The Future of Long-Term Care in Italy: Ageing, Workforce, Technology and System Reform

Italy can already see many of the conditions that will shape its long-term care system over the next quarter-century. More people are reaching advanced old age. The working-age population is contracting. Families are becoming smaller. Home care and telemedicine have expanded. New territorial healthcare infrastructure is being built. National long-term care reform is attempting to connect health, social support and non-self-sufficiency more coherently than before.

The question is no longer whether demographic change will require a different model. It is whether the reforms now under way can mature quickly enough to create one. The Italy Ageing, Long-Term Care & Community Support Knowledge Hub has examined the country's system from financing, home care and residential support through to workforce, digitalisation, family care, inequalities and reform. The strategic challenge now is to understand how those elements interact over time.

Italy begins that next phase with important assets. The Servizio Sanitario Nazionale provides a universal health foundation. Regions possess substantial delivery capability. PNRR investment has expanded home healthcare, telemedicine and territorial infrastructure. Law 33/2023 and Legislative Decree 29/2024 have established a national framework for more coordinated ageing and non-self-sufficiency policy. Yet the demographic scale of the challenge means incremental improvement alone will not be enough.

The future of Italian long-term care will depend on whether policy can move from expanding individual programmes towards redesigning the relationship between prevention, home support, workforce, family care, digital infrastructure, residential provision and national accountability.

Demography will change the scale and composition of care need

Italy's ageing trajectory is exceptionally clear.

At the beginning of 2026, around 14.8 million residents were aged 65 or over, representing 25.1% of the population. More than 2.5 million people were aged at least 85.

The significance of the 85-plus population is particularly important for long-term care. Dependency is not an inevitable consequence of age, but risks associated with frailty, dementia, multimorbidity, sensory impairment and functional limitation rise substantially at very advanced ages.

Current population projections suggest that by 2050 around one-third of Italy's population could be aged 65 or over, while the share aged 85 and above could approach twice its current level.

This will change both the quantity and complexity of demand.

More people may require combinations of:

• chronic disease management;
• personal assistance and supervision;
• dementia support;
• rehabilitation and falls prevention;
• medication support;
• home adaptation and assistive technology; and
• coordination across health and social services.

The relevant planning unit is therefore not simply the number of older people.

Italy will need to understand how many people are likely to live with different levels of dependency, how long those needs may last and what mix of support will allow them to remain independent.

This connects directly with assessment and changing needs. Future systems need to identify trajectories of dependency earlier rather than waiting until people cross a crisis threshold.

The working-age population creates the other half of the demographic equation

Ageing increases demand while demographic contraction simultaneously affects supply.

Italy's working-age population is already declining. This matters because long-term care depends heavily on labour.

Nurses, doctors, Operatori Socio-Sanitari, social workers, therapists, home-care workers, domestic carers and family members all provide time-intensive support that cannot simply be automated.

A smaller workforce therefore affects more than government revenue.

It influences whether services can recruit enough people to deliver care at all.

This is one reason headline demographic ratios can be more informative than population size alone. A growing older population supported by a shrinking working-age base creates pressure on taxation, social expenditure, provider labour markets and informal family support simultaneously.

The future system will need to increase productivity without interpreting productivity as doing less for each person.

Technology can reduce travel, administration and duplication. Better service design can make professional time more effective. Prevention can delay intensive dependency. Workforce roles can be redesigned.

But these measures have limits.

Personal care, reassurance, rehabilitation, clinical observation and human relationships remain labour-intensive.

The future challenge is therefore not replacing workers with technology. It is ensuring that scarce human capacity is concentrated where human involvement adds the greatest value.

Operational scenario: workforce planning becomes a demographic strategy

A Region projects its population to 2035 and identifies a substantial rise in residents aged over 80 alongside a decline in its working-age population.

Traditional workforce planning would estimate how many additional nurses, OSS and home-care workers will be needed and attempt to recruit accordingly.

The regional authority instead models several scenarios.

One assumes the existing service model continues unchanged. Another assumes stronger prevention delays some dependency. A third increases home care and telemonitoring while redesigning professional roles. A fourth expands residential provision because community capacity cannot keep pace.

Each produces different workforce requirements.

The exercise shows that even an ambitious recruitment programme will not meet future demand if current productivity and service boundaries remain unchanged.

The Region therefore combines workforce expansion with changes in delivery: multidisciplinary home teams, stronger digital coordination, more appropriate skill mix, improved support for family carers and selective use of remote specialist input.

It also identifies activities that consume professional time without improving outcomes and targets them for redesign.

The scenario demonstrates why the Predictive Workforce Risk Module can be relevant to organisations considering comparable pressures. It is not a forecasting model for Italy's SSN, but the underlying principle is important: demographic planning and workforce planning increasingly need to become one exercise.

Italy’s formal long-term care workforce will need to become substantially stronger

Italy currently has a comparatively small formal long-term care workforce relative to its older population.

Recent international data indicate around 1.5 formal long-term care workers per 100 people aged 65 and over, substantially below the OECD average.

That measure does not capture all care actually provided in Italy. Domestic workers and family carers supply substantial additional capacity outside formal long-term care statistics.

Nevertheless, the figure highlights a structural issue.

Future dependency cannot be absorbed indefinitely through family and household labour alone.

Recruitment will matter, but retention may matter just as much.

Long-term care roles compete with hospitals, other healthcare settings and different sectors of the economy. Work can involve unsocial hours, travel, physical strain and emotional responsibility.

A sustainable workforce strategy therefore needs to address employment quality, training, supervision, career pathways and workload as well as vacancies.

The wider principles of workforce resilience and continuity will become increasingly important as demographic pressure intensifies.

Italy may also need clearer professional development routes across home and residential long-term care. As people supported outside hospitals live with greater clinical complexity, boundaries between traditional social assistance and health-related support will become more demanding to manage.

Migration will remain part of the workforce solution but cannot carry the whole system

Migration has already become fundamental to Italy's care economy.

Large numbers of migrant women work as badanti, while international recruitment also contributes to the wider health and care workforce.

Italy's 2026–2028 migration framework includes routes for family and social-health assistance, reflecting the continuing demand for paid household care.

This will remain important.

But migration should not be treated as an unlimited reserve of labour.

Other ageing countries are competing for the same workers. Countries of origin are also ageing. Migrant workers themselves require fair pay, employment protection, training and sustainable working arrangements.

In the domestic-care market, future policy will increasingly need to decide how far the badante model should remain primarily a private household arrangement and how far it should become more systematically connected with formal long-term care.

That does not necessarily mean turning domestic workers into health professionals.

It may mean clearer competence expectations, stronger employment formalisation, better communication with healthcare teams and more reliable escalation when a person's needs exceed what one household worker can safely manage.

This connects workforce sustainability with fair work and responsible employment. A future care system cannot be genuinely sustainable if its continuity depends on insecure or exploitative labour.

Family care will remain essential, but the assumptions around it will have to change

Families will continue to be one of Italy's greatest sources of care capacity.

That does not mean future policy can continue assuming that family support will be available in the same quantity or form.

Low fertility means fewer adult children in younger generations. Geographic mobility separates families. Women's employment changes the availability of unpaid care. More older couples may themselves be providing support while managing their own health problems.

Household projections also point towards more people living alone.

The future distinction will therefore be between family involvement and family substitution.

Involvement can strengthen relationships, choice and continuity. Substitution occurs when essential support is not provided formally because relatives are expected to absorb it.

Those two models can look similar in conventional service data.

A person may remain successfully at home in both cases. Only one arrangement may be sustainable.

Future assessment and care planning therefore need to treat family capacity as dynamic.

The presence of a daughter or spouse should not automatically be translated into hours of available care. The system needs to understand what relatives are willing and realistically able to provide, and whether that contribution remains sustainable over time.

Home care will become the central operating platform of long-term care

Italy's policy direction increasingly places the home at the centre of care.

PNRR investment has substantially expanded the number of people aged over 65 receiving home healthcare. The national target associated with taking home care towards 10% of the older population was reached, marking a significant increase from the 2019 baseline.

That expansion changes the strategic position of home care.

ADI can no longer be understood simply as a supplementary service sitting alongside hospitals. It is becoming part of the infrastructure through which Italy intends to manage chronic disease and dependency outside institutional settings.

But the future of home care will depend on depth as well as reach.

A short clinical visit may be sufficient for one person and almost irrelevant to the overall support needs of another.

People with advanced frailty or dementia can require continuous supervision, personal assistance and social support far beyond what healthcare visits provide.

Future home-based care therefore needs stronger integration between:

ADI, municipal social support, rehabilitation, general practice, specialist services, family carers, domestic workers, telemonitoring and community infrastructure.

The strongest opportunity lies in treating the home not as a location to which separate services travel, but as one care environment around which different services coordinate.

This makes home-care service models and pathways one of the central strategic issues for the next decade.

Operational scenario: home-first policy reaches the limits of fragmented visiting

Rosa is 89 and lives alone in Toscana. She has heart failure, moderate dementia and reduced mobility. Her son lives nearby but works full time.

Several services support her.

A nurse visits through ADI. A physiotherapist provides intermittent rehabilitation. Her son organises a privately employed care worker for part of the day. Telemonitoring supports her heart failure.

Every individual intervention appears appropriate.

The problem is the space between them.

Rosa begins wandering at night, forgets meals and becomes anxious when different professionals arrive without understanding what others have changed.

The future model cannot solve this simply by adding another visit.

A single integrated plan clarifies priorities and roles. Clinical monitoring is connected with the wider care arrangement. The domestic worker knows when to escalate concerns. Family capacity is assessed honestly. The possibility of increased formal support is considered before the arrangement collapses.

The key shift is from multiple services delivered at home to one coordinated home-based model.

That distinction will become increasingly important as more people with complex needs are supported outside residential facilities and hospitals.

Residential care will remain necessary but its role is likely to change

A home-first future does not eliminate the need for RSA and other residential provision.

Some people will have needs that cannot safely or sustainably be supported at home. Others may prefer residential care because of isolation, housing constraints or family circumstances.

The future role of residential long-term care is therefore likely to become more specialised.

As policy succeeds in supporting more people with moderate needs at home, residential services may increasingly support residents with advanced dementia, severe physical dependency and complex health needs.

That has workforce and quality implications.

Facilities designed around lower dependency may require different skill mixes, clinical relationships and staffing intensity. Technology may support monitoring but cannot replace skilled direct care.

Residential capacity also needs to be planned geographically.

Some northern Regions have historically had substantially greater bed availability than southern areas. Future investment cannot rely only on existing provider-market patterns if demographic need changes differently across territories.

The relevant planning question is therefore not simply whether Italy needs more or fewer residential beds.

It is what level of dependency residential care should support, where capacity should sit, and how it should connect with hospitals, home care and community services.

The end of PNRR investment will test whether transformation can be sustained

The PNRR has given Italy an unusual opportunity to accelerate territorial healthcare reform.

Investment has supported Community Houses, COTs, Ospedali di Comunità, home care, telemedicine and digital infrastructure.

By 2026, major targets for home care and telemedicine had been reached, while at least 1,038 Community Houses formed part of the revised minimum infrastructure objective.

The next challenge is operational sustainability.

Buildings require staff. Digital platforms require maintenance. Remote monitoring requires professionals to review alerts. Home care expansion requires recurrent expenditure after capital or reform funding ends.

This is one of the most important transitions in the entire programme.

A capital investment can create infrastructure quickly. A long-term care system needs operating capacity every day.

Italy will therefore need to distinguish completion of PNRR milestones from completion of system transformation.

The latter will take much longer.

Organisations considering comparable transition risks can use the Governance Maturity Assessment to examine whether accountability, ownership and assurance remain sufficiently clear after the initial reform programme ends. The tool is not an Italian policy instrument, but the underlying governance question is relevant: who owns the benefits once implementation funding and project structures disappear?

Community Houses will matter through what happens inside them, not how many exist

Case della Comunità are one of the most visible symbols of Italy's territorial healthcare reform.

Their long-term significance will depend on whether they become genuine access and coordination points rather than simply new facilities.

For older people, the strongest model could connect general practice, nursing, prevention, chronic-disease management, social-health support and links with PUA functions.

This would create a local platform that can identify deterioration before hospitalisation and coordinate support around the person.

But Community Houses face several future tests.

Workforce availability may determine operating hours and service range. Regional organisational models differ. Urban and rural areas require different configurations. Relationships with general practitioners remain crucial.

The future measure of success should therefore move beyond the number of facilities completed.

Relevant outcomes include whether people receive earlier support, whether hospital use changes, whether access improves and whether health and social pathways become easier to navigate.

The physical infrastructure can support integration. It cannot create integration automatically.

Digital health is becoming part of the permanent care architecture

Italy's digital transformation has moved beyond isolated telemedicine pilots.

The National Telemedicine Platform, regional telemedicine infrastructure, FSE development and remote-care pathways now form part of the wider health system.

The PNRR target of at least 300,000 people assisted through telemedicine was reached by 2026.

Additional digital capability, including artificial-intelligence tools developed to support primary care, has also reached planned PNRR implementation milestones.

This does not mean AI-driven long-term care is already routine nationally.

It means the infrastructure for more data-enabled care is developing.

The next phase will involve deciding where digital tools produce lasting value.

Remote monitoring may allow earlier intervention for chronic disease. Teleconsultation can extend specialist access. Assistive technology can support independence. Digital records can improve continuity.

But digital transformation also creates workload, cyber risk and exclusion.

The future of interoperability and system integration will therefore be more important than the proliferation of individual applications.

Older people gain relatively little from five advanced digital systems if the systems do not communicate and professionals still require families to repeat information.

Operational scenario: AI identifies risk but cannot own the response

A territorial healthcare system introduces predictive analytics to help identify older people at elevated risk of deterioration or unplanned hospital use.

The model draws on available clinical and service data.

An 82-year-old man with COPD, diabetes and several recent urgent contacts is flagged as high risk.

The technology has completed only the first task.

The system must now decide who receives the alert, whether the data are sufficiently reliable, what assessment follows and which team can intervene.

A nurse reviews the case and discovers that the principal problem is not uncontrolled disease. The man's wife, who had previously organised medication and meals, has recently been admitted to hospital herself.

A purely clinical algorithm identified elevated risk but did not explain the social change underlying it.

The response combines clinical review with assessment of practical support.

The scenario illustrates the likely future relationship between AI and long-term care. Predictive systems can prioritise attention, but professional judgement and contextual assessment remain essential.

The Digital Transformation Readiness Assessment can help organisations explore whether governance, data, workforce and cyber resilience are sufficiently mature before such tools are scaled. Digital sophistication without operational ownership simply creates more signals.

Prevention will become a long-term care investment rather than a separate health programme

Italy cannot prevent population ageing, but it can influence the level and timing of dependency.

This makes prevention strategically important.

Falls prevention, physical activity, vaccination, chronic-disease management, nutrition, social participation and early frailty identification can help preserve functional capacity.

The new Piano Nazionale della Prevenzione 2026–2031 provides an important national framework for that wider agenda.

The future opportunity is to connect prevention more explicitly with long-term care planning.

A prevented fracture may avoid a transition into dependency. Better cardiovascular management may reduce disability. Supporting an isolated older person to remain active may preserve mobility and confidence.

These outcomes have both human and system value.

The challenge is measurement.

Prevention benefits are often realised years after investment and may appear in a different budget. A municipal programme may reduce hospital use. Healthcare intervention may preserve independence and reduce later social-service need.

Future governance will therefore need stronger cross-system measures capable of recognising value beyond one organisation's expenditure.

Financing will need to become more coherent even if budgets remain separate

Italy's long-term care financing is fragmented by design.

The SSN finances healthcare and substantial social-health provision. The Fondo per le Non Autosufficienze supports social measures and LEPS. INPS administers Indennità di Accompagnamento. Regions and municipalities contribute their own resources. Households purchase private care. Families contribute unpaid labour.

The 2025–2027 National Non-Self-Sufficiency Plan provides approximately €3 billion through the national fund over the three-year period, creating a more structured social-policy framework.

That funding is important but represents only one part of the total care economy.

The future question is whether resources can become operationally coherent without requiring immediate institutional pooling.

An older person does not experience the distinction between a healthcare euro and a social-care euro when both are needed to remain at home.

The PAI and wider SNAA architecture can help align interventions around one person, but financial rules still influence what can be funded, by whom and under which eligibility criteria.

Over time, Italy may need stronger mechanisms that connect expenditure with outcomes across systems.

This does not necessarily require one national long-term care budget.

It does require fewer situations in which one institution saves money because another institution, household or unpaid carer absorbs the cost.

The end of the Prestazione Universale experiment will provide an early policy test

The Prestazione Universale is scheduled to run until the end of 2026.

Because it targets a narrowly defined group of people aged at least 80 with extremely high need and very low socio-health ISEE, it should not be interpreted as Italy's future national benefit model in itself.

Its evaluation can nevertheless inform several strategic questions.

Does adding a care-linked component to Indennità di Accompagnamento increase the amount of formal home assistance people receive?

Does it encourage formal employment of domestic care workers?

Does it help prevent or delay residential admission?

Are the eligibility thresholds too restrictive to generate wider population effects?

Can households navigate the administrative requirements?

These questions go beyond the future of one benefit.

They address the balance Italy may eventually choose between unrestricted cash, service-linked cash and directly provided services.

Different countries answer that balance differently. Italy's experiment is valuable precisely because it can generate evidence rather than assuming one funding mechanism is inherently superior.

Operational scenario: the future system measures what happens after funding decisions

A Region expands home support for older people with significant dependency and records a substantial increase in the number receiving services.

Politically and administratively, the programme appears successful.

Governance then asks a second set of questions.

Are people remaining at home longer? Are family carers experiencing less unsustainable burden? Are hospital admissions changing? Are people with dementia receiving adequate continuity? Are service hours sufficient for the level of need?

The answers show mixed results.

Coverage has improved widely, but people with the highest levels of dependency still rely heavily on families. Several territories have workforce shortages that limit service intensity. In some areas, hospital use has fallen; in others, it has not.

The Region therefore avoids treating coverage as the endpoint.

It uses outcome data to adjust workforce, service intensity and eligibility pathways.

This illustrates the future importance of Quality Dashboard Builder principles. The tool is not designed to measure Italian regional performance directly, but it demonstrates how leaders can distinguish activity, capacity, quality and outcomes rather than collapsing them into one headline measure.

Regional variation will remain, but the acceptable range may narrow

Italy will continue to have regional variation.

The country's constitutional structure, different population profiles, provider markets and territorial geography make complete uniformity unrealistic and undesirable.

The future challenge is deciding which differences are legitimate.

One Region may deliver more home care through public organisations, another through accredited providers. One territory may rely more heavily on residential care because of historical infrastructure. Rural regions may need different digital and mobile models from dense urban areas.

Variation in mechanism can be compatible with equity.

Variation in basic access or outcomes is more problematic.

The SNAA and stronger national LEPS create an opportunity to establish a clearer national floor while preserving regional delivery freedom.

Future monitoring therefore needs to compare:

• assessment and waiting times;
• home-care intensity as well as coverage;
• access to residential and community support;
• workforce availability;
• avoidable hospital use;
• carer sustainability; and
• outcomes relating to independence and quality of life.

The wider principles of data and quality metrics will become central to distinguishing adaptable regionalism from persistent inequality.

Climate resilience and housing will become larger care issues

Future long-term care planning cannot focus only on conventional service systems.

Italy's ageing population will increasingly be exposed to extreme heat, flooding and other climate-related risks.

Older people living alone, people using certain medicines and those with mobility limitations can be particularly vulnerable during heatwaves or service disruption.

Housing also influences whether people can remain independent.

Older apartment blocks without lifts, inaccessible bathrooms, poor thermal performance and rural homes far from services can all accelerate dependence.

Adaptation and resilience therefore need to become part of ageing policy.

Telecare can support monitoring during extreme weather. Community networks can identify isolated people. Home adaptations can prevent falls. Energy-efficient housing can protect health.

But these interventions cross health, housing, municipal and social-policy responsibilities.

The future care system will therefore need a broader definition of infrastructure.

A nurse is care infrastructure. So is an accessible home, reliable electricity, transport, digital connectivity and a safe neighbourhood.

Quality assurance will need to follow people across organisational boundaries

Italy's current long-term care quality arrangements are distributed between national guarantees, regional accreditation, local contractual and administrative oversight, professional governance and provider-level systems.

As integration increases, quality assurance will need to become more pathway-based.

A person may receive excellent care from each individual organisation while experiencing a poor overall pathway because information is delayed, services overlap or nobody owns a gap.

Future quality systems therefore need visibility of transitions and interfaces.

Important indicators may include continuity after hospital discharge, response to changing needs, reliability of PAI implementation and whether deterioration leads to timely reassessment.

The principles of quality and governance for older people's services increasingly need to extend beyond organisational compliance to system experience.

This is particularly important as digital care, household workers and family support become more integrated into formal pathways.

Person-centred care will become more important as resources become tighter

Resource pressure can encourage systems towards standardisation.

Some standardisation is useful. Common assessment, evidence standards and clearer pathways can reduce variation.

But tighter resources also make personal priorities more important.

Not every older person wants the same balance between independence, safety and family involvement. Some will prioritise remaining at home despite manageable risk. Others may prefer residential support rather than relying heavily on relatives.

Care planning therefore needs to understand what outcome the person is trying to preserve.

The principle of choice and co-production should become more, not less, important as systems become more technologically and administratively sophisticated.

Otherwise integration risks creating a smoother system that still delivers decisions around people rather than with them.

Italy’s reforms now need to become institutional rather than project-based

The most important transition after 2026 is institutionalisation.

PNRR programmes have deadlines. Pilot benefits have end dates. Reform projects have implementation phases.

Long-term care needs permanent operating arrangements.

The SNAA provides one mechanism for making coordination durable. Unified multidimensional assessment, due to extend nationally under the current timetable from 2027, can become another.

But permanence requires more than legislation.

Professionals need stable roles. Information systems need maintenance. Regions need recurrent funding. Local implementation needs oversight. National policy needs feedback loops capable of identifying what is not working.

The future system should therefore become less dependent on individual reform initiatives and more capable of continuous adaptation.

This is a governance maturity question.

The strongest systems are not those that complete transformation once. They create mechanisms through which services repeatedly adapt as population needs, technology and workforce conditions change.

What Italy’s future direction offers internationally

Italy's institutional design cannot be transferred directly to countries with social insurance, centralised long-term care or different regional structures.

Its experience nevertheless illustrates several challenges that many ageing societies will face.

First, demographic ageing needs to be planned alongside contraction of the available workforce.

Second, home-first policy is sustainable only when adequate service intensity accompanies increased coverage.

Third, family care should be supported as a relationship rather than treated as an invisible labour reserve.

Fourth, capital investment in digital and territorial infrastructure needs a plan for recurrent operation.

Fifth, regional flexibility works best when national systems are capable of identifying unacceptable inequalities in access and outcomes.

Finally, long-term care reform needs to connect prevention, healthcare, social support, housing and technology rather than treating each as a separate programme.

The transferable lesson lies in the architecture of the response: ageing societies need systems designed around trajectories of need, not simply institutions created for historical categories of service.

Conclusion

Italy enters the next phase of long-term care reform with more policy and infrastructure in place than it had at the beginning of the decade. Home healthcare has expanded substantially. Telemedicine has reached national scale. Community Houses and territorial coordination infrastructure are developing. The SNAA, unified assessment, LEPS and the wider reform under Law 33/2023 and Legislative Decree 29/2024 provide a clearer framework for connecting health, social support and non-self-sufficiency.

The demographic challenge will nevertheless intensify. More people will reach very advanced age while the working-age population contracts, family structures become smaller and competition for care workers increases. The next strategic task is therefore not simply to preserve existing services. It is to redesign how Italy uses workforce, family capacity, digital technology, residential provision and public funding together.

The strongest future direction combines prevention with sufficient home-care intensity, digital reach with human response, regional flexibility with a dependable national floor, and family involvement with stronger formal support. PNRR infrastructure needs to become permanent operating capacity, while reform governance needs to move from measuring structures to measuring independence, continuity and lived outcomes.

Italy will not create a sustainable long-term care system through one law, one fund or one technology platform. Its success will depend on whether the reforms now under way become a coherent operating model capable of adapting for decades. That is the defining task ahead: turning an ageing society from a forecast into a service design challenge that national, regional and local systems can manage deliberately rather than react to incrementally.