No specific reference to ICT was found in any documents concerning healthcare policy related to older people. Technological supports to rehabilitation and daily living - also including ICT - fall mainly within the range of provisions established by the Legislation for people with disabilities. Elderly people can benefit from such support in case of significant disabilities, which luckily applies to a minority of the elderly population, those who are fully dependent (estimated 4% or the overall elderly population) or partially dependent (estimated 20%).
Social alarms often are included in the organisation of healthcare services and specific provisions are established for promoting the installation of them. Such ICT systems are well widespread throughout the Country; they are used by both people with disabilities, and by people with no specific disabilities but just with health or social risk. Other kinds of technological supports do not seem to be specifically considered by the overall health and social care system related to the elderly.
In the past the Health System (mainly based on the National Health Service, established in 1978) and the Social System (mainly based on Municipality or their Consortia) worked quite separately, their co-ordination depending on Regional regulations. Recent developments in Legislation introduced the concept of "Integrated System of Health and Social Care" that commits the various Bodies involved to work together around individual needs. This evolution proceeded through a number of steps at national level, and often at different paces in different Regions. The new approach is community-centred, based on multi-disciplinary work, aimed at maintaining the client as much as possible at home, exploiting all resources available in the community (families, profit companies, non-profit organisations) according to a kind of "subsidiarity" principle. Key actors are the local District (a territory sub-section of the Local Health Authority) and the Department (a functional organisation within the Local Health Authority charged with a specific competence, eg. the older population).
In conclusion changes are currently in progress in Italy in the healthcare sector in relation to people with long term needs. These are expected to yield significant impact for people with disabilities and elderly people in need of care. Even if this scenario is just in the early stage of its implementation (especially in Regions that did not anticipate or keep the pace of the trend), it seems to open, more than in the past, new horizons for ICT applications supporting care as well as safety and independent living at home. However, it must be taken into account that the healthcare system is highly decentralised, thus the situation is likely to develop at different paces in the various Regions, or even in the different local communities.
Currently, it seems that the major driving forces in introducing ICT among older people are manufacturers and suppliers of ICT-related products and services. These are increasingly devoting marketing efforts to both the clients themselves (older people start to be considered a significant market) and the public Bodies that are responsible for health and care services.
Provisions have been introduced by recent national legislation - and also by local legislation in some regions - for people who choose to stay at home (or stay longer away from work) to take care of family members who are in permanent and severe need of intensive assistance. These provisions range from extended work leaves (eg. a parent of disabled child can stay away from work for a maximum of two years without loosing his/her position, and then obtain a certain number of leaves in the course of the year), to the possibility of having a family member regularly hired as personal assistant (which means to have assistance recognised as work for the sake of pension contributions). Also personal assistance schemes have been introduced by recent laws, however this is left to the initiative of Municipalities within their budgets. It is also worth mentioning that personal assistance paid directly by the family is eligible for reduced VAT (10% instead of 20%), which often makes it more affordable.
Although Telecare is an emerging field in Italy with some promising developments, there are still few applications in use and these are mainly limited to some specialised areas of medicine (e.g tele-monitoring of electrocardiograms for people exposed to cardiological risks). Social Alarms systems are the only technology that show high penetration and degree of acceptance among users - including the older population - and healthcare professionals or social workers. Greater diffusion of advanced telecare system seems to be possible as a natural consequence of the diffusion of general ICT technologies in the organisation of Health and Social services.
Computer literacy among most professionals in the field is still low; the modification of work habits would require significant investment in training. However, the attitude of clients and professional is rapidly changing, in line with the fast uptake of ICT among the general population (e.g Italy is one of the Countries where the diffusion of cellular phones increased most rapidly in recent years), and powerful telecommunication facilities are becoming more and more available at affordable price (eg. broadband 10 Mb/s is already available to entire neighbourhoods in some cities). This is expected to open new horizons for telecare applications of the next generation, rather that to today's application.
| listing | back | next |