1. Beatrice Rovai, CHP/Local Health Unit, area of North-Western Florence Rossella Scarpelli, CHP/Local Health Unit, area of Florence Raffaele Uccello, Municipality of Florence EUROSOCIALNETWORK System of services for non-self sufficient elderly people EUROSOCIALNETWORK

2. EUROSOCIALNETWORK TITOLO La gestione delle adozioni internazionali in Italia THE DEMOGRAPHIC CONTEXT IN SHORT SIZE OF THE ELDERLY POPULATION Elderly population in Italy: 20.23% of the total population Elderly population in the Province of Florence: 23.63% of the total population Elderly population in the city of Florence: 25.66% of the total population Ageing index in Italy: 144 (144 people aged 65 and over/100 people aged 14 and less) Ageing Index in the Province of Florence: 183 (183 people aged 65 and over/100 people aged 14 and less) Ageing Index in the city of Florence: 218 (218 people aged 65 and over/100 people aged 14 and less) Consequently: high incidence of the presence of elderly people in the population of the Province of Florence, with consequences on the social and healthcare policies.

3. EUROSOCIALNETWORK TITOLO La gestione delle adozioni internazionali in Italia DEFINITION OF NON-SELF SUFFICIENCY Non-self sufficient are considered those persons, who have permanently, partially or totally lost the autonomy of their physical, sensorial, cognitive and relational skills because of any determined cause with consequent inability to perform the essential acts of everyday life without the relevant help of other people. Italian regional Law No. 66/2008 (establishing the Fund for non-self sufficient people)

4. EUROSOCIALNETWORK TITOLO La gestione delle adozioni internazionali in Italia REGIONAL AND LOCAL TARGETS Improve the quality, the quantity and the pertinence of the care services Promote the achievement of a system based on the prevention of non-self sufficiency and frailty Favour care paths which make independent life and home care possible

5. EUROSOCIALNETWORK TITOLO La gestione delle adozioni internazionali in Italia THE FUND FOR NON-SELF SUFFICIENT PEOPLE The Tuscan Regional District has set up in 2008 the Fund for non-self sufficient people. GOALS: sustain and extend the system of integrated public health services in favour of non-self sufficient people with disabilities and elderly people

7. EUROSOCIALNETWORK TITOLO La gestione delle adozioni internazionali in Italia HOW CAN ELDERLY PEOPLE HAVE ACCESS TO THE SERVICES FOR NON-SELF SUFFICIENCY The access is granted through a procedure, which provides for the intervention of the following actors in the following order: PUNTI INSIEME (“together points”): reception desk where families can ask for information and for the activation of the procedure for the admittance to the services. ADMITTANCE SINGLE-POINT (It. PUA): Coordination and management of the procedure of admittance MULTIDISCIPLINARY ASSESSMENT TEAM: it is an integrated group formed by a doctor, a social worker and a nurse. It is responsible for the assessment of the real needs and for the settlement of a Customized Welfare Project (It. PAP). PAP: covers home care, residential and/or semi-residential care in conjunction with the needs, with the goals of the intervention and with the severity level.

10. EUROSOCIALNETWORK TITOLO La gestione delle adozioni internazionali in Italia Cognitive Impairment (Pfeiffer score) Dependecy BADL Light (MDS-ADL score 8-14 or <8 but ≥3 in at least one ADL) Dependency BADL Mild (MDS-ADL score 15-21 or 8-14 but 4 in at least one ADL) Dependency BADL Severe (MDS-ADL score 22-28) Behavioural/mood disorders (MDS files integrated score) Behavioural/mood disorders (MDS files integrated score) Behavioural/mood disorders (MDS files integrated score) None-Light (0 – 3 no 2) Mild (4 – 7 or < 4 but one item = 2) Severe (8 – 12 or 4 -7 but at least 2 items = 2) None-Light (0 – 3 no 2) Mild (4 – 7 or < 4 but one item = 2) Severe (8 – 12 or 4 -7 but at least 2 items = 2) None-Light (0 – 3 no 2) Mild (4 – 7 or < 4 but one item = 2) Severe (8 – 12 or 4 -7 but at least 2 items= 2) None-Light (0 – 4) 1 2 3 2 3 4 4 4 5 Mild (5 – 7) 2 2 3 3 3 4 4 4 5 Severe (8–10) 3 3 4 3 4 5 4 5 5

11. EUROSOCIALNETWORK TITOLO La gestione delle adozioni internazionali in Italia The interventions for non-self sufficient elderly people are based on severity levels from 3 to 5 (in green in the chart above) . The persons with lower severity level (from 0 to 2, in red in the chart) do not have the right to access to the interventions financed by the Fund for non-self sufficient people, but can benefit from other resources. THE ROLE OF THE SOCIAL EVALUATION Once assessed the level of severity, the socio-environmental situation is fundamental in order to establish the type of healthcare needed (homecare or residential care). If homecare must be provided the regional model contemplates a relationship between level of severity and provided resources.

14. EUROSOCIALNETWORK TITOLO La gestione delle adozioni internazionali in Italia HOW THE SHARING ON PART OF THE BENEFICIARIES IS DETERMINED The sharing is based on the equivalent economic status indicator (ISEE), a combination of revenues and property (real and personal) of the family, calculated on the basis of the number of members and of the existence of any possible “hard situation” for the family (people with disabilities, minors, …) For non-self sufficient people the indicator (ISEE), only referring to the beneficiary, is taken into account (the rest of the family is excluded) In case of reception in a nursing home also the personal and economic situation of the partner and of the children is evaluated. The level of sharing ranges from zero (corresponding to the exemption threshold) to 100% of the total cost of the service. The cost covered by the public health reports is not subject to any sharing.

15. EUROSOCIALNETWORK TITOLO La gestione delle adozioni internazionali in Italia FORMS OF ADMINISTRATION OF THE SERVICES Direct administration (through direct resources or contracts) Indirect administration (agreements/enlistment and possible vouchers) Economic contributions (usually bound to the expenses) Main examples: Residential care and day care centres  Usually, agreements with private structures and some experiences of vouchering Home care  Usually through contracts with co-operatives. Some experiences of vouchering, which can be spent only at enlisted facilities Subsidies for family caregivers  Reimbursement in favour of the beneficiary bound to the employment of a family caregiver

16. EUROSOCIALNETWORK TITOLO La gestione delle adozioni internazionali in Italia Thanks for your attention!