The residential healthcare for the elderly in Italy: some considerations for post-COVID-19 policies

Abstract

In Italy, the COVID-19 pandemic and the death of many elderly people have put in evidence the uneven territorial distribution of nursing homes, which have amplified the spread and severity of the pandemic. By applying a pooled OLS model to the Italian regions, over the 2010–18 period, we investigate the demand factors, market forces and institutional drivers of the spatial distribution of residential healthcare for the elderly. Using a fine-grained approach that considers specific regional and age-related elements and the market environment, which can reduce or increase the pressure on regional governments to provide formal assistance, we find that the financial resources and the availability of unemployed women as potential caregivers explain the distribution of expenditure better than the health needs of the elderly. As a result, the expenditure is concentrated in richer and more financially autonomous regions and it is not congruent with the distribution of chronicity, health and frailty factors or income among the elderly. These critical issues of the care services for frail elderly people, related to a highly decentralized governance and resulting in fragmented, market-driven provision, could be attacked only by a national reform.

What Kind of Interventions Were Perceived as Effective Against Coronavirus-19 in Nursing Homes in Italy? A Descriptive Qualitative Study

“…32 At the fourth wave, the NHs included reported from a few (9.9%) residents to almost all (91.6%) residents being infected, and in all, there was a higher mortality than that reported in other countries, 33 although data available should be considered with prudence given that only at the end of the pandemic will it be possible to definite the precise mortality rates according to the causes. 34,35 Our NHs were not prepared to cope with a pandemic, as reported in many facilities around the world. 26 Their marginal role in the health-care sector, with a poor coordination with hospitals considered to be at the core of the healthcare system, 7 might have rendered more challenging the interventions' identification 6 and implementation, along with the pre-existing frailty of the NH system.…”

“… 32 At the fourth wave, the NHs included reported from a few (9.9%) residents to almost all (91.6%) residents being infected, and in all, there was a higher mortality than that reported in other countries, 33 although data available should be considered with prudence given that only at the end of the pandemic will it be possible to definite the precise mortality rates according to the causes. 34 , 35 …”

“… 26 Their marginal role in the health-care sector, with a poor coordination with hospitals considered to be at the core of the health-care system, 7 might have rendered more challenging the interventions’ identification 6 and implementation, along with the pre-existing frailty of the NH system. 35 Moreover, according to the Haddon Matrix structure, 23 where interventions affecting public health challenges – such as the COVID-19 pandemic is – have been divided into “pre-event”, “event” and “post-event” time, our NHs enacted interventions during the “event”, targeting the environment, the nursing staff and the residents. The first attempt was to keep the COVID-19 virus out of the facility; once the virus penetrated, the NHs turned their forces to the internal reorganization as an initial awareness of the situation and a consequent response to it.…”

“…The NHs implemented several interventions to progressively escalate the issues, and it is possible that their perceived effectiveness has also been influenced by the interactions of such actions with each other. 35 , 36 In other words, NHs built and provided a pandemic plan during the event, suggesting that investing in the NHs disaster preparedness is a priority.…”

Spread of COVID-19 Infection in Long-Term Care Facilities of Trieste (Italy) during the Pre-Vaccination Era, Integrating Findings of 41 Forensic Autopsies with Geriatric Comorbidity Index as a Valid Option for the Assessment of Strength of Causation

“…It was observed that characteristics of the residents in long-term care facilities (age, higher body mass index, male sex, and renal impairment) had a different impact on the death rate as well as the quality level of healthcare and the adequacy of safety measures adopted to face the spread of the infection and its deadly consequences (specific training of the staff, good staff/resident ratio) [ 21 , 22 , 23 , 24 , 25 ]. In Italy, the territorial distribution of long-term care facilities (or residential care homes) exhibits a gradient moving from the North to the South of the country and has been considered significant in the distribution of death during the COVID-19 pandemic [ 26 ]. Concerns about the possibility that personnel represented the source of COVID-19 introduction and promoted the spread of the infection among the residents favored the onset of claims and triggered efforts to ensure equal access to high-quality healthcare across long-term care facilities as well as to provide the extensive vaccination of residents and personnel [ 27 , 28 , 29 ].…”