Raffaele Fabrizio, Bishkek, April 10th 2015

1. “Integrated social and health services for
older people: an italian example (Emilia-
Romagna) ”
Raffaele Fabrizio
Bishkek, April 10th
2015

2. CENTRAL Goverment
-Pension National care allowance
-National Health system Standard professional skills
- National FUND
- compulsory standard of care
REGION
Organisation regional health care
Social services planning (rules, standard, funding):
authorization
accreditation
network (public and private) coaching
Local Authorithies
-Needs assestment -planning service with public fund support
-use of resource ules for copayment
-- contracting with providers monitoring quality

3. •About 450€ per month - criteria: 100% disabled people,
need to be helped for ADL (activities day life)
•No income’s limits
•No control about how the money is used
•No link with services' network
• PEOPLE RECEVEING NCA:
Italy: about 1,2 mln people =>65years old (about 6
milliards Euros per year)
Emilia-Romagna 103.000 people: 10% of =>65years ; 20%
of =>75years , about 600 millions € per year
NATIONAL FUND?
THE NATIONAL CARE ALLOWANCE (NCA)

4. Changes in the context: changes in the life
Pension system Recent changes in
the pension
system
Current average
age at retirement
59,5
Prospective average age at
retirement
67
Number
pensioners
in ER (2012)
% pensioners % pensionars on
less than euro
1.000/month
National average monthly
pension
1.331.283 30 40 832 euro

5. Local authorithies
categories per number of
inhabitans
(to 01.01.2014) Number People %
Up to 1,000 21 15.016 0,3
From 1,001 to 5,000 135 399.926 9,0
From 5,001 to 30,000 171 1.877.547 42,1
From 30,001 to 100,000 12 575.429 12,9
> 100,000 9 1.591.328 35,7
EMILIA-ROMAGNA REGION
Inhabitants: 4.459.246 1.1.2014
9 PROVINCES 348 MUNICIPALITIES

6. EMILIA-ROMAGNA:
context data

7. ECONOMICS
GDP per capita 2013
E-R 32.500E-R 32.500
Italy 26.400Italy 26.400
EU 28 27.000EU 28 27.000
From ISTATFrom ISTAT
Unemployment rate
15-64 2013
TotalTotal
E-R 8,5%E-R 8,5%
Italy 12,2%Italy 12,2%
EU28 10,8%EU28 10,8%
Older persons employment rate, persons
aged 55 to 64 years,
Lisbon strategy Goal 50%
Italy 30
ER 40

8. Elderly : not only costs.
elderly helps helderly volunteers and not only elderly (grandfather and
grandmother «canguro»)
646,520 at regional level (55,4% male – 44,6% female)
14,5% of total population
Age of volunteers
total % % in class
18-64 years 512.756 79,3% 19,3
=>65 years 133.764 20,7% 13,6
services for elerderly also an
economic opportunity

9. MOBILITY
Great help to elderly people
is provided by social
transport (to health
services, cultural and
social events, etc.) run
by volunteer organisation
(mainly by retired
people)
Social transport by
volunteers (2010)
Hours 1.171.803
Number
transports 550.071
km 11.697.416

10. EMILIA-ROMAGNA
REGION:
DEMOGRAFIC TRENDS
1981 2001 2005 2013 2020
=>65 16,4 22,2 22,7 22,8 22,2
=>75 5,8 10,7 11,3 11,9 11,7
=>80 2,8 5,9 6,6 7,3 7,5
1981 1991 2001 2008 2013 2020
0-14 671.248 447.907 470.293 547.512 560.379 595.193
60-64 201.308 259.049 266.191 254.930 269.357 275.325
65-69 226.727 252.898 239.830 252.548 248.534 246.352
70-74 187.209 167.540 224.557 227.191 239.643 241.443
75-79 120.567 167.056 196.819 196.640 205.450 194.509
> 80 108.844 178.021 236.259 291.829 324.426 346.567
Total 3.922.388 3.909.512 4.037.095 4.275.843 4.471.104 4.635.400

11.
E-R Italia UE 25
% 0-14 anni 12,3 14,1 16,2
% 65 anni e più 22,8 19,5 16,7
% 75 anni e più 11,9 9 7,6
% 80 anni e più 7,3 5 4,1
Aging Index 167,9 147,2 112
EMILIA-ROMAGNA REGION: AGING INDEX
E-R

12. Resident population
Total males Foreign males Total females Foreign females
- 53% of foreign
population between
20 & 45 years old
- Under 18 are
increasing (23%)
GENDER
NATIONALITY
AGE
Age structure of the population residing in the ER by gender, citizenship and single
year of age, 01/01/2013

13. •REGION: (Health services and FRNA)
•ELDERLY: (people and families,
including us of NCA)
•LOCAL AUTHORITIES
WHO PAYS THE COST OF
SERVICES?
NATIONAL FOUNDS?
40%
40%
20%

14. AN integrated system:
Not only social and health
The mainly problem: integrate
all local policies(urbanistic planning,
housing, transport, long life learning, tourism, social
and health)
FOCUS NOT IMPROVING
ADMINISTRATION BUT ON THE
SINGLE INDIVIDUAL.

15. FRAIL ELDERLY
Multifactor approach
health problems,
functional deficit,
social context,
incomes
loneliness
no close relations
No possible a
general model
without
context
analysis

16. 0
4
8
12
16
20
24
28
32
36
40
44
Meno di 25 25 - 34 35 - 44 45 - 54 55 - 64 65 - 74 75 - 84 85 e oltre
% M in unip %F in unip % MF in unip
% total
population
11,5%
% =>75
34%
% =>85
38%
% Femm
=>85
46%
FAMILIES COMPOSED BY ONLY 1 PERSON (BY AGE
GROUPS)

17. Services network forServices network for
Not-selfsufficientNot-selfsufficient
elderly peopleelderly people

18. SENIORS HEALTH:
3 LEVELS OF INTEGRATION
INSTITUTIONAL
AGREEMENT BETWEEN
MUNICIPALITY AND AUSL
ORGANIZATIONAL-
OPERATING SENIOR ASSISTANCE SERVICE (SAA)
Case manager
Local Geriatrical
evaluation Unit
(UVGT)
PROFESSIONAL

19. GERIATRICAL EVALUATION
UNIT (UVG) •GERIATRICIST
•NURSES
•SOCIAL WORKERS
•MULTI-DIMENSIONAL EVALUATION
•INDIVIDUAL PLAN (PAI)
•PROPOSAL USING SERVICES
•FOLLOW UP
GP
OTHER SPECIALISTS
Integrated Home
care
Nursing homes =CRA
Caregivers and
family assistant
supporting
Day centers= CD

20. Total no.
of
services
Users per
service
% of
services
per
=>75
population
Providers
Publi
c
Privat
e
non-
profit
Private
for-
profit
TOTAL
Residential
(nursing homes)
328 17.556 3,1% 89 186 53 328
Day Care
Center
215 3.342 0,6% 92 108 15 215
Regional
Care
Allowance
20.500
people
4 different levels in relation to the level of care provided by
relatives: 280, 450, 700, 1050 euro per month
Home care
services
129 24.207 30 99 0 129
Day social activity center 354 Center 135.000
Members
Volunteer
Association
SERVICES FOR THE ELDERLY in Emilia Romagna Region
National Care Allowance 105.000
(=>65 years)
490 euro per month In ER 600.000.000
euro per year

21. Women from foreignWomen from foreign
countries (mainly Easterncountries (mainly Eastern
European) take on the taskEuropean) take on the task
of caring for elderly andof caring for elderly and
disabled people, sharing thedisabled people, sharing the
same home.same home.
How ointegrate familyHow ointegrate family
assistant in the network?assistant in the network?
How to reduce black marketHow to reduce black market
for home care?for home care?
Family assistants

23. • Integration of all actorsIntegration of all actors
Some lessons we learnt
• Access system:Access system:
 Single door systemSingle door system
 Multidimensional evaluationMultidimensional evaluation
 Case managmentCase managment
• Support caregivers and familySupport caregivers and family
assistantassistant
 TraningTraning
 Respite care servicesRespite care services
 Care allowanceCare allowance
 Support self help groupSupport self help group

24. Some lessons we learnt
• Planning specific approach forPlanning specific approach for
emergencies:emergencies:
 Hospital dischargeHospital discharge
 Suddenly changes health or in theSuddenly changes health or in the
supporting familysupporting family
 Climate emergency (heartquacke)Climate emergency (heartquacke)
• Provide servicesProvide services
• Integrated data systemIntegrated data system
• Innovation in soft, flexible and communityInnovation in soft, flexible and community
services and opportunitiesservices and opportunities

25. Some lessons we learnt
• Professional integration:Professional integration:
 Good training for specific skillGood training for specific skill
 Training and upgradeTraining and upgrade
 Common approach and language for allCommon approach and language for all
professionalsprofessionals
 Common training on good relation withCommon training on good relation with
elderly people and thei relativeselderly people and thei relatives

26. THANK YOU
FOR YOUR ATTENTION
rfabrizio@regione.emilia-romagna.it