Financing of Care Services for Persons with Disabilities
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Latvia Czech republic Hungary Poland Estonia Slovenia Lithuania Malta Fact Sheet Slovakia Cyprus Italy FINANCING OF CARE SERVICES FOR PERSONS WITH DISABILITIES Written by Fabio Belafatti, Senior Researcher, Policy Impact Lab Coordination and Editing by Policy Impact Lab Copyright © EASPD 2020 All rights reserved. No part of this publication may be reproduced, stored in or introduced into a retrieval system without the prior permission of the copyright owners. This publication has been produced with the financial support from the European Union Programme for Employment and Social Innovation “EaSI” (2014-2020). This publication reflects the view only of the author and the Commission cannot be held responsible for any use which may be made of the information contained therein. Financing of Care Services for Persons with Disabilities Contents Executive summary 2 Introduction 3 Legal framework for governance and delivery of services ............................................................................................................... 3 Management of care services ......................................................................................................................................................................................................... 3 Who delivers services? .............................................................................................................................................................................................................................. 4 Amounts and main funding models in day care, supported living, long-term care ................................ 5 Chronology of introduction of funding models used in the three sectors ............................................................... 8 Future Plans ................................................................................................................................................................................................................................................................ 9 Day Care 9 Accessibility ................................................................................................................................................................................................................................................................. 9 Amount of state funding – specific to day care services ..................................................................................................................... 9 Quality of day care services .........................................................................................................................................................................................................10 Independent/Supported Living 10 Amount of state funding – specific to supported/independent living services ............................................10 Accessibility and quality of supported/independent living services ............................................................................10 Working conditions of staff of providers of supported/independent living services ..........................11 Future plans in financing/governance of supported/independent living services ..................................12 Long-Term Institutional Care 12 Amount of state funding – specific to long-term institutional care .................................................................................12 Funding of providers of long-term institutional care ..............................................................................................................................13 Accessibility and quality of long-term institutional care ...................................................................................................................13 Links between funding models and changes in access, quality, working conditions ......................13 Future plans for financing/governance of long-term institutional care ....................................................................13 Respite care 14 Interviews 15 References 16 Annex 1 19 Annex 2 26 Annex 3 30 Annex 4 33 1 Latvia Czech republic Hungary Poland Estonia Slovenia Lithuania Malta Slovakia ITALY Cyprus Executive summary Funding of social care for PWDs in Italy mostly relies on Social care not directly organized by families themselves families and users’ own expenditure, much of which is is accessible (when local budgets allow it) through unaccounted for. As most PWDs in the country are over structures, services or facilities managed by private non- 65, a vast portion of care for PWDs is handled as care for profit organizations or private for-profit ones, and to an older people: this depends heavily on families’ ability to ever decreasing extent, by public authorities themselves. afford solutions of independent living, often through the Throughout the country, the dominating model for help of semi-legally or illegally employed caregivers. As funding of providers is accreditamento (accreditation), employment in this crucial area of care is mostly un(der) a process of pre-selection of providers on the basis of declared, data on families’ expenditure is necessarily strict quality requirements and guarantees of continuity scarce and incomplete. of services which allows to avoid repeating public tenders for every service. Accreditation guarantees high quality, Existing data allow to trace only the amounts that but stifles innovation. All areas of care are considered to authorities spend, be it for the direct provision of social be underfunded and providing insufficient coverage, and care services, or in the form of integration of families face major funding problems due to the COVID-19 crisis. and users’ personal budgets through pensions or other indemnities. Local authorities cover 83% of costs of the Main Findings social services for PWDs they offer, although it should The Italian system of care suffers from heavy reliance be noted that such services address only a small fraction on families and users’ budgets: this creates an issue of of care needs. The remaining 17% is paid by National sustainability as the population ages and family networks Healthcare Service (13%) and users (4%). For the direct of support shift towards narrow, multi-generational provision of social care for PWDs, Italian municipalities structures. It also creates measurement and planning spent €1.311bln in 2019, down from €1.870bln in 2017. problems, due to the lack of reliable statistics on National funds exist but their aggregated value is lower expenditures for home caregivers, often hired illegally or than the amount spent by municipalities: in 2020 the semi-legally, which leave authorities unable to properly key national funds totalled €704.1mln. Italian authorities plan and address care needs. Public funding through spend considerably more for integration of families and the accreditation model guarantees very good quality, users’ budgets: €20.052bln (2019 data) in tax-funded but does not ensure full coverage. National funds remain pensions, and an additional €14bln (2017 data) in secondary to local authorities’ ones. Private funds are an pensions funded via social security contributions. Private underexploited but a promising area of funding for the funds also exist but their development is still in its infancy. future. Care for PWDs in Italy is regulated at national and regional Besides the lack of resources, the other key problem for level. Social care is in turn managed and delivered at the Italian system of care relates to regional inequalities, municipal level, either by municipalities themselves or especially in the area of social care, due to the reliance supra-municipal authorities, while care for PWDs that on local taxation to fund services. The idea of delegating includes elements of healthcare is generally managed and social services to municipalities to ensure a provision and delivered at regional level. Differences in regional laws management of services that could correctly reflect the cause variations in local governance. Massive regional territory’s needs eventually resulted in the creation of and sub-regional inequalities exist in quality and coverage massive gaps between regions, and between low- and of care services for PWDs: as social care services are high-income areas within the same regions. North-South financed with local taxation, municipalities from lower- inequalities create a situation of “two Italies” with vastly income areas (especially in the South of the country, and different coverage figures, but inequalities exist also in de-industrialized areas in the North and Centre) are between North-Western and North-Eastern regions. put in a condition of major disadvantage and are unable National funds need to be vastly increased and directed to ensure more than a negligible amount of social care. with priority at the reduction of regional inequalities. 2 Financing of Care Services for Persons with Disabilities Introduction Legal framework for governance Management of care services and delivery of services Central authorities define general guidelines and monitor their implementation Care for PWDs in Italy is regulated by Laws 104/1992 : Since 2018, oversight and 328/2000,1 with a thorough reform expected in was centralized in a dedicated office, supported by a 7 2021.2 These laws set standards for regional and local National Observatory. Both fall under the Council of authorities, but since social care is often handled with Ministers, and respond to the