Migrant Care Workers in Italy: Employment, Integration, Rights and the Future of Family Assistance

In many Italian households, the person providing the most consistent daily assistance to an older relative is not a nurse employed by the public healthcare system or a worker visiting through a municipal service. It is an assistente familiare, often referred to as a badante, employed directly by the family. A substantial proportion of these workers have migrated to Italy, bringing skills, experience and personal commitments that extend across national borders.

This arrangement has become an important component of Italy's response to population ageing. It enables many older people to remain in familiar surroundings, but it also creates a distinctive relationship between migration, employment, family responsibility and long-term care. The wider Italy Ageing, Long-Term Care & Community Support Knowledge Hub examines the policy and service structures within which household assistance and formal care operate.

The central issue is not whether migrant workers should contribute to Italian care services. They already do. The more important question is how that contribution can be supported through lawful employment, appropriate training, accessible services and fair working conditions.

Italy's long-term care reforms, changing demographic profile and continuing demand for assistance at home make this question increasingly significant. Migrant workers are essential participants in the care economy, yet their employment experiences vary considerably between household arrangements, residential facilities and professional healthcare services.

Understanding these differences is necessary to develop policies that protect workers, support families and maintain the dignity and independence of older people.

How Migrant Workers Became Central to Italian Family Care

Italy's reliance on household assistance reflects several long-established characteristics of its welfare and care arrangements. Family members have traditionally played a substantial role in supporting older relatives, while publicly organised long-term care services differ in availability and intensity between territories.

Population ageing, smaller households, changing employment patterns and increased geographical mobility have made it more difficult for families to provide all required assistance themselves. At the same time, many older people prefer to remain at home rather than move into residential accommodation.

Household employment has consequently developed as an important way of organising everyday support.

An assistente familiare may help with washing, dressing, meals, mobility, household activities, companionship and the organisation of daily routines. Responsibilities depend on the employment arrangement, the worker's competence and the older person's needs.

Some assistants work for limited periods each week. Others provide extensive daytime assistance, while certain arrangements involve living in the older person's home.

These arrangements can offer continuity that is difficult to reproduce through short, scheduled visits. A familiar assistant may understand an older person's preferences, communication style, household routines and relationships with relatives.

However, household assistance is not equivalent to professional nursing or a comprehensive public long-term care entitlement.

Workers employed as domestic assistants do not automatically possess regulated healthcare qualifications. Where an older person requires clinical assessment, nursing interventions or specialist rehabilitation, appropriately qualified professionals and relevant health services remain necessary.

The distinction matters because the convenience of having one familiar person in the household can gradually obscure the limits of that person's responsibilities.

Migrant workers have become prominent in this employment market for several interconnected reasons. International migration has supplied labour at a time when demand for household support has increased. Personal networks can help workers identify employment opportunities, while families may recruit through recommendations and community contacts.

Nevertheless, migrant care workers are not a homogeneous group. Their countries of origin, qualifications, language skills, migration status, family circumstances and employment ambitions differ considerably.

Some intend to build long-term careers in Italy. Others maintain substantial responsibilities to relatives living abroad or may eventually return to their country of origin.

Policies that treat all migrant workers as interchangeable labour risk overlooking the conditions that determine whether employment is sustainable.

The Institutional Framework: Migration, Employment and Care Responsibilities

Italy's household care system operates across several institutional frameworks that were not designed as a single integrated structure.

Migration policy is primarily a national responsibility. Entry and residence arrangements for non-EU nationals are governed through Italian immigration legislation, including the Testo Unico sull'Immigrazione, Legislative Decree 286/1998, as subsequently amended.

EU citizens have different residence and employment rights under the applicable freedom-of-movement framework.

Employment conditions are governed by Italian labour legislation and relevant collective agreements. Domestic workers are covered by the applicable national collective agreement for domestic employment, commonly referred to as the CCNL lavoro domestico.

Public healthcare is organised through the Servizio Sanitario Nazionale, with regions responsible for arranging services through their respective healthcare systems and territorial organisations.

Municipalities and associated Ambiti Territoriali Sociali organise social assistance within applicable national and regional arrangements.

These responsibilities intersect when an older person receives household assistance alongside publicly organised healthcare or social services.

A family may employ an assistant directly while the older person receives home nursing through the territorial healthcare system. The same person may also be eligible for particular financial benefits or municipal support, depending on the relevant conditions.

Yet these arrangements do not necessarily create a single organisation responsible for coordinating every aspect of the person's care.

For migrant workers, this fragmentation has practical consequences.

Employment rights may be clear in law, but a worker may have limited knowledge of available advice or support. A family may understand its responsibility to provide assistance without fully appreciating the distinction between domestic employment and professional healthcare.

Territorial services may become involved only when needs increase or a specific assessment is requested.

Stronger coordination therefore depends on clearly identifying responsibilities rather than assuming that household employment is automatically integrated into formal care pathways.

The wider principles of organisational accountability are relevant because responsibilities must remain clear even when support crosses several institutional boundaries.

Legal Migration Pathways and the Practical Reality of Recruitment

Recruiting a non-EU national from abroad can involve immigration procedures that differ from employing someone already legally entitled to work in Italy.

Italy's employment-related migration arrangements include mechanisms associated with the decreto flussi system, through which government measures establish entry opportunities and applicable conditions for specified categories of work.

The numbers, eligibility criteria, application procedures and categories can change between programming periods. Household assistance may be addressed through particular provisions, but employers should not assume that every domestic care vacancy automatically qualifies for an entry authorisation.

Where applicable, the process can involve an employer's application, relevant authorisation procedures, visa arrangements and subsequent residence formalities.

Employment eligibility must be established under the rules applicable to the individual worker.

Workers already residing in Italy may have different permissions and employment rights. EU nationals do not follow the same entry procedures as third-country nationals.

These distinctions are important because informal recruitment practices can create uncertainty for both workers and families.

A household may find an assistant through personal recommendations and assume that an agreed salary is sufficient to establish lawful employment. In reality, the employer must consider the worker's entitlement to work, contractual obligations, required employment notifications and relevant social insurance contributions.

Formal recruitment should also protect workers from misleading promises concerning duties, accommodation, working hours or remuneration.

Recruitment intermediaries can provide useful assistance, but families need to understand the services being offered, the fees involved and the responsibilities that remain with the employer.

Where recruitment occurs across national borders, transparency becomes especially important.

A worker who has incurred substantial expenses to secure employment may be reluctant to challenge unfair conditions after arrival. Dependence on an employer for accommodation can create additional vulnerability.

The objective should be to make recruitment lawful, understandable and financially transparent, rather than treating migration authorisation as the end of the employment process.

Operational Scenario: Recruiting a Household Assistant in Emilia-Romagna

Consider a hypothetical family in Bologna seeking a live-in assistant for an older father who requires help with mobility, meals and daily routines.

A relative recommends a non-EU worker who is interested in employment but currently lives outside Italy. The family initially assumes that an invitation and an agreed salary will be sufficient.

Before proceeding, the family seeks appropriate advice about the worker's immigration position and the applicable recruitment route. It establishes whether a lawful entry and employment mechanism is available under the rules operating at that time.

The family also examines the domestic employment agreement, including the correct occupational classification, remuneration, working time, rest arrangements, accommodation conditions and social contribution responsibilities.

During discussions, it becomes apparent that the older father sometimes requires assistance transferring from bed to a chair. The family arranges an assessment of his mobility needs and considers whether equipment, training or professional support is required.

The proposed assistant is not presented as a substitute for a nurse or physiotherapist.

The family explains the role in accessible language, including the expected duties and the arrangements for communicating concerns. It also identifies who will provide support if the assistant is unavailable.

When employment begins, the worker receives a structured introduction to the household, the older man's preferences and the relevant professional contacts.

The family reviews the arrangement after an initial period rather than assuming that the original expectations will remain appropriate indefinitely.

This scenario illustrates how migration compliance, employment quality and care safety are connected. A lawful recruitment route is necessary, but successful household assistance also depends on realistic duties, appropriate support and a shared understanding of responsibilities.

Employment Rights and the Particular Vulnerabilities of Domestic Work

Domestic employment differs from work in a conventional organisation because the workplace is a private household and the employer may have little experience managing employees.

Italian domestic employment arrangements establish obligations concerning contractual conditions, remuneration, working time, rest, leave and social contributions. The applicable CCNL provides an important framework for determining the conditions associated with particular roles and employment arrangements.

Employers are generally responsible for fulfilling relevant notification and contribution obligations through the appropriate systems, including INPS procedures.

These requirements are particularly significant for live-in workers.

Living in the same home as the person receiving assistance can support continuity, but it can also blur the boundary between employment and personal availability.

A worker may feel obliged to respond whenever the older person needs help, even during periods that should be reserved for rest.

Families may similarly assume that live-in employment provides continuous coverage because the worker is physically present.

That assumption is neither a sustainable employment model nor a reliable basis for care planning.

Live-in arrangements require attention to contractual working time, rest periods, privacy and replacement support. Where an older person requires assistance beyond what one employee can lawfully and reasonably provide, additional arrangements may be necessary.

The principles of fair work and responsible employment are particularly important where workers may have limited bargaining power.

Employment protection also includes freedom from discrimination, intimidation and abuse.

Workers should be able to raise concerns about unsafe duties, unreasonable expectations or inappropriate treatment. Families need access to reliable information so that employment disagreements can be addressed without unnecessarily disrupting an older person's care.

Trade unions, patronati, relevant advisory organisations and professional employment services can help people understand their rights and obligations.

However, access to advice may be more difficult for workers with limited Italian language skills, irregular working hours or few local contacts.

Accessible information and independent support are therefore important elements of employment protection.

Fair employment should not be viewed as competing with the interests of older people. Stable working conditions can strengthen continuity, reduce conflict and help preserve the relationships on which household assistance depends.

Integration, Language and the Experience of Belonging

Successful integration involves more than learning enough Italian to undertake everyday care tasks.

Migrant workers may need to understand employment procedures, healthcare access, local transport, professional development opportunities and the institutions that can provide assistance.

Those living with an employer may have fewer opportunities to establish independent social relationships, particularly where working patterns are demanding.

Isolation can become a retention issue.

A worker who has little contact outside the household may find it difficult to access information, maintain wellbeing or seek support when difficulties arise.

Language also influences the quality of care.

An assistant needs to understand the older person's preferences, communicate changes in wellbeing and recognise when professional assistance should be requested.

However, communication is not simply a matter of technical vocabulary.

Older people may use regional expressions, dialects or familiar phrases that are not immediately understood by someone who has learned standard Italian.

Family members can help explain established routines and communication preferences, while workers may contribute valuable knowledge about culturally sensitive assistance.

Integration should therefore be reciprocal.

Employers need to recognise the worker as an individual with a cultural identity, personal responsibilities and a life beyond the employment relationship.

Workers also benefit from opportunities to understand the expectations and practices of the household in which they are employed.

The wider principles of cultural and identity needs apply to both the person receiving support and the worker delivering it.

Municipal information services, community associations, language programmes and local voluntary organisations may contribute to integration, although provision differs between territories.

These activities are not substitutes for employment rights, but they can make lawful employment more sustainable.

Professional Qualifications, Training and the Boundary Between Care Roles

One of the most important distinctions in Italy's care workforce concerns the difference between domestic assistance and regulated healthcare employment.

A migrant worker may have worked as a nurse, healthcare assistant or other professional in their country of origin. However, experience or qualifications obtained abroad do not automatically establish the right to practise a regulated profession in Italy.

Recognition requirements depend on the profession, the qualification, the country in which it was obtained and the applicable legal framework.

For regulated healthcare professions, recognition and professional registration requirements must be addressed through the appropriate Italian authorities and professional bodies.

The Ministry of Health has responsibilities concerning recognition procedures for relevant foreign healthcare qualifications, while professional registration may also be necessary.

Different arrangements apply to qualifications and competencies associated with the operatore socio-sanitario role.

Household assistance itself is not equivalent to holding an OSS qualification.

These distinctions protect both workers and the people receiving support.

A family may value an assistant's previous nursing experience, but that experience should not be used to bypass professional recognition requirements or justify assigning regulated clinical responsibilities outside the applicable framework.

At the same time, qualified migrant workers should have access to understandable information about recognition pathways.

Where appropriate, language development, additional education or professional preparation may help workers pursue employment aligned with their qualifications.

Training opportunities are also valuable for assistants who do not intend to enter regulated healthcare professions.

Relevant learning may cover safe mobility support, communication, dementia awareness, nutrition, recognition of deterioration and the boundaries of domestic assistance.

Training should be proportionate to the role and connected to practical support.

The broader principles of continuous professional development help explain why workers benefit from opportunities to strengthen competence without being expected to undertake responsibilities beyond their professional status.

For Italy, the strategic opportunity is to improve the connection between migrant workers' existing capabilities, recognised qualifications and realistic career pathways.

Operational Scenario: A Qualified Nurse Working in Household Assistance in Lombardy

Consider a hypothetical migrant worker living in Milan who qualified as a nurse outside the European Union but is currently employed as an assistente familiare.

Her employer values her experience and increasingly asks her to undertake activities associated with nursing care.

The worker is concerned because her foreign qualification has not been recognised for professional practice in Italy.

She explains that her domestic employment role does not authorise her to practise as an Italian registered nurse. The family seeks appropriate clinical support through the older person's healthcare contacts.

Meanwhile, the worker investigates the qualification recognition process applicable to her circumstances. She obtains information about documentation, language requirements and any additional procedures necessary before she could lawfully practise the profession.

The recognition process is not assumed to be automatic or guaranteed.

She also explores whether local training and employment advice could help her understand opportunities within the Italian healthcare system.

The family reviews the household assistance arrangement to ensure that her current responsibilities remain appropriate and that professional nursing needs are addressed separately.

Her employer supports reasonable flexibility for relevant appointments where this can be accommodated within the employment arrangement.

The worker ultimately has a clearer understanding of her options, while the older person continues receiving assistance within appropriate professional boundaries.

The scenario illustrates a wider workforce issue. Italy may employ migrant workers whose previous skills are not fully utilised, but recognising those skills requires legitimate processes rather than informal assumptions.

Better information and career guidance can benefit individuals and potentially strengthen the wider care workforce without compromising professional safeguards.

Family Affordability, Cash Benefits and the Economics of Household Care

Household assistance is often financed substantially through family resources, making affordability a central determinant of employment conditions.

Italy's indennità di accompagnamento is an important national cash benefit for eligible people with qualifying disability-related needs. It is administered through INPS and is not generally means-tested in the same way as some social assistance measures.

However, it is not a dedicated wage reimbursement scheme for household assistants, and receipt does not establish that the benefit will cover the cost of employing a worker.

Other public support may be available through regional or municipal programmes, subject to local rules, resources and eligibility conditions.

Tax and contribution arrangements may also influence household costs, although the applicable treatment depends on the circumstances and current rules.

Families therefore face different financial positions.

Some can afford formally employed assistance for substantial periods. Others rely on a combination of family caregiving, limited paid support and publicly organised services.

Where household income is constrained, there may be pressure to reduce employment costs by limiting hours, postponing replacement cover or using informal arrangements.

These responses can create risks for workers and older people.

An assistant may be expected to provide more support than the contracted hours permit, while family members may become increasingly dependent on one individual.

Affordability should therefore be examined alongside the actual level of assistance required.

Public policy faces a difficult balance. Supporting home-based care can align with older people's preferences and potentially reduce demand for some residential services, but poorly designed financial arrangements can transfer substantial costs and risks to households and workers.

The relevant question is not simply whether a family can employ an assistant today. It is whether the arrangement remains lawful, safe and financially sustainable as needs change.

Organisations exploring comparable issues can use the Digital Twin Scenario Modeller to examine illustrative relationships between workforce capacity, service demand and continuity. It does not calculate Italian benefit eligibility or determine domestic employment obligations.

When Household Assistance Meets Territorial Health and Social Services

Household assistants frequently work alongside family members and professionals involved in an older person's healthcare or social support.

The relationship becomes especially important when needs increase following hospital treatment, a fall, cognitive deterioration or a change in mobility.

Italy's territorial healthcare services may provide relevant professional assessment and interventions through regional and local arrangements. Municipal social services may also become involved where eligibility and available provision permit.

The Punti Unici di Accesso and multidimensional assessment arrangements associated with long-term care reform are intended to support more coordinated access and assessment, although implementation and practical availability vary across territories.

These developments do not automatically make household assistants members of a formally constituted clinical team.

Nevertheless, assistants may possess valuable knowledge about everyday functioning.

They may notice that an older person is eating less, becoming more confused or struggling with activities previously managed independently.

Families and professionals can benefit from this information when it is communicated appropriately and with due regard to privacy and consent.

The assistant's role should be to communicate observations within agreed arrangements, not independently diagnose conditions or assume clinical responsibility.

Clear communication is particularly important during transitions from hospital to home.

A discharge plan may identify professional interventions, equipment or follow-up appointments, but the practical implications for household assistance also need consideration.

For example, a person returning home with substantially reduced mobility may require more than the existing domestic employment arrangement can safely provide.

The broader principles of support planning and review are relevant because changing needs require the responsibilities of everyone involved to be reconsidered.

Care coordination should respect the worker's employment role while ensuring that older people are not left dependent on assistance that is insufficient for their needs.

Operational Scenario: Hospital Discharge and a Live-In Assistant in Puglia

Consider a hypothetical older woman in Bari who returns home following hospital treatment for a fractured hip.

Before admission, her live-in assistant helped with meals, personal routines and household activities. Following surgery, the woman requires greater assistance with mobility and has new rehabilitation needs.

Her daughter initially expects the assistant to resume the previous arrangement and provide whatever additional help is necessary.

During discharge planning, however, the family learns that the woman's current mobility needs require professional assessment and appropriate rehabilitation arrangements.

The relevant healthcare professionals explain the recommended support, including any equipment, safe movement guidance and follow-up interventions.

The family reviews whether the assistant can continue her established duties safely and identifies activities requiring professional input or additional assistance.

The worker contributes observations about the woman's previous routines and the practical layout of the home, while remaining within her employment role.

The daughter also considers whether the existing working hours and rest arrangements remain realistic.

Where appropriate, the family contacts relevant territorial services to explore available support and assessment pathways.

As the woman's mobility improves, the assistance arrangement is reviewed rather than permanently expanding the worker's responsibilities without consideration.

The scenario demonstrates that continuity of household assistance can be valuable during recovery, but familiarity does not replace professional assessment.

Good coordination protects the older person, supports the family and prevents a migrant worker from becoming the default solution to every unmet care requirement.

Safeguarding, Dependency and the Rights of Both Workers and Older People

Household care creates a relationship of mutual dependency that deserves careful attention.

Older people may depend on an assistant for intimate personal care, communication, meals and access to daily activities. Workers may depend on the household for income and, in live-in arrangements, accommodation.

These relationships can be positive and enduring, but unequal power and limited external oversight may create vulnerabilities.

Older people require protection from neglect, coercion, financial exploitation and inappropriate restrictions on their independence.

Workers require protection from harassment, discrimination, unreasonable working expectations and abusive treatment.

Families may also experience pressure when they are managing complex care responsibilities without adequate professional guidance.

Safeguarding arrangements must therefore recognise the rights and circumstances of everyone involved.

Italy does not operate a single UK-style adult safeguarding framework. Relevant protections arise through criminal, civil, employment, healthcare and social assistance arrangements, with different institutions holding responsibilities according to the circumstances.

Where an older person experiences abuse or serious risk, appropriate healthcare, social services or law-enforcement involvement may be necessary.

Where a worker experiences exploitation or employment abuse, relevant labour protection mechanisms and other competent authorities may be involved.

The appropriate response depends on the nature and urgency of the concern.

Preventive arrangements can reduce vulnerability by clarifying duties, establishing communication with relatives and identifying sources of independent support.

However, families should not assume that routine monitoring of a worker justifies intrusive surveillance.

Any use of cameras or digital monitoring must respect applicable privacy, employment and data protection requirements.

The wider principles of risk management and compliance are relevant because protection depends on proportionate safeguards, clear responsibilities and appropriate escalation.

Organisations examining similar governance questions can use the Governance Maturity Assessment to structure general consideration of accountability and oversight. It is not an Italian safeguarding or employment compliance instrument.

Regional Integration and the Role of Community Organisations

The experience of migrant care workers varies across Italy because local employment opportunities, community networks and support services differ.

Large urban areas may provide greater access to migrant associations, language education, employment advice and specialist services.

Smaller municipalities may offer fewer dedicated resources, although local relationships can sometimes support more personalised assistance.

Regional and municipal initiatives can contribute to better employment and integration outcomes, but their availability should not be assumed to be uniform nationally.

Community organisations, social cooperatives, patronati and voluntary associations may help workers navigate administrative procedures and understand available services.

Some local initiatives seek to connect families with suitable assistants or provide training and information. Their scope, eligibility and institutional arrangements vary.

The strongest opportunity lies in linking employment support with the wider organisation of ageing services.

For example, families seeking household assistance may also need information about professional assessment, public benefits, respite arrangements and the limits of domestic care.

Workers may need guidance about employment rights, language development and recognised training opportunities.

Providing these forms of information separately can leave both parties navigating a complicated system.

More coordinated local access could improve understanding without creating a new national entitlement or assuming that every municipality has identical resources.

The principles of community benefit and local partnerships are relevant because sustainable care employment is influenced by the wider social infrastructure surrounding workers and families.

Organisations assessing comparable community initiatives can use the Social Value Report Builder to structure consideration of employment, inclusion and community outcomes. The framework does not determine compliance with Italian migration or domestic employment law.

Measuring Integration, Employment Quality and Care Continuity

Improving the position of migrant care workers requires better evidence about employment conditions and the experiences of people receiving support.

However, household employment is more difficult to monitor than employment within a large provider organisation.

Individual families may have limited capacity to collect formal workforce information, while informal employment can remain outside conventional reporting systems.

National administrative data, employment records, research and territorial service information can provide useful insights, but each has limitations.

For example, formal employment registrations do not necessarily capture every hour of assistance provided or reveal whether workers experience reasonable conditions.

Similarly, the number of migrant workers employed does not demonstrate whether older people receive sufficient professional support.

A proportionate evidence framework should consider several connected dimensions:

• Employment legality: appropriate contractual arrangements, work eligibility and required employment contributions.
• Employment quality: working hours, rest, remuneration, safety and access to independent advice.
• Integration: language support, access to information, community participation and opportunities for professional development.
• Care continuity: stability of assistance, replacement arrangements and the experiences of older people and families.
• Professional boundaries: clarity about domestic assistance, healthcare responsibilities and access to qualified professionals.

These dimensions should not be collapsed into a single performance score.

For example, a stable household employment arrangement may still involve unreasonable working hours. Equally, a worker changing employment may reflect career progression rather than poor retention.

Interpretation requires attention to individual circumstances and the institutional context.

Public authorities and service organisations can also examine whether particular groups experience greater barriers to information or support.

The Quality Dashboard Builder offers a general way to organise employment, continuity and service-quality indicators where organisations have appropriate data. It does not establish official Italian reporting requirements.

The purpose of measurement should be to identify improvements that benefit both workers and older people, rather than treating migrant employment solely as a labour supply statistic.

The Future of Migrant Care Employment in Italy

Italy's demographic trajectory suggests that demand for assistance with everyday living will remain an important long-term policy issue.

Migration is likely to continue contributing to the care workforce, but sustainable provision cannot depend on an assumption that sufficient workers will always be available under existing conditions.

Other countries also face ageing populations and demand for care labour. International recruitment therefore takes place within a wider environment of competition, changing migration policies and ethical considerations.

Italy's future approach will need to connect several policy areas that are often considered separately.

Migration pathways need to be understandable and lawful. Domestic employment arrangements need to support fair working conditions. Professional recognition systems should provide legitimate routes for appropriately qualified workers.

Families need clearer access to information about care options, financial responsibilities and the circumstances in which professional intervention is required.

Territorial services need to recognise the practical contribution of household assistants without transferring clinical or statutory responsibilities to them.

Technology may support this development through accessible employment information, digital training and better communication between relevant services.

However, digital systems should not exclude workers with limited technological confidence or create intrusive monitoring arrangements.

The principles of digital inclusion and access are therefore relevant to the design of future workforce support.

Reform should also acknowledge the gendered nature of care employment and unpaid family caregiving. Policies that assume women will continue absorbing increasing care responsibilities may conceal substantial economic and personal costs.

A more sustainable approach would recognise household assistance as one component of a wider long-term care system, rather than expecting families and migrant workers to compensate indefinitely for gaps in formal provision.

International Lessons From Italy's Migrant Care Workforce

Italy offers an important example of how migration, household employment and ageing policy can become closely connected.

Its experience demonstrates that care workforce planning cannot be limited to regulated professionals employed by formal organisations.

Household assistants may provide substantial daily support while remaining outside many conventional workforce development structures.

The model also illustrates the importance of distinguishing employment status from professional competence.

Workers may bring valuable experience and qualifications, but responsibilities must remain consistent with the legal and professional framework in which they operate.

Another transferable lesson concerns the relationship between affordability and employment rights.

Families may genuinely struggle to finance assistance, but financial pressure does not remove the need for lawful and reasonable employment conditions.

Countries with different long-term care funding systems may address these tensions through different mechanisms. The underlying challenge remains relevant: support must be affordable without depending on insecure labour.

Italy also demonstrates the value of recognising migrant workers as participants in communities rather than temporary solutions to labour shortages.

Language support, professional opportunities, employment protection and social inclusion can contribute to sustainable care relationships.

The institutional model cannot be transferred directly to countries with different migration systems, public entitlements or family care traditions.

However, the principle is widely applicable: the rights and wellbeing of care workers are inseparable from the quality and continuity of support received by older people.

Conclusion

Migrant care workers are an established and important part of Italy's long-term care arrangements, particularly through household assistance that enables many older people to remain at home.

Their contribution reflects the interaction of population ageing, family responsibilities, migration patterns and the availability of formal services. It also reveals the limitations of treating care as a private household arrangement disconnected from employment policy and public service planning.

The strongest future direction is not simply to recruit more workers from abroad. It is to develop conditions in which migrant workers can enter employment lawfully, understand their rights, access appropriate training and build sustainable working relationships.

Families need reliable information about their responsibilities and the boundaries between domestic assistance and professional healthcare. Territorial services need to recognise the practical contribution of household workers while maintaining clear clinical and organisational accountability.

Professional recognition, fair employment, integration and community support should form connected elements of workforce development rather than separate policy concerns.

Italy's regional diversity means that implementation will require different local responses. Nevertheless, national frameworks can provide clearer expectations while regional and municipal organisations strengthen practical access to information and support.

Ultimately, sustainable household care depends on protecting the dignity and autonomy of older people without overlooking the rights, aspirations and wellbeing of those providing assistance.

Italy's long-term care future will be strengthened when migrant workers are recognised not merely as a source of labour, but as skilled individuals whose employment conditions and social inclusion are integral to dependable, person-centred care.