Rsa access: between waits and fixed-term hospitalizations. Think about structures modeled on a house

The daughter of an 84 year old lady says, admitted to a Roman hospital: My mother, 100% disabled, has to be transferred to one Rsa as it requires continuous assistance, but noYou can't find the “place”. And thehome assistance can be guaranteed only a few hours a day (excluding holidays). Meanwhile, waiting in the hospital. It also happens that the admission to a residential facility is completeignoring the patient's healthcare needs, as reported by Francesco Pallante, full professor of Constitutional Law at the University of Turin: Mr. GS, ninety years old, 100% disabled and in need of continuous care, lives in a Region whose legislation provides that non-self-sufficient chronically ill people can be hospitalized in RSA paid by the regional health service
for a maximum of 90 days a yearregardless of whether or not he is cured. Having reached 88 days of hospitalization, he received a letter urging him to “resign”. The relatives have presented opposition to the resignation, forcing the RSA to keep him hospitalized their sick relative: certainly, you cannot put a non-self-sufficient person on the street, otherwise you would commit a crime.

The strategies adopted by the Regions

These are not isolated cases. The Regions they adopt one plurality of different strategies to make the right to health less “demandable”, underlines the jurist. Someone they differ in time taking care of sick people with their inclusion on waiting or review lists (non-urgent case, therefore hospitalization is postponed from year to year). Other Regions subordinate taking charge of the patient toexistence of further (non-health) requirements) such as economic hardship, lack of family members, social isolation; others, still, they ascribe healthcare services to the arealegislatively less protected and subject to cost sharing, of welfare or social benefits.

What will change with the non-self-sufficiency reform

What will change with the Reform of non-self-sufficiencyin force from March 2023, which will be operational only after the definitive approval of the Legislative Decree General principles and measures to support the elderly population
(approved by the Council of Ministers on 25 January, the process for the final green light will now follow ed)? There law 33/23 pushes towards strengthening of home care, obvious solution for a world made up of non-self-sufficient elderly people with multiple pathologieswhich they must find answers to their needs, in their home, with adequate medical-nursing but also social assistance – underlines Professor Roberto Bernabei, president of Italia Longeva (national research network on aging and active longevity, created by the Ministry of Health with the Marche Region and the National Institute of hospitalization) —. Currently, according to data from the Ministry of Health, thehome care guaranteed to 3.6 percent of those aged over 65but in reality it is less than 1 percent if you consider that, on average, a person receives approximately 20 hours of home care in a yearWhile d
it should be at least 20 hours per month. A truly insignificant figure, just think about it no European country has less than 7-8 percent of those assisted at home
And with more than 20 hours a month

.
Hence the frequent use of our elderly people in the emergency room. Professor Bernabei points out: If you go to any Emergency room Italian the
n any time of the year one is found 90 percent of the queue is made up of people over 75 who cannot find answers elsewhere.

Italian care model in crisis

We are among the people longest-lived in the world but fewer and fewer children are bornso in the future we will be able to count less and less on the support of large families. And she's starting to creak the Italian model of assistance for non-self-sufficient people cared for at home by family members and carers.
The geriatrician reasons: In our country they live approximately 22 thousand centenarians and over 900 thousand over 90 years oldof which approx 650 thousand women. Between these, half suffer of dementia. And there will be more and more people with cognitive problems, without children, alone. From here the also requires residential care for people non self-sufficient people who cannot benefit from home care (unthinkable that they are 24 hours a day) and without caregivers. Already today – reports Professor Bernabei – approximately 60 percent of residents in nursing homes suffer from dementia, others – but also those with dementia – suffer from
diabetes, ischemic heart disease, hypertension and other pathologies, that is sick people
. It is necessary to ensure that this
And structures they are of quality And,
in addition to offering aadequate healthcare with trained and competent healthcare personnel, are more and more close to the model of a house, that is, a place where life is as pleasant as possible, also made up of sociality and relationships.
In short, not “parking spaces for old people”, but residences to be in cared for and live with dignity in contexts capable of enhancing the residual capabilities of those who are no longer self-sufficient.

Even geriatricians must become permanent presences

The geriatrician
that doctor who takes care of the needs and pathologies of elderly people, for example slow down physical and cognitive decline as much as possible, and yet present only in a few RSAsas Andrea Ungar, president of the Italian Society of Geriatrics and Gerontology, points out: one figure foreseen only in some Regionsbut National rules and standards are needed because there is a geriatric approach in all residential facilities.
The promoters of the program also ask for it Manifesto for the RSAssigned by scientific societies of geriatrics and all the employers' associations that adhere to the inter-association coordination of the social and healthcare sector.

Among the new features are animal-assisted interventions in Rsa

The Implementation decree of Law 33approved by the Council of Ministers on 25 January and which will have to follow the process for the definitive green light, provides among other things interventions assisted with animals in RSA And that residential facilities promote the quality of living environments in order to make them friendly, familiar and safe. It is then reiterated that, in compliance with the requirements for accreditation by Legislative Decree no. 502/1992, residential socio-health facilities can be equipped with distinct modules for the provision of treatments with different levels of care intensity as well as integrated home care, characterizing itself as Multiservice Residential Centres (CRM).

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