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The economic impact of moderate stage Alzheimer's disease in Italy: evidence from the UP-TECH randomized trial
- Carlos Chiatti, Gianluca Furneri, Joseph M. Rimland, Federica Demma, Franco Bonfranceschi, Laura Cassetta, Filippo Masera, Antonio Cherubini, Andrea Corsonello, Fabrizia Lattanzio, on behalf of the UP-TECH research group
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- Journal:
- International Psychogeriatrics / Volume 27 / Issue 9 / September 2015
- Published online by Cambridge University Press:
- 15 April 2015, pp. 1563-1572
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- Article
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Background:
There is consensus that dementia is the most burdensome disease for modern societies. Few cost-of-illness studies examined the complexity of Alzheimer's disease (AD) burden, considering at the same time health and social care, cash allowances, informal care, and out-of-pocket expenditure by families.
Methods:This is a comprehensive cost-of-illness study based on the baseline data from a randomized controlled trial (UP-TECH) enrolling 438 patients with moderate AD and their primary caregiver living in the community.
Results:The societal burden of AD, composed of public, patient, and informal care costs, was about €20,000/yr. Out of this, the cost borne by the public sector was €4,534/yr. The main driver of public cost was the national cash-for-care allowance (€2,324/yr), followed by drug prescriptions (€1,402/yr). Out-of-pocket expenditure predominantly concerned the cost of private care workers. The value of informal care peaked at €13,590/yr. Socioeconomic factors do not influence AD public cost, but do affect the level of out-of-pocket expenditure.
Conclusion:The burden of AD reflects the structure of Italian welfare. The families predominantly manage AD patients. The public expenditure is mostly for drugs and cash-for-care benefits. From a State perspective in the short term, the advantage of these care arrangements is clear, compared to the cost of residential care. However, if caregivers are not adequately supported, savings may be soon offset by higher risk of caregiver morbidity and mortality produced by high burden and stress. The study has been registered on the website www.clinicaltrials.org (Trial Registration number: NCT01700556).
three - Older volunteers in Italy: an underestimated phenomenon?
- Edited by Andrea Principi, Per H. Jensen, Aalborg Universitet Institut for Statskundskab, Denmark, Giovanni Lamura
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- Book:
- Active Ageing
- Published by:
- Bristol University Press
- Published online:
- 05 March 2022
- Print publication:
- 14 May 2014, pp 47-70
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Summary
Introduction
Despite recent changes, the familistic Mediterranean Italian welfare state (Esping-Andersen, 1996; Ferrara, 1996) is still largely anchored in the male breadwinner/female carer family model (Lewis, 1992; Pfau-Effinger, 2005). According to this model and its cultural context, women are expected to have the main responsibility for carrying out homemaking and caring tasks, often on a full-time basis, and particularly in the Central-Southern regions. This explains why female labour force participation rates – as for older workers – are still very low in most Italian regions (although a trend towards higher participation rates can be observed in recent years), whereas the state's role is mainly that of providing not so much in-kind services, but rather care allowances (Bettio and Plantenga, 2004), financial support that is frequently used by households to privately hire migrant care workers (Di Rosa et al, 2012).
The limited extent of state-run or funded care services helps explain why voluntary work in Italy is concentrated in this field. On the whole, however, the voluntary sector in Italy appears to be underdeveloped when compared to other European countries, especially those in the North. This may be explained by the fact that, on the one hand, volunteering in Italy is not felt as a ‘social norm’ (Ascoli and Cnaan, 1997), while on the other, actual volunteering-like activities, particularly in the culture and recreation fields, may not be perceived as such in the eyes of many Italians. Indeed, the dominant profile of volunteering in Italy has often been described as mainly ‘altruistic’ and ‘service-oriented’ (ISTAT, 2006a; Fondazione Roma Terzo Settore, 2010). However, the amount of ‘self-expressive’ volunteering may be underestimated by some of the existing surveys, due to sample biases and cultural social norms, as this form of volunteering is, to some extent, not perceived as such by the common Italian mentality. As a consequence, only about 10 per cent of the population describes itself as being actively engaged in voluntary activities (ISTAT, 2011), which are performed in about 220,000 non-profit institutions, mainly registered as associations, 81 per cent of whose workforce is made of volunteers (ISTAT, 2001a). The total contribution produced by voluntary work has been estimated to reach 0.7 per cent of GDP (gross domestic product), while the whole non-profit sector adds up to over 4 per cent of GDP (CNEL-ISTAT, 2011).
eleven - Migrant care work for elderly households in Italy
- Edited by Joseph Troisi, University of Malta, Hans-Joachim von Kondratowitz
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- Book:
- Ageing in the Mediterranean
- Published by:
- Bristol University Press
- Published online:
- 04 February 2022
- Print publication:
- 21 August 2013, pp 235-256
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Summary
Introduction
The increase in life expectancy is leading to growing numbers of frail older people worldwide, while the potential availability of family and informal care resources – especially from older people's children – is dramatically declining in Europe, due to lower fertility rates, rising labour market participation by women and higher shares of lone-elderly households (OECD, 2005a). Providing appropriate longterm care to large numbers of disabled, very old people therefore represents an increasing challenge to all welfare states, particularly in the light of the preference granted by official policies, in Europe as elsewhere, to arrangements promoting ‘ageing in place’, by enhancing tailor-made home and community care services, and moving away from institutional care (European Commission, 2008). A solution that is increasingly being adopted to tackle this challenge is based on the employment of migrant care workers, a discreet and to a large extent invisible trend that is giving rise to a sort of ‘ethnic segmentation’ of the elder care sector across Europe (Lamura, 2013). Italy is one of the countries where this phenomenon has become most widespread. Due to the overlapping of increased female employment, generous cash-for-care schemes and a still ‘familistic’ approach to elder care, in the last decade an increasing number of Italian families have indeed opted to privately employ a migrant care worker, often on a live-in basis, in order to provide support to their frail older family members. In this chapter, after a short introduction on the global and European situation, a more in-depth overview of the main trends currently affecting the demand and supply of elder care in Italy is provided, including an outline of the motivations driving Italian families to employ migrant care workers as well as of the difficulties experienced by migrant workers themselves. The conclusion analyses the opportunities and challenges for receiving as well as sending countries, in an attempt to set an, albeit provisional, agenda for future research, policy and practice in this still largely neglected area.
Migrant care work in ageing societies: the phenomenon in a global and Mediterranean perspective
One of the major concerns resulting from population ageing is that expenditure to provide ‘formal’ long-term care services (services that are delivered by public, profit or non-profit organisations to dependent, mainly older, people requiring continuous assistance) are expected to increase worldwide (Oliveira Martins and de la Maisonneuve, 2006)