ROME (ITALPRESS) – The year 2026 is just a step away, and the NRP speaks clearly: it is necessary to move from about 4 percent of integrated home care (ADI) for the over-65s in 2023 to at least 10 percent in order to achieve the fundamental goal for the evolution of NHS care of the “home as the first place of care.”The situation of ADI, the analysis of critical issues and operational proposals to overcome the situation, making this type of care, fundamental especially for the epidemiological evolution of the population and chronic conditions, put it down on paper for the first time in an analytical and organic way Salutequità, which edited a report, prepared after consultation with a panel of experts. The report was presented and discussed at an event in Rome attended by leading experts and stakeholders in the field produced with the unconditional contribution of Confindustria Dispositivi Medici.The good news is that in 2023 most regions appear to have reached the increase in the number of elderly cared for at home envisaged by the PNRR: two regions have doubled the target (over +200%) and they are Umbria and PA Trento; four, on the other hand, have not reached their targets namely Sicily (1%), Campania (62%), Sardinia (77%), and Calabria (95%) (source Agenas – National Agency for Regional Health Services – 2023).On taking care, over 65 and over 75, respectively, result closer to the 2026 target: Molise (7.26 percent and 11.97 percent), Abruzzo (5.80 percent and 9.57 percent), Basilicata (4.98 percent and 8.51 percent), Tuscany (4.70 percent and 7.55 percent) and Umbria (4.62 percent and 7.40 percent), which recorded the highest percentage of elderly assisted in ADI, conversely, are furthest behind, with lower rates of elderly receiving home care, Calabria (1.67 percent and 2.87 percent), Sardinia (2.15 percent and 3.60 percent), Puglia (2.49 percent and 4.16 percent), Valle d’Aosta (3.23 percent and 5.02 percent) and Campania (3.25 percent and 5.64 percent) (Source Italy Longevity) But there is no shortage of bad news.Intensity of care, or the amount of care, according to the Ministry of Health’s monitoring of the Essential Levels of Care (LEAs), was still too low in 2022: 6 regions were below the minimum threshold (Lombardy, Campania, Apulia, Calabria, Sicily and Sardinia) for the indicator – intensity of care CIA 1 and for that of intensity of care CIA 2 and CIA 3 there were 4 regions below the minimum threshold (respectively on CIA 2: PA Trento, FVG, Calabria and Sardinia and on CIA 3: Valle d’Aosta, PA Bolzano and Calabria).CIA (coefficient of care intensity) indicates the frequency with which the patient received home care during the period of care, and levels 1, 2 and 3 refer to low, medium and high care complexity.In 2023, in the face of an increase in the number of people assisted in ADI, in 14 regions (data from Italia Longeva, National Association for Aging and Active Longevity) the degree of attention to care intensity is low and corresponds for more than 50 percent to levels between GdC 0, when the date of the first and last access coincide and therefore it is a single access, and CIA Base (a level not assimilated to those provided by the LEA Commission); measures the numerosity of IAPs (Individual Care Plans) with CIAs between 0 and 0.13.), i.e., visits of an episodic nature.GdC are the Days of Care and indicate the duration of caregiving.In Lombardy and Calabria, 50 percent or more of home care delivery is concentrated in a single access, i.e., date of first and last service are coincident.On the hours of care provided to each elderly person over 65 has not fared any better: Crea Sanità (Center for Applied Economic Research in Health Care at the University of Tor Vergata in Rome) observes an average annual decrease of 2.6 percent between 2018 and 2023, from 18 to about 15.8 hours. The supply between regions was heterogeneous: Calabria in 2023 provided an average of more than 56 hours against a similar number of caregivers as Basilicata, where hours stopped at about 38; even between Lombardy and Emilia-Romagna, with a similar number of over-65s, the hours of care provided were significantly different, 10.9 and 15.0, respectively.The transition from hospital to home care is also insufficient as shown by the Ministry of Health’s advances on the SDO (Hospital Discharge Cards) report: in 2023 only 1 percent of ordinary discharges and 0.3 percent of protected discharges had ADI activation.Progress is too slow on accreditation and compliance with the quality standards set by the 2021 State-Regions agreement, starting with telemedicine to be guaranteed in the provision of ADI. Transposition by the regions has been going in slow motion: =12 months for Lombardy, Liguria, Umbria, Sicily, Abruzzo, Veneto, Basilicata, Molise and Calabria; within 18 months for Emilia-Romagna, Marche, Sardinia and Piedmont; the others starting in 2023.Four years after the signing of the Understanding, however, regional resolutions are also struggling to get off the ground, hampered by a lack of functional opinions and field audits.According to homecare providers who participated in a Salutequità reconnaissance, procedures for ADI accreditation are complex and have been completed in only three regions (Lazio, Sicily and Campania).A picture made even more complex in light of the staffing shortages needed to guarantee care at home. Of particular concern is that of nurses, who ensure 67 percent of current ADI: for example, those in family and community care (IFeC) in 2022 numbered just 1,464, according to the Ministry of Health survey, just 7.6 percent of the need indicated in DM 77 of 19,314. Even assuming a 25 percent increase in the number of IFeC in the next two years, the shortage would be at least 14,485 nurses today.And again from AIDOMUS-IT data (a study carried out by the National Nurses Federation and CERSI, Center of Excellence for Nursing Research and Development, on Home Nursing in Italy), less than 1 out of 2 ASLs (40 percent) has a social worker on staff, only 1 out of 2 ASLs (53.2 percent) has hired at least one social worker (OSS), a value that drops by more than 10 points in Southern Italy (41.7 percent). And for palliative care physicians, only 22 percent (37) of the residency fellowships have been awarded compared to the 170 contracts advertised, and there will be only 195 palliative medicine and palliative care specialists in the next 5 years.”The risk we run,” says Tonino Aceti, president of Salutequità, “is to make a good impression with Europe and, on the contrary, a very bad impression with patients because we are focusing on a performance model that cares more about the quantity of people who have health care access at home and not instead about a true take-home care for those who need more intensive and continuous care. It is precisely on quality aspects that specific goals should be assigned to the regions.We cannot miss the great opportunity of the NRP to produce real value in the Public Health Service. A stronger central monitoring and intervention capacity is needed to ensure uniform and timely implementation of the State-Regions Agreement on ADI accreditation. It is necessary to overcome the shortage of skilled professionals and ensure the use of technology, with the adoption of truly accessible digital tools. Finally, we must already now gear up to ensure a structural increase in the National Health Fund that goes beyond the temporary resources of the NRP, to avoid the collapse of home care.”-photo Ipa Agency -(ITALPRESS).
