Protection of the elderly: the right place for the silver years

The Babel of social and health systems

The measure is an important signal, but it remains a drop in the ocean of a sector that needs an overall reform and that brings order, as it underlines Auser (Association for active aging), in Babel also caused by the presence of 21 different regional health and social systems. Municipalities for the social part and local health authorities for the health sector (the ADI, integrated home care) continue to proceed along parallel lines. Forgetting that the person they take care of is only one, and has a complexity of needs. “Other European countries, such as France or Spain, have been dealing with this problem for thirty years already,” comments Cristiano Gori, professor of Social Policy at the University of Trento and coordinator of the Pact. Now it’s our turn. “It is necessary to reduce the fragmentation of the system, to increase the offer giving priority to care at home and strengthening tax breaks for families who use carers, and following the multidimensional care approach, which includes all the existential dimensions of the person »adds Gori. Today it is mostly offered nursing care from ADI, however very low: 17 hours per year on average per elderly patient. “The reform is crucial for the country’s social stability in the future,” Mandorino underlines. The good news is the PNRR: it has finally foreseen this change, to be implemented through a delegated law by 2023. There is no need to claim victory: we will have to see how it will be implemented.

Nursing homes, nursing homes and carers

In the meantime, those with an elderly non self-sufficient parent have two options: treat him at home, or find him a place in a nursing home (Rsa), different from the retirement home where guests are mostly self-sufficient. When a family member takes care of the elderly, she is almost always a woman (76.8 percent of caregivers, of which just under half are aged between 51 and 65). Otherwise, the caregiver is used, who is often foreign or unprepared, therefore unable to solve every problem. A willing son or grandson is always needed: anything that has to do with technology and digital is too complicated. “Even though I have a caregiver, I’m the one who manages her paychecks, online payments, bureaucratic formalities” says Marta, 55. “How can you think that a non self-sufficient elderly person gets a SPID and uses it? Even an elderly person in good health sometimes struggles to use the ATM at the supermarket and asks the cashier for help ».

When home management becomes impossible, RSA is used. “In theory, these structures should be a place of passage: for example, for those who need rehabilitation after an acute phase” explains Claudio Falasca of the Auser Studies Office. “But often this is not the case and people stay there permanently.” Also for the RSA, the child or relative are involved in finding the structure and following the practices. And here comes another sore point. “In Italy, in 2018, we had 18 beds in RSA for every thousand elderly people»Comments Mandorino. “In Great Britain there were 44, in Sweden about seventy.” Few facilities and long waiting lists to access public or private RSA affiliated companies. There is also a quality of service theme. These are places that sometimes resemble hospitals, where the elderly are parked in the last phase of life. As underlined by Auser Nazionale in a document for the reform of the RSA, “the central objective must be to continue to make the elderly feel like a person”. Specifically, single or double rooms would be needed, which safeguard dignity and privacy, where the guest can bring objects, photographs, small furnishings to which he is fond. «It is also necessary to respect the times of each one, without having meals at the same time for everyone; an enhancement of the residual capacities of each elderly person and differentiated responses according to the characteristics of the guests: for example, different activities for those who are lucid but have motor problems, and for those who perhaps have Alzheimer’s»Comments Gori. In addition to a different organization, more staff would also be needed. “However, the strong demand cannot be answered only by creating new RSAs,” adds Falasca. “It is necessary to strengthen home care, keeping the person in his home for as long as possible.” And if the house is incompatible – for example due to the presence of architectural barriers – a new housing offer is needed, which meets the needs of old age. For example, residences where you have a room or a studio with 24-hour nursing care, meal service, laundry and cleaning, and social spaces. The presence of such structures would also represent an ideal solution for those baby boomers who in the coming decades will reach the fourth age, without children.

An interesting model in Parma

Another interesting model is that of family homes, present for now only in a few regions. In Parma, Raggio di Sole is an apartment in the city center that hosts six semi-self-sufficient elderly people followed by two qualified operators, with the support of external medical representatives. “We try to maintain their habits as much as possible »explains Costanza Ulivi, in charge of the structure, which is private. “Each guest has a single or double room with television, where he can keep whatever he likes. One lady brought her favorite chair, another her sewing machine. There is no strict wake-up time and in the evening we have dinner around 7 pm. Since there are few people, we try to meet their tastes in the kitchen too. Before Covid, relatives could visit whenever they wanted. For example, in one of our facilities (Costanza and two aunts take care of six foster homes, ed) was there the habit of five o’clock tea. The living room is the shared space for socializing. And if the weather is good, anyone who wants can take a walk with the entertainer ». Being in the middle of the city helps people feel less marginalized. The cost? “From 2300 to 2500 euros per month”.

The accompanying allowance

In the United States, where public assistance is not a right, there are assisted living communities where the non self-sufficient elderly person enjoys personalized services in a luxurious apartment, which he has to pay out of his own pocket. If we don’t want an increasingly unequal society – in which only the rich can afford such services – it is necessary to move immediately by expanding the offer and changing the skin of the RSAs, for the restyling of which the NRR foresees funds. At present, the different solutions existing in Italy have different costs. A full-time caregiver costs a minimum wage of 16,692 euros (Assindatcolf calculation). A place in a RSA it generally provides for public coverage of health costs and a variable contribution for the hotel one requested from the guest, but sand you can access it privately from around 2400 euros per month and up. And if the pension and any accompanying allowance do not cover the expenses, to supplement it is always useful to have savings, so as not to weigh on the children. Faced with an ever-increasing demand for assistance, the reform could open up new professional scenarios for young people. ORThere are nurses, social workers and trained health workers to interact with the elderly, psychiatrists and, as Auser asks, geriatricians (today there are only 3.1 for every 10 thousand elderly people over 65). All jobs to be created in the area, protected from the competition from abroad that afflicts other sectors.

In Milan, a one-stop shop for the care of the elderly

An initiative to support families who often have to turn to different operators to obtain services.

Finding the right caregiver for family and home care, asking for relief services, planning the removal of architectural barriers in one’s home, obtaining psychological support. These are just a few examples of the problems encountered when caring for a dependent elderly person. Each time, the family is forced to turn to different interlocutors. To offer a single place to find answers, in Milan there Ravasi Garzanti Foundation with the collaboration of the Pasquinelli Foundation has recently inaugurated the second proximity desk of the project Cure Me & Protect Me in progress Magenta 42, which is added to that in zone 7. Some services are free, such as information and guidance to administrative support, others require a controlled contribution; in cases of poverty, the Foundation evaluates a dedicated economic support intervention. Access to services takes place both in person and by telephone (info on: curamieproteggimi.it).

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