The COVID-19 Long-Term Care situation in Italy: nursing homes alone on the frontline

Sara Berloto, Elisabetta Notarnicola, Eleonora Perobelli, Andrea Rotolo (Observatory on Long Term Care, Cergas SDA Bocconi School of Management)

30th April 2020

Key findings from an updated report on the Long-Term Care situation in Italy during COVID-19, the full report is available here:

  • The Italian government acted late on the COVID-19 outbreak management in nursing homes. The first operational guidelines were released after the country’s total lockdown on March 9th, only requiring care homes to suspend visitations. An update of the operational guidelines dedicated to nursing homes was released by the Ministry of Health only on March 25th. The first COVID-19 case was detected in Italy on January 30.
  • Regions are responsible for the operational regulation of the LTC sector: after the outbreak, they enacted late and differing responses without any clear guidance from the national legislator.
  • Italy faced a massive shortage of Personal Protection Equipment (PPE): nursing homes were not prioritized for receiving new procurements. Workers and care users have not been sufficiently protected from the spread of COVID-19.
  • The National Institute of Health (Istituto Superiore di Sanità) launched a survey to investigate the incredibly high numbers of deaths registered in residential care homes for older people, after the national press raised the attention on the potentially large underestimation of COVID-19-related deaths in care homes. Preliminary results confirm that the actual number of COVID-19 related deaths might be much higher than the one reported in official documents.
  • As of today, current procedures do not foresee testing older people in care homes, neither those who died after presenting symptoms.
  • Coordination with health care actors (mainly acute care but also general practitioners) has been limited and poorly implemented, mainly relying on professional linkages of individual professionals and without a regional or national framework.
  • The response to the COVID-19 emergency has been left to the initiative of each Nursing Home alone, relying on their capacity and willingness to cope with extraordinary conditions while having poor support from institutions.

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