The LTC system in Italy is characterized by a high level of institutional fragmentation, as sources of funding, governance and management responsibilities are spread over local (municipalities) and regional authorities, with different modalities in relation to the institutional models of each region. The actors directly involved in the organization of LTC services are municipalities, local health authorities (aziende sanitarie locali, ASLs), nursing homes (residenze sanitarie assistenziali, RSAs) and the National Institute of Social Security (Istituto Nazionale Previdenza Sociale,INPS), but other players are involved in planning and funding these services – i.e. the central state, regions and provinces. Additionally, in Italy a significant share of LTC expenditure is funded directly by households. Moreover, a large part of caregiving is still provided by informal carers, especially in regions where public services are less advanced and in families that cannot afford the cost of private services. Privately purchased home care is often provided by immigrants.
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