Innovating European Long-Term Care Policies through the Socio-Economic Support of Families: A Lesson from Practices

LTC and socio-economic deprivation of families are two relevant issues in international debate. The economic or time investment made by families in caregiving has an impact on the socio-economic status of family members in terms of economic means and social inclusion. This study analyzes the practices that are supported by home LTC, examining their characteristics, identifying their strengths, weaknesses, drivers, and barriers, as well as identifying social innovation aspects. The study provides a qualitative interpretative comparison of 22 practices from eight countries, representing the four LTC care models existing in Europe. Cross-studies aid in the development of sustainable policies. The study highlights the differences and similarities between selected practices. The results indicate the effectiveness of integrative and coordination strategies at the macro, meso, and micro levels for the development of supportive policies for family members with burdens of care. Nevertheless, the results underline the lack of a genuine focus on families’ socio-economic support for providing care. The partial support provided by compensatory cash benefits or unpaid care leave schemes partially addresses the difficulties of familial burden of care. The study recommends that fair economic compensation and social security benefits be incorporated into innovative and sustainable strategies for supporting caregiving in LTC and welfare schemes

Polarized blazar X-rays imply particle acceleration in shocks

Most of the light from blazars, active galactic nuclei with jets of magnetized plasma that point nearly along the line of sight, is produced by high-energy particles, up to around 1 TeV. Although the jets are known to be ultimately powered by a supermassive black hole, how the particles are accelerated to such high energies has been an unanswered question. The process must be related to the magnetic field, which can be probed by observations of the polarization of light from the jets. Measurements of the radio to optical polarization—the only range available until now—probe extended regions of the jet containing particles that left the acceleration site days to years earlier1,2,3, and hence do not directly explore the acceleration mechanism, as could X-ray measurements. Here we report the detection of X-ray polarization from the blazar Markarian 501 (Mrk 501). We measure an X-ray linear polarization degree ΠX of around 10%, which is a factor of around 2 higher than the value at optical wavelengths, with a polarization angle parallel to the radio jet. This points to a shock front as the source of particle acceleration and also implies that the plasma becomes increasingly turbulent with distance from the shock

X-ray Polarization Observations of BL Lacertae

Blazars are a class of jet-dominated active galactic nuclei with a typical double-humped spectral energy distribution. It is of common consensus the Synchrotron emission to be responsible for the low frequency peak, while the origin of the high frequency hump is still debated. The analysis of X-rays and their polarization can provide a valuable tool to understand the physical mechanisms responsible for the origin of high-energy emission of blazars. We report the first observations of BL Lacertae performed with the Imaging X-ray Polarimetry Explorer ({IXPE}), from which an upper limit to the polarization degree $\Pi_X<$12.6\% was found in the 2-8 keV band. We contemporaneously measured the polarization in radio, infrared, and optical wavelengths. Our multiwavelength polarization analysis disfavors a significant contribution of proton synchrotron radiation to the X-ray emission at these epochs. Instead, it supports a leptonic origin for the X-ray emission in BL Lac.Comment: 17 pages, 5 figures, accepted for publication in ApJ

Quality Assurance Policies and Indicators for Long-Term Care in the European Union, Country Report: Italy. ENEPRI Research Report No. 102, February 2012

In Italy, regions are at the centre of the system providing long-term care services, which typically include residential services, formal home care and monetary benefits. The regions define their own policies for the provision of care, ranging from needs assessment and monitoring tools to the accreditation of service providers. Quality assurance policies are primarily directed at residential services and formal home care, but as this research report highlights, there are many differences across regions

Quality Assurance Indicators of Long-Term Care in European Countries. ENEPRI Research Report No. 110, April 2012

This study reports on the quality indicators that were collected by the ANCIEN project partners in each country considered in Work Package 5 (Quality in Long-Term Care). The main contribution of this report is a classification of the quality assurance indicators in different European countries according to three dimensions: organisation type (indicators applied to formal institutional care – FIC, formal home-based care – FHBC, formal home nursing care - FHNC, and informal home care - IHC); quality dimensions (indicators about effectiveness, safety, patient value responsiveness, or coordination) and system dimensions (input, process, or outcome indicators). The countries that provided quality indicators, which are used at a national level or are recommended to be used at a local level by a national authority, are: Estonia, Finland, France, Germany, Hungary, Italy, Latvia, the Netherlands, Spain, Sweden and the United Kingdom. In total, we collected 390 quality indicators. Each quality indicator has been assigned to one or more options in each dimension

Long-Term Care Quality Assurance Policies in the European Union. ENEPRI Research Report No. 111, March 2012

This report analyses the quality assurance policies for long-term care (LTC) in the following countries: Austria, Estonia, Finland, France, Germany, Hungary, Italy, Latvia, Poland, Slovakia, Slovenia, Spain, Sweden, the Netherlands, and the United Kingdom. The authors first discuss quality assurance in LTC by analysing: the dimensions of quality, the policy frameworks for quality in LTC, the different levels of development of LTC quality policies at the international, national, organisational, and individual levels. Second, they describe the methodology for collecting and analysing data on quality policies in the selected countries, and report and discuss the results. Policy recommendations are proposed at the end

Disability in Older People and Socio-Economic Deprivation in Italy: Effects on the Care Burden and System Resources

The sustainability of European Long-Term Care systems faces the demographic and socio-economic circumstances, mainly the increasing ageing of the population, with its chronic disease conditions, and the simultaneous economic general crises, exacerbated by the recent COVID-19 pandemic. Beyond the increase in general rate of relative poverty, there is a higher risk of poverty among elderly and families in a high demand of care, especially if situations of Activities Daily Living (ADL) disability are present. Italian welfare, which is based on family care regimes and regional strategies, and is oriented to private or public care, is a relevant case study with which to analyze such a relationship. This paper aims to study the relationship between ADL disability and the socio-economic deprivation of families, that is, household poverty. Variables came from the ISTAT Health for All Italian Database and the INAIL Disability Allowance Database. A pool of statistical methods, based on bivariate and multivariate analyses, from bivariate correlation, through multiple linear regression to principal component factor analysis, were used to reduce the number of the variables and compute the indicators. The multivariate analysis underlines how ADL disability impacts on a household&rsquo;s poverty, confirming the existence of statistical correlation between them. Moreover, the study identifies and measures two answer capability models to cope with household poverty. The answer capability of the formal system is the main tool for reducing poverty due to one family member&rsquo;s ADL disability. Integration and collaboration between the formal system and family capabilities remains the main solution

Disability in Older People and Socio-Economic Deprivation in Italy: Effects on the Care Burden and System Resources

The sustainability of European Long-Term Care systems faces the demographic and socio-economic circumstances, mainly the increasing ageing of the population, with its chronic disease conditions, and the simultaneous economic general crises, exacerbated by the recent COVID-19 pandemic. Beyond the increase in general rate of relative poverty, there is a higher risk of poverty among elderly and families in a high demand of care, especially if situations of Activities Daily Living (ADL) disability are present. Italian welfare, which is based on family care regimes and regional strategies, and is oriented to private or public care, is a relevant case study with which to analyze such a relationship. This paper aims to study the relationship between ADL disability and the socio-economic deprivation of families, that is, household poverty. Variables came from the ISTAT Health for All Italian Database and the INAIL Disability Allowance Database. A pool of statistical methods, based on bivariate and multivariate analyses, from bivariate correlation, through multiple linear regression to principal component factor analysis, were used to reduce the number of the variables and compute the indicators. The multivariate analysis underlines how ADL disability impacts on a household’s poverty, confirming the existence of statistical correlation between them. Moreover, the study identifies and measures two answer capability models to cope with household poverty. The answer capability of the formal system is the main tool for reducing poverty due to one family member’s ADL disability. Integration and collaboration between the formal system and family capabilities remains the main solution

Disabilità, non autosufficienza e diseguaglianze socioeconomiche e strutturali: le strategie di cura e la correlazione esistente con l’incidenza di povertà. Uno studio pilota

Questo studio pilota affronta la correlazione fra deprivazione socioeconomica, disabilità, non autosufficienza e strategie di copertura a livello nazionale e regionale, cercando di individuare punti critici e di forza per i sistemi regionali. L’esistenza di un legame tra queste dimensioni è infatti verificato dai dati: oltre ad essere aumentato il tasso generale di povertà relativa, aumenta il rischio di povertà tra gli anziani e tra le famiglie ad alto carico di cura. La non autosufficienza, intesa come rischio individuale che si corre o come bisogno a cui si deve far fronte, è il punto di incontro. Il lavoro, svolto su dati da fonti ufficiali (Istat, Inps, etc.), ha prodotto una selezione delle variabili correlate significativamente con l’incidenza di povertà, evidenziando come un aumento del tasso di disabilità, dell’indice di dipendenza e di altri fattori di contesto (livello di istruzione bassa, numerosità elevata del nucleo familiare) produca un aumento proporzionale dell’indice di povertà e come l’erogazione pubblica di servizi contribuisca significativamente alla riduzione dell’incidenza di povertà nelle famiglie. La copertura, intesa come utenza raggiunta, mantiene un effetto di riduzione sull’incidenza di povertà ma non raggiunge gli stessi risultati di significatività che, invece, ha la presenza sul territorio dei servizi. L’effetto protettivo della spesa in convenzione totale e delle misure pensionistiche indennitarie sembra confermare la valenza del ruolo dei servizi pubblici. Le Regioni a minor incidenza di povertà mettono in campo sia una buona risposta del sistema, sia buone risorse familiari di sostegno, mentre nelle Regioni ad alta incidenza di povertà sia l’offerta territoriale sia il supporto familiare sono deboli. Se si pensa alla forte relazione che esiste fra anzianità e disabilità e alle previsioni di invecchiamento per la popolazione occidentale, è evidente come queste azioni dovranno essere considerate prioritarie per ridurre il peso sulle famiglie, principale centro di spesa

Social Innovation in Long-Term Care: Lessons from the Italian Case

The debate on policies addressing the challenges posed by population ageing pays increasing attention to sustainable and innovative ways to tackle the multidimensional impact this phenomenon has on society and individuals. Moving from the findings of two European research projects, a qualitative study based on a rapid review of the literature, expert interviews, focus groups and case studies analysis has been carried out in Italy. This study illustrates which social innovations have been recently implemented in this country&rsquo;s long-term care (LTC) sector, and the areas in which further steps are urgently needed in the future. This takes place by first highlighting the existing links between social innovation and LTC, and then by identifying the key factors that can facilitate or hinder the implementation of these initiatives. Finally, the study suggests how to promote social innovation, by strengthening the &ldquo;integration&rdquo; and &ldquo;coordination&rdquo; of available services and resources, through a&mdash;for this country still relatively&mdash;new approach towards ageing, based on pillars such as prevention and education campaigns on how to promote well-being in older age