Download ltc reform trends between national and local policies: insights from italy

CeRGAS
Centre for Research on Health and
Social Care Management
LTC REFORM TRENDS BETWEEN
NATIONAL AND LOCAL POLICIES:
INSIGHTS FROM ITALY
Giovanni Fosti*, Elisabetta Notarnicola
[email protected]
4th International Conference on Evidence-based Policy in Long-term Care
London School of Economics and Political Science (LSE),
London, 4 - 7 September 2016.
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LTC accross Europe
• LTC Key Policy Priority across Europe:
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Demografic / socioeconomic changes
Significant growth in the need for LTC
Long run increases in service unit costs
Reduction in the availability of unpaid care
Rising political voice of key LTC consumer groups
General pressure on public service budgets
(Fernandez and Gori, 2015)
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LTC national trends accross Europe
“The tsunami of the 2008 economic crisis hit particularly hard most of the southern
European countries, which at a certain point had been making efforts to catch up by
providing more services and resources addressed to old age welfare, looking toward
the more successful northern and central European welfare states as reference points
in their own LTC policies”  wind of reforms and changes in the European
countries
Deinstitutionalization
Subsidiarity
Privatization
Refamiliarization
Restructuring
National policies and reforms had different impact at the local level:
If the national debate is concentrated on framework policies, what is
happening at the local level, where care is delivered to families?
(Deusdad, B. A., Pace, C., & Anttonen, A.; 2016)
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Our research:
from national reforms to local changes
Objective:
• Our work offers a picture of what is going on in Italy in terms of LTC
innovation and reforms at the local level.
• Period 2014 - May 2016
Steps:
• We first provide an overview of the recent national public debate about Long
Term Care.
• We then provide a synthesis of trends in the care sector, reviewing the
contents of regional policy making about Long Term Care
• Finally we provide an insight on innovation going on at the local level.
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A method to understand trends at the
national, regional and local level (1)
Focus of
analysis
TRENDS AT
THE NATIONAL
LEVEL
Target
Italy
TRENDS AT
THE REGIONAL
LEVEL
Lombardy
Emilia
Romagna
Liguria
TRENDS AT
THE LOCAL
LEVEL
Local
authorities
and care
providers
in the
north of
Italy
Objective
Method
Procedure
Understanding which
policies concerning LTC
have been under discussion
in the 2014-2016 period.
Review of existing
literature and
official documents
from the ministries
1.Identification of main trends at the
national level.
2.Check through official documents
and articles.
Understanding which
policies concerning LTC
have been under discussion
in the 2014-2016 period.
Scanning the
press, the italian
scientific literature,
regional legislation
and official
documents and the
press.
1.Identification of keywords
2.Scanning of the 2014-2016
legislation including the keywords
and classification of the initiatives.
3.Checking and expanding the
research through a keywords
driven search in the sectorial
press and the Italian scientific
literature,
Understanding what is
going on at the local level,
especially concerning new
projects and field test
Questionnaire
asking if new
projects or field
test about long
term care have
been performed in
the period
1.Submission to the questionnaire
to private and public managers
participating to executive
education initiatives (around 90
people)
2.Classification of the initiatives.
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A method to understand trends at the
national, regional and local level (2)
Looking for trends and innovation at the national, regional and local level:
1. Once scanned the official sources …
2. Classification of the initiatives and experiences:
Newness of the
contents
Confirmation of existing
(annual) intervention
Contents
Funding and Financing
Governance
Change of an existing
intervention.
Care standards
Service features
Radical innovation
Access criteria
Need evaluation
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The national level
3 main themes explicitly concerning LTC have been under
discussion at the national level:
theme
contents
classification
Annual confirmation of
the National Fund for
dependant people
• Annual allocation of the fund.
• The fund is destinated to region
• Criteria and destionation is strictly
defined at the ministerial level.
• Trend of an orientation towards
serious disability (such as ALS) not
LTC.
• Confirmation of annual
intervention.
Approval of the ISEE
Reform, concerning
personal requirements
to access public social
care
• Operational from 2015.
• Review of the existing requirements
(both personal and income based
requirements).
• Relevant for every social care target,
not specific for LTC.
• Change of an existing
intervention.
• Concern access criteria to
public social care.
• Considered more inclusive by
some professionals, less
inclusive by others.
Discussion of a possible
reform of the LTC cash
for care scheme
• Political debate about the opportunity
af a re-allocation of the funds
dedicated to the cash for care
scheme (Indennittà di
Accompagnamento)
• Radical innovation  but still
under political discussion
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The regional level (1)
• 3 regions, chosen for their relevance and importance among
regional welfare systems in Italy.
• Sources that have been analyzed:
Regional legislation and
official documents
Scientific literature
concerning the regions
Specialized press
Lombardia
13 citing LTC
keywords
11 citing Lombardia
3 citing Lombardia
Emilia Romagna
12 citing LTC
keywords
8 citing Emilia
Romagna
1 citing Emilia
Romagna
Liguria
8 citing LTC
keywords
2 citing Liguria
None citing Liguria
2014-2016
Strategic plans, annual and multi
year legislation
Italian journal dedicated to LTC or
social care
Websites and professional press
dedicated to LTC or social care
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The regional level (2)
Regional legislation and official documents, what’s going on?
Confirmation of existing
(annual) intervention
Change of an existing
intervention
Radical innovation
Lombardia
3
5
5
Emilia
Romagna
5
5
2
Liguria
2
2
4
Governance
Access criteria
Need evaluation
Service features
2014-2016
Care standards
Confirmation of existing
rules and standards year
after year
Funding and
Financing
Updating of existing
rules for the current
year
Access criteria
Need evaluation
Funding and
Financing
Next slide
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The regional level (3)
Which radical innovation in the official documents?
2014-2016
Service features
Lombardia
• Introduction of new vouchers
and cash for care
interventions dedicated to
elderly
• Introduction to cash for care
interventions dedicated to
indipendent living
• Continuity of care
Emilia
Romagna
• Introduction to counselling and
training for care givers
• Continuity of care
Liguria
• Introduction of a new regulation
for personal carers at home
• Introduction of public
intervention dedicated to active
aging
Access criteria
Need evaluation
Funding and
Financing
• Introduction of a
new funding
mechanism for
residential care
based on service
rating
• Introduction of new
need assessment
tools
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The regional level (4)
What’s more?
• Specialized press confirmed the same evidences found in
official documents
• Scientific literature concerning the regions 
– confirmed the same evidences found in official documents
– Add some insights on innovation going on in care homes and
within home care services providers that emerge from the local
level
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The local level (1)
• 90 questionnaires filled in by public and private
managers operating in the LTC sector in the 3
regions.
• Gate question: Has your organization been
working on something you considered innovative
about LTC in the last two years?
– NO: 66
– YES: 24
Next slide
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The local level (2)
Which innovation from the local level?
24 experiences collected:
TARGETS
CONTENTS
Active elderlies
Dependent elderlies
Home Care
Counselling
Families
LTC
Home and personal living
Need assessment
Sharing economy
Care pathways
Mental health
13%
13%
4%
21%
46%
42%
12%
12%
8%
12%
17%
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The local level (3)
Which innovation from the local level?
24 experiences collected:
OBJECTIVES AND NEEDS THAT ARE PURSUED
NEED OF INFORMAL CARE BOTH FOR THE FAMILY AND THE DEPENDENT PERSON
NEED OF INCREASING CARE INTENSITY
FEELING OF SAFETY AT HOME AND IN ALL THE ASPECTS OF THE PERSONAL LIFE
NEED FOR THE FAMILY TO FIND A CARE - LIFE BALANCE
MORE SOCIAL RELATIONS AND ACTIVE LIFE
Different
from what is
promoted at
the national
and regional
level
FINDING NEW RESOURCES THROUGH SHARED INTERVENTIONS
MORE PSYCHOLOGICAL COUNSELLING
BUILDING A SAFETY NET FOR THE ELDERLY
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Conclusions (1/2)
• National Focus: Existing intervention/access criteria
• Regional Focus: Changes of existing intervention and
radical innovation
• Local Focus: Targeting on caregiver and families
• Regional and local level are more active and innovative
than the national level.
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Conclusions (2/2)
Main issues:
Continuity of care/ Active ageing
• Public Sector as enabler and promoter
not only focused on financing and
regulation
• From service production to connection
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Selected references
Gori, C., & Fernandez, J. L. (2015). Long-term Care Reforms in OECD
Countries. Policy Press.
Lechevalier, A., Giraud, O., & Kumpers, B. (2013). Policy learning and
innovation in local regimes of home-based care for the elderly: Germany,
Scotland and Switzerland (No. halshs-00788968).
Deusdad, B. A., Pace, C., & Anttonen, A. (2016). Facing the Challenges in the
Development of Long-Term Care for Older People in Europe in the Context of
an Economic Crisis. Journal of Social Service Research, 42(2), 144-150
Autosufficienza, N. N. (Ed.). (2015). L'assistenza agli anziani non autosufficienti
in Italia. Maggioli Editore.
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