1. Lazio Regional Authority strategy
Workshop presented by:
Regione Lazio, Italia
Social and healthcare integration
Lazio Regional Authority strategy
to support people with Alzheimer’s
22nd European Social Services Conference – Rome, 7-9 July 2014

2. 7.3 million people with dementia in EU27
Alzheimer’s in Europe
CONTEXT
7.3 million people with dementia in EU27
numbers expected to at least double by 2040
€ 160 billion: the total estimated cost of dementia disorders in EU27 in 2008
56% of which were costs of informal (unpaid) care
€ per person per year: the average cost with dementia in EU27
Source: Anders Wimo, 2008 – in Alzheimer Europe
22nd European Social Services Conference – Rome, 7-9 July 2014

3. Alzheimer’s in Italy CONTEXT
In Italy, more than 1 million people are affected by dementia
affected by Alzheimer's disease
Total cost of dementia is estimated beyond 29 billions €
The cost per demented is about €
Source: Alzheimer Italia, 2011 e Alzheimer Europe, 2008
Direct costs are 15% of the total,
i.e € per demented
Informal care costs are 85% of total cost, i.e € per demented
Source: Alzheimer Europe, 2008
22nd European Social Services Conference – Rome, 7-9 July 2014

4. Alzheimer’s in Lazio CONTEXT Total inhabitants of Lazio: 5.500.000
Inhabitants aged 65+:
Estimated dementia incidence:
(6% of population aged 65+)
Estimated Alzheimer’s incidence: (55% of all dementias)
Actual patients in care affected by dementia:
Costs incurred by families (80%)
Costs incurred by public sector (20%)
Direct costs
Direct share of health and social service costs
Costs for assistance personnel and aid tools
Informal care costs
Loss of productivity (for both demented and family members)
Psychological and physical stress and pain for informal caregivers
Direct costs
Medical exams, hospital stays, medicines
Formal care: home care, day care centers
Nursing homes
Financial support to demented and families: disability pensions, vouchers for assistance, etc.
22nd European Social Services Conference – Rome, 7-9 July 2014

5. World Report on Alzheimer’s 2013 CONTEXT
The 2013 World Report on Alzheimer’s outlines the following main Recommendations:
Governments around the world should make dementia a priority by implementing national plans…
Monitor the quality of dementia care in all settings
Autonomy and choice should be promoted at all stages of the dementia journey
Health and social care systems should be better integrated
Need to train caregivers and to provide them with financial reward
Quality of life at home can be as good, and costs are comparable
The quality of care in care homes should be monitored through the quality of life and satisfaction of their residents
22nd European Social Services Conference – Rome, 7-9 July 2014

6. National level Lazio Region Regulatory framework in Italy CONTEXT
L. 104/1992 – National law on assistance, social inclusion and rights of the disabled
L.R. 6/2012 – Regional Plan for people affected by Alzheimer-Perusini’s and other dementias
A national plan on Alzheimer’s is to be approved
It defines the service network, access procedures, some governance tools such as the Dementias Information System and the Dementias Regional Register.
Services are designed as follows:
Centres for diagnosis and medical treatment
Semi-residential/Residential services (both health and social care)
Home care
Financial support to families and to volunteering associations
Training courses for caregivers + information for demented and families
Register and Information system
22nd European Social Services Conference – Rome, 7-9 July 2014

7. Objectives Overview on the Regional Plan REGIONAL POLICY
National and regional resources in 2012
Fund for disability (non self sufficient persons, LSA, dementias, etc.) € ,00
 Specific fund for Alzheimer's € ,00 (DGR 504/2012)
Objectives
To foster a multidimensional approach to Alzheimer's disease
To realize and integrated network of health and social services for demented and their families
To even out the services offer on the whole of regional territory
22nd European Social Services Conference – Rome, 7-9 July 2014

8. New social units coinciding with health units
Outstanding features
REGIONAL POLICY
New social units coinciding with health units
Integrated health-and-social actions
Bottom up process in service design and delivery
Service standardization
Online monitoring and financial reporting
22nd European Social Services Conference – Rome, 7-9 July 2014

9. Health Social New social units REGIONAL POLICY
Health units (ASL)
Social Districts and new social scope units
8 new social units coinciding with health units and formed by social districts
22nd European Social Services Conference – Rome, 7-9 July 2014

10. Health Social Social & healthcare integration REGIONAL POLICY
New social services units: coinciding with health units
Shared methodology between social services and health sector
Shared design of Individual Assistance plan (PAI)
Shared services delivery with health sector
22nd European Social Services Conference – Rome, 7-9 July 2014

11. 41 53 6 Resources destination REGIONAL POLICY
22nd European Social Services Conference – Rome, 7-9 July 2014

12. Outcome Criticalities
Residential & semi
RESULTS AND PERFORMANCE
Day care centres for Alzheimer's
Short term residential service
Outcome
Criticalities
Service offer in 2012:
19 day care centres with 400 places
Increase of service offer in 2014:
8 new day care centres and 140 places
High start up and management costs
Uncertainty about level of financial resources through different years
Service offer in 2012:
120 short term residential places
Increase of service offer in 2014:
30 short term residential places
Territorial diversity in service offer:
17 day care centres in Rome

13. Outcome Criticalities
Home-care
RESULTS AND PERFORMANCE
Direct and indirect home-care
Outcome
Criticalities
Current offer:
8.500 users
Increase of:
500 new users who will receive home-care
Uneven service supply:
from six months to one year
from 12 to 44 hours per month
from 100 to 800 € per month
Home care is the most requested service in
non-metropolitan areas

14. Outcome Criticalities
Information & training
RESULTS AND PERFORMANCE
Information to families
Self-mutual help of informal care-givers
Alzheimer Cafè
Care-givers training
Outcome
Criticalities
Uneven use of financial resources and kind of service delivered
New places for socialization (Alzheimer Café)
Development of family networks
Training for 130 formal and informal caregivers
Care-givers often get little Alzheimer’s specific training

15. Summing up… on the positive side
Conclusions
RESULTS AND PERFORMANCE
Summing up… on the positive side
Widening of type and quantity of supplyed services
Guidelines in service supplying
Online application for monitoring and financial reporting

16. Summing up… the critical sides
Conclusions
RESULTS AND PERFORMANCE
Summing up… the critical sides
Uneven territorial distribution of service supplying (cultural and social differences, infrastructure, etc.)
Lack of specific standards for services (access procedures, fruition, territorial characteristics, functions, costs)

17. Themes for working groups
Informal care: choice or necessity?
Quality of services: the point of view the supplier Vs the point of view of the user
A look at the future: what services for Alzheimer’s?
22nd European Social Services Conference – Rome, 7-9 July 2014