Home care for the elderly reducing the need for extra beds in care homes

Between 2019 and 2021, your department developed the Integrated Elderly and Home Care Planning for 2021-2030. Are you finding similarities with the national study?

"A direct comparison between the two estimates is difficult, first of all because of the different time horizon considered and secondly because in developing the Integrated Planning, the estimates took into account specific cantonal features that are not evaluated in the OBSAN report, designed on a national scale. I am thinking in particular of the - more advanced - Ticino's age structure relative to the national average and the significant range of services provided in a widespread manner by support services (e.g., day care centers). Yet, the adaptation of the OBSAN study's nationwide estimates to Ticino's situation allows us to confirm a future need for beds in our region's homes for the elderly that is similar to that indicated in Integrated Planning. Moreover, the cantonal estimate of staffing requirements is substantially in line with the one made by another OBSAN report."

By contrast, what are the most important differences between the two estimates?

"In 2010, the evolution of the projected need for the number of beds in homes for the elderly was partially slowed down considerably due to one of the cardinal principles of Cantonal Planning, which gives priority to maintenance at home, respecting the freedom of choice and self-determination of the people concerned, and which is proposed to be guaranteed through an important strengthening of home care."

The high growth rate of the elderly population confronts cantonal authorities with the need for rapid and thoughtful action. Does Integrated Planning meet the future needs of this segment of citizens?

"Western society in general and national or cantonal society in particular are facing demographic challenges and changes that require a new approach in the provision of long-term care. Integrated Planning provides the sectoral strategic vision for the next decade and proposes concrete responses that focus on the needs of the elderly and their families and, more generally, on the person with his or her values. Central to enabling access to long-term care for every needy person in future is the choice to further strengthen home-based caregiving. This corresponds also to the desire of the majority of elderly individuals to be able to remain at home, even in the face of complex and fragile situations. This strategy has been followed in our canton for about two decades and places us along with other cantons in French-speaking Switzerland among the pioneers in this field. In fact, the OBSAN study placed Ticino in the group of cantons with the strongest emphasis on home care."

How does the home care-oriented strategy translate in practice?

"The most obvious is the progressive reduction in the density of beds in homes for the elderly, in proportion to the population aged 80 and over, which finds a concrete answer to its care needs in the major strengthening of home care and care services and home maintenance support services, such as day care centers, services that provide meals at home or transportation services. Integrated care networks are also a cornerstone of the sector's future operation. Planning promotes the integration of networked facilities and services in order to improve access to services, facilitate dialogue among all actors, and respond in a calibrated manner to regional needs. Integration of services is essential for social and health care provision on the ground."

How many long-term care beds will Ticino need by 2040?

"At this time, cantonal estimates of the need until 2040 have not yet been developed. However, under the demographic scenario considered most likely for the canton of Ticino, the Federal Statistical Office predicts that the population over 80 years of age, which is the one that will determine the need for beds in long-term care homes the greatest, will grow by about 18 percent between 2030 and 2040, while the overall population will increase by only 1.4 percent during the same period. Providing a supply targeting the needs of this group will therefore remain a key task even in the next decade."

But what if we look "only" to 2030 instead? What is the planning horizon?

"We expect the creation of 1,180 new beds in homes for the elderly (of which 870 have already been authorized), compared to 4,580 today. This is an increase of about 25 percent by 2030. Such an approach reflects the strengthening of home care versus inpatient care, given that, as I mentioned, it entails a reduction in the density of beds in homes for the elderly as a proportion of the elderly population. In addition, we expect the restraint in bed growth to be offset through an increase in the services provided by home care and nursing services by about 60 percent, and in those offered in the area of support services and direct aids for home maintenance by about 105 percent. The major increase in the latter is due to the fact that, in addition to the future need to accommodate more users in the home care setting, there is currently an unfilled need in the support services, which we will try to fill."

Speaking of caregivers: the study indicates 34,000 new jobs by 2040. A huge need. How does the government plan to act, taking into consideration the fact that there is a shortage of staff already today?

"Already today, in order to cover the need for manpower in the social-health sector, it would take one in five young people from Ticino to pursue this career. And that is why, to satisfy the demand, institutions rely on the Italian market. The government, at the beginning of the legislature, had recognized this need and formulated the Prosan 2024 project (already approved by the GC, ed.), aimed on the one hand at strengthening training, and on the other at raising awareness among young people to bring them closer to these professions. Not forgetting some economic incentives for internships."

A sensitive chapter, a direct consequence of a societal phenomenon, concerns family caregivers. Today, fewer and fewer children are able to care - by choice or for professional reasons - for their elderly parents. How does cantonal planning respond?

"We are confident that family caregivers are a core reality, one of the main elements of the care-giving network, especially with regard to home maintenance. Cantonal Planning aims to further enhance these fundamental figures. Indeed, with the gradual aging of society and the growing need for care highlighted also by the OBSAN report, this role will only increase in importance. The enhancement of volunteerism is also on the list of priorities for the implementation of Integrated Planning, which includes a range of supporting measures."

Will Planning be revised again before the year 2030?

"Yes. In addressing the sector's future challenges, the goal is to ensure flexibility and responsiveness in a timely and financially sustainable manner, which Planning intends to consider with a periodic update in the middle of the decade and any further updates that may be necessary. It needs the collaboration of all stakeholders to encourage the strengthening of sharing and dialogue between institutional and private partners."

The cantonal health system is placing increasing emphasis on outpatient care. But is this kind of strategy still bearable in the long run, considering the marked aging of the population and thus the gradual increase in the need for inpatient care?

"The outpatient health care system pathway is viable even with an aging population that is increasingly living in frail situations, provided that outpatient interventions are well matched between acute and post-acute care providers. Along with the evolution of medical technology, which influences downward the average hospital stay, Hospital Planning, as well as the aforementioned Integrated Elderly and Home Care Planning, must take into account the aging population by arranging for segments of care that can allow for the reconciliation of continuity of care and staying at home as long as possible."