Italy races to reform long-term care amid soaring demand from an ageing population

Italy is facing a rapid rise in elderly care needs, but its long-term care system remains fragmented and heavily dependent on families and informal workers. A new OECD-led report urges the country to build a coordinated, integrated home-care model before demographic pressures overwhelm existing services.

Italy is ageing faster than almost any other country, and its care system is struggling to respond. This is the warning from a new report produced by the OECD together with Italy’s Ministry of Health, Ministry of Labour and Social Policies, the National Institute of Health, Agenas, and the European Commission. Almost a quarter of Italians are already over 65, and by 2050, they will make up more than one-third of the population. Many live alone, especially in the South, and growing numbers need help with everyday activities, from bathing and dressing to shopping, cooking, and managing money.

A Patchwork System Held Together by Families

Despite soaring demand, Italy’s long-term care services remain fragmented. Families shoulder most of the responsibility. The attendance allowance, €515 a month for people with severe disabilities, is the most common benefit, often topped up by small, uneven municipal allowances. Residential and day-care facilities exist, but access and standards differ sharply across regions. Home-based support is even more limited. Health-led home care (ADI) focuses on nursing and rehabilitation, while municipal social home care (SAD) provides help with household tasks. Yet only a small share of older people with limitations receive these public services. Instead, almost all rely on relatives or privately hired carers, more than a million nationwide, many working informally. Public spending reinforces this imbalance: only 2.5% of Italy’s €185 billion health budget goes to home-based care, and municipalities devote just a sliver of their resources to long-term support at home.

Learning from Countries That Got Ahead

To understand what Italy could do differently, the report examines international examples. Japan’s community-based integrated care system offers a single entry point for older people, with teams of nurses, social workers, and care managers coordinating services. England is pushing health and social services to work together through integrated care systems. Denmark relies on strong municipal governance, while Australia has reshaped its system around person-centred care. In Spain’s Basque Country, joint assessment teams bridge the divide between health and social services. These models share key ingredients: a unified access point, shared assessments, digital systems that connect professionals, multidisciplinary teams, and financing arrangements that encourage cooperation rather than fragmentation. They also recognise the essential role of family and migrant care workers by offering training and formal pathways into the sector.

Italy’s Slow but Promising Shift Toward Integration

Italy has begun to move in this direction. Reforms such as Decree 77/2022, the National Plan for Non-Self-Sufficiency, Law 33/2023, and Legislative Decree 29/2024 aim to strengthen territorial health services, define essential social-care standards, and encourage joint planning between health districts and municipalities. Investments under the National Recovery and Resilience Plan are creating community health centres and expanding telemedicine. Yet progress is far from uniform. Surveys of all regions and focus groups in 14 local areas reveal deep inequalities: some regions are piloting shared digital platforms, multidisciplinary teams and joint assessments, while others still rely on informal cooperation among doctors, nurses and social workers. Many professionals say they face staff shortages, low pay, temporary contracts, and digital tools that are difficult to use, hindering any attempt at systematic coordination.

A Race Against Time to Build a Coherent Home-Care System

The report concludes that Italy should focus on a strong coordination model rather than merging its health and social systems outright. This means creating a single access point where people can request help, using joint health–social assessments, and designing integrated care plans that combine medical, rehabilitative, and social support. Better digital systems, clearer governance rules, and more investment in home and community care are essential. So is a long-term workforce strategy to improve pay, training, and stability for both professional and informal carers.

The study describes a country running against the clock. With one of the oldest populations in the world, Italy must turn successful local experiments into a nationwide system capable of helping people remain independent at home. The foundations are starting to emerge, but the pace of reform will determine whether the system can withstand the demographic pressure already building across the country.