Italy has one of the oldest populations in the EU and OECD. At the beginning of 2025, people aged 65 and over accounted for 24.7% of the population, while those aged 80 and over represented 4.1%. By 2050, these shares are projected to rise to 37% and 15%, respectively – the second highest in the world after Korea. Functional limitations are widespread among other people in Italy: 13.7% report difficulties with basic daily activities and 15.9% with more complex instrumental activities.
Despite rising needs, services for dependent older people in Italy remain fragmented. Responsibilities are divided across health and social care, levels of government and multiple providers, resulting in uneven access and outcomes. Support may take the form of cash transfers, residential or semi-residential services, home care, and informal family care. The most common cash transfer is the National Social Security Institute (INPS) support allowance for certified disability, supplemented in some municipalities by additional transfers with varying rules for access and use. Semi-residential and residential facilities provide day or round-the‑clock care, with significant regional variation in access, service offerings and costs. At home, Integrated Home Care (ADI) mainly delivers nursing care, while Social Home Care (SAD) provides social benefits, often delivered by the third sector.
The growth in chronic conditions has heightened the need for an integrated system of care for non-self-sufficient persons. In Italy, integration between health and social services is widely recognised as central to reducing fragmentation and improving co‑ordination. Governance of social and healthcare services for non-self-sufficient individuals is highly decentralised, with a multi-level governance approach spanning national, regional and local levels.
Several reforms have been launched in Italy to improve the governance of home care services. Decree 77/2022 defines models and standards for territorial assistance in the National Health Service. The National Plan for Non-Self-Sufficiency 2022‑2024, for the first time, defines Essential Levels of Social Benefits, mandating guaranteed home care, relief and support for non-self-sufficient older people. Other significant initiatives regarding long-term care include Law No. 227/2021, “Delegation to the Government on Disability”, Law No. 33/2023, “Delegation to the Government on Policies for the Elderly,” and Legislative Decree No. 29/2024, adopted in implementation of these delegations, as well as the 2024 update of the National Chronic Disease Plan. Law No. 33/2023 – and its implementing decree – aims to build a system of integrated social, healthcare, and socio-healthcare services to ensure better and more comprehensive care for individuals. Furthermore, the aforementioned decree established the Interministerial Committee for Policies for the Elderly (CIPA), with the aim of strengthening the co‑ordination of measures for the elderly and identifying planning and co‑ordination tools such as Territorial Activity Programs, Area Plans, and Program Agreements, which are increasingly used. The National Recovery and Resilience Plan approved by the European Commission on 22 April 2021, also includes two key components for improving the integration of social and health services: component 2 of Mission 5, which enhances the entire social dimension of healthcare policies for older people; and component 1 of Mission 6, which envisages the implementation of interventions to develop local networks, facilities, and telemedicine for local healthcare..
Consultations with policymakers, professionals and service providers in Italy confirm the urgency of further policy reform. Common challenges include fragmentation of responsibilities, underinvestment in home and community care, wide territorial disparities, staff shortages, financial pressures and weak information systems. Stakeholders emphasised the need for a clear governance framework, stronger support for informal carers, improved workforce training and reliable data to monitor needs and outcomes. While recognising regional autonomy, many underlined that a national framework is essential to reduce inequalities and guarantee minimum levels of care across the country.
Many other OECD countries face similar challenges in long-term care. Case studies from Japan, England (United Kingdom), Denmark, Australia and the Basque Country (Spain) illustrate strategies for integration. Most cases follow a co‑ordination model, with mechanisms to link health and social services while maintaining separate structures. Comparative analysis highlights six key building blocks for integration: institutional arrangements, single access and standardised assessment, financial integration, governance with spending levers, multidisciplinary teams, interoperable data systems and recognition of informal support. Countries are also investing in community networks, volunteer programmes and caregiver recognition to reduce the burden on families. Staff shortages remain a common barrier, underlining the need for training and investment.
Also for Italy, co‑ordination appears the most feasible approach for integration – as opposed to full integration (total centralisation of functions and resources) or linkage (isolated agreements or initiatives that do not change the existing institutional structure). Such co‑ordination model would involve recomposing medical/nursing case, personal care and assistance functions through joint planning and delivery, while leaving their institutional ownership unchanged. This would rely on unified governance across national, regional and local levels and operate around three interrelated functions: the integrated care pathway, the mix of measures and providers, and the mobilisation of resources. The integrated care pathway requires a single access and assessment system, shared permanently between health and social services, with personalised care plans combining medical, nursing, rehabilitation, social and family support measures. Delivery would need to evolve from fragmented sectoral services to co‑ordinated packages managed by multidisciplinary teams, engaging public, private and community providers. Finally, financing would need to shift towards integrated allocations combining health and social resources, complemented by family contributions and community networks.
Various actions can enable such integration:
Creating a supportive legal and institutional framework: Establishing clear roles across levels of government, fostering collaboration among stakeholders, and empowering qualified multidisciplinary teams.
Promoting community action: Recognising the role of civil society and private actors in delivering social innovation and strengthening community-based support.
Ensuring timely and robust evaluation of the implementation of integrated care through the systematic collection and analysis of both process and outcome indicators.
Encouraging the use of cost-effective health technologies: Deploying assistive tools, telemedicine and digital solutions to support independence, continuity of care and healthy ageing.
Strengthening workforce skills, competencies and knowledge for effective integrated, person-centred care.