A Mixed-Methods Analysis of Care Arrangements of Older People with Limited Physical Abilities Living Alone in Italy

Abstract

Older people with limited physical abilities, who live alone without cohabiting family members, need support ageing in place and to perform daily living activities. In this respect, both the available informal and formal care seem crucial. The present study aimed to explore the current role of the care arrangements of older people, especially if they have functional limitations. Qualitative interviews were carried out in 2019 within the “Inclusive ageing in place” (IN-AGE) research project, involving 120 older people who lived at home, alone, or with a private personal care assistant (PCA) in three Italian regions (Lombardy, Marche, and Calabria). A mixed-methods analysis was conducted. Results showed that support networks are still mainly made up of family members, but also of domestic home help (DHH) and PCAs, friends/neighbours, and public services, albeit the latter provide support in a residual way, while the former is not as intensive as it was in the past. Frequency and geographical/living proximity of help play a role, emerging also as a territorial differentiation. The paucity or absence of support, especially from the family, risks compromising the ability of ageing in place. It seems, thus, necessary to innovate and improve, in particular, home services, also through real formal and informal care integration.

Role and Characteristics of Personal Care Assistants of Frail Older People with Functional Limitations Ageing in Place in Italy

“…The paper presents findings from the “Inclusive Ageing in Place” (IN-AGE) study, that involved 120 older men and women aged 65 years and over, who were interviewed in May–December 2019, in urban and rural sites of three Italian regions: Lombardy (North), Marche (Centre), and Calabria (South). These three contexts can in fact well represent the vertical/regional differentiations characterizing this country, with greater socio-economic disadvantage, especially regarding the availability of public services for caring older people, in the South, greater overall development of such services in the North, and with the Centre often showing an intermediate situation in this regard [ 16 ]. In particular, the three regions belong to three different welfare/care clusters [ 33 ], as follows: mainly cash-for-care, e.g., several beneficiaries of IA, in Calabria; mixed cash-for-care (IA and home care services) in the Marche; and the residential care cluster, with prevalence of beds availability in care facilities, in Lombardy.…”

“…The most fragile locations were detected within both urban and rural contexts, by using indicators regarding material, social and territorial vulnerability, e.g., greater presence of older people living alone; share of families living in public housing ( Edilizia Residenziale Pubblica —ERP); low education level; high unemployment level; and scarce availability of public services [ 39 ]. A purposive sample was built [ 40 ], with respondents selected as follows [ 16 ]: older people living alone at home or with the support of a PCA (cohabitant or on daily/nightly hourly basis, for at least 28 h per week); intermediate mobility (within the home, and outside with the support of a person or aids); absence of cognitive impairment as capacity to answer questions of interview independently; and absence of very close family members who give help (living in the same urban block/rural building). Respondents were recruited with the help of the local sections of Auser (Voluntary association for active ageing), operators of municipal/public home services (e.g., SAD), and further voluntary associations (Anteas, Caritas).…”

“…Reassurance was given to participants with regard to confidentiality/privacy and anonymity of the information collected, also following ethical issues according to the European General Data Protection Regulation (GDPR) n. 679 of 27 April 2016 [ 45 ]. Narratives were thus audio-recorded and transcribed verbatim by interviewers, replacing the identity of the respondents with alphanumeric codes [ 16 ].…”

“…Also, a thematic content analysis was carried out [ 48 ], starting from the questions included in the interview/topic guide. This was built as preliminary framework, based on theoretical-based categories relevant to the topic to be studied, and taken from the literature and experience of the researchers [ 16 , 49 ]. Statements from the interviews were then broken down within thematic charts (with cases/interviewees in rows and categories in columns), which were provided as Microsoft Excel 2019 (Microsoft Corporation, Washington, USA) sheets [ 40 ].…”

“…Moreover, in this country, about 50% of people living alone are over 65 [ 14 ], and 44% of this population group have severe limitations in performing the overall activities of daily living [ 15 ]. The main Long-Term Care (LTC) support for frail older people in Italy is still represented by the informal help of family members, especially children [ 16 , 17 ], who provide care to 86% of older people living alone [ 18 ]. Recent studies [ 19 , 20 ] indicated also that in this country, family caregivers are mainly women (60%) in the “middle age” (45–64 years).…”