Long term care in Italy: coping with frailty and dependence

By employing micro-data from the SHARE survey and the ISTAT Multipurpose survey, we assess the unmet demand for long term care of older Italians and identify the groups of individuals that are at higher risk of lack of protection. We measure frailty/dependence based on an adaptation of the Katz index, which makes use of the number of limitations in the activities of daily living ADL. We propose different models to identify the determinants of the probability of experiencing frailty in later life and introduce a novel concept of “pre-frailty” . Our results indicate that lower levels of education, being a woman and residing in Southern Italy are associated with increased likelihood of being pre-frail/frail. Living alone significantly affects dependence as measured by frailty or pre-frailty at older ages. The potential demand for long term care services is compared with the existing coverages, both public and private: a marked and widespread lack of protection emerges for people who are mostly in need, with very high potential costs for individuals, households and society at large.