Home Care in Italy: Supporting Older People to Remain at Home

For many older people in Italy, long-term care begins not with entry into a formal institution but with an attempt to preserve everyday life at home. A spouse manages meals and medicines, an adult child coordinates appointments, a privately employed care worker provides practical assistance, the family doctor remains involved, and health professionals may visit through the regional home-care system. Municipal social services can add further support. What appears from outside to be one home-care arrangement may therefore be a combination of several different systems.

This makes home care one of the most important areas within the Italy Ageing, Long-Term Care & Community Support Knowledge Hub. Italy has increasingly strengthened the policy objective of supporting people in their own homes, particularly through the Servizio Sanitario Nazionale, territorial health reform and the Piano Nazionale di Ripresa e Resilienza. By 2025, more than 1.6 million people aged over 65 had received at least one home-healthcare intervention recorded through the national monitoring system, exceeding the PNRR target.

Yet coverage is only part of the story. Remaining at home sustainably depends on the intensity and continuity of formal services, the condition of the home, workforce availability, municipal support, family capacity and the ability to coordinate clinical and everyday assistance. A brief professional intervention can be valuable, but it is not equivalent to the hours of practical support required by someone living with advanced frailty or dementia.

Italy’s strategic opportunity therefore lies not simply in expanding home care, but in developing a more coherent home-based care ecosystem around the person.

Home care in Italy is not one service

International readers can misunderstand Italian home care if they treat it as a single publicly organised service. Several distinct forms of support can coexist within one household.

The Servizio Sanitario Nazionale provides cure domiciliari, including integrated home healthcare known as Assistenza Domiciliare Integrata, or ADI. These services are organised through regional health systems and territorial districts and can involve medical, nursing, rehabilitation, diagnostic and other health or social-health interventions.

Municipalities and territorial social-service arrangements may provide social home assistance, commonly associated with the Servizio di Assistenza Domiciliare or similar locally named services. These interventions can support personal care, household activity, social participation and other non-clinical needs, although arrangements, eligibility and availability vary geographically.

Families provide a third and often substantial layer. Relatives may deliver direct care, coordinate appointments, supervise privately purchased support and manage the administrative boundaries between health and social services.

Finally, many households employ personal care workers, widely referred to as badanti, often through private household arrangements. Migrant workers have become particularly important within this part of Italy’s care economy.

These components do not operate under one unified funding mechanism. Health services covered within the Livelli Essenziali di Assistenza are part of the publicly funded SSN. Municipal social assistance can involve different local eligibility and financial arrangements. Families may receive cash benefits but still organise and purchase substantial care themselves.

The result is less a single home-care programme than a mixed economy of professional healthcare, social assistance, family labour and private household purchasing.

ADI is the clinical backbone of publicly funded home care

Home healthcare forms part of Italy’s Livelli Essenziali di Assistenza. The current model distinguishes basic home care and integrated home care at different levels of intensity, reflecting the complexity of the person’s needs.

ADI can include interventions from doctors, nurses, physiotherapists and other qualified health and social-health professionals. Its purpose includes stabilising clinical conditions, limiting functional decline and supporting quality of life for people who are non-self-sufficient, frail, chronically ill or otherwise require planned professional care at home.

This matters because home is not simply a cheaper alternative location for treatment. It changes how care is organised. Professionals enter an environment controlled primarily by the person and household rather than by a healthcare institution. Equipment, family capability, housing conditions and communication between visiting professionals become part of clinical safety.

Home-care intensity is therefore formally relevant. The national Sistema Informativo Assistenza Domiciliare records information about planned health and social-health interventions and uses measures including the Coefficiente di Intensità Assistenziale to differentiate levels of care.

For operational leaders, the important question is not merely whether somebody has been admitted to ADI. It is whether the level, frequency and professional mix of intervention remain proportionate to changing need.

This distinction connects with wider homecare service models and pathways. A home-based system becomes credible when assessment, delivery, escalation and review operate as a pathway rather than as disconnected visits.

Italy has rapidly expanded the reach of home healthcare

The PNRR made home care a central element of Mission 6 under the principle of casa come primo luogo di cura — home as the first place of care. Significant investment was directed towards domiciliary healthcare, territorial coordination and telemedicine.

The scale of expansion is substantial. The 2019 baseline used for PNRR monitoring recorded 645,590 people aged over 65 receiving qualifying home healthcare. National monitoring for 2025 recorded 1,625,785 people aged over 65 receiving one or more interventions during the year, equivalent to approximately 11.3% of the older population and above the minimum target.

This represents an important change in reach. It demonstrates that a national policy objective can drive significant expansion through Italy’s regional health systems.

However, interpreting the figure requires precision. Being counted as a person receiving home healthcare does not mean receiving continuous or high-intensity long-term care. The indicator captures people receiving one or more qualifying interventions.

That distinction is operationally crucial. A system can successfully expand reach while still needing to strengthen intensity for people with advanced dependency.

Future assurance therefore needs to consider several dimensions together:

• how many people receive home healthcare;
• how quickly support begins after assessment or hospital discharge;
• the intensity and duration of intervention;
• the professional disciplines involved;
• continuity when needs increase; and
• whether home care prevents avoidable deterioration or institutional transition where that is the person’s preference.

Coverage tells Italy how far the system reaches. Outcomes and intensity reveal what that reach actually achieves.

Operational scenario: discharge home reveals the difference between clinical care and everyday support

An 82-year-old woman returns to her apartment after hospital treatment for a hip fracture. She also has diabetes and early cognitive impairment. Her daughter lives twenty kilometres away and works full time.

The hospital and territorial services establish a home-healthcare pathway involving nursing and rehabilitation. Clinically, the transition appears well planned. A physiotherapist works on mobility, a nurse monitors the wound and medication-related issues, and her general practitioner remains responsible for primary medical care.

Yet the woman also needs help preparing meals, washing, dressing and moving safely around the apartment. Those needs do not disappear between professional visits. Her daughter initially fills the gap but quickly finds that combining employment, travel and daily support is unsustainable.

The family then needs to explore municipal social assistance and potentially privately purchased care. If those arrangements take time, the clinically appropriate ADI package can still sit inside an unstable home situation.

A strong pathway therefore asks more than whether nursing and rehabilitation have started. It identifies who is providing practical support, whether that arrangement is sustainable, whether the home environment is safe and what happens if the daughter becomes unavailable.

For systems internationally, this is an important distinction. Hospital-to-home pathways can appear successful from a healthcare perspective while transferring significant operational responsibility to the household. Effective hospital discharge and home-based reablement requires visibility of the whole support arrangement, not only the clinical component.

Municipal social assistance occupies a different part of the home-care system

Health and social support are administratively distinct in Italy even though older people frequently need both simultaneously. Municipalities, often working through Ambiti Territoriali Sociali and associated arrangements, organise important elements of social assistance.

Home-based social support can include help with personal activities, household tasks, social connection and maintaining daily life. The precise service model differs between territories, as do eligibility rules, resources and the balance between direct provision and contracted services.

This local variation creates one of the defining interfaces in Italian home care. A regional health system may have expanded ADI substantially while municipal social support remains constrained. Conversely, a municipality with established social services may be able to wrap practical assistance around health interventions more effectively.

For the person, the distinction between a health-funded visit and a municipally organised support service can feel artificial. Both may be necessary to remain at home safely.

The policy challenge is therefore coordination rather than simply organisational consolidation. Italy does not need every function to be delivered by one institution, but people should not have to become system navigators merely because responsibilities are distributed.

Family care remains the connective tissue of many home arrangements

Italian long-term care has historically depended heavily on families. That role includes direct physical assistance but also coordination: arranging appointments, contacting services, purchasing supplies, managing private workers and noticing deterioration between professional visits.

Family involvement can provide continuity that formal services struggle to reproduce. Relatives know routines, preferences and subtle changes in behaviour. For many older people, support from people they trust is central to remaining connected to home and community.

But the value of family care should not be romanticised. Intensive caring can reduce employment, income, rest and social participation. Responsibilities are not distributed evenly, and women continue to carry a substantial share of unpaid care.

Demographic change is making the traditional model harder to sustain. Smaller families, lower birth rates, increased female labour-market participation, geographic mobility and the ageing of spouses all reduce the assumption that a relative will always be available.

That creates a strategic issue for Italy. Expanding formal home healthcare while continuing to assume unlimited household capacity risks building services around an increasingly fragile resource.

Home-care assessment therefore needs to recognise family sustainability explicitly. This aligns with the wider principles of family partnership and carer support in ageing well: involving relatives is different from silently transferring responsibility to them.

Operational scenario: the care package works only because the daughter does

A 79-year-old man with Parkinson’s disease lives at home with support from ADI and a privately employed care worker for several hours each weekday. His daughter visits every evening and stays overnight twice a week.

On paper, the arrangement appears stable. He has professional healthcare, practical assistance and strong family involvement. There have been no recent hospital admissions.

His daughter then tells the family doctor that she is exhausted and is considering reducing her working hours. She is managing nighttime problems, shopping, administration and coordination whenever the privately employed worker is absent.

The key risk is not an immediate clinical deterioration in her father. It is the potential failure of the support architecture around him.

A mature response treats the daughter’s situation as relevant evidence. The person’s needs may require reassessment; available municipal support, respite or changes in the private care arrangement may need consideration. Professionals also need a clear contingency if the daughter suddenly becomes unable to continue.

If governance records only the father’s clinical status, the warning signal is missed. If it recognises carer sustainability as part of continuity, the system has an opportunity to intervene before the arrangement collapses.

Organisations examining comparable risks can use the Digital Twin Scenario Modeller to explore how loss of one critical source of capacity changes service stability. It is not an Italian assessment mechanism, but the scenario principle is valuable: apparently stable care can depend on resources that formal datasets barely see.

The badante model fills a major gap between formal services and continuous need

One of the most distinctive features of Italian home care is the extensive use of privately employed personal care workers commonly described as badanti. Many are migrant women who live with or spend substantial time supporting an older person.

This workforce helps households bridge the gap between intermittent formal services and the continuous practical assistance that advanced dependency can require. A worker may support personal care, meals, household routines, mobility, supervision and companionship.

The model has enabled many older people to remain at home who might otherwise require a different care setting. It also reflects a structural reality: cash benefits and family purchasing decisions can translate into privately organised labour rather than publicly delivered services.

Yet the arrangement creates important governance questions. Employment conditions, training, role boundaries, continuity and coordination with health professionals can vary. A privately employed worker may spend far more time with an older person than any professional service and therefore notice important changes first, but may sit outside formal multidisciplinary communication.

There is also an equity dimension. Families with greater financial resources and stronger networks are better positioned to organise private care. Cash support may contribute to costs, but the household remains responsible for constructing the arrangement.

The stronger future model is unlikely to involve removing private household care from Italy’s system. Its scale and embedded role make that unrealistic. The opportunity lies in better connecting this workforce with assessment, training, information and formal care pathways while protecting both the older person and the worker.

Home care depends on housing as much as healthcare

The policy objective of ageing at home can sound straightforward until the home itself becomes a barrier. Italian housing varies enormously, from modern apartments with lifts to older buildings with stairs, narrow bathrooms and limited accessibility.

For someone with reduced mobility, the difference between an accessible and inaccessible dwelling can determine whether home care remains viable.

A physiotherapist may improve walking ability, but a fourth-floor apartment without a lift still limits community participation. A care worker may assist with bathing, but an unsuitable bathroom can increase risk for both the older person and worker.

Home-based care therefore needs to connect with equipment, adaptations and environmental assessment where available. This is particularly important after sudden changes such as stroke, fracture or hospitalisation.

The issue also reinforces why positive risk-taking for older people requires proportionate judgement. Eliminating every risk can unnecessarily restrict independence; ignoring environmental hazards can make home unsustainable. The objective is to support autonomy with controls proportionate to the person’s circumstances.

Workforce capacity determines whether home-first policy is deliverable

Home care is labour intensive. Expanding eligibility or funding does not automatically create nurses, rehabilitation professionals, social-health workers or personal assistants.

The challenge is particularly acute because home-based work disperses the workforce across thousands of individual locations. Travel time reduces productive capacity, especially in rural and mountainous areas. Scheduling becomes more complex as people require visits at similar times of day.

Continuity matters as well. Repeatedly changing workers can undermine trust, particularly for people with dementia, communication difficulties or complex routines.

Italy therefore needs workforce planning that considers not just overall headcount but geographic distribution, skill mix, travel, working conditions and the relationship between formal and privately employed care.

Technology can remove some administrative burden and allow selected clinical activity to occur remotely, but it cannot replace the physical workforce required for personal care, transfers or hands-on rehabilitation.

The Predictive Workforce Risk Module can help organisations structure analysis of vacancy, turnover and continuity pressures. In the Italian context, the broader principle is especially relevant: national expansion targets need to be tested against the local workforce capacity required to convert entitlement into delivered care.

Operational scenario: rural home care changes the economics of each visit

An 86-year-old widower lives in a small mountain community. He has heart failure, diabetes and worsening mobility but strongly wishes to remain in his home.

The territorial health service can provide nursing input, but staff travel significant distances between patients. A visit that might require a short journey in an urban district can occupy much more professional time here. Recruitment is also difficult because younger workers have moved towards larger towns.

His niece lives nearby and helps with shopping, but she cannot provide personal care. A privately employed worker is available only on selected days.

The operational question is not whether home care is theoretically available. It is how to create a sustainable combination of in-person care, family assistance and remote clinical support without leaving critical gaps.

Some monitoring can be undertaken remotely, reducing unnecessary professional journeys. Scheduled visits can be coordinated geographically. The niece can participate in planning with her uncle’s consent. But digital contact cannot substitute for every physical intervention.

Regional and district governance should therefore monitor whether rural services achieve comparable outcomes rather than identical visit patterns. If the man experiences repeated emergency admissions because necessary face-to-face support cannot be delivered, the home-care model needs redesign.

This is a practical example of why home-first policy requires local flexibility. Equality is not achieved by giving every locality an identical operating model; it requires enough adaptation to produce meaningful access in different geographic conditions.

Territorial reform is creating new infrastructure around the home

Ministerial Decree 77 of 2022 established national standards for territorial healthcare and is reshaping the infrastructure surrounding home care. Case della Comunità, Centrali Operative Territoriali and Ospedali di Comunità are intended to create stronger community alternatives and improve coordination between settings.

The Centrali Operative Territoriali are particularly relevant because their function includes coordinating care transitions and connecting professionals across territorial, hospital and emergency pathways. For someone receiving support at home, this can reduce the risk that each organisation sees only its own part of the pathway.

Case della Comunità are intended to provide accessible community points through multidisciplinary teams, including general practitioners, community nurses, specialists and other professionals according to local arrangements.

These structures should not be interpreted as replacing the home. Their strategic value lies partly in making home-based care more sustainable by creating stronger professional networks around it.

The implementation challenge is operational maturity. Buildings and formal structures matter, but the real test is whether referrals move reliably, professionals share relevant information, responsibilities are clear and people experience continuity.

Telemedicine can extend home care without turning the home into a clinic

Telemedicine has become an important part of Italy’s territorial-health reform. PNRR investment has supported national infrastructure and regional implementation, and the target of at least 300,000 people receiving assistance through telemedicine tools was reported as achieved by June 2026.

The potential benefits for home care are significant. Remote monitoring can support selected chronic conditions, clinicians can review information without requiring every interaction to involve travel, and specialist expertise can reach people in geographically isolated areas more efficiently.

But the purpose should be to improve care rather than maximise technology use.

Older people vary in digital confidence, cognition, sensory ability and access to family support. A technology that enables one person to remain independent may increase anxiety or exclusion for another. Devices also create new requirements around consent, privacy, cybersecurity, response protocols and workforce competence.

This makes remote monitoring and telecare an operational model rather than simply an equipment purchase. Someone must review information, determine thresholds for action and respond when deterioration is detected.

Organisations examining comparable transformations can use the Digital Transformation Readiness Assessment to test whether governance, workforce, infrastructure and adoption are aligned. It does not assess compliance with Italian digital-health requirements, but it reflects an important principle: technology becomes useful only when embedded within a dependable care pathway.

Operational scenario: remote monitoring detects deterioration, but someone still has to respond

An 84-year-old woman with chronic heart failure receives home nursing and is enrolled in a telemonitoring pathway. She weighs herself and records selected measurements using connected equipment.

Over several days, the system shows a concerning pattern. The value of remote monitoring lies not in recording the data but in what happens next.

The pathway needs a defined clinical response: who reviews the alert, how urgently it is assessed, whether the family doctor or territorial team is contacted and when an in-person visit becomes necessary. If the information simply accumulates on a dashboard, the technology adds surveillance without improving care.

In this case, the territorial team contacts the woman, reviews symptoms and arranges an earlier assessment. Treatment is adjusted and a potential hospital admission is avoided.

The episode also generates useful governance evidence. Leaders can examine the time between alert and review, whether escalation thresholds were appropriate and whether similar interventions are producing consistent outcomes across the service.

That is the difference between digitising home care and transforming it. The first collects information remotely. The second redesigns professional decision-making around that information.

Quality at home needs different evidence from quality in an institution

Home-care quality cannot be assessed simply by importing institutional measures. Care is delivered across dispersed households, often by several organisations and alongside unpaid family support.

Some important outcomes are inherently personal: whether the individual remains able to follow familiar routines, maintain relationships, move safely around the home and participate in community life.

Clinical indicators remain important, as do incidents, medication safety, falls, hospital use and continuity. But the broader objective of home care is to support life rather than merely deliver interventions.

Good assurance should therefore connect activity, quality and outcomes. Relevant evidence can include timeliness, care intensity, missed or delayed interventions, workforce continuity, functional change, unplanned hospital use, family sustainability, complaints and the person’s experience.

This connects with outcomes-based homecare. Counting visits is necessary for operational control, but visits are inputs. The strategic question is what those inputs enable the person to do or avoid.

The Quality Dashboard Builder provides organisations with a way to bring multiple evidence domains into one assurance view. It is not designed to reproduce Italian national monitoring, but its underlying logic is relevant to any home-care system trying to connect reach, reliability, workforce and outcomes.

Home care also requires clear escalation boundaries

A policy preference for home should never become an assumption that remaining at home is always the right outcome.

Needs can increase beyond what a particular home arrangement can safely or sustainably provide. Dementia may progress, nighttime supervision may become necessary, repeated falls may occur, or a family carer may become unable to continue.

Person-centred practice therefore requires both commitment to home-based support and honesty about changing risk.

The key is timely review. A strong pathway identifies deterioration before an emergency forces the decision. It considers whether additional home support, rehabilitation, equipment, palliative care or another service model could restore stability. Where residential care becomes appropriate, transition should be planned around the person rather than treated as evidence that home care has failed.

This balance is especially important within quality and governance for older people. Governance should protect autonomy while ensuring that preference for home does not obscure escalating need, carer exhaustion or unsafe arrangements.

Integration is ultimately tested at the front door

Italy’s home-care architecture involves national legislation, regional health systems, territorial districts, municipalities, family doctors, health professionals, social services, private providers, household employees and relatives. Integration can therefore appear impressive on organisational diagrams while remaining difficult in practice.

The true test occurs at the person’s front door.

Does the nurse know that the privately employed worker has noticed a change in appetite? Does the municipal service understand that the daughter can no longer provide evening support? Does the family know whom to contact when mobility deteriorates? Can the territorial system distinguish a routine issue from a situation requiring urgent escalation?

Those questions reveal whether separate components function as a system.

Digital records and interoperability can help, but information-sharing needs clear governance and lawful access. Multidisciplinary working can improve decisions, but meetings alone do not guarantee accountability. Care plans can describe responsibilities, but they need updating when circumstances change.

The strongest home-care systems therefore combine coordination mechanisms with clear ownership. Someone needs sufficient visibility of the overall pathway to recognise when the combination of services is no longer coherent.

Italy’s long-term care reform could make home support more coherent

Law No. 33/2023 and Legislative Decree No. 29/2024 created a significant reform framework for policies concerning older people and people who are non-self-sufficient. Among the central ambitions is stronger coordination between health, social and social-health interventions and a more integrated approach to assessment and personalised planning.

This direction matters greatly for home care because fragmentation is most visible where several services enter the same household without necessarily operating as one pathway.

The Sistema Nazionale per la Popolazione Anziana Non Autosufficiente is intended to strengthen coordination across State, regional and local responsibilities. The development of essential social-service levels also offers a route towards reducing some of the geographic variation surrounding non-clinical support.

Implementation will be decisive. National architecture cannot itself create local workforce, municipal capacity or provider supply. Nor can it automatically connect privately employed care workers with formal services.

The reform opportunity lies in creating a clearer person-centred framework within which those different resources can operate. Assessment should identify the whole support requirement; planning should distinguish professional, social and family contributions; review should detect when any component becomes unstable.

What other countries can learn from Italy’s home-care model

Italy’s institutional arrangements cannot be transferred directly to other systems, but its experience highlights several internationally relevant principles.

First, home care should be understood as an ecosystem. Healthcare, practical assistance, housing, family support, privately purchased care and technology interact whether policy formally integrates them or not.

Second, increasing coverage is only the beginning. Systems need to measure intensity, continuity and outcomes if they want to know whether expanded home care is genuinely supporting people with higher needs.

Third, informal care is productive capacity but not unlimited capacity. Policy that depends on families needs mechanisms for recognising burden and responding before arrangements become unsustainable.

Fourth, cash benefits and private purchasing can increase flexibility while also creating inequalities and governance challenges. Understanding who actually delivers care is as important as knowing who funds it.

Fifth, technology is most useful when it strengthens a human response pathway. Remote monitoring without timely professional action does not create integrated care.

Finally, a home-first strategy needs alternatives. Supporting people at home is meaningful when it reflects preference and appropriate support, not when limited residential or community capacity leaves the household with no realistic choice.

The next phase is to turn expanded reach into dependable capacity

Italy has already demonstrated that national investment can produce a major expansion in the number of older people reached by home healthcare. The PNRR has also strengthened the surrounding territorial infrastructure and accelerated telemedicine.

The strategic question now changes. It is no longer simply how many people can be enrolled in home care, but whether the system can provide the right intensity for the right duration and coordinate that care with the rest of the person’s life.

That will require sustained workforce investment, stronger interfaces between regional health and municipal social services, realistic recognition of family capacity and better connection with privately employed carers. It will also require evidence capable of distinguishing a brief episode of professional intervention from a genuinely resilient long-term home arrangement.

The strongest future measure of success will therefore not be home-care coverage alone. It will be whether older people with increasing needs can remain at home for as long as that setting remains safe, sustainable and consistent with their preferences, without transferring unreasonable risk or workload to their families.

Conclusion

Home care sits at the centre of Italy’s response to population ageing because it connects a strong cultural preference for remaining in familiar surroundings with a strategic shift towards territorial and community healthcare. The expansion of ADI, PNRR investment, telemedicine and new territorial infrastructure have significantly strengthened the formal health component of that model.

But Italian home care cannot be understood through ADI alone. Municipal social assistance, family caregiving, privately employed badanti, housing conditions and local workforce capacity determine whether professional interventions can become a sustainable everyday arrangement. A person may be clinically well supported and still have an unstable care package if meals, mobility, supervision or family resilience are overlooked.

The next phase therefore requires depth as well as reach. Italy needs to convert expanded home-healthcare coverage into coordinated pathways capable of adjusting intensity as needs change. National reform can establish stronger expectations for integration, but regional systems and local services ultimately determine what happens inside individual homes.

The most important measure of a home-first system is not how long institutional care can be postponed. It is whether the person retains dignity, safety, relationships, autonomy and meaningful choice while the people providing support can sustain their roles. When policy, professional care, social assistance, technology and family capacity align around those outcomes, home becomes more than the location where care is delivered. It becomes a viable long-term care setting in its own right.