As Italy’s population gets older, chronic diseases like dementia will place heavy burdens on healthcare and pension systems. Attitudes must change if Italy is to successfully overcome these challenges, says Marco Trabucchi, President of the Italian Psychogeriatric Association.
 | Marco Trabucchi, President of the Italian Psychogeriatric Association"We are approaching a crisis: an increase in the need for money for patients at the same time as a decrease in the money available." (Photo: Trabucchi) |
How many people in Italy suffer from dementia?
The percentage of Italian people over 65 years old with dementia is 7-9 percent [between 800,000 and one million people]. That incidence of dementia is not increasing but in Italy we have more and more old people so there is an increasing prevalence of dementia. Certainly the number of people affected will rise as the number of Italians over 80 years old rises.
Is this leading to greater healthcare costs?
The impact is variable because the Italian healthcare system is based on regional institutions, but the regions live on the money they receive from central government. Overall, our national health system cannot afford increasing numbers of people affected by dementia.
In the later stages of the disease, when people require nursing homes or other protected environments, there are strong increases in costs. But the Italian government is now capping the budget of the health system for the next few years. At the same time, it is negotiating an agreement with unions to increase the pay of health workers by about six percent.
So we are approaching a crisis: an increase in the need for money for patients at the same time as a decrease in the money available. We have a particular problem in the south, where the situation is much worse. To put the southern part of Italy at the same level as the north would require a lot of money we don’t have. To maintain the same level in the north will also require more money because of inflation and increased labor costs.
How many elderly Italians rely on their family to care for them?
In the south it is completely the family. In the northern region of Lombardy, where I live, every day there is less involvement of families in caring for the elderly and consequently an increase in the need for institutions.
We also have a peculiar system whereby we import caregivers from places like Moldova and the Ukraine who are not professional caregivers and are paid directly by families without government control. These female caregivers are called ‘badanti’. Today families will pay badanti about 1000 euros per month. The cost of a nursing home is about 2500 euros a month. It is very convenient to have these ladies.
The phenomenon started in the north 5-6 years ago and has spread southwards. We calculate that in Italy we now have between 800,000 and one million of these ladies. In Lombardy we have 50,000 beds in nursing homes but we have more than 100,000 badanti working with our elderly. But this system will not last long with increased prosperity in Eastern Europe. Most badanti will return home or ask for higher pay.
That will mean that the burden of care falls back onto the family.
Certainly young families in the next 20 years will have great difficulties and there are a lot of questions to be answered about what will be the role of the public healthcare system and the role of the private insurance system, which in Italy is rather small.
People need to be educated to put money aside for their future. In the past everyone counted on their pensions but even now pensions are not enough to finance local care. From my experience with patients, people don’t think to save for their future. Since they have been used to generous pensions people think the government will take care of them.
Only recently they have started reading in the papers that there will not be enough money to for the pension system and only recently have people started thinking about saving for the future.
Italian pensions are generous by international standards. Does the system have to change?
The increases in life expectancy in Italy will send the pension system into crisis. If you retire aged 56 and claim a pension until 89 or something it’s unsustainable. We will have reductions in pension entitlements and the government is trying to reduce the generosity of the pension system.
We have to ask more from private citizens through systems of private insurance. In the next 10 years we need a 50 percent increase in funding for this area and this money has to come from various sources, from increased GDP, from public and private sector investment and from increases in individuals’ contributions.
For those suffering with dementia, however, there will be a convergence of two crises: reduced pensions at the same time as increased costs for healthcare.
How is Italian society adapting other structures and systems for the elderly?
One of the main discussions in Italian society is employment for people after retirement, so they can earn money aged 60 to 70 to put aside for extreme old age. Education and retraining for the elderly, however, is very poor, there is no national programme for this.
Housing and transportation for the elderly are not really problems. In general Italian society is taking care of these. But the number of geriatricians produced by our universities is the same as 15 to 20 years ago. The system of universities is very slow in adapting to the needs of society. Society today neglects people suffering from chronic diseases and mental problems. I would like to see a society more dedicated to giving mental and psychological care, a society that increases the money directed towards mental health.
editor: James Tulloch
publishing date: September 17, 2008
Do you have something interesting to add? Write a comment and discuss this topic with other readers. Comments should be on-topic, non-commercial, and not contain abuse of any kind.
Comment Policy
