Health care for older persons in Italy.

The aging of the population, with the ensuing rise in the number of older "clients" of the Health Agencies (15.2% people aged 0-14 vs 16% of those aged 64+ already in 1993), the new prospective payment system and a corporate philosophy were the driving forces that led the local Health Agencies to redesign the long-term care system, shifting resources from the hospital to the community. This shift constitutes a present challenge to the entire National Health Service. Furthermore, the Italian Health Service is also becoming decentralized, reflecting closely the political and administrative division of Italy into twenty regions. Regional authorities assign the available resources according to local needs and often interpret the central government's directives for controlling their health care budgets at their own discretion. As a result, profound interregional differences in health care expenditure occur which may aggravate the pre-existing inequalities between the Italian regions. In the coming years, the main priorities to satisfy the needs of frail elderly people are the following: 1) to adapt the number of rehabilitation beds to the standard of 1 bed for 1000 inhabitants; 2) to guarantee in all Health Agencies the presence of Geriatric Evaluation Units in a position to: perform comprehensive geriatric assessment immediately upon request; design and implement individualized care plans in agreement with general practitioners; determine the services that patients are eligible for; and coordinate the delivery and facilitate the integration process between social and health care professionals; 3) to develop all possible alternatives to hospitalization, chiefly programs of integrated home health care or hospital at home; and 4) to realize the number of beds already funded in skilled nursing facilities (RSA) while decreasing acute beds to 4/1000.