Socio-Economic Predictors of Hiring Live-In Migrant Care Workers to Support Community Dwelling Older Adults with Long-Term Care Needs: Recent Evidence from a Central Italian Region

Abstract

To meet the rising demand for home care, many families in Italy hire live-in migrant care workers (MCWs). However, the reliance on MCWs to provide long-term care (LTC) and a lack of alternative formal care services raises concerns around equality in access to care. This study aimed to determine the socio-economic predictors of hiring live-in MCWs among older adults with LTC needs in Italy, the objective care burden placed on MCWs, and the financial barriers that people in need of care and informal caregivers face when hiring MCWs, analysing data from a cross-sectional questionnaire with 366 older adults with LTC needs and their primary family caregivers living in the Marche region. Binary logistic regression was used to calculate the predictors of hiring a live-in MCW. Having a primary caregiver that had a high school education or above significantly increased the odds of hiring a live-in MCW (Odds Ratio (OR) = 3.880), as did receiving a social pension (OR = 2.258). Over half (57.5 percent) of the people in need of care had difficulties in affording the costs of hiring an MCW in the past year. To increase the sustainability of the Italian MCW market and reduce socio-economic barriers to accessing care, the Italian Government should increase funding for LTC benefits and add means testing and restrictions on the use of cash-for-care allowances.

Role and Characteristics of Personal Care Assistants of Frail Older People with Functional Limitations Ageing in Place in Italy

“…However, as emerged from our results, PCA cannot be always present, due to various reasons, such as lack of need and the feeling of being autonomous, fear of mistreatment, need for freedom and privacy, but mainly due to economic reasons of the cared for and respective families, since the related cost is not affordable for all. Previous studies underline socio-economic inequalities in accessing the private care market by older people, and particularly the cost represents a financial barrier for many [ 57 , 61 ]. According to DOMINA [ 34 ], when seniors are dependent due to functional limitations, the need for assistance increases, and consequently the economic cost of private care.…”

“…DOMINA [ 34 ] puts in evidence data partially different for Italy, with a minority of living-in care workers (34%), and a greater 66% hired on hourly basis, with cohabitation requiring a greater number of working hours, on average 38 h, against 20 for non-cohabitants. Other authors indicate that families hiring PCAs expect them to care around the clock, i.e., 24 h each day [ 67 ], whereas they officially (by regular employment contract) should work up to 54 h per week and up to 10 h per day [ 61 , 68 ]. Our findings further stressed the existence of combination of daily/nightly assistance, and the importance in particular of a supervision during the sleep.…”

“…According to DOMINA [ 31 , 34 ], in 2017 60% of irregular figures in Italy was estimated, and over 50% in 2020. Other sources [ 19 , 61 ] estimated only 40% of foreign PCAs regularly hired in 2020. Italian families have become “domestic employers”, but often they have not a complete/precise knowledge of legal norms occurring in the private care market, and when also low economic resource need to be considered, they rely on irregular/undeclared PCAs to reduce costs, exposing their loved ones to possible inadequate assistants.…”

“…DOMINA [ 34 ] reports that regular annual costs for a PCA vary from 2000 EUR, for five hours a week, to almost 15,000 for a 54-h care with cohabitation. According to further sources [ 61 , 68 ], PCAs living-in with formal contracts should be officially paid about EUR 1000–1200 per month, following their skills and tasks. In some cases, however, low wages of PCAs allowed relatively low-cost private care services, as substitute or complement of public ones [ 58 ].…”

“…Starting from these considerations, it seems necessary to integrate PCAs in the Italian LTC system, also impacting its sustainability [ 73 , 88 ], within the network of local services, and to provide incentive systems, as follows: fiscal benefits for related expenses [ 89 ]; means-based assessment of the IA to identify people most in need of financial assistance [ 57 , 61 ]; and care allowances for regular hiring of PCAs [ 90 ]. Irregular employment impacts indeed their working conditions [ 81 ], which in turn impact quality standards of care services for older people [ 58 ].…”