Assistenza a domicilio e assistenza residenziale: politiche di intervento e analisi empirica

Although in Italy most Long-Term Care is still provided in kind by unpaid informal caregivers, families are less and less likely to be in the condition to care for a disabled elderly. Given the social and financial implications associated with this trend, there is a growing interest in understanding the determinants of family decisions regarding living arrangements of the elderly, in order to implement effective policy measures aimed at containing costs and to enhance the quality of care. We estimate the effects of various household and individual characteristics on the choice of living care arrangement, considering a representative population sample of the Italian region Emilia Romagna. We exploit detailed information on the health conditions of the elderly person, on household socio-economic status and on family attitudes towards current welfare state services in order to identify the main determinants of the choice between institutionalisation and home care. Our results outline the predominance of disability indicators as opposed to family characteristics, economic variables and public services availability in determining the decision of the family. In an context in which social norms about filial responsibility still tend to consider the elderly institutionalisation with a consistent amount of social stigma, the institutionalisation is strictly influenced by the growing functional or cognitive impairments of the elderly and, to a lower extent, by economic status. Partly different from the international empirical literature, wealthier households have a larger probability to opt for the residential alternative.