One of the most obvious inconsistencies is the failure to implement the so-called intermediate care in Lombardy; over 2,000 beds and which focus on the return home path of frail people, after hospitalisation. The same function of community hospitals, which are currently not active due to a lack of professionals on the labor market.
We are faced with a regulatory overproduction: the National recovery and resilience plan – Pnrr, with the structural funding of “hospitals and community homes” and with the provision of a five-year funding, partly current, for the strengthening of home care, law 33 /23 for the elderly, the ministerial decree 77/23 which defines the standards of the structures financed by the Pnrr, the hypothesis of new ministerial decrees on the auxiliary health professions to the nursing ones. However, no choice puts these acts into a programming logic.
In other words, there is no reading of the need, no verification of the effective structural and professional resources available, no definition of treatment paths based on the appropriateness of the response.
The hope is that the answer can be found, for example, in the implementing decrees of national law 33/23 on the subject of life paths of the elderly population. In that context, however, it is not difficult to read, due to the continuous declarations of the promoters of the law, a vision in which home care is valued in absolute terms without assessing the need for differentiated responses to the developmental needs of elderly people. The emphasis placed on setting home care, the set of treatments to be carried out at the home of the elderly, that is, it does not consider the most critical situations.
In other words, the integration between hospital and territory must start from the integration of available resources: the social and health system, and not just the hospital one, must be considered an integral part of the health system and treated with equal dignity. The enhancement of the territorial network is the instrumentto ease the pressure on hospitals and emergency rooms and also in favor of primary care.
We must not forget, for example, that a day of hospitalization of an elderly person in hospital costs the Regional Health Service – Ssr from 800 to one thousand euros, while a day of hospitalization in intermediate care is remunerated for just over 150 euros and a day in RSA and it does not exceed, for the Health System, the cost of 45, because the difference is paid by the family with the tuition.
It is necessary to implement integration with concreteness and valorise all the players in the system through a coherent allocation of resources, placing programming at the center of public political action.
* president of Uneba Lombardia