Italy Long Term Care Market Overview, 2031

Key Insights

• Italy is one of the oldest countries in the European Union and globally, with a population aged 65 and over accounting for 24.7% of the total population in 2025, representing 14.5 million people. The country faces an unprecedented demographic challenge, with 4.6 million people aged 80 and over, representing 7.8% of the population.
• The number of non-self-sufficient elderly people in Italy exceeds 4 million, representing approximately 4.8% of the total population. These individuals require continuous care and assistance in daily life. By 2030, the number of non-self-sufficient elderly is projected to reach approximately 5 million.
• Italy has one of the lowest levels of long-term care investment among EU countries, allocating just over 10% of health expenditure to LTC approximately €15 billion annually compared to over 25% in Northern European countries. Only 3.2% of people aged 65 and over receive home care services, placing Italy at the bottom of the European ranking.
• The residential care sector comprises approximately 12,987 residential facilities with around 426,000 beds as of January 2024. However, Italy has fewer than 400 beds per 100,000 residents aged 65 and over more than two-thirds below the European average.
• Public spending on long-term care for the elderly and disabled is approximately €35 billion annually, comprising €13 billion in strictly health care spending, €15 billion for accompaniment allowances, and approximately €7 billion for locally provided services. Italian families bear a significant out-of-pocket burden, spending an estimated €21 billion annually for care and assistance.

Market Outlook

• According to the research report, "Italy Long Term Care Market Overview, 2031," published by Bonafide Research, the Italy Long Term Care Market is expected to reach a market size of more than USD 45.70 Billion by 2031. This growth is supported by accelerating demographic aging, rising prevalence of chronic conditions, and ongoing policy reforms aimed at strengthening the long-term care system.
• Italy's demographic trajectory is a primary driver of long-term care demand. By 2050, the population aged 65 and over is projected to reach 37% of the total population the second highest in the world after South Korea. The population aged 80 and over is expected to reach 15% of the population by 2050. While the total population is projected to decline from 59 million to 54.7 million, the number of people aged 85 and over will increase by 70% in absolute terms.
• The number of non-self-sufficient elderly is expected to rise significantly. Over 4 million non-self-sufficient elderly currently require continuous assistance. By 2030, this number is projected to reach approximately 5 million. By 2050, one in three Italians will be over 65, compared to one in four today, creating sustained demand for long-term care services across all segments.
• Italy faces a chronic underinvestment in home and community care services. The Integrated Home Care (ADI) program, which is the primary formal home care service, reaches only 3.2% of people aged 65 and over. In 2023, a non-self-sufficient elderly person receiving ADI received on average only about 14 hours of care annually. This highlights a significant gap between care needs and formal service provision, creating substantial opportunities for market expansion.
• Public spending on long-term care is under significant pressure, with public expenditure on LTC as a percentage of GDP declining from 1.43% in 2020 to 1.18% in 2024. This funding gap is driving increased out-of-pocket spending by families. Italian families spend an estimated €21 billion annually for care and assistance, rising to over €30 billion when including direct and indirect costs for caregivers and live-in care workers.

Market Dynamics

Driver: Accelerated Demographic Aging and Rising Dependency Italy is experiencing a profound demographic transformation that is fundamentally reshaping the long-term care landscape. As of January 1, 2025, 14.5 million people were aged 65 and over, representing 24.7% of the population, with 4.6 million aged 80 and over representing 7.8%. The aging index has reached 207.7 for every 100 young people, there are over 207 elderly people. Life expectancy at birth has reached 83.4 years (85.5 for women and 81.4 for men), but healthy life expectancy has declined to 58.1 years. This means Italians live on average 25 years with chronic conditions or disabilities. Over 4 million non-self-sufficient elderly require continuous care and assistance. By 2050, the population aged 65 and over is projected to reach 18.9 million, exceeding 34% of the population. The number of people aged 85 and over will nearly double from 2.3 million (3.9%) to 3.9 million (7.2%). Family structures are also transforming, with projections showing an increase of 1.7 million elderly people living alone, who cannot rely on family support networks and will depend more on formal services.

Challenge: Severe Workforce Shortages and Capacity Constraints Italy's long-term care market faces a persistent and intensifying workforce crisis that threatens service availability and quality. The residential care sector for dependent elderly persons is characterized by a growing labor shortage. Beyond the long-standing shortage of nurses, there is also a shortage of personal care workers. The nursing shortage is estimated at an average of 30%, with particularly concerning peak percentages that compromise service management and care quality. In some regions, the shortage is acute in the province of Treviso, 54 nursing homes reported a shortage of 1,750 workers, with 3,000 elderly people on waiting lists. In Lombardy, which has 738 RSA facilities as of 2025, this represents 9 more than in 2024 and 72 more than in 2015. Over the next decade, the National Health Service will face a mass exodus of over 150,000 doctors, nurses, and other healthcare workers due to retirement. Without significant investment in workforce recruitment, training, compensation, and career development, Italy's long-term care system will face increasing difficulty in meeting growing demand.

Trend: The "Virage Domiciliaire" and the Shift Toward Home and Community Care A fundamental shift in long-term care delivery is occurring in Italy, with increasing emphasis on home and community-based services. Currently, only 3.2% of people aged 65 and over receive home care services, and a non-self-sufficient elderly person receiving ADI receives on average only about 14 hours of care annually. However, the Italian government is actively working to strengthen home care. The PNRR (National Recovery and Resilience Plan) has supported the achievement of the target of 10% of people aged 65 and over receiving integrated home care (ADI), with €250 million dedicated. The OECD has recently published a report dedicated to Italy on the structured and systemic integration of home care for non-self-sufficient individuals, highlighting the urgency of reform. The government is also advancing legislation to integrate ADI (Integrated Home Care) and SAD (Social Home Care) services. The "Home Care Premium" program, with a new call for 2025-2028, provides economic support for families caring for disabled individuals. The integration of health and social services is widely recognized as central to reducing fragmentation and improving coordination. This shift toward home-based care, driven by both patient preference and potential cost savings compared to institutional care, is expected to continue.

Policies

• The National Plan for Non-Self-Sufficiency 2025-2027 is the first national plan dedicated to the elderly population following the approval of the care reform (Law 33/2023). The plan defines the allocation of the Fund for Non-Self-Sufficiency (FNA), the implementation of Essential Levels of Benefits (LEPS), and guidelines for intervention planning over the next three years. The plan introduces new criteria for the distribution of the Fund, making the allocation of resources between regions more equitable.
• The Fondo per le Non Autosufficienze (FNA) has a total allocation of €3 billion for the 2025-2027 period. Resources are now distributed between regions using indicators that are more aligned with real needs: the population aged 75 and over (exposed to risk), recipients of accompaniment allowances (recognized need), and people with severe disabilities.
• Law 33/2023, the "Delegation to the Government on Policies for the Elderly," and its implementing decree (Legislative Decree 29/2024) aim to build a system of integrated social, healthcare, and socio-healthcare services. The law established the Interministerial Committee for Policies for the Elderly (CIPA) to strengthen coordination of measures for the elderly.
• The National Recovery and Resilience Plan (PNRR) includes two key components for improving the integration of social and health services: Mission 5, Component 2, which enhances the social dimension of healthcare policies for older people; and Mission 6, Component 1, which implements interventions to develop local networks, facilities, and telemedicine for local healthcare. The target of 10% of people aged 65 and over receiving integrated home care was achieved in 2025.
• Decree 77/2022 defines models and standards for territorial assistance in the National Health Service. The National Plan for Non-Self-Sufficiency 2022-2024, for the first time, defined Essential Levels of Social Benefits, mandating guaranteed home care, relief, and support for non-self-sufficient older people.
• The government is advancing legislation to integrate ADI (Integrated Home Care) and SAD (Social Home Care) services, with provisions for support for family caregivers. The "Home Care Premium" program, with a new call for 2025-2028, provides economic support for families caring for disabled individuals.
• The accompagnamento (accompaniment allowance) is the most common cash transfer for non-self-sufficient individuals, provided by INPS (National Social Security Institute) for certified disability. In 2025, approximately €15 billion is allocated for accompaniment allowances.

Segment Analysis

Italy Long-Term Care Market By Service Type • Home Healthcare: Home healthcare represents a growing segment of Italy's long-term care market, driven by the strong preference of Italians to age in place and government efforts to strengthen home care services. Integrated Home Care (ADI) is the primary formal home care service, delivering nursing care and health services. Social Home Care (SAD) provides social benefits, often delivered by the third sector. However, coverage remains extremely limited only 3.2% of people aged 65 and over receive home care services. The PNRR has supported the achievement of the 10% target for ADI coverage of people aged 65 and over, with €250 million dedicated. Italy's home care services are characterized by significant regional variation in access, with Northern regions generally having better coverage than Southern regions.
• Nursing Care / Skilled Nursing Facilities: The residential care sector in Italy comprises approximately 12,987 residential facilities with around 426,000 beds as of January 2024. There are 3,646 facilities dedicated specifically to the elderly with 212,874 beds, according to the Ministry of Health. The sector includes RSA (Residenze Sanitarie Assistenziali), which provide 24-hour nursing care, medical supervision, and personal assistance for non-self-sufficient elderly. Italy has fewer than 400 beds per 100,000 residents aged 65 and over more than two-thirds below the European average. Residents in residential facilities reached 385,871 in January 2024, an increase of 6% compared to the previous year. Only 7.6% of non-self-sufficient elderly are cared for in RSA facilities.
• Assisted Living Facilities: Assisted living is an emerging segment in Italy's long-term care market. The senior housing market is growing, driven by demographic factors and increasing demand for housing solutions dedicated to the elderly. Senior housing includes independent living apartments with common services, designed for autonomous seniors aged 65 and over. These residences offer nursing assistance, social and cultural activities, dining services, cleaning and maintenance, transport, support for daily activities, and security services. The sector is expanding in major Italian cities, including Milan, Rome, Bologna, Turin, and Florence. A €300 million co-investment program between the European Investment Fund and CDP Real Asset Sgr has been launched to develop social infrastructure for housing, including senior housing.
• Hospice and Palliative Care: Hospice and palliative care services in Italy are delivered across multiple settings, including homes, RSA facilities, hospitals, and dedicated hospice facilities. The growing prevalence of chronic conditions and the aging population are driving demand for end-of-life care services. Legislation is being advanced to integrate ADI and SAD services, including provisions for palliative care at home and in hospice settings. The number of people requiring palliative care is expected to grow as the population continues to age.
• Other Services: This segment includes day care centers, semi-residential services, and short-term respite care. Semi-residential facilities provide day or round-the-clock care. Day care services provide social engagement and support for older adults, supporting the preference for home-based care. Respite care services provide temporary relief for family caregivers. The need for these services is growing as families seek alternatives to full-time institutional care while maintaining caregiving responsibilities. Over 8.5 million caregivers, predominantly women, provide care in Italy, supporting a system that would otherwise not be sustainable. Approximately 70% of caregivers are women.

Italy Long-Term Care Market By Payer Type • Public: Public sources are the dominant payer for long-term care services in Italy. Public spending on long-term care for the elderly and disabled is approximately €35 billion annually, comprising €13 billion in strictly health care spending, €15 billion for accompaniment allowances, and approximately €7 billion for locally provided services. The National Plan for Non-Self-Sufficiency 2025-2027 has a total allocation of €3 billion. Public LTC spending as a percentage of GDP has declined from 1.43% in 2020 to 1.18% in 2024, reflecting the pressure on public finances.
• Private: Private sources account for a growing and significant portion of long-term care spending in Italy. Italian families spend an estimated €21 billion annually for care and assistance out-of-pocket, rising to over €30 billion when including direct and indirect costs for caregivers and live-in care workers. Private out-of-pocket spending for long-term care is estimated at approximately €33 billion. Approximately 83% of residential care facilities are privately owned. Supplementary health funds are beginning to develop long-term care products, with six major funds covering approximately 6.5 million members starting to explore LTC offerings.
• Out-of-Pocket: Out-of-pocket payments represent a substantial and growing component of long-term care spending in Italy. Italian families spend an estimated €21 billion annually out-of-pocket for care and assistance. RSA care costs can exceed €2,000-2,500 per month for Alzheimer's patients. The accompaniment allowance, while provided by INPS, is often insufficient to cover the full cost of care, forcing families to supplement with out-of-pocket spending. Private care spending is estimated at €33 billion, highlighting the significant financial burden on Italian families.

Italy Long-Term Care Market By Gender • Female residents account for the largest share of Italy's long-term care spending, driven by higher life expectancy and higher rates of disability in advanced age. Women's life expectancy in Italy is 85.5 years compared to 81.4 years for men. Among those aged 85 and over, women represent the majority. The caregiver workforce is predominantly female approximately 70% of the 8.5 million caregivers in Italy are women. Women are more likely to live alone in old age, increasing their reliance on formal paid care services.
• Male residents account for a smaller but growing share of Italy's long-term care spending. The need for long-term care affects persons of all ages and is generally measured by limitations in an individual's ability to perform daily personal care activities. Men are more likely to need long-term care at younger ages due to disabilities and chronic conditions. As male life expectancy increases, the representation of men in the older adult cohort is slowly growing. The gender gap is gradually narrowing as male life expectancy increases.

Italy Long-Term Care Market Economics

• The cost of long-term care services varies significantly by service type, geographic location, and facility status. RSA care for Alzheimer's patients can exceed €2,000-2,500 per month. Italian families bear a significant out-of-pocket burden, spending an estimated €21 billion annually. Regional variation in costs and access is significant, with Northern regions generally having higher costs and better service availability.
• Public spending on long-term care is approximately €35 billion annually, comprising €13 billion in strictly health care spending, €15 billion for accompaniment allowances, and approximately €7 billion for locally provided services. Public LTC spending as a percentage of GDP has declined from 1.43% in 2020 to 1.18% in 2024. The National Plan for Non-Self-Sufficiency 2025-2027 has a total allocation of €3 billion.
• Staffing costs represent the largest operating expense for all long-term care providers. The nursing shortage is estimated at an average of 30%. The sector faces a growing labor shortage of both nurses and personal care workers. Over the next decade, over 150,000 healthcare workers are expected to retire.
• Out-of-pocket costs represent a substantial burden on Italian households. Private care spending is estimated at €33 billion. The accompaniment allowance, while provided by INPS, is often insufficient to cover the full cost of care. Annual spending for dementia care and management in Italy is approximately €23 billion, with about 63% borne by families.
• The economic value of home and community-based services relative to institutional care is a key policy consideration. Home care is generally less expensive than institutional care on a per-patient basis, and the shift toward home care is expected to continue. The OECD has highlighted the urgent need for reform to strengthen home care services.


Considered in this report
• Historic Year: 2020
• Base year: 2025
• Estimated year: 2026
• Forecast year: 2031

Aspects covered in this report
• Long-term care Market with its value and forecast along with its segments
• Various drivers and challenges
• On-going trends and developments
• Top profiled companies
• Strategic recommendation

By Service Type
• Home Healthcare
• Nursing Care / Skilled Nursing Facilities: 
• Assisted Living Facilities
• Hospice & Palliative Care:
• Other Services

By Payer Type
• Public
• Private
• Out-of-Pocket

By Gender
• Male
• Female