Innovating LTC policy in Italy from below: Lombardy and Piedmont confronting the challenge of inclusive local care environments

Abstract

Italy is one of the countries with the oldest population in the world. In spite of that and of the alarming estimates about future demographic trends, Long Term Care (LTC) policy in Italy is still struggling to be acknowledged as a relevant issue in the public debate and political agenda. So far, policy inertia has instead been prevailing at the national level, leaving the question of how to take care of the growing number of vulnerable elderly people largely dependent on the abilities of (shrinking) individual families. To date, while institutionalization rates are comparatively low and public home care services are weak, the major national measure to support elderly people in need of care consists in a flat-rate, unconditional cash-transfer. In this context, most families end up taking care of the elderly at home, either directly (through informal care) or indirectly (by hiring a caregiver or a helper, not rarely in the shadow economy). Against this backdrop, the interplay between high functional pressures and low public effort, compared to other social policy sectors, makes LTC policy likely to constitute a privileged area for investigating current and potential Social Innovation policy developments, especially at the local level. In sharp contrast with the frozen national scenario, in the last years many territories – especially in the North of the country – have indeed been experimenting new solutions in the field of LTC, addressing the challenge of building more inclusive local care environments for frail (dependent) elderly people and their families. Building on this, the paper aims at dealing with the most recent academic literature on Social Innovation and the policy discourse elaborated by the EU over the last decade in order to: i) develop a “working definition” of Social Innovation with specific reference to LTC and the notion of inclusive local care environment; ii) illustrate and provide a comparative analysis of a set of selected innovative solutions implemented in two Italian regions, Lombardy and Piedmont, which fall in between full institutionalization and full family-based care; iii) discuss the factors behind the adoption of socially innovative policy solutions at the local level, shedding light on the key role played by new actors (e.g. nonprofit organizations, bank foundations, social partners, private companies) and the building up of multi-stakeholder networks between them and local public institutions. Keywords: Ageing, Long Term Care, social innovation, inclusive local care environments, Italy JEL: I30 / I38