Aging without a safety net
Demographic aging is a feature of Europe as a whole, accompanied by increasing life expectancy (people are living longer) and declining fertility. Italy is the country in Europe’s with the oldest population: half of the Italian population is over 48. Furthermore, by 2050, one in five Italians will be 75 or older. And an aging population translates into a growing need for long-term care.
A fragmented system that places the burden on families
The main tool for meeting the need for long-term care in Italy is the Disability Care Allowance, a transfer paid by Italian Social Security (INPS) to people with severe disability, regardless of age and income. For 2026, the disability benefit is set at €551.53 per month. Responsibility for establishing and guaranteeing essential levels of health provision, including home care or nursing home care, lies with Italian Regions or, where applicable, Municipalities. The Italian long-term care system, therefore, is fragmented and inconsistent, and marked by strong inequalities among regions. To date, the need for long-term care is met primarily by the unpaid labor of family caregivers
and by a shadow economy of unskilled at-home caregivers, often migrant women. Conversely, overall spending on long-term care insurance is still marginal (1.7% of GDP) and totally private.
In a research study titled "Long-Term Care in Italy: Coping with Frailty and Dependence", I investigated with the co-authors which personal characteristics are associated with a greater risk of frailty, how the transition to frailty in old age can be "delayed," and especially to what extent current needs for long-term care are being met.
Frailty Follows Age, Education, and Region
We define "frail" as a person who has limitations in at least four kinds of daily activities. The likelihood of becoming frail is higher among women and increases with age. Furthermore, people who have high school education or more are less likely to become frail, and the same is true for those who have living partners. The likelihood of being frail is lower in the North, with respect Central Italy, and especially Southern Italy.
The higher risk of frailty among women can be attributed to biological factors: with the onset of menopause, the likelihood of developing osteoporosis increases, bringing a reduction in bone density. On the other hand, it's unsurprising that the likelihood of being frail increases with age. Also, the education level correlates with socioeconomic status: those that are better educated are likely to have more resources available to afford better medical care. Geographic disparities can be explained by the fact that healthcare is managed by regions, while it can be assumed that partners perform care tasks within the couple, protecting each other from the risk of invalidating frailty.
It follows that a 75-year-old single person living in Southern Italy, for example, is three times more likely to be frail than a couple living in Northwestern Italy (13% vs. 4%). And this gap increases with age.
Those most in need are often the least covered
Furthermore, the needs of frail people are not fully covered by public services: more than half of frail people aged 70+ have no access to long-term care or disability transfers. Therefore, it is precisely those who are most vulnerable and frail among the elderly who are receiving the least support.
Rethinking Care: Prevention, Services, and Integration
From our evidence, some policy recommendations can be drawn. First, comprehensive monitoring systems should be established, capable of capturing the evolving needs and preferences of individuals that have limitations in carrying out daily activities (including those who are not necessarily frail). Second, preventive healthcare and personalized services of home care should be expanded, focusing on support for personal and household care activities.
Furthermore, synergies between the public and private sectors (e.g., public incentives to facilitate access to private long-term care insurance products) could ensure broader access to high-quality care and further improve the capacity to cover long-term care needs.
