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

Abstract

When older people become frail with functional limitations, and age alone in place, caring support is fundamental for performing daily living activities. The present study aimed to explore the current role and characteristics of privately hired Personal Care Assistants (PCAs) of older people in Italy, in light of the decreasing care availability of the family and the low provision of public services. In the study “Inclusive ageing in place” (IN-AGE), 120 qualitative interviews were carried out in 2019, involving frail older people living at home in three Italian regions: Lombardy, Marche, and Calabria. A content analysis was conducted, in addition to some simple quantifications of statements. Results showed the support of PCAs in 27 cases, mainly when health issues of seniors were referred. In addition, informal and irregular employment contracts were reported. Moreover, a comparison between PCA and Domestic Home Help (DHH, 44 cases), highlighted how they even more provide very similar functions (i.e., home and personal care). The role of PCA emerged as crucial in Italy, especially in the South. Thus, to boost up home services seems necessary for allowing ageing in place, also by integrating PCAs in formal public Long-Term Care (LTC), and by providing incentive systems for regular hiring.

Caring for Frail Older People Living Alone in Italy: Future Housing Solutions and Responsibilities of Family and Public Services, a Qualitative Study

“…Several authors point out that the availability of receiving support at home, at least through help for domestic work, allows older people to age in place [ 35 , 78 ]. In particular, a PCA is usually hired when seniors have health problems and require continuative help and nightly monitoring, but also in cases of widowhood [ 21 ].…”

“…The main risk factors for elder abuse are indeed related to the specific characteristics of the victims, and include, among others, cognitive impairment, dementia, poor mental health, depressive symptoms, and physical disabilities [ 83 ]. Previous studies in the literature also stressed the issue of the high cost of PCAs, impeding their involvement in caregiving for older frail adults with poor financial conditions [ 21 ].…”

“…In the latter country, where this study was carried out, the proportion of over 65 s was about 24% of the total population as of 1 January 2021 (i.e., the highest value among European countries), with 50% of people living alone aged over 65 years, and 44% of this population group having severe functional limitations and great difficulties in performing ADLs [ 21 ]. In such a context, belonging to a family-based care regime, the long-term care (LTC) system provides services such as home care, residential care, and especially cash benefits.…”

Social Innovation in Home-Based Eldercare: Strengths and Shortcomings of Integrating Migrant Care Workers into Long-Term Care in Tuscany

“…In practice, social innovation in Italian regions concerned with addressing both the gaps in governance of LTC, as well as the shortcomings of LTC provision, seems to neglect the integration of MCWs [ 45 ] despite their vital role in enabling older people’s ‘ageing in place’. Paid family assistants (of whom the majority are MCWs) compensate for decreasing resources of family caregivers and insufficient public homecare [ 47 ], and the deep-rooted informality and precarity of their employment calls for innovative solutions.…”

Frail Older People Ageing in Place in Italy: Use of Health Services and Relationship with General Practitioner

“…Overall, seniors reported severe functional limitations [ 5 ]. Indeed, physical and cognitive limitations often occur in later life and are a predictor of the overall degree of older adults’ frailty [ 6 ].…”