Complete the reform of assistance for the elderly started with law 33/2023 and increase the intensity of care provided at home, focusing more on services than on simple monetary disbursements. These are two challenges that remain open after the National Recovery and Resilience Plan, which laid the foundations for innovative actions and achieved some of the planned objectives, but did not fully meet the needs of older people. Needs destined to grow, considering that in Italy there are 4.6 million over-80s, who have surpassed the number of children under ten years old, and could double by 2050 (reaching 13.6% of the population).
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The demographic dynamic is also reflected in public spending. The attendance allowance, that is the economic benefit recognized to people with total disability, who therefore need help in all daily life activities (€551.53 per month in 2026), had one million beneficiaries in 2002, but today reaches 2.18 million (source Inps). The expenditure for this benefit, which is granted to everyone without distinction for care needs, has reached 15 billion annually (0.7% of GDP). The allowance can be used to pay a caregiver (at least for part of the annual costs), and there is no incentive in Italy to invest it in services.
THE PICTURE
Home care
The PNRR brought with it the delegation law 33/2023, that is the framework rules to reform elderly care, mainly based on simplification and on the integration of interventions and health services. The reform is still awaiting a series of implementing measures, for which the latest Milleproroghe decree (Dl 200/2025) has granted more time, aiming to have the new system fully operational by 2028.
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After the experience of the Covid-19 pandemic, which had dramatic outcomes for many elderly hospitalized in institutions, the PNRR allocated four billion to strengthening the home as the first place of care and to telemedicine. Indeed, the goal of extending integrated home care (ADI) to 10% of the over-65 population has been reached. According to the latest available data from the Ministry of Health, the beneficiaries of home care provided in the territory by nurses, doctors, rehabilitation therapists, are 1.645 million (11.3% of over 65s), while historically, in the pre-pandemic years, they were 650,000 (5%).
Each beneficiary, however, receives on average 15 hours of care per year, compared to 18 hours provided in 2019.
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