Lack of self-sufficiency: ten million ignored by the budget

There is a peculiar hierarchy in Italian politics: those who have a cause to champion count for a great deal, while those who no longer even have the strength to leave the house count for very little.

The 67-year-old discussing his pension finds political parties, platforms and slogans. The 88-year-old with Alzheimer’s, who cannot dress himself and needs someone to help him even at night, has no march to join, no group capable of bringing traffic to a standstill, no protest to make the front page.

And yet, all around him, there is a world that the political sphere all too often observes from afar.

There are around four million elderly people in Italy who are unable to look after themselves. Taking into account family members and care workers, the number of people affected is around ten million. Ten million. Not a niche group, not a negligible minority, not a minor detail of the welfare system. A huge section of the country that is wondering who will take a parent to the doctor, who will prepare meals, who will pay the home care worker, and how to balance a job with a sleepless night.

Major social issues don’t always come with a megaphone: sometimes they begin with a fall in the bathroom, a phone call from hospital, or a life-changing diagnosis.

The paradox is that Italy talks obsessively about old age when it comes to pensions, but far less so when it comes to losing one’s independence. The political establishment, holed up in its own little world, recognises those who already have a public voice; it struggles to see those who depend on the voices of their children, spouses or carers. And when a need does not make the headlines, it often does not even make it onto the agenda.

Then there is an age-old excuse, one that even appears affectionate on the surface: ‘the family will take care of it’. But this phrase conceals an invisible cost, paid for in lost working hours, depleted savings and stunted careers. Care does not disappear if the state fails to organise it: it is simply shifted into people’s homes. According to data collected by the Pact for a New Welfare System on dependency, elderly people receiving home care receive, on average, just sixteen hours of public assistance per year; around 270,000 people are waiting for a place in a residential care home. Sixteen hours a year for needs that arise every day.

This is not an intractable problem, nor is it a story where nothing has changed. In 2023, a reform was passed, and in early October the government approved a National Plan addressing the frailty and lack of self-sufficiency amongst the elderly. These are important steps. But there is a gap between drafting a reform and implementing it on the ground, a gap measured in terms of services, staff and resources.

There is a concrete proposal, drawn up by sixty organisations united under the Pact: fewer offices and repetitive assessments, home care that combines medical treatment with day-to-day support, more places and staff in care facilities, funding proportionate to needs, and incentives for regular care work. In July, they were asking for around one billion for 2027; taking budgetary constraints into account, they have reduced their request to at least five hundred million to get started. They do not claim to be able to solve everything in a year. They are asking that the first step not be postponed any further.

And bear in mind: helping an elderly person who is unable to look after themselves is not merely a social welfare expense. It can prevent hospital admissions, create jobs in the care sector, and enable children and spouses to continue working. It is also an economic issue. And these sixty organisations offer a lesson: they are not calling for a strike, nor are they looking for a scapegoat. They offer figures, solutions and a roadmap. A proposal, not a protest.

Politics must not have to choose between young and old, or between fiscal prudence and solidarity. It must, however, take notice of a silent majority from whom it continues to demand patience.

Over the next ten years, according to the Pact’s estimates, the number of people aged over 85 will rise by 30 per cent. That silence will become increasingly crowded. Perhaps the real political breakthrough will not be to invent yet another battle for those who know how to make themselves heard, but to finally recognise those who cannot shout.