Why is it important to develop an integrated care system for non-self-sufficient persons? What governance model can foster co‑ordination between the different levels of government and between the public, the non-for-profit and the private sector in Italy? And what obstacles complicate, at the local level, the co‑ordination between the various figures involved in assistance activities? What steps should be taken to structure information systems and service models integrated between the health and social spheres? Which practices are considered most relevant and innovative internationally?
This report aims to provide some answers to these questions and to the main issues posed by population ageing, with a look at the Italian situation. In Italy, and in OECD countries at large, integration policies are becoming increasingly important due to the intersection of the demographic and epidemiological transitions. Advances in medicine, various public health interventions and improved socio‑economic conditions are leading, especially in high-income countries, to a significant increase in life expectancy, accompanied by a decline in infectious diseases and the prevalence of chronic degenerative diseases. During this same period, important demographic changes have also taken place, resulting in Italy in what is now known as the “demographic winter”. The coming decades are expected to be characterised by a strong birth rate decline, a reduction in the resident population, marked ageing of the population and further fragmentation of households – with uneven dynamics between inland and metropolitan areas, given the processes of urbanisation and depopulation.
Care needs will be influenced by the increase in multimorbidity, and an associated rise in conditions of non-self-sufficiency, or disability, and to features linked to social fragility or marginalisation. The multidimensional nature of complex health needs, the reduced capacity of households, the marked inequalities, and the spread of in-work poverty, forcefully pose new challenges to the resilience of home‑based care settings, and to the feasibility that they will be able to address the needs of a substantial number of elderly and non-self-sufficient persons.
The complexity of the needs of people requiring home care and the problems faced by their carers call for a co‑ordinated, and person-centred approach that overcomes the traditional divisions between the health and social sectors. The implementation of a new model of integrated home care services will require overhauling the assumptions that characterise the current situation: personal care supported mainly by the ties of still large and not very dispersed families; and decent levels of economic support guaranteed by work, savings and assets. This important issue is at the centre of the concerns of policymakers, users, and those working in health and social realities in many OECD countries.
The main objectives of this report are therefore to understand the challenges and potential associated with the integration of home care services for people who are not self-sufficient, and to promote progress in policies for the integration of health and social care – ensuring that integrated care systems are people‑centred and sustainable in the long term.
The report adopts a multidisciplinary approach to explore the main dynamics of the sector, identify good practices in Italy and abroad, and highlight key innovations and areas for improvement. Particular attention is paid to the regional and local dimension, given the increasing decentralisation of Italy’s healthcare system over the past two decades. The analysis combines a review of existing policies and practices with an analysis of national and international data, complemented by new and unpublished data from two OECD surveys conducted in 2024‑2025 – one targeting Italian regions and autonomous provinces, and the other covering 14 local areas. Comparative experiences from other OECD countries provide further insights into different models of social and health integration and the lessons they may offer for Italy.
A home care system that can effectively respond to the health demand of non-self-sufficient elderly persons, and their families, must reasonably address at the same time the three dimensions of care, assistance and protection without avoiding the resulting complexity. It also requires multi-level governance; service design tools; synergies among public, private and family workforce; and technological and digital innovation; and needs to have, at the centre, the non-self-sufficient elderly and the peculiar characteristics of their households and their specific living arrangements. The system’s financing capacities play on the possibility of a stronger co‑ordination of resources committed to chronicity with resources committed to non-self-sufficiency and social inclusion.
The analysis of these specific features of the Italian context, together with an examination of common international practices, has highlighted the “co‑ordination” model as a relevant model for social and health integration in the Italian system. This model provides for a plurality of levels that are co‑ordinated through common standards and tools, as opposed to alternative approaches such as “full integration” (total centralisation of functions and resources) or “linkage” (isolated agreements or initiatives that do not change the existing institutional structure).