Migrant Care Workers and Italy’s Badante Model: The Hidden Infrastructure of Home Care

In thousands of Italian homes, the person providing the most hours of long-term care is neither employed by the Servizio Sanitario Nazionale nor sent by a municipal social service. She may instead be a privately employed care worker living in the same household, helping an older person wash, dress, eat, move safely, maintain routines and remain in the home they want to keep. A nurse may visit periodically, relatives may coordinate decisions and a national cash benefit may contribute towards costs, but the worker present across the ordinary day often provides the practical continuity on which the entire arrangement depends.

This is the reality commonly associated with Italy’s badante model. Within the wider Italy Ageing, Long-Term Care & Community Support Knowledge Hub, it represents one of the clearest examples of how formal public provision, private household expenditure, migration and family responsibility intersect. The model has helped make ageing at home possible for many people whose needs exceed the intensity of publicly organised home services.

It is also a major labour-market system in its own right. Official data for 2025 recorded more than 800,000 domestic workers with at least one social-security contribution paid to INPS, with workers classified as badanti representing just over half. Women overwhelmingly dominate the sector, and workers from outside Italy remain central, particularly those originating from Eastern Europe and other migrant communities.

Calling this workforce “informal care” therefore understates its significance. Much of it is paid employment, albeit organised household by household rather than through conventional care-provider organisations. Italy’s strategic challenge is to recognise that hidden infrastructure clearly enough to improve employment quality, workforce supply, skills, continuity and integration without destroying the flexibility that made the model valuable in the first place.

The badante model grew in the space between family care and formal services

The badante model cannot be understood simply as a cultural preference for hiring domestic help. It developed because several features of Italian long-term care aligned.

Families have historically carried substantial responsibility for supporting older relatives. The national indennità di accompagnamento provides a cash benefit to eligible people with significant dependency without prescribing one standard service model. Formal home healthcare, including Assistenza Domiciliare Integrata, provides important clinical and social-health interventions but does not ordinarily provide continuous everyday personal assistance. Municipal social support varies territorially and can be limited in intensity.

Households therefore needed a way to convert financial resources into practical time.

Privately employing a care worker offered one answer. A live-in or regular badante could provide the continuity that neither intermittent professional visits nor relatives in employment could always sustain. The arrangement fitted closely with many older people’s preference to remain at home and with families’ desire to avoid or delay residential care where home living remained viable.

This means the model is structurally connected to homecare service models and pathways, even where the worker is not employed through a conventional service provider. Household employment has effectively become one of Italy’s mechanisms for producing long-duration home-care capacity.

The distinction is important internationally. Where a country appears to have relatively modest formal home-care intensity, that does not necessarily mean older people receive little support. Some of the missing care may have shifted into privately organised household labour.

The workforce is predominantly female and strongly shaped by migration

Domestic care in Italy is overwhelmingly women’s work. INPS data for 2025 show women making up close to nine in ten registered domestic workers. Among the wider domestic workforce, workers originating outside Italy remain a large component, with Eastern Europe representing the largest geographic group after Italian nationals.

This gendered and migrant composition reflects several overlapping forces. Italy’s ageing population created sustained demand for home-based assistance. At the same time, increased participation of Italian women in paid employment reduced the capacity for adult daughters to provide unlimited care directly. Migrant women entered a labour market where demand for household-based care was high and where live-in arrangements could offer employment and accommodation.

Over time, migration networks reinforced the model. Workers helped relatives and acquaintances find employment, while families increasingly relied on personal recommendations and informal local networks to recruit trusted carers.

This has created considerable strengths. Migrant care workers have allowed many households to maintain stable, highly personalised support and have provided substantial social and economic contribution to Italian communities.

But dependence on migration also creates vulnerability. Workforce availability is influenced by immigration rules, competing employment opportunities elsewhere in Europe, demographic change within migrant communities and the attractiveness of domestic care as an occupation.

Long-term care workforce policy therefore cannot treat migration as a peripheral issue. It is part of workforce planning because a significant proportion of the home-care capacity on which Italian households rely is supplied through cross-border labour mobility.

Domestic employment is different from provider-organised home care

A family employing a badante is operating a fundamentally different organisational model from a public or private provider delivering scheduled home-care visits.

The household becomes the employer. Employment may be governed through the national collective framework for domestic work, with responsibilities relating to contract, pay, social-security contributions, working time, leave, holidays and termination. Where employment is properly declared, the worker participates in a recognised employment relationship rather than simply receiving cash for informal assistance.

Yet the organisational infrastructure around that worker can remain thin.

A conventional provider may have managers, supervisors, training systems, contingency arrangements, policies and colleagues available for consultation. A privately employed worker may operate alone inside one household with much greater practical autonomy.

This can create an unusually intense relationship. The worker may know the older person better than anyone outside the family, especially where she lives in the household. At the same time, there may be limited professional supervision or peer support.

Several distinct relationships are therefore operating simultaneously:

• the employment relationship between household and worker;
• the caring relationship between worker and older person;
• the family relationship through which relatives retain involvement;
• the clinical relationship between the person and healthcare professionals; and
• the wider public-service relationship involving health or municipal support.

Many operational problems arise not because any one relationship is inherently weak, but because responsibilities between them are poorly defined.

Operational scenario: the family assumes the worker is the care system

An 86-year-old woman with moderate dementia lives at home in Lazio with a live-in badante. Her son lives nearby and handles finances. ADI nursing is involved intermittently because of a chronic wound, while her general practitioner oversees her medical care.

The arrangement has worked for two years. As the woman’s dementia progresses, however, she begins waking frequently at night, becomes unsteady and needs more help with eating. Her son assumes the worker can absorb the additional needs because she lives in the home.

The worker gradually becomes responsible for daytime personal care, repeated nighttime supervision, household work and monitoring the wound between professional visits. She has no regular supervision and becomes increasingly tired.

A fall finally triggers review. The central problem is not simply whether the worker performed the correct task. The care arrangement itself has changed without formal recognition. One employee has effectively become responsible for an increasingly complex twenty-four-hour support model.

A stronger response reassesses the older woman’s dependency, clarifies what ADI and other formal services are providing, examines nighttime requirements and determines whether additional workers, respite or another care model is necessary. The family also needs to understand that live-in employment does not create unlimited labour availability.

The scenario demonstrates why privately organised care still requires governance. Where need changes, the support model must change with it rather than allowing greater responsibility to accumulate invisibly around the worker who happens to be present.

The distinction between presence and working time matters

Live-in care can easily create unrealistic assumptions about availability. A worker living in the same home may be physically present for much of the day and night, but that does not mean every hour can legitimately be treated as active working time.

Rest, leave and personal time are essential employment protections and important safety controls. A chronically exhausted worker is more likely to make mistakes, become unwell or leave the employment relationship altogether.

This is particularly important where an older person develops substantial nighttime needs. Families may initially employ one live-in worker to support a person who sleeps reliably. Months later, dementia, pain, continence or anxiety may produce repeated waking.

The same contract and workforce model can then become operationally inadequate even though the person has not moved home and no formal service has changed.

The issue links directly with worker wellbeing. Wellbeing is not merely an organisational benefit offered by large providers. In household care, adequate rest, respectful employment and manageable workload are prerequisites for safe continuity.

Italy’s ageing-at-home strategy therefore needs to recognise that a live-in care worker is a worker, not an inexhaustible substitute for a staffed twenty-four-hour service.

Undeclared employment remains a structural concern

Official domestic-worker data capture people for whom at least one social-security contribution has been recorded. They do not capture the entire labour market. Domestic work has historically had a significant undeclared component, and care employment is no exception.

Irregular employment can arise for several reasons. Households may attempt to reduce costs. Workers may have insecure migration status or limited knowledge of employment rights. Families may begin with an informal short-term arrangement that gradually becomes permanent. Both parties may underestimate the legal and financial consequences of remaining outside formal employment.

The resulting risks extend beyond lost tax or social-security revenue.

Workers in undeclared arrangements may have weaker access to employment protections, leave, pension contributions and routes for challenging exploitation. Families can face legal and financial exposure. Older people can become dependent on an arrangement whose continuity is uncertain and whose responsibilities have never been formally specified.

Formalisation therefore has a care-quality dimension as well as a labour-market dimension. Clear employment creates at least a basic structure around expectations, working time and contribution records.

It does not guarantee good care. A formally employed worker can still be undertrained, unsupported or poorly matched to the person. But reducing undeclared work strengthens the foundation on which wider workforce development can be built.

For Italy, the policy challenge is particularly sensitive because household employers are not large organisations with specialist human-resources departments. Formal employment processes need to be enforceable while remaining navigable enough that ordinary families can realistically comply.

Migration policy is now explicitly linked with family-assistance workforce demand

Italy increasingly recognises through migration policy that family assistance is a labour-demand category requiring planned entry routes.

The 2026 migration-flow programme included specific quotas for non-seasonal workers entering the family-assistance sector. In February 2026, 13,600 places were allocated territorially for family-assistance employment under the relevant flow arrangements.

A separate mechanism also supports additional annual entry outside the ordinary quota framework for workers employed in family or social-health assistance for people with disabilities or people aged over 80. For 2026–2028, the framework provides for up to 10,000 such entries annually.

These mechanisms are significant because they make explicit something long visible at household level: migrant labour is a planned component of Italy’s care capacity.

But migration quotas alone do not create a sustainable workforce. Recruitment routes need to connect with lawful employment, language support, skills development, integration and protection against exploitation.

There is also a timing problem. Care needs can escalate rapidly, while migration processes operate on administrative cycles. A family cannot necessarily wait months for a new international recruitment route when a parent suddenly requires continuous assistance after hospitalisation.

The strongest migration strategy therefore sits inside a wider workforce strategy. It should complement retention and professionalisation of workers already in Italy rather than treating international recruitment as an endlessly renewable source of labour.

Operational scenario: migration status becomes a continuity-of-care issue

A family in Emilia-Romagna employs a migrant care worker who has supported their father for eighteen months. She has established a strong relationship with him, understands his dementia-related routines and communicates effectively with community health professionals when his condition changes.

An administrative problem with her right to remain and work threatens the continuity of the arrangement.

For the family, this initially appears to be an immigration matter unrelated to care quality. Operationally, however, the consequences are immediate. Replacing the worker would mean introducing an unfamiliar person to an older man who becomes distressed around strangers. His daughter would need to increase her caring role during any gap, and existing health services do not provide continuous supervision.

The scenario illustrates the interdependence between migration governance and long-term care. A worker’s legal status should never be manipulated to trap her in unsuitable employment, but stable lawful migration routes can protect both employment rights and continuity for people receiving support.

It also shows why workforce resilience cannot depend entirely on one relationship. Important information about routines, risk and preferences should be documented appropriately so that continuity does not disappear if a worker leaves.

Organisations examining similar continuity vulnerabilities can use the Predictive Workforce Risk Module to structure questions about dependence on individual workers, turnover and service stability. It is not an Italian migration tool, but the underlying principle is relevant: workforce risk should be visible before an unavoidable departure becomes a care crisis.

Skills requirements rise as people stay at home with greater complexity

The traditional image of a badante providing companionship, meals and basic household assistance captures only part of the modern role. As people remain at home for longer, some workers support individuals with dementia, severe mobility impairment, neurological conditions, advanced frailty and complex medication routines.

This creates a skills challenge.

A privately employed care worker is not automatically a healthcare professional. Yet families can gradually expect workers to perform increasingly complex tasks because formal professional input is intermittent and the worker is present when needs arise.

Safe boundaries are therefore essential. Workers need enough knowledge to recognise deterioration, support mobility safely, understand dementia-related communication, maintain infection-prevention practices and know when professional help is required. They should not be expected to perform clinical interventions beyond their training, legal scope or appropriate delegation arrangements.

The distinction between assistance and healthcare needs to remain visible to families as well as workers.

This connects with the wider importance of staff training. Training in household care should not imitate an institutional workforce programme blindly, but workers need practical competence aligned with the actual people they support.

Italy’s stronger opportunity lies in creating clearer pathways through which domestic care experience can be recognised, skills can be developed and workers who want to progress can build more sustainable careers.

Professionalisation should not mean turning every badante into a nurse

Calls to professionalise domestic care can create another form of confusion if professionalisation is equated with medicalisation.

The value of the badante role lies partly in ordinary life. Preparing familiar meals, supporting routines, accompanying someone outside, maintaining conversation and helping a person remain connected with home are not lesser activities because they are non-clinical.

Professionalisation should therefore strengthen quality without stripping the role of its relational character.

Useful development could include clearer recognition of competencies, accessible training, language support, understanding of dementia and frailty, safe mobility, nutrition, communication, boundaries and emergency escalation. It can also include pathways towards formal qualifications for workers who want them.

Equally important is strengthening the household’s competence as an employer. Families need to understand job boundaries, rest requirements, respectful employment and what to do when the older person’s needs exceed what one domestic worker can reasonably provide.

The model becomes safer when both sides know what the employment relationship can and cannot carry.

Integration with formal healthcare remains underdeveloped

A badante may spend forty, fifty or more hours each week in proximity to an older person while a nurse, doctor or therapist sees that person much less frequently. This gives the domestic worker an extraordinary observational position.

She may notice reduced appetite, confusion, a new walking difficulty or subtle changes in mood before anyone else.

Yet privately employed domestic workers do not automatically sit within formal multidisciplinary systems. Professionals may communicate primarily with relatives, and privacy or information-governance rules can restrict what can appropriately be shared.

The solution is not to give every household worker unrestricted access to health records. It is to develop proportionate communication arrangements where the person consents and where the worker has a legitimate role.

The care plan might specify which changes should trigger contact, whom the worker should call and what information can appropriately be exchanged. Families should understand these boundaries as well.

This is where system integration becomes partly a human communication challenge. Digital platforms matter, but a care pathway is not integrated if the person who sees the older adult most frequently has no safe route for escalating important observations.

Operational scenario: the worker notices deterioration before the formal system

An 81-year-old man with heart failure lives with a privately employed care worker in Piemonte. Community nursing is involved periodically, and his daughter visits at weekends.

Over several days, the worker notices that he is more breathless when walking to the bathroom, is eating less and has begun sleeping upright. None of these observations individually appears dramatic, but she knows they are unusual for him.

In a poorly connected system, she may simply tell the daughter later that evening and wait for instructions. In a stronger model, the care plan includes a clear escalation route. With the older man’s agreement, the worker knows whom to contact and which symptoms require prompt professional review.

The territorial healthcare team assesses him, identifies deterioration and adjusts treatment before an emergency admission becomes necessary.

The worker has not diagnosed heart failure deterioration or undertaken clinical treatment. She has contributed observational continuity.

That distinction is important for future integration. Italy does not need to turn privately employed care workers into unregulated clinicians. It needs to make better use of the information already generated by people who spend substantial time alongside individuals with long-term conditions.

Clear escalation, appropriate consent and defined role boundaries can improve safety without medicalising the domestic care relationship.

Safeguarding applies in both directions

Household care involves an unusually private working environment. This creates safeguarding responsibilities towards the person receiving care and towards the worker.

An older person with dementia, communication difficulties or physical dependency can be vulnerable to neglect, financial abuse, coercion or exploitation. A worker living inside the household may have substantial access to the person, finances and daily routines, sometimes with limited external oversight.

But workers can also be vulnerable. Migrant status, dependence on employer-provided accommodation, isolation, language barriers and uncertainty about rights can create conditions in which excessive hours, withheld pay, intimidation or other exploitation are difficult to challenge.

A mature safeguarding approach therefore avoids assuming that one side is inherently the source of risk and the other inherently vulnerable.

Families, professionals and public services should remain alert to indicators affecting both people. Where there is evidence of abuse or exploitation, appropriate routes for reporting and protection need to be accessible.

The principles within safeguarding incident response and escalation are relevant precisely because private homes should not become invisible spaces. Privacy deserves protection, but privacy does not remove the need for proportionate safeguards where a person is highly dependent or a worker may be exploited.

The Prestazione Universale creates a stronger connection between public money and formal care work

The experimental Prestazione Universale, operating from January 2025 until December 2026 for a tightly defined group of people aged at least 80 with very severe care needs and the applicable economic criteria, provides an important policy signal.

Its additional assistance component can be used to remunerate appropriately employed domestic care workers or purchase specified home-support services. The measure sits alongside the existing attendance allowance rather than replacing the wider long-term care system.

The experiment is significant because it creates a more explicit relationship between additional public finance and formalised care expenditure.

That may offer several policy benefits. It can encourage properly declared employment, improve visibility over how additional public support is used and strengthen the link between cash benefits and home-based care capacity.

Its scope should not be overstated. The Prestazione Universale is experimental, targeted and limited in eligibility. It does not represent a universal restructuring of household care finance.

Nevertheless, the principle deserves careful evaluation. If public policy wishes to support household employment as part of long-term care, it needs to consider not only how much money is transferred but whether expenditure promotes lawful employment, appropriate support and sustainable care.

Quality assurance is difficult when the unit of delivery is one household

Traditional quality systems are generally designed around organisations. A provider can be inspected, audited and required to report data. A single household employing one worker is different.

Italy therefore faces a genuine governance challenge. Requiring every family employer to operate the assurance infrastructure of a professional provider would be disproportionate and impractical. Leaving household care almost entirely outside quality systems risks ignoring a huge part of long-term care delivery.

The stronger approach lies between those extremes.

Formal employment can provide a baseline. Training and recognised competence can improve capability. Integrated assessment can identify how the worker contributes to the care plan. Healthcare professionals can clarify escalation routes. Families can be supported to recognise when needs exceed the worker’s role. Complaints, safeguarding and labour-law enforcement can address serious problems.

At system level, better data can illuminate workforce trends without attempting to monitor every private interaction.

Useful indicators include registered workforce size, age, nationality, geographic distribution, worker turnover, formalisation rates, training participation and the relationship between domestic care availability and residential or formal home-care demand.

The Quality Dashboard Builder offers organisations a framework for connecting workforce, quality, risk and outcome evidence. It is not intended to regulate Italian household employment, but its underlying principle is relevant: a system cannot govern effectively what it never attempts to make visible.

The ageing of the domestic workforce is a future capacity risk

Italy is not only experiencing population ageing among people who need care. The domestic workforce itself is ageing.

Recent INPS data show a substantial proportion of registered domestic workers already in older age groups. This creates a future replacement challenge. Workers who supported Italy’s first major wave of ageing-at-home demand will themselves retire or develop support needs.

Attracting younger workers may prove difficult if care work remains low-status, physically demanding or associated with limited career progression. International recruitment can contribute, but other countries are competing for workers at the same time.

Technology may improve productivity around coordination, scheduling and remote professional support, but it cannot eliminate the human labour required for personal assistance.

Future workforce strategy therefore needs to address the attractiveness of care work itself. Respectful employment, formalisation, skills recognition and progression matter not only for worker rights but for national care capacity.

Organisations examining long-term workforce resilience can use the Digital Twin Scenario Modeller to explore how demand and workforce availability interact under different assumptions. Italy’s policy challenge is analogous: planning needs to ask what happens if the supply of privately employed carers does not keep pace with the number of households seeking them.

Operational scenario: demand rises faster than the local workforce

A group of municipalities in northern Italy experiences rapid growth in the number of residents aged over 80. Families have historically been able to recruit domestic carers through local migrant networks, and this has helped many older residents remain at home.

Over several years, the labour market tightens. Some established workers retire, others move into better-paid employment and fewer new workers enter the locality.

Households begin competing for the same small pool of experienced carers. Wages rise, waiting periods lengthen and families increasingly rely on short-term arrangements. Some older people enter residential care earlier than they otherwise might because no dependable home worker can be found.

The issue initially appears private: individual families cannot recruit. At territorial level, however, the pattern is a system-capacity problem.

Regional and municipal planning needs to understand whether domestic-worker scarcity is changing demand for formal home services, hospital discharge and RSA placements. Workforce strategy might include better links with lawful migration routes, training, local employment support and collaboration with organisations capable of matching workers and families.

The key point is that a privately organised workforce can still generate public-system consequences. If household labour supply contracts, demand does not disappear; it moves elsewhere in long-term care.

Better integration should preserve the strengths of the model

The badante model has weaknesses, but reform should not overlook what has made it successful for many households.

It can provide exceptional continuity. One worker may learn the person’s routines, communication style, food preferences and relationships in a way that rotating short visits struggle to achieve.

It can also be flexible. Support can be organised around ordinary life rather than predetermined visit slots. For older people who strongly value remaining at home, that continuity can preserve identity and independence.

The objective should therefore not be to absorb every domestic care worker into a large provider structure. The stronger opportunity lies in building a better-supported interface around household employment.

That could mean easier formal employment, accessible training, clearer role boundaries, stronger links with territorial assessment, proportionate communication with health professionals and more reliable backup when the principal worker is unavailable.

It also means recognising the worker as part of the wider workforce assurance challenge without pretending that household employment and provider employment are identical.

What Italy’s badante model offers international systems

Italy’s experience has relevance well beyond Italy because many countries face the same basic problem: people want to remain at home, formal services cannot provide continuous support to everyone and families increasingly purchase or organise additional labour privately.

The first transferable lesson is that household care markets should be treated as part of long-term care infrastructure. Ignoring them does not make them disappear; it merely reduces policy visibility.

Second, migration and care policy are interconnected. Where a long-term care system depends substantially on migrant workers, lawful entry routes, employment protections and integration become care-capacity issues.

Third, cash benefits can stimulate flexible home-care markets, but flexibility requires safeguards. Public funding does not automatically guarantee appropriate employment, competence or continuity.

Fourth, professionalisation does not require medicalising domestic assistance. The objective should be competent, recognised and safe care while preserving relationship-based support.

Fifth, integration needs to reach beyond conventional providers. A health system may coordinate perfectly with municipal services while still overlooking the worker spending most of the week with the person.

Finally, hidden labour creates hidden dependency. A home-care system can appear sustainable until migration slows, domestic workers retire or employment becomes less attractive. Countries relying on household care therefore need to include that workforce in long-term demand and capacity planning.

The future requires a clearer social contract around household care

Italy is unlikely to replace the badante model in the foreseeable future. Demography, personal preference and the established role of household employment make privately organised care a durable part of the system.

The more important question is what kind of model Italy wants it to become.

A weak version leaves families to recruit in fragmented markets, workers to navigate employment and migration largely alone, and formal services to operate alongside household care with limited connection.

A stronger version recognises domestic workers as an important part of national care capacity while preserving the household-based character of the employment relationship. It promotes lawful work, fair conditions, skills development and clear boundaries. It helps families become competent employers. It connects workers appropriately with assessment and escalation. It plans migration alongside workforce demand. It provides alternatives when one worker cannot meet increasingly complex needs.

Current reform of long-term care, the National Plan for Non-Self-Sufficiency, experimental funding mechanisms and migration policy provide parts of that architecture. The next stage is to connect them around the practical reality already visible inside Italian homes.

Conclusion

Italy’s badante model is not a marginal or temporary feature of long-term care. It is one of the mechanisms through which the country has translated family responsibility, cash benefits, migration and household resources into sustained care at home. Migrant women in particular have provided the everyday continuity that allows many older and disabled people to remain in familiar environments despite substantial dependency.

That contribution also reveals the model’s vulnerabilities. Household employment can leave workers isolated, families carrying complex employer responsibilities and formal health and social services operating beside rather than with the person who provides most daily support. Undeclared work, migration insecurity, exhaustion, limited training and dependence on one worker can turn an apparently stable care arrangement into a fragile one.

Italy’s stronger opportunity is therefore not to dismantle household care but to make its role more visible and sustainable. Formal employment, skills recognition, lawful migration routes, proportionate safeguarding, better integration and realistic contingency planning can strengthen the model while retaining its flexibility and relational value.

As population ageing continues, this matters for the whole long-term care system. If the domestic care workforce weakens, pressure will appear in family caregiving, formal home services, hospitals and RSA provision. The badante workforce is therefore no longer merely a private household solution. It is part of Italy’s national care infrastructure, and the sustainability of ageing at home increasingly depends on governing it as such.