Better at home?
Principal investigator: Elisabetta Notarnicola
Team UB/Cergas: Michela Meregaglia, Simone Manfredi, Eleonora Perobelli, Andrea Rotolo
Partners: Fondazione Ravasi Garzanti
Duration: March 2022 – February 2024
Abstract:
This study aimed to examine the economic and social impact of home care for elderly individuals with dementia living in the metropolitan area of Milan. Using various investigative tools, complex issues emerged: caregivers face difficulties accessing adequate information, partly due to the fragmentation of services. The costs of care are almost entirely borne by families, who must piece together adequate solutions from a patchwork of services. Quality of life deteriorates, particularly for women—the primary caregivers—who attempt to balance many hours of daily care with professional activities and other daily responsibilities. The study highlights how complex it is to manage dementia at home. Case management appears to be the most significant unmet need, placing considerable pressure on caregivers. When opting for home care solutions, families should better account for non-monetary expenses such as opportunity costs, time, quality of life, and emotional burden, even though these are much harder to quantify. This also applies to policymakers when comparing home care with residential care in the development of new policies for the elderly. The study is based on a mixed method, bridging together interviews with caregivers and care professionals with the deployment of a questionnaire to gather information about quality of life and cost of illness and a discrete choice experiment, where caregivers expressed a strong preference for an increase in the hours of professional home care combining healthcare and social assistance, for meetings with professional support for caregivers, and for a reduction in monthly costs.
Material produced and publications:
Notarnicola E., Meregaglia M., Manfredi S., Perobelli E., Rotolo A., "Meglio a casa? L’impatto economico e sociale dell’assistenza domiciliare per le persone anziane con demenza nell’area metropolitana di Milano", Fondazione Ravasi Garzanti, Quaderno n°1, 2024, avalaible here: Book | Cergas
Notarnicola E. Manfredi S., Meregaglia M., Perobelli E., Rotolo A., La gestione della demenza al domicilio: la prospettiva dei caregiver, Rivista Sperimentale di Freniatria, Fascicolo 2024/2, DOI 10.3280/RSF2024-002004
Michela Meregaglia, Simone Manfredi, Eleonora Perobelli, Andrea Rotolo, Elisabetta Donati, Elisabetta Notarnicola, Caregiver Preferences and Willingness-to-Pay for Home Care Services for Older People with Dementia: A Discrete Choice Experiment in the Milan Metropolitan Area, Health Policy Journal, December 2024
Dissemination:
Video: The Costs of Managing Dementia at Home
Presentations:
Convegno AIES 2023, Economic burden and health-related quality of life among older people with dementia living at home and their informal caregivers in the Milan metropolitan area
Convegno AIES 2023, Carer Preferences and Willingness-to-Pay for Home Care Services for Older People with Dementia: A Discrete Choice Experiment in the Milan Metropolitan Area
Convegno ISPOR EUROPE 2023, Economic burden and health-related quality of life of older people with dementia living at home and their informal caregivers in Milan
Convegno ILPN 2024, International Long Term Care Policy Network, Economic burden and health-related quality of life of older people with dementia living at home and their informal caregivers in Milan