In 2050, one in ten Italians will be frail, but home care is a “joke”

Caring for chronically ill patients at home and not in the hospital? The line between taking care of them and making fun of them is, alas, very thin. Indeed: we are teetering dangerously on that ridge, unfortunately more with the risk of falling into deception than seizing the opportunity to finally provide a civilized health service to Italians.

The state of affairs is clear for all to see, as confirmed by statistics and third-party analyses: the country is overwhelmed by chronic conditions, with over 29 million Italians suffering from one or more chronic diseases, almost 9 million elderly people with at least one serious chronic disease, and approximately 4 million non-self-sufficient over-65s. The outlook, according to Istat, is even more complicated since it is expected that in 2050, in the face of a population of 54.4 million people, one in ten Italians will be elderly and non-self-sufficient, moreover in the context of a hospital system that, from the current difficulty, will devolve into asphyxiation.

Too many unresolved critical issues: the failure to adjust rates to labor costs, the rationing of resources, regional disparities, the downsizing of hospitals, the delay in the territory, the problem of waiting lists and the consequent renunciation of care, privatistic drifts, the self-referentiality of professions. All this, in a tendency towards disorder in the public service, capable of expressing also high and quality care capacity, but acutely inhomogeneous because it lacks a unitary strategy.

The inevitable consequence of this picture is the dramatic social fracture between those who can get treatment and those who cannot, sometimes due to economic problems, sometimes due to waiting lists or difficulties in accessing it. Intolerable, because it conflicts with the principle of equity on which the National Health System is based. Legislative Decree 73/2024 risks bringing the benefit of a warm blanket, since it only provides measures for the reduction of waiting times for diagnostic and specialist services.

And instead, primary care, evoked by many voices already in the midst of the Covid storm as an indispensable panacea, seems finally reduced to a cameo in the framework of the requalification of care models, so much so as to skew the data for achieving the objective imposed by the PNRR: in the Home Care category, home care scheduled by general practitioners and outpatient pathways enter, like in a pot of broth. For a total average of 16 visits per year, of which 12 are nursing: not a real, appropriate care, in fact, but a real mockery. This while the newspapers scream: "Too many useless hospitalizations, with home care you save over 3 billion", "1.3 million inappropriate hospitalizations, very high costs for the Health Service", "We need more home nursing care, but we are short of 65 thousand operators and the Community Homes are at a standstill".