bolzano. They relate to the timetable of service provision (and tolerated deviations), transparency as to the availability of clear and updated information; specific care standards defined in cooperation with the local healthcare services; service provision by qualified staff.

  218. 218.

    Sanità in cifre (SIC), 19 January 2012.

  219. 219.

    E.g. according to the legislation of the Autonomous Province of Bolzano, cash allowances can be substituted by service vouchers.

  220. 220.

    Cf. D.P.C.M. of 12 January 2017, Art. 22 (4); Vetrano and Vaccaro (2017), p. 11.

  221. 221.

    See Art. 6 (2), Art. 3 (5) of D.P.C.M. No. 159/2013.

  222. 222.

    For details see Gioncada et al. (2011).

  223. 223.

    Cf. for various denominations in 17 regions Gori et al. (2010), p. 104, table 6.

  224. 224.

    The nationally proposed coverage should provide 1.5 beds per 1000 senior citizens in centres for dependent persons, and another 1.5 beds for 1000 senior citizens in Alzheimer centres. Most regions have established their own regional targets. For the evolution of day care centres for dependent persons (seniors and adults) cf. Pesaresi (2015), p. 197 ff.

  225. 225.

    Pesaresi (2015), p. 204.

  226. 226.

    30 hours/week in the Autonomous Province of Bolzano and 60 hours/week in Emilia-Romagna. Cf. Pesaresi (2015), p. 207.

  227. 227.

    Cf. Pesaresi (2015), p. 215 ff. referring to the period 2007–2014.

  228. 228.

    Day care centres in the Autonomous Province of Bolzano have established minimum and maximum tariffs with regard to the individual benefits. Users co-payment (for 8 h services) varies according to the level of dependency, starting at 11 € for self-sufficient individuals, and ranges between 14 and 42 € for partially self-sufficient individuals; in day care nursing homes the maximum tariff per day is 54 € (2014).

  229. 229.

    So-called “quota sanitaria” under D.P.C.M. of 14 February 2001.

  230. 230.

    On average, cost participation of the beneficiaries (or the municipality) amounts to 24.59 € per day (29.86 € in Alzheimer centres), cf. Pesaresi (2015), p. 216 f.

  231. 231.

    In 2010, the national average for providing care in these cases within the hospital sector was 0.6 beds per 1000 inhabitants, but in several regions (Piedmont, Autonomous Province of Trento, Lazio, Molise) the rates were much higher.

  232. 232.

    For the terminology used in different regions cf. Masera et al. (2011), pp. 104–106; for the evolution towards more flexibilization and diversification of services see Gori and Rusmini (2015b), p. 165.

  233. 233.

    Protected facilities are defined as nursing care homes characterized by a medium intensity of social care services and medium or high organizational complexity, cf. D.M. No. 308 of 21 May 2001 (Regolamento concernente “Requisiti minimi strutturali e organizzativi per l’autorizzazione all’esercizio dei servizi e delle strutture a ciclo residenziale e semiresidenziale, a norma dell’articolo 11 della legge 8 novembre 2000, n. 328”).

  234. 234.

    Liguria, Sicily.

  235. 235.

    Because of the lack of long-term care places in nursing homes it is not unusual for totally or partially dependent elderly persons to stay in RA homes waiting to be admitted to nursing homes better equipped to meet their needs. Cf. Long (2013), p. 29, No. 46.

  236. 236.

    D.M. No. 308/2001 distinguished between facilities with a community character, and facilities with prevalent hotel services. The community care type is aimed at individuals with limited personal autonomy, and characterized by a low intensity of care services, medium or high organizational complexity; the residential facilities with prevalent hotel services are characterized by a low intensity of care services, a medium or high organizational complexity, but the target group are self-sufficient or partially self-sufficient individuals.

  237. 237.

    Cf. Ministerial Decree (D.M.) No. 308/2001; Art. 9 (1) of Law No. 328/2000; Art. 8-ter of D.Lgs. No. 502/1992 as amended by D.Lgs. No. 229/1999.

  238. 238.

    The Autonomous Province of Bolzano offers short-term residential care (and transitional residential care) for periods of between 4 weeks and 3 months, with a maximum of 6 months per year, cf. Decision of the Provincial Council No. 2976 of 14 December 2009.

  239. 239.

    For an example of regional legislation see Veneto: LR No. 30/2009; Tuscany: LR No. 66/2008; DGR (Tuscany) No. 370/2010.

  240. 240.

    For the system of waiting lists operated by the “Health Societies” of Florence and Pisa and by the region of Veneto, see AGENAS (2012), pp. 197 f., 205.

  241. 241.

    LR (Lombardy) No. 3/2008 “Governo della regione dell Unità d’offerta sociosanitarie e sociali”, and LR No. 33/2009 “Testo Unico delle leggi regionali in materia di sanità”. For recent policy priorities in Lombardy, see Piano Socio-Sanitario 2010–2014.

  242. 242.

    Gioncada et al. (2011), p. 157 ff. The signature of the municipality is required for instance in Lombardy, DGR No. 8496/2008.

  243. 243.

    For the controversial juridical questions and the judicial orientations cf. Long (2013), p. 69 ff., 99 ff., 125–130. According to the Corte di Cassazione, the agreement on cost-sharing signed by relatives can be void in cases where services complement a primary healthcare activity to be granted without any co-payment, Cass. Civ. Sez. I, 22 March 2012, sent. No. 4558 (on long-term care services in residential care for an Alzheimer patient).

  244. 244.

    ISTAT (2015b).

  245. 245.

    For the availability of beds in residential care and semi-residential care across Italy see ISTAT (2014a), p. 129, table 4.4; Barbabella et al. (2013a), p. 20.

  246. 246.

    Tediosi and Gabriele (2010), p. 11 f. In some regions, the proportion of private service providers is much higher, e.g. in Sicily (94%).

  247. 247.

    Pesaresi and Brizioli (2009), p. 58.

  248. 248.

    Long (2013), p. 33.

  249. 249.

    E.g. the administration has to respect the principles of cost efficiency, impartiality, transparency, equal treatment, etc. The principle of prohibition to interrupt a public service implies that a client cannot be dismissed abruptly even if the contract with the user/client is terminated.

  250. 250.

    The current classification system adopted in the document of the Commission for the LEA envisages four categories of residential care services: (1) sub-intensive care (hospice, coma etc., R1), residential care with a high level of healthcare integration (R2), residential care for patients with senile dementia (R2D), and residential care with a low level of healthcare integration (R3), cf. QMS No. 6/2010, p. 105.

  251. 251.

    Ministry of Health (2010) QMS, p. 107; Barbabella et al. (2015), p. 24.

  252. 252.

    DPR 14 January 1997.

  253. 253.

    Chiatti et al. (2013), p. 80 ff. (comparing 10 regions).

  254. 254.

    Ministry of Health (2010) QMS, p. 110.

  255. 255.

    For a detailed analysis cf. Masera et al. (2011), p. 108 ff.

  256. 256.

    See Masera et al. (2011), p. 108.

  257. 257.

    Art. 11 Law No. 328/2000.

  258. 258.

    Cf. Art. 30 D.P.C.M. of 12 January 2017. Under the previous regulation, an equal 50–50 sharing of costs between the healthcare and the social service sector has been adopted only by 30% of the regions (Campania, Molise, Apulia, Sardinia, Sicily, Veneto), while except for Lombardy, all other regions have adopted a healthcare quota of above 50% (79–82% in Umbria), cf. Pesaresi (2011), pp. 137 ff., 139.

  259. 259.

    The tariffs for residential care for the elderly should have been defined according to Art. 8-sexies of D.Lgs. No. 502/1992.

  260. 260.

    Brizioli and Masera (2011), p. 124 ff.

  261. 261.

    Both regions apply a single tariff for residential care, but most regions apply tariffs which differentiate according to the increase in intensity of care requirements. For details see Brizioli and Masera (2011), p. 127 ff.

  262. 262.

    Except for Lombardy and the Autonomous Province of Bolzano, cf. Brizioli and Masera (2011), p. 130.

  263. 263.

    Pasquinelli and Rusmini (2013), p. 95, at fn 2.

  264. 264.

    Pesaresi (2011), p. 137.

  265. 265.

    Art. 8 (3) of Law No. 328/2000.

  266. 266.

    DGR No. 862/2011.

  267. 267.

    Cf. Brizioli and Masera (2011), p. 130 f.

  268. 268.

    Pesaresi (2011), pp. 152–154.

  269. 269.

    Art. 6 (3) lett. b of D.P.C.M. No. 159/2013. Exemptions apply in cases of presumed hardship, namely when the adult child or a member of his or her family unit has a certified condition of disability, or when the absence of economic or affective bonds has been established by a court or public authority.

  270. 270.

    On the maintenance obligations of adult children in Italy see Hohnerlein (2009), pp. 139, 162 ff.

  271. 271.

    Tediosi and Gabriele (2010), p. 10. For the diffusion of different forms of individual or collectively organized support activities cf. Di Rosa et al. (2015), p. 38 ff.

  272. 272.

    The countries of origin have changed over the past years. Today most migrant care workers come from Eastern Europe (Ukraine, Moldovia, and Romania), see Costa (2013), p. 225.

  273. 273.

    Law No. 104/1992.

  274. 274.

    Law No. 388/2000, Art. 80 (2).

  275. 275.

    Art. 33 Law No. 104/1992. The same entitlement applies if assistance is provided to a child older than 3 years.

  276. 276.

    Art. 4 (2) of Law No. 53/2000. Paid care leave for informal family care was first introduced by Law No. 388/2000, Art. 80 (2).

  277. 277.

    Art. 42 of D.Lgs. No. 151/2001, as modified by D.Lgs. No. 119 of 18 July 2011. This paid leave is not to be confounded with the unpaid leave of 2 years for grave family reasons.

  278. 278.

    Art. 3 of Law No. 104/1992 (handicap con connotazione di gravità).

  279. 279.

    An exception to this requirement applies if the presence of the caring family member is requested by the healthcare facility, D.Lgs. No. 119/2011.

  280. 280.

    See Corte cost. sent. No. 233/2005 (brothers and sisters); Corte cost. sent. 203/2013 (relatives by blood or marriage up to the third degree).

  281. 281.

    Art. 42 (5) of D.Lgs. No. 151/2001.

  282. 282.

    Exceptions apply for severely handicapped children in case of adoption or pre-adoptive placement.

  283. 283.

    Art. 33 (3) Law No. 104/1992; Art. 42 (5-ter) D.Lgs. No. 151/2001.

  284. 284.

    The total amount including social security contributions was set at 47,446 € in 2015 (provisional data), cf. Seghieri (2015), p. 781.

  285. 285.

    INPS (2016), p. 77 f. About 904,000 benefits for paid leave were registered in 2015.

  286. 286.

    Art. 42 (1) and (2) of T.U. on maternity and paternity = D.Lgs. No. 151/2001 with subsequent modifications.

  287. 287.

    Art. 33 (5) of Law No. 104/1992, as modified by Art. 24 (1) of Law No. 183/2010.

  288. 288.

    Cf. Law No. 903/1977, Art. 5 (2), as modified by Law No. 25/1999, Art. 17 (1), and amended by D.Lgs. No. 151/2001, Art. 53 (3) and D.Lgs. No. 66/2003 (Art. 11).

  289. 289.

    E.G. for Emilia-Romagna, LR No. 2 of 28 March 2014.

  290. 290.

    E.g. the highly disputed legislation of the Piedmont Region. Although the regional government tried to deny such reimbursement and to shift responsibility to local authorities, the Regional Administrative Court (TAR) revoked the decisions on non-reimbursement.

  291. 291.

    E.g. Lombardy, Sicily (DGR 885/2010). In 2013, a majority of 14 regions had implemented minimum standards for professional training of family assistants, and some others had activated minimum qualification requirements on an experimental basis, cf. Rusmini (2013), p. 160 ff. For quality standards in informal care cf. also Casanova (2012), p. 7.

  292. 292.

    See Rusmini (2013), p. 161, table 2, p. 162.

  293. 293.

    In particular by professionals acting as tutors for families with a member with long-term care needs.

  294. 294.

    E.g. Piedmont, Tuscany; for details see Rusmini (2013), p. 164.

  295. 295.

    Persons in a vegetative state, in a state of minimal consciousness, mostly due to severe brain injuries, and to people with severe neuromuscular degenerative diseases such as ALS, cf. Ministry of Health (2011).

  296. 296.

    Agreement (Intesa Stato Regioni) of 3 August 2016, adopted as Decreto Interministeriale (not yet published): at least 40% of the FNA must be directed towards persons with most severe disabilities (Art. 3). The same priority rule had been enacted in the 2015 agreement, cf. Decreto Interministeriale of 14 May 2015, G.U. n. 178 of 3 August 2015.

  297. 297.

    See CGIL, CISL, UIL (2016), p. 5.

  298. 298.

    For the dramatic features of this development cf. Gramiccia (2014).

References

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    Eva Maria Hohnerlein

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    Ulrich Becker

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    Hans-Joachim Reinhard

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Hohnerlein, E.M. (2018). Long-Term Care Benefits and Services in Italy. In: Becker, U., Reinhard, HJ. (eds) Long-Term Care in Europe. Springer, Cham. https://doi.org/10.1007/978-3-319-70081-6_7

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