The growing elderly population and increasing healthcare expenditure are both key drivers of demand for healthcare services and healthcare real estate, including long-term residential care facilities.
The increasing complexity in the diagnosis of diseases and their treatment, coupled with increasingly widespread risk factors among the population, has broadened the spectrum of therapies and, ultimately, the ways in which they are treated, thus also expanding the need for increasingly diverse spaces.
The elderly population: snapshot of health status and services
There are about 96 million elderly people in Europe, identified in the over 65 age group, which is about 19% of the population on average.
In the ranking of European countries with the largest percentage of elderly population, Italy stands out with about 21.7 per cent of the population, followed by Germany and Greece; in contrast, the ‘youngest’ country is Ireland.
A study by Istat – the National Institute of Statistics -, which analysed the elderly population, provided an interesting snapshot of the state of health of this population group.
The first positive aspect is that, on the whole, the various indicators show a ‘compression of morbidity or disability’, i.e. the average age at which the first chronic illnesses occur has gradually increased.
On average in Italy 34 per cent of the elderly population suffers from serious chronic diseases (cardio-circulatory, respiratory, but also physical-motor and psychic diseases such as dementia and depression), and 44.3 per cent have at least three of them. These percentages rise in the 75-84 age group, about half of whose population has serious chronic diseases.
In this picture of the elderly population, it is significant that Istat notes that 44% of those with severe difficulties state that they do not have adequate aids and/or assistance, which is below the EU 22 average.
The treatment of chronic and terminal diseases
In the context of health care, the treatment of chronic and terminal illnesses is becoming increasingly important, including supporting activities that are not specifically health care: palliative care. Palliative care has been defined by the World Health Organisation (WHO) as ‘an approach that improves the quality of life of patients and their families facing problems associated with incurable diseases, through the prevention and relief of suffering by early identification and optimal treatment of pain and other physical, psychological, social and spiritual problems’.
In Italy, law no. 38 of 15/3/2010 identifies the Regional Networks and Local Palliative Care Networks as fundamental tools to guarantee access to quality palliative care through forms of integration between the subjects involved in the care pathway.
Characteristics of the hospice
Today, such care is available both at home and in hospital and, ultimately, in facilities known as ‘hospices’.
The hospice is the place designated for palliative care and interventions of various kinds aimed at relieving the patient, at that stage when the disease no longer responds to specific treatments and the hospital can no longer take charge even though continuous care is needed in an institutional setting.
It is therefore a place, with characteristics of temporary residency for both the patient and his or her family/caregiver, where various professional figures offer medical-assistance services, accompanied by psychological support, spiritual accompaniment, containment of functional reduction, and global well-being. The hospice articulates its services through a multidisciplinary team that seeks to ensure the best quality of life for the patient, providing medical and nursing care and the presence of technical caregivers seven days a week, 24 hours a day, who have formalised protocols.
The supply of hospice services in Italy
By the end of 2021, some 300 facilities, both private and public, providing hospice palliative care, with a total of about 3,400 beds, have been counted throughout the country.
In particular, in Lombardy, faced with a demand for home or residential palliative care of about 27,000 oncological patients and 23,000 non-oncological patients, 72 hospice facilities are available for a total of about 850 beds. Although undersized compared to demand, this offer of facilities is nevertheless the largest among the Italian regions: to date, in fact, the formula of services offered at home or in outpatient clinics prevails.
Hospice facilities do not necessarily have to be as large as hospital facilities; they are often housed in small building complexes, with a limited number of rooms, often less than 20, and space for treatment.
Sometimes they are integrated into social and health facilities that offer additional services, such as long-term care and psycho-physical therapy services.
They are often close to major urban areas, where hospital facilities are quickly accessible, but at the same time set in pleasant and quiet surroundings.