Community Health Reform in Italy: Case della Comunità and the Future of Local Care

For many older Italians, the weakness of community healthcare has never been the complete absence of services. The greater difficulty has been navigating services that sit in different organisations, operate through different access routes and do not always behave as one continuous pathway. A person with diabetes, heart failure and increasing frailty may know their general practitioner, attend hospital specialists, receive occasional home healthcare and depend heavily on relatives, yet still lack a clearly identifiable place where those needs are considered together.

Italy's Case della Comunità — Community Houses — are intended to help change that experience. They sit within a much wider reform of territorial healthcare examined throughout the Italy Ageing, Long-Term Care & Community Support Knowledge Hub: a shift towards stronger proximity services, multidisciplinary working, home-based care, digital coordination and greater continuity between hospitals and communities.

The reform is strategically important because Italy is trying to strengthen local healthcare while its population is ageing, multimorbidity is increasing and family capacity cannot be assumed indefinitely. Ministerial Decree 77/2022 established national organisational models and standards for territorial assistance, while Mission 6 of the Piano Nazionale di Ripresa e Resilienza (PNRR) has funded the physical and technological infrastructure needed to accelerate implementation.

By mid-2026, Italy reported achievement of the European PNRR target for at least 1,038 operational Case della Comunità. That is an important implementation milestone. It is not, however, the final test of reform. The more consequential question is whether Community Houses become functioning local care systems rather than simply new or refurbished healthcare buildings.

Why Italy is redesigning territorial healthcare

The Servizio Sanitario Nazionale (SSN) has historically combined nationally defined healthcare guarantees with substantial regional responsibility for organisation and delivery. This has enabled Regions and Autonomous Provinces to develop different models suited to their circumstances, but it has also contributed to variation in territorial healthcare capacity and organisation.

Hospital care has often been more institutionally visible than community services. General practitioners provide an essential point of continuity, but chronic disease, frailty and non-self-sufficiency increasingly require contributions from multiple professions and services. A hospital-centred response is poorly matched to needs that persist for years and are strongly influenced by function, housing, family support and the person's ability to manage everyday life.

The policy direction behind territorial reform is therefore broader than moving activity out of hospitals. It seeks to create a more coherent layer of healthcare closer to where people live.

This aligns with wider principles of community and home-based service design. A strong territorial system needs to identify needs earlier, coordinate chronic disease management, support people at home, connect professionals and provide understandable routes into care before an emergency becomes the default access point.

For Italy, that challenge is amplified by demography. A growing older population means more people living simultaneously with chronic disease, frailty and functional limitations. The distinction between a discrete healthcare episode and longer-term support becomes increasingly difficult to sustain in practice.

What is a Casa della Comunità?

A Casa della Comunità is intended to provide a recognisable territorial point through which people can access healthcare and social-health support and through which professionals can coordinate the care of the population they serve.

Ministerial Decree 77/2022 places the model within the SSN's District architecture. Community Houses are not simply outpatient clinics with a new name. Their intended function includes access, assessment, chronic disease management, nursing, primary medical care, specialist contributions, prevention and coordination with other parts of the territorial network.

The multidisciplinary principle is fundamental. Depending on the model and local organisation, the professional network can involve:

• general practitioners and paediatricians;
• family and community nurses;
• specialist medical professionals;
• other health professionals, including rehabilitation roles where organised locally;
• administrative and access functions; and
• connections with social and social-health services where people's needs cross institutional boundaries.

Not every Community House will contain every service in the same way. DM 77 distinguishes between more comprehensive hub models and spoke arrangements, allowing territorial networks to be organised around population needs and geography.

This flexibility is important in a country ranging from dense metropolitan areas to mountain communities, islands and sparsely populated inner areas. Uniform national purpose does not require every building to have an identical operating model.

But flexibility also creates a governance requirement. Residents need to know what their local Community House actually provides, when services are available, how it connects with their general practitioner and what happens when a need cannot be resolved there.

A building is only one component of the reform

The PNRR has necessarily made infrastructure highly visible. Italy allocated major investment to constructing, renovating and technologically equipping Community Houses, with the minimum European target revised to at least 1,038 facilities following wider PNRR remodelling.

By July 2026, the Ministry of Health reported that this minimum operational target had been achieved, while the wider national programme envisages more facilities than the European minimum.

That distinction between infrastructure and operating capability is now becoming increasingly important.

A Community House can be physically complete while the maturity of the service model continues to develop. Buildings require professionals. Professionals require workable rotas and clinical relationships. Multidisciplinary teams require information. Referral routes need to be understood. Links with home healthcare, hospitals, Centrali Operative Territoriali and municipal services need to function in everyday practice.

Capital investment can therefore create the platform for reform, but recurring operational capacity determines its value.

This is a useful context for the Digital Twin Scenario Modeller. Organisations examining comparable service transformations can use scenario modelling to test how demand, workforce capacity and service configuration interact. It is not an Italian planning instrument, but the underlying question is directly relevant: what operational capacity is required for infrastructure to deliver the outcomes assumed in the strategy?

Operational scenario: the difference between a facility and a functioning pathway

Consider an 82-year-old woman in Tuscany, Elena, who lives alone and has diabetes, hypertension and early frailty. She remains independent but has begun missing appointments and has fallen twice without serious injury. Her daughter lives in another municipality and visits at weekends.

In a fragmented pathway, each issue can remain separate. Her general practitioner manages medication. A hospital specialist reviews her diabetes periodically. The falls may not generate any coordinated response because neither required hospital admission. Her daughter gradually takes on more organisation without anyone formally recognising that Elena's ability to manage is changing.

A mature Community House model creates a different possibility. Elena has a visible local route into territorial healthcare. Her changing function can be considered alongside her chronic conditions rather than only when one disease reaches a clinical threshold. Nursing input, medical review and other relevant professionals can contribute to a more coherent assessment, with referral onwards where additional services are needed.

The value lies not in giving Elena more appointments. It lies in connecting information and intervention around an emerging pattern.

If the Community House merely relocates existing appointments into one building, little has changed. If it enables professionals to identify increasing frailty, coordinate care and establish who will follow up the falls risk, it begins to alter the trajectory.

The scenario captures the central implementation test for Italy: co-location can help integration, but it does not create integration by itself.

The District remains fundamental to territorial organisation

Community Houses need to be understood within the wider District rather than as standalone institutions.

DM 77 strengthens the District as an organisational centre for territorial healthcare. The District connects primary care, home healthcare, Community Houses, intermediate care and other services serving the local population. It is therefore the wider organisational layer through which different components can become a network.

This matters because people do not organise their needs according to service categories.

An older person with chronic obstructive pulmonary disease may need primary medical care, nursing, rehabilitation, medicines support and eventually home healthcare. Following an acute deterioration, they may move through hospital and intermediate care before returning home. A Community House can provide an important access and coordination point, but continuity depends on the surrounding network.

The same applies to Centrali Operative Territoriali. COT provide a coordination function across professionals and care settings. They are not interchangeable with Community Houses. One provides a visible proximity service and multidisciplinary platform; the other strengthens operational coordination across transitions and settings.

Together with home healthcare and Ospedali di Comunità, these elements create the architecture through which Italy is attempting to move from separate territorial services towards a more connected model.

Primary care relationships will determine how the model feels to citizens

General practitioners remain central to Italian primary healthcare. Territorial reform therefore cannot succeed by constructing a parallel system around them. The stronger model is one in which Community Houses support more connected multidisciplinary practice while preserving clear clinical relationships and continuity.

This is operationally significant because structural integration and relational continuity are not the same thing.

A person living with multiple long-term conditions may benefit from access to several professionals, but repeatedly explaining their history to unfamiliar practitioners can create fragmentation of a different kind. More multidisciplinary input does not automatically produce more coherent care.

The Community House model therefore needs mechanisms that allow professionals to contribute without obscuring who is following the person's overall trajectory.

That can involve shared information, defined clinical responsibilities, planned multidisciplinary discussion and clear escalation routes. It also requires the person to understand the arrangement. If professionals understand the organisational model but the citizen does not know whom to contact, integration remains incomplete.

The broader principle reflected in support planning and review is relevant here: coordinated care should remain organised around the person's changing goals and needs rather than becoming an accumulation of professional interventions.

Community Houses could strengthen prevention and earlier intervention

The greatest long-term value of territorial reform may emerge before people require intensive care.

Population ageing increases demand for treatment, but it also increases the importance of preventing or delaying avoidable loss of independence. Blood-pressure control, diabetes management, vaccination, medication review, falls prevention, rehabilitation, nutrition, physical activity and earlier recognition of frailty can all affect later demand.

A local multidisciplinary infrastructure creates opportunities to make these interventions more systematic.

This shifts the strategic question from "Which service does this person currently qualify for?" towards "What is changing in this person's health and function, and what action could prevent further deterioration?"

The difference is important. Reactive systems tend to see people when an event has already occurred. Preventive territorial care tries to identify trajectories.

Community Houses could also strengthen population-level understanding. When services know their local population, they can identify patterns of chronic disease, vulnerability and access rather than relying solely on people presenting themselves.

This links territorial reform with health inequalities, prevention and early intervention. Proximity alone does not guarantee equity. People who are socially isolated, digitally excluded or unable to navigate services may remain less visible even when a facility exists nearby.

A genuinely population-oriented model therefore needs both an accessible front door and ways of identifying people who rarely reach it.

Operational scenario: preventing a recurring cycle of emergency care

Giuseppe is 76 and lives in a densely populated neighbourhood in Naples. He has chronic obstructive pulmonary disease and diabetes. During the previous year he has attended emergency services several times following worsening breathlessness.

Each episode is treated appropriately, but Giuseppe's wider pattern receives less attention. He finds it difficult to navigate appointments, sometimes takes medication incorrectly and becomes anxious when his breathing changes. His adult children help when they can, but neither lives with him.

The Community House offers an opportunity to reorganise his care around continuity rather than repeated episodes. His general medical care can connect with nursing and other relevant territorial input. His medication understanding and self-management can be reviewed, while professionals establish an agreed response to early deterioration.

Crucially, the pathway does not promise that Giuseppe will never require hospital care again. COPD can deteriorate despite good community management. The objective is to distinguish deterioration that can be managed earlier from episodes that genuinely require acute intervention.

Over time, the territorial team can examine whether emergency attendance is reducing, whether Giuseppe is managing treatment more confidently and whether planned care is occurring consistently.

This is a more useful definition of success than simply recording that he attended the Community House. It connects access with outcome.

For organisations developing comparable measurement systems, the Quality Dashboard Builder provides a practical framework for moving from activity counts towards decision-relevant indicators. In Italy, the specific measures must of course reflect SSN, regional and local governance arrangements.

Health and social integration remains the harder boundary

Community Houses are healthcare institutions within a wider social reality.

An older person's deteriorating health may be inseparable from their ability to wash, prepare food, move around the home, maintain social contact or rely on a family caregiver. These needs cross the institutional boundary between healthcare and social support.

Italy's municipalities and territorial social structures retain important responsibilities for social assistance, while the SSN and regional health systems organise healthcare and social-health services. The organisational landscape therefore cannot be integrated simply by bringing healthcare professionals into one location.

This is particularly relevant for non-self-sufficient older people. A Community House may identify that a person's diabetes is poorly controlled because dementia is affecting medication management. The healthcare problem is visible, but the sustainable response may involve family support, social assistance, home care and assessment of longer-term dependency alongside clinical intervention.

Italy's broader long-term care reform under Law 33/2023 and Legislative Decree 29/2024 is important in this context because it seeks stronger coordination around older people and non-self-sufficiency. The territorial healthcare reform and long-term care reform are distinct policy developments, but their effectiveness increasingly depends on how they meet in practice.

The central governance issue is not whether health and social services become administratively identical. It is whether people encounter a coherent pathway when their needs require both.

Family care must not become the invisible integration mechanism

Italian families have historically connected fragmented systems by doing the coordination themselves.

Relatives book appointments, transport older parents, communicate between professionals, employ badanti, organise medicines and fill gaps between formal services. This contribution is substantial, but it can conceal weaknesses in formal coordination.

Community reform creates an opportunity to reduce that burden.

Families should remain partners where the person wishes them to be involved, but they should not have to function as the sole information system connecting primary care, hospital specialists and territorial services.

The issue is especially important as household structures change. Adult children may live further away, women have greater labour-market participation and older spouses may themselves have significant health needs.

Stronger family partnership and carer support therefore requires an explicit understanding of what relatives can sustainably contribute.

A Community House that asks "Who is the family contact?" is gathering useful information. A stronger service also asks what that person is actually doing, whether the arrangement remains sustainable and which responsibilities require formal support.

Workforce is now one of the decisive implementation questions

Italy's PNRR has been able to accelerate physical and technological infrastructure on a defined timetable. Building a stable multidisciplinary workforce is a different type of challenge.

Community Houses require professionals who can deliver the intended model over the long term. Family and community nursing is particularly important, but medical, specialist, rehabilitation and other professional capacity also matters. Availability differs geographically, and shortages cannot be solved simply by redistributing existing staff from another part of the system without considering what happens to the services they leave.

The workforce challenge therefore has at least three dimensions: numbers, distribution and ways of working.

A multidisciplinary model can improve productivity by allowing different professionals to contribute at the appropriate level of expertise. But that requires role clarity, shared protocols, communication and trust. Putting several professions under one roof without redesigning workflows can simply reproduce professional silos at closer physical distance.

Geography further complicates the picture. A Community House serving a rural or mountain population may need to combine physical presence with outreach, home visits and digital support. Travel time can consume workforce capacity that is less visible in headline staffing numbers.

Organisations considering similar models can use the Predictive Workforce Risk Module to explore how vacancies, turnover and continuity risks affect service capability. The tool does not define Italian workforce requirements, but the planning principle is relevant: infrastructure and workforce assumptions need to be modelled together.

Operational scenario: one national model, different territorial realities

Two Community Houses may meet the same national structural framework while facing very different operational conditions.

A facility in metropolitan Milan serves a dense population and can potentially draw on a wide professional network, specialist services and strong transport infrastructure. Demand may be high, but professionals and patients are geographically concentrated.

A Community House serving an inland area of Sardinia faces a different equation. The population is dispersed, many residents are older and transport can be difficult. Recruiting particular professionals may be harder, while home visits require more travel time.

Applying identical staffing assumptions to both locations could therefore produce very different practical access.

The rural model may need stronger integration between physical services, home healthcare and telemedicine. Some specialist consultations can be supported remotely, allowing people to avoid unnecessary journeys, while nurses and other professionals provide local continuity. But hands-on assessment and care still require people on the ground.

Governance should consequently distinguish consistency of purpose from uniformity of delivery.

The national objective is equitable access to appropriate territorial healthcare. Achieving that may require different operational models in different places. The relevant question is not whether every Community House looks identical, but whether residents can obtain comparable functional access to the care the model is intended to provide.

Digital infrastructure can connect the territorial network

Community Houses are being developed during a wider digital transformation of Italian healthcare. That creates opportunities that would have been more difficult in earlier models of community provision.

Telemedicine can extend specialist reach. Remote monitoring can support selected people with chronic conditions. The Fascicolo Sanitario Elettronico can strengthen access to health information. COT can use digital systems to coordinate transitions, while Community House professionals can work with information generated across different care settings.

The potential is significant because territorial healthcare depends on information following the person.

But digital maturity cannot be judged by the number of systems installed. Information needs to be accurate, accessible to authorised professionals and usable within clinical workflows. Different systems need sufficient interoperability to prevent staff becoming the manual connection between incompatible records.

Remote monitoring illustrates the point. A device can identify an abnormal reading, but the care model still needs to determine who reviews it, what threshold triggers action, how quickly the person is contacted and where responsibility moves if their condition worsens.

This is why remote monitoring and telecare should be understood as components of care pathways rather than standalone technologies.

Digital inclusion matters equally. Older people who cannot use an application, lack reliable connectivity or prefer face-to-face contact should not encounter a weaker service as care becomes more technologically enabled.

The Digital Transformation Readiness Assessment can help organisations exploring comparable changes consider technology alongside governance, workforce capability and implementation. The transferable principle is that successful digital transformation changes how care works rather than simply adding technology to an unchanged process.

Quality needs to move from counting facilities to understanding impact

During an infrastructure programme, progress is understandably measured through milestones: sites identified, contracts completed, buildings renovated, equipment installed and services activated.

Those measures establish whether investment has been implemented. Once the network is operational, however, quality assurance needs to move further.

For Community Houses, useful questions include whether people obtain timely access, whether multidisciplinary working changes care, whether chronic conditions are managed more proactively, whether vulnerable people are identified earlier and whether hospital use changes where community intervention could reasonably prevent escalation.

Other measures should examine continuity and equity. A national average can improve while particular populations remain poorly served.

A mature evidence framework might therefore combine:

• access and waiting-time measures rather than attendance totals alone;
• continuity and completion of planned follow-up;
• management of chronic disease and frailty trajectories;
• avoidable emergency use where clinically meaningful;
• patient and family experience of coordination;
• workforce stability and multidisciplinary capacity; and
• geographic and socioeconomic variation in access and outcomes.

This connects with wider data and quality measurement. Metrics are most valuable when they allow decision-makers to distinguish implementation activity from actual improvement.

Governance also needs qualitative intelligence. People may technically obtain appointments while still experiencing confusing pathways. Professionals may identify duplicated processes that headline data cannot reveal. Family feedback may expose coordination gaps long before those gaps appear in hospital utilisation statistics.

Operational scenario: governance detects an access problem hidden by activity data

A regional health organisation sees apparently strong performance from a group of Community Houses. Appointment volumes are increasing, more people are receiving nursing input and chronic disease reviews are being recorded.

At first sight, the reform appears to be functioning well.

More detailed analysis shows a different pattern. Residents living closest to the facilities are using them extensively, while several outlying communities have substantially lower access. Older residents in those areas report transport difficulties, and some general practitioners say that patients are continuing to rely on hospital routes because territorial services feel inaccessible.

The issue is not poor clinical performance inside the Community Houses. It is the design of the territorial network around them.

The response therefore combines data with local operational intelligence. Outreach sessions are considered for particular communities. Home healthcare interfaces are reviewed. Telemedicine is expanded where clinically appropriate, while non-digital access remains available. Transport barriers are included in planning rather than treated as matters outside healthcare.

Performance is subsequently monitored by geography rather than only through aggregate attendance.

The scenario demonstrates why quality monitoring systems need enough granularity to expose unequal access. High activity can coexist with important gaps if the data are not examined from the perspective of the population the service is intended to reach.

Community Houses are part of a network, not a replacement for it

The visibility of the Case della Comunità model can create a temptation to treat it as the answer to every weakness in territorial care. That would misunderstand the reform.

Community Houses cannot replace hospitals where acute treatment is required. They do not replace home healthcare for people who need professional care where they live. They do not remove the need for general practitioners, municipal social services, rehabilitation, Ospedali di Comunità or specialist services.

Their strategic value lies partly in connecting those components more effectively.

This means success depends on interfaces. A person leaving hospital may need COT-supported coordination and home healthcare, with the Community House contributing to longer-term follow-up. A person whose chronic disease is deteriorating may first be identified through primary care and then benefit from wider multidisciplinary support. Someone developing non-self-sufficiency may require social and long-term care pathways extending beyond the Community House itself.

The strongest territorial model therefore avoids creating a new institutional silo.

That principle is particularly important during reform because new organisations naturally develop their own processes, identities and performance measures. Governance needs to keep the focus on population pathways rather than organisational boundaries.

From PNRR implementation to long-term sustainability

The PNRR has given Italy an unusual opportunity to accelerate territorial healthcare reform through substantial time-limited investment. The next policy phase is necessarily different.

Once buildings are completed and technological infrastructure is installed, the system must sustain staffing, maintenance, service capacity and integration through ordinary healthcare governance and funding.

This is where reform moves from project implementation into institutionalisation.

The question for Regions will increasingly be how Community Houses fit within their enduring service models rather than whether individual PNRR milestones have been completed. Workforce plans need to support them. District governance needs to use them. General practitioners and other professionals need workable relationships with them. Citizens need to understand them.

There is also a strategic opportunity to use implementation evidence to refine the model. Different Regions and territories will develop different operational approaches. Some variation is inevitable and potentially useful. The national challenge is to identify which differences reflect legitimate adaptation and which produce unacceptable inequality.

That requires a learning system capable of connecting local experience with regional and national decisions. The relevant form of continuous improvement is not endless organisational restructuring. It is disciplined use of evidence to improve access, pathways and outcomes as the territorial model matures.

What international systems can learn from Italy's reform

Italy's Community House programme emerges from a specific institutional context: a tax-funded national health service with substantial regional organisation, established general-practice arrangements, municipal social responsibilities and significant family involvement in long-term support. The Case della Comunità therefore cannot be separated from the SSN and transplanted directly into a different system.

Several underlying principles are nevertheless internationally relevant.

First, strengthening community care requires more than relocating outpatient activity. The strategic objective should be continuity, prevention and population management.

Second, physical infrastructure and operating capability need separate assurance. A completed building is an input; a functioning multidisciplinary pathway is an outcome of implementation.

Third, integration depends on information, relationships and accountability as much as co-location. Multiple professionals working in the same facility can still deliver fragmented care.

Fourth, national consistency should focus on meaningful access and outcomes rather than assuming identical operating models will work in every geography.

Finally, time-limited capital programmes need an explicit route into sustainable recurring operations. Workforce and service capacity determine whether infrastructure continues to create value after the investment programme ends.

The transferable lesson lies less in the Community House as a building and more in the attempt to create a visible, multidisciplinary and accountable territorial layer between people's homes and acute hospitals.

Conclusion

Italy's Case della Comunità programme represents one of the most visible elements of a much broader redesign of territorial healthcare. The achievement of the PNRR infrastructure target is significant, but it marks a transition in the reform rather than its completion. The strategic task is now to convert facilities, professionals, digital systems and national standards into reliable local care.

For older people and those living with chronic conditions, success should be tangible. Care should become easier to navigate. Changes in health and function should be recognised earlier. Professionals should work from a more connected understanding of need. Families should spend less time acting as the informal coordination mechanism between separate services. Geography should influence how care is organised without determining whether meaningful access exists at all.

That requires sustained workforce capacity, mature District governance, effective relationships with general practitioners, stronger health and social interfaces, interoperable information and measures that follow outcomes rather than buildings or appointments alone.

Italy has created important territorial infrastructure through DM 77 and the PNRR. Its longer-term significance will depend on whether Community Houses become genuine centres of continuity, prevention and population care. The future of the model will therefore be determined less by what stands behind the entrance sign than by how effectively the entire local care network works around the person who walks through the door.