Italy has been the first western country strongly hit by the Covid-19 outbreak. WHO did not proclaim Covid-19 as a “high global risk” until February 28: on that same day, Italy already had 888 official infected persons, 345 hospitalized covid-19 patients, 105 patients in intensive therapy and 21 deaths.
In this context, Italian nursing homes were probably the first residential institutions in the western world that had to deal with the pandemic. The diffusion of the infection and the huge number of death due to Covid-19 in such institutions became visible and alerted the public opinion and policy makers only one month after the process started to happen: a strong delay in the capacity of the system to acknowledge the problem that had a tremendous impact in terms of number of deaths especially among frail older people.
In the search for possible causes, in this paper we investigate what the structural situation in such institutions was before the beginning of the epidemic. We used national data provided by ISTAT (the National Institute of Statistics) to analyse the distribution and main characteristics of nursing homes in the country, including the coverage rate of available beds in residential structures, changes in the number of patients, in the number of professionals employed in such structures, and the public-private mix.
We show that policy legacy factors, coupled with the strong pressure on the health system exerted by the very quick spread of the outbreak, have played an important role in the way nursing homes have (poorly) dealt with the pandemic. The lack of public knowledge about the spread of the virus in these structures, and the weak response they could give to the pandemic, are to be seen as the result of the poor development of long-term care policy in Italy, and of the marginality of such institutions within such system.
The paper can be downloaded here: http://www.lps.polimi.it/wp-content/uploads/2020/06/Nursinghomes_inage.pdf