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The Active Ageing Index and policy making in Italy
- Andrea Principi, Mirko Di Rosa, Antia Domínguez-Rodríguez, Maria Varlamova, Francesco Barbabella, Giovanni Lamura, Marco Socci
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- Journal:
- Ageing & Society / Volume 43 / Issue 11 / November 2023
- Published online by Cambridge University Press:
- 16 December 2021, pp. 2554-2579
- Print publication:
- November 2023
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- Article
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Although the active ageing concept generally has positive connotations, with expected benefits at the micro, meso and macro levels, the application of this concept in terms of policy making presents challenges and risks to be avoided (for instance, a predominantly productivist interpretation and a top-down imposition with limited possibilities for bottom-up exchanges; or a disregard for the risk of excluding older people with more disadvantaged backgrounds). Two crucial strategies to minimise risks are the implementation of policies by considering and respecting territorial diversity, and the involvement of all the relevant stakeholders in a participatory consultative and co-decisional approach. This paper entwines both strategies together by focusing on Italian in-country differences in terms of active ageing, and employing the Active Ageing Index for policy-making purposes. This activity is part of a governmental national pilot project aimed at promoting multilevel co-managed co-ordination of active ageing policies across Italy. The analysis identified five groups of regions that differ from the classical, geographic and socio-economic division between the North, Centre and South. Additional in-group analyses were conducted to investigate within-cluster differences. This study will inform a large multilevel stakeholder network for evidence-based policies and their monitoring at both the national and regional levels, in line with the perspective of mainstreaming ageing.
Four - How different countries allocate long-term care resources to older users: a comparative snapshot
- Edited by Cristiano Gori, London School of Economics and Political Science, Jose-Luis Fernandez, London School of Economics and Political Science, Raphael Wittenberg
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- Book:
- Long-Term Care Reforms in OECD Countries
- Published by:
- Bristol University Press
- Published online:
- 19 August 2022
- Print publication:
- 18 December 2015, pp 47-76
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Summary
Introduction
Public responsibility for long-term care (LTC) – in particular, care for frail older people – has expanded rapidly in most advanced nations in the past two or three decades. A key issue is resource allocation: how much money to spend and on what. But although the LTC field has drawn more and more attention from researchers – we know far more about how various approaches work than ever before – patterns of resource allocation have not been adequately studied. As a recent report indicates, ‘the current available statistics about public LTC programs are somewhat patchy’ (Carrera et al, 2013, p 31). Actually, information is available about LTC expenditure in most individual countries, and recently several admirable surveys of LTC policy across several countries have appeared (see, for example, Colombo et al, 2011; Riedel and Kraus, 2011; Mot et al, 2012; Rodrigues et al, 2012; Genet et al, 2013; OECD, 2013; Ranci and Pavaloni, 2013; Mor et al, 2014). However, systematic comparative analysis of expenditure and coverage of national LTC systems has been lacking.
The objective is simple; the task is quite difficult. Two of us discovered this in trying to compare expenditures in just three countries, Germany, Japan and the US (Campbell et al, 2010). It took far longer than we expected and required many delicate decisions to match up the categories. The present study takes on seven countries, a number small enough to manage the necessary mutual adjusting with our limited time and resources, but large enough to represent significant models of LTC policy.
To draw on quite conventional images in the welfare state literature, we have Sweden in social-democratic Northern Europe, Italy in familial Southern Europe, Germany in corporatist mid-continent, Australia, the US and England as quite different versions of the Anglo-Saxon ‘residual’ model, and Japan as the relatively new entry that shares aspects of all the other models. This chapter presents details of each country's approach to LTC and how their policies have changed over time. This chapter is essentially a ‘snapshot’ cross-sectional analysis of spending and coverage data.
Since our contribution is largely methodological, we begin by explaining how we have tried to deal with the inherent problems of comparing LTC policy. There are four key approaches.
Five - How different countries allocate long-term care resources to older users: changes over time
- Edited by Cristiano Gori, London School of Economics and Political Science, Jose-Luis Fernandez, London School of Economics and Political Science, Raphael Wittenberg
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- Book:
- Long-Term Care Reforms in OECD Countries
- Published by:
- Bristol University Press
- Published online:
- 19 August 2022
- Print publication:
- 18 December 2015, pp 77-116
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Summary
Introduction
A key policy debate in long-term care (LTC) policies across OECD countries today can be summarised by the following question: what measures and strategies can be adopted to optimise resources? New policies are required for balancing finances and access to care, with different options on the table and waiting for governments’ decisions.
This chapter looks at changes over time in public resource allocation among LTC users in the same OECD countries considered in the previous chapter (except for Australia). As in Chapter Four, this chapter focuses exclusively on public care inputs, defined as those inputs that are (at least partially) publicly funded, and looks at users aged 65 and over. Chapter Four led the way to reconsidering how public resources are allocated in different LTC systems through an in-depth analysis of current spending. To complement that analysis, this chapter adopts a long-term perspective, investigating the changes that have occurred over the last 20–25 years in three crucial dimensions of resource allocation: the mix of LTC services for older people, their intensity, and their coverage.
The countries considered are representative of the OECD environment with respect to both the overall welfare models and the models of LTC policies. Concerning the former, as Campbell et al have noted in Chapter Four, ‘we have Sweden in social-democratic Northern Europe, Italy in familial Southern Europe, Germany in corporatist mid-continent, Australia, the US and England as quite different versions of the Anglo-Saxon “residual” model, and Japan as the relatively new entry that shares aspects of all the other models.’ From the point of view of LTC policies, the sample of countries selected represents the different models in the OECD context:
• Universal coverage within a single programme: this model guarantees people access to formal services without taking into account users’ income or assets as eligibility criteria. It is also organised as a single system, separated or integrated with the overall health system (Germany, Japan and Sweden).
• Mixed systems: in this case, LTC is provided through a mix of different universal programmes and benefits operating alongside, or a mix of universal and meanstested LTC entitlements (England and Italy).
• Means-tested systems: under this type of scheme, LTC coverage is provided through safety-net programmes. In countries using this system, income and/ or asset tests are used to define thresholds for eligibility to publicly funded care.
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)