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Private Assistants in the Italian Care System: Facts and Policies

Giuliana Costa
p. 99-117

Résumé

In the last ten to fifteen years, Italian families taking care of dependent individuals at home have received massive help from personal assistants, mostly immigrant women. The article illustrates the welfare context in which this private market emerged and discusses to what extent and how it has been addressed by national and local regulation. It also shows the many dilemmas that co-opting personal assistants poses to public policies and to the Italian society as a whole as well as the many dilemmas that still have to be faced. Some considerations about the impacts of these aspect on those involved in filling the gaps of the poor Italian long term care policies will be presented.     

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Texte intégral

Introduction

1In the last ten to fifteen years, Italian families taking care of dependent individuals at home have received massive help from personal assistants, mostly immigrant women. This ‘private to private’ arrangement fits into the welfare system characterized by a very modest provision of in kind services for people with care needs and it has been called a “hidden welfare” (Gori 2002) since private services provided by personal assistants “worked” for many years with no public input in terms of regulation. The relative success of this solution has not been addressed either by explicit or by specific caring policies, or by migration policies despite the growing numbers of individuals and families involved as dependent people and care workers. Awareness of the existence of this private market entered Italian public debate very slowly, at a particular moment when the accelerated ageing of the population and the social risks involved in it came to the fore in the public agenda, mainly in relation to the pension system sustainability issue.

2This article will focus on the policy dimensions connected with the emergence and consolidation of this solution for dependent people in Italy, whilst also looking at the issue from the care workers’ perspective. The main features of the Italian care system are characterized by a strong “familism” as family members are almost completely responsible for care duties and by weak entitlements in terms of public care policies, with the development of an ad hoc private long-term care system.

3In the following sections, national and local regulation towards care policies will be addressed, showing how paradoxically, central government inertia has, to a certain extent, boost the use of personal assistants without dealing with the many dilemmas that co-opting personal assistants pose to public policies and to Italian society as a whole. A local and context based experiment in Milan will also be described as an illustration of ways forward. In the conclusions some implications for those involved in this private market will be presented and discussed from a gender perspective. The article draws on different research projects conducted over the past five years and is mainly based on institutional data and qualitative interviews to policy makers, activists, trade union actors and NGO leaders.

Main Features of the Care System in Italy

4As a wide corpus of research has pointed out, care remains a family task even in those contexts characterized by generous publicly funded personal services as the Nordic European countries (Öesterle 2001). The Italian welfare regime, along with other Mediterranean countries, has been defined as “implicitly familistic” (Saraceno 2010) due to the huge duties assigned to families in coping with caring needs and because policies assume that family members are always capable and available to provide care. Formal services are indeed scarce and intervene only residually, in very urgent and complex cases. This approach is embedded in social policies as well in the wider normative framework, for example concerning financial responsibilities towards relatives.

5The extent to which care is a family issue can be gauged by analyzing caring arrangements of Italian households that have at least one elderly person (65+). Informal care is by far the most widespread form of support (ISTAT 2011), the only exceptions being households with very old (80+) and/or severely dependent members, but even in this case almost 40% of them do not receive any kind of formal help (Table 1).

Table 1. Percentage of Italian households with elderly people by type of help received (2009)

Kind of family

Households with

formal (public/private) help

Households that rely only on informal (family) help

With 65+

29.2

70.8

With 65+ severely dependent

49.6

50.4

With 65+ dependent

31.1

68.9

With 80+

45.0

55.0

With 80+ severely dependent

61.5

38.5

With 80+ dependent

43.9

56.1

Source: ISTAT (2011)

6Formal support is modest in terms of coverage and intensity throughout the country but with differences which correspond to historic inequalities between north Northern and Southern Italy (Table 2).

Table 2. Coverage rates of Italian public support for care (2008-2011)

% of over 65 receiving:

Italy

Centre-Northern Italy

Southern Italy

IA (Attendance Allowance) (2011)

11.6

10.4

14.7

Social Home care (2009)

1.6

1.5

1.8

Nursing Home care (2009)

4.1

4.9

2.3

Residential and Day care (2009)

2.5

3.0

1.2

Note: the figures of social home care (run by Local Authorities) and nursing home care (run by the National Health Service) cannot be simply added together because they partially refer to the same beneficiaries.

Source: own computation from ISTAT (2011), ISTAT (2012)

7The institutional design of public care policies has not varied over the last decade and public spending for caring services increased by merely 12% between 2004 and 2010, rising from 1.05% of GDP to 1.18% (Costa 2013), in a context where care needs grew significantly. The only public support that followed the increasing demand for care is the indennità di accompagnamento, an attendance allowance for individuals with severe care needs and assessed as completely dependent (unable to perform the basic activities of daily living without help) on a long-term basis. A flat rate allowance of €480 per month (2010), it is not graduated to the severity of caring needs and can be used freely, with no checks on its use. Services in kind (residential and home-based ones), be they socially oriented or concerning health issues, are planned at a regional level and implemented at the municipal one. This institutional architecture reinforces the historical fragmentation of welfare policies. The only benefit regulated by the central State is the indennità di accompagnamento which is also the single enforceable support by those who are severely dependent. That is the reason why this cash allowance constitutes the pillar of the Italian caring system. It is widespread and it can be used by individuals and families to cope with their care needs.

8A further specific aspect of the current Italian care system is that families’ capacity to care on a long term and intensive basis is decreasing because of a complex combination of societal transformations (demographic, socio-economic and cultural ones at the same time). The fast ageing population, the reduction in the household size, the multiplication of caring tasks and the progressive participation of women in the labor market can explain why informal care for older people cannot be taken for granted any more. It is important to remember that Italy is one of the oldest countries in the world and, together with Germany, its ageing rate is the highest in Europe. Spouses, sons and daughters, grandchildren and elderly parents are “competing” with each other to be cared for, mainly by middle-aged / mature women because Italian households are getting more and more “thin and stretched”, as, compared to previous decades, they are composed of fewer members who coexist for longer, producing different care needs (Costa 2012). The proportion of the 65+ population is 20.6% according to ISTAT (2012), a rate that grew by around 38% in the last two decades and almost doubled in less than 50 years. In the early 1990s, there were 8.7 million elderly people living in Italy, which had risen to around 12 million by 2012: a net increase of 3.3 million individuals. The number of dependent people in need of care is therefore growing in absolute numbers, as well as the severe dependency rate (defined as being confined at home) (Costa 2012). However, empirical evidence shows that even if family members “are still there”, they are taking care of elderly dependent members less intensively (ISTAT 2010).

Emergence of the private care market

  • 1  The main countries of origin for personal assistants has changed over the years. Nowadays they com (...)

9Such was the context in which the employment of personal assistants spread as a private solution for families with caring needs. They are nowadays crucial actors in the Italian care regime. In fact the gap between the expanding demand for care services, the modest public long-term care services provision and the reduced capacity of families to care on a long-term basis, has largely been filled by low-cost care work provided by private workers hired by families to take care of their frail and dependent members. The vast majority of those involved in these private arrangements are migrant women coming from less developed countries even if a small number of them are Italian (Catanzaro and Colombo 2009)1.

  • 2  The first mention of the badanti, as “assistants to members of a family affected by pathologies an (...)
  • 3  The cost of a badante varies between 700 and 1200 euros per month, according to the most recent su (...)
  • 4  Just to give one example, a survey carried out in Lombardy throughout public services users, showe (...)
  • 5  Even if they are also used to assist dependent people in hospitals or residential settings to fill (...)

10The old word – badante - has been re-used to name those who care (from Italian verb badare, to take care of) for someone on a long term basis in Italian households and families2. The badanti or personal assistants are the protagonists of what Castegnaro called “the hidden revolution in caring elderly people” (2002). Widespread social reorganization has occurred concerning long-term care needs and dependency in Italy in the last fifteen years but within an institutional framework characterized by inertia (Costa 2012; Ranci and Pavolini 2011). As stated before, the public long-term care provision is nowadays almost the same as two decades ago. Co-opting a co-residing personal assistant is today the best solution to cope with caring needs on a long-term basis and a good and less expensive alternative compared to residential services. Hiring a badante is not only less costly than other care providing schemes3, it is also more practical because they ensure long hours of care (badanti are often complementary to public services, which are not organized to give care on a 24 hour basis or in the long term4), they are flexible (arrangements can be made over the 24 hours) and assist people at home5. The use of a badante has become a common practice in Italy, even by less affluent families, and supply has raised demand (Colombo 2005). The availability of this kind of worker has raised expectations that such a solution is reliable and “ready to go”, even if recent research shows that emotional, material and organizational relationships can be very problematical.  

11In general terms, it can be stated that the Italian care regime has been profoundly redesigned by the emergence of a private care market and the use of migrant care workers. The model of care experienced a transition from being family-based to a more mixed one. Some scholars have argued that the consolidation of a private care market, composed of foreign migrants, changed the nature of the Italian model of care with a “‘transition from a ‘family’ to a ‘migrant in the family’ model” (Bettio et al. 2006: 272). Many empirical research results show that personal assistants are not completely replacing families in their caring activities but rather they are complementing them (Eurofamcare 2006; ISTAT 2010). Families provide the bulk of personal care and domestic help as well as health and psychological assistance and have a crucial organizational role in monitoring financial aspects, coordinating different kinds of care resources. Migrants are though supporting Italian families and not substituting them in their care responsibilities. They are, as shown by empirical evidence, doing the “hands on” caring work (Costa 2012).

  • 6  Catholic Italian workers association, present throughout the country.

12 The badanti are mainly employed to care for elderly people. According to a survey carried out by Iref (Istituto di Ricerche Educative e Formative) on behalf of the ACLI6 (2007), 29.5% of them take care of a lonely old person, 19.5% look after a couple of them, 7.5% work in a household where an old person live. The duties are heavy. 78.7% of those who have been co-opted to take care for a lonely old person perform different activities (personal care, home care, bureaucratic duties, etc.). According to another survey conducted in 2004-2006 (Fullin, Reyneri and Vercelloni 2009), 76.4% of personal assistants live with the person the care, in co-residence even if this arrangement is declining along with the number of years they stay in the country (Fullin, Reyneri and Vercelloni 2009). Co-resident personal assistants’ weekly working time is much longer (59 hours) than that of those who do not live with her or his employer (39 hours) (ACLI 2007).

13In 2009, more than 14% of families with an older relative (aged 65+) employed a personal assistant. The rate increases with the level of dependency and with the age of the elderly. Almost 32% of families with a severely dependent 80+ person employ a badante (ISTAT 2010; Costa 2012). According to recent estimates, Italian families spend around €9.5 billion a year to pay for personal assistants (Pasquinelli and Rusmini 2011). Many badante are not registered as formal employees and many are illegal migrants, so numbers are difficult to estimate, but recent estimations indicate that around 750.000 persons are personal assistants, more than 50% of whom have no regular contract and/or are undocumented migrants (Pasquinelli and Rusmini 2011). In fact informality (which in some cases turns to illegality) plays an important role in the personal assistants success in the Italian context because, together with the attendance allowance described above, it fuelled a low-cost private market. The growth of this private market is due to many different factors including the availability of a large immigrant female labor force, the scarcity of and difficult access to public personal care services, the traditional preference for caring at home, the increase of the female employment rate in the country and finally, the availability of an adequate income for a significant proportion of the current generation of Italian pensioners (Costa 2012; Da Roit 2007; Spanò 2006).

Migrant care work regulation & national public policies

14Ignored for many years, the emergence of this private care market entered the public arena very slowly, when personal assistant and particularly migrant ones were already in place in Italian households. This “homemade welfare” or “hidden welfare” (Gori 2002) started to be the object of careful attention by politicians, policy makers, media, trade unions, private organizations in mid 2000s. Its role in the Italian local welfare is now given permanent attention by the press. But national policies (be they social care ones, migration or family ones) have not explicitly addressed this issues related to the presence and the relevance of this type of care market for a long time (Costa 2012). The regulation of this private care market is a real puzzle for the policy makers for many reasons: first of all, it concerns several social policies (health, immigration, family, employment and housing policies and taxation choices) which are conceived and implemented at different institutional levels (local, regional, national and supra-national levels). To local authorities is left the burden of settling the resulting conflicts, with limited jurisdiction, tools and money. It involves a great number of care workers (750 000 assistants) and a large number of families employing them. The private care market is one where differing interests collide: cost and efficiency, quality and justice, equity and privacy and so on. The care-giving market is very fragmented: supply and demand are represented by individuals who are not organized; contracts are concerned with goods and services that are not defined or that are difficult to define (this is a typical case of “experience good” that involves duties that are peculiar, that change over time and are not standardized) and where labour relationships are “one-to-one”. Furthermore, this market is composed of relatively frail actors, both those that require help and assistance (the elderly and the less able-bodied) and personal assistants (who are often migrants in difficult economic and personal conditions situations). Besides, transactions in this market are often unbalanced: on one side personal assistants frequently lack official documents (new migrants), on the other hand, labor laws are frequently incorrectly applied.

15As personal assistants are mostly migrants, it is important to remember that their co-optation and employment by Italian families require (as in other countries) an analysis of the dual institutional contexts in which this employment is located, be they state policies towards care or the intersection with immigration policies (Shutes and Chiatti 2012; Williams 2012).

  • 7  The fact that at the beginning of the 2000s the Italian government acknowledged the important soci (...)

16Immigration policies in Italy are mainly based on two policy tools. Firstly, amnesties (sanatorie) for migrants living and working in Italy; and, secondly, a yearly planning of the total number of migrants allowed to come to Italy to work (decreto flussi). Amnesties aim to regularize the position of migrants who are already living in the country. Such amnesties occurred in 1986, 1990, 1995, 1998, 2002, 2009 and 2012. If they are compared with the use in many other European countries, “amnesties” should theoretically be applied as policy tools in an ad hoc and sporadic way. Instead the regularity with which they take place indicates that, in Italy, they have become a “quasi-permanent” tool for immigration policies. The yearly planning of incoming migrant fluxes, set at national level, with the help of local institutions and according to market needs, should be the main regulatory tool in immigration policies: annually the Government delivers a document stating how many migrants will be allowed into the country and for which specific working tasks. In relation to both policy tools, the Italian legislation recognizes as a specific field the needs of those who want to legally employ a migrant for caring tasks. Therefore, in the last decade, amnesties and the yearly planning of migrants incoming fluxes reserve a specific quota to migrant care work even if too small in comparison with the households’ demand7. The possibilities to hire regularly a care worker are limited and as a matter of fact, the solution is to employ an Italian personal assistant (but just a very small proportion of workers are autochthonous), to co-opt a person who is already regularly living in the country or to hire a migrant without a work (and residence) permit, and then to wait for an immigration amnesty: this has created a loop based on a sort of “abuse by necessity”, with households hiring a large number of immigrants in the grey or illegal market and then asking for their regularization (Ambrosini 2007).  

17The only specific regulatory action for the private market of care has been the introduction of a National Work Contract for Homecare Workers, designed to define a framework in term of salaries, contributions and work conditions. This contract is not always applied, informality being much more appealing for families, who have not enough incentive to use formal contracts: employment controls by public agencies are quite rare and tax rebates on household services and personal care are very modest and do not compensate for higher costs emerging from the correct application of contracts, especially for carers working on a cohabitation basis. Empirical evidence shows that migrant workers are frequently paid also using the resources given by the indennità di accompagnamento. The beneficiaries of this program receive a cash allowance without any conditionality in its use. To some extent, this situation feeds the widespread appeal of non regular work contracts.

Private care markets and local policy

18The national inertia in regulating more in detail the private care market has, to a certain extent, been filled by some regional and local governments’ steering actions. These actions are intended to reach many different goals, which are not always compatible with each other:

  • to help match care workers and households in need of help and willing to find and hire reliable and competent personnel;

  • to protect families, people needing personal assistance and personal assistants;

  • to assist families and care workers in complying the necessary bureaucratic steps;

  • to qualify care giving work; to avoid any social dumping and to ensure the soundness of the existing social protection schemes; to regularize working contracts;

  • to make care giving attractive to new generations; to increase the coverage rate of public and private services and to incorporate the private services into the public network;

  • to pool public and private funds (Costa 2007c).

19Most policy makers and policy analysts have concentrated their attention only on the economic aspects of the spread of personal assistants among Italian families and on the marketization of care, assuming that these private arrangements would relieve public budgets and be important resources for welfare provision. However, the list above and the complexity of the problems involved show that a more detailed analysis is needed.

20The newcomers, the badanti, not only relieve public expenditure; they also introduce changes in the care market at large and in the logics of public institutions dealing with dependent people. Despite that, till now, their presence has not led to sound innovations in the local welfare systems. It is not surprising then that the badanti are spotlighted just when strong signals of a decreasing availability of them are in sight. The above mentioned survey (ACLI 2007) shows that only a quarter of the foreign badanti intend to stay in Italy while the rest is determined to return to their country or to move elsewhere. Another indicator of this tendency is the decreasing availability to cohabit with their employer, highlighted by the same survey and by other research (Fullin, Reyneri and Vercelloni 2009). In other words, the badanti, today abundant and available, may not be in the near future, either because of their institutionalization or because of radical changes in their way of life. The risk is today to take for granted something that is not such (Costa 2004) or to forget that countries of the former Soviet block, such as Ukraine and Moldavia, may not in the future be sources of cheap labour (Mazzacurati 2005), useful to fill the gaps in Italian welfare.

21 To regulate the care private market at the local level, various instruments have been developed:

  • special “counters” where families can find the right badante, sometimes supported by employment agencies;

  • a public register of badanti with certified professional or/and personal standard as assistants;

  • improving of service standards through training courses;

  • provision of modest care allowances and care allowances to pay for personal assistants;

  • promotional campaigns in favour of regular employment;

  • networks among the different actors in the care market.

  • 8  For further information about Catholic organizations in this particular sector of Italian work mar (...)

22 Counters are supposed to favour the match between supply and demand, until some years ago in the hands of trade unions and Catholic organizations8, are now becoming part of the local authority set of tools, often as the result of local trials and later consolidated thanks to institutional economic aid. They are aimed at families in search of family assistance and at badanti in search of employment, by trying to capitalize on strategies families use when looking for help, based on personal relationships. The counters differ according to the number of people working in it, to their position within the local service network, and to the kind of service offered. Most of the local counters are lodged at the social services department, seldom at the jobcentres. The counters also differ in the services they supply, ranging from just collecting data and investigating the best way to match both supply and demand in order to supply contractual assistance, up to monitoring the introduction of the assistant in the household and the subsequent state of relations between assistant, dependent person and the family.

23 Registers are certified lists of individuals whose professional background and personal qualification have been recognized by the public authority as being suitable for care work. In view of the lack of national standards for this profession, local government thus tries to assess and ensure the quality of the supply end. Applications are strictly personal. The certificate consists of a test to assess the experience and skills of the candidate. Registration is sometimes conditional on attendance at a training course for badanti, but more often the registers also accept candidates ready to undergo a test of professional skills. In the majority of cases, it is the civil servant at the counter who recommends the most suitable candidate after assessing the family conditions and requests. Applications to and consultation of the registers are free of charge.

24 Training courses are among the first initiatives in favour of personal assistants. They are organized by municipalities with the help of commercial or non-profit organizations. Their contents range from rather basic subjects such as Italian language and Italian cooking to medical knowledge and social know-how such as how to interact with general practitioners, public offices etc. Courses differ in general organization, in the amount of total lesson hours and in the degree to which they give the opportunity to obtain training credits for other professions. They are always free of charge. Each region sets the basic parameters of these courses because there are no shared standards or common definitions at the national level of what training for personal assistants should consist of.

25 Care allowances and vouchers were introduced in Italy in the nineteen-nineties, at the same time as the emergence of the “home care culture” in public services and with the reduction of public budgets. Modest in monetary terms, they are offered to help dependent people pay for their care arrangements, replacing other kinds of local financial support (but not the indennità di accompagnamento which is a national allowance). Some areas have privileged help to families assuming that they are responsible for care, others decided, on the contrary, to support only the use of private paid care, including this condition in the eligibility criteria. The amount varies from 200€ to 500€ per month (Pasquinelli and Rusmini 2009) but their coverage rates are still very low, less that 1% of the target population at a national level (ISTAT 2012).  

  • 9  The costs of illegality for employers and personal assistants are badly paid jobs, skill waste eff (...)

26 Specific allowances to support the hiring of personal assistants have also been developed at the local municipal level and in a few regional cases such as Emilia-Romagna and Puglia. They are normally sufficient to pay for the costs associated with the regularization of contracts, and are an incentive to fight against irregularities in the labour market, encouraging families to hire a badante with a regular work contract, more costly than informal arrangements because of the compulsory state social contributions9.    

27Even if these local attempts to regulate and qualify the private market are considered quite innovative, they are poorly funded and their take up rate is very low. They cannot intercept a conspicuous part of the market and these policy tools are quite rarely coordinated. Many local authorities are currently engaged in financing and implementing suitable combinations of the described instruments but most of them are just experimenting one or two of them. Even if it is not possible to define the total expenditure for the regulation of this market in Italy (no databases are available), empirical evidence shows that very few care workers and families are subject to (and benefit from) the existing regulations.

28A particular limit of the described policies is that they address only Italians and documented migrant workers. The undocumented ones are literally “invisible” to public policies (Costa 2007c). This is a clear form of “institutional cynicism” as the presence of undocumented migrants that care is tolerated by society at large (ibidem). Therefore, only a portion of the market comes within public policy treatment while the other is delegated to NGOs, mostly Catholic, engaged in providing very basic services to migrants. The large portion of the care market not touched by this public regulation has thus been left and indirectly delegated to non-profit associations, mostly Catholic ones, engaged in providing services to migrants and households with dependent elderly, without strong public guidelines.

29The lack of public action towards undocumented and illegal migrant care workers goes along with the difficulty of reaching out to Italian middle class families traditionally not users of social services due to the residualism of local welfare (Costa 2007c). Even if some of the policy tools are promotional in their approach and structure (like the training courses), they do not catch the attention of those who do not use other social services. This is an important obstacle in a welfare system – such the Italian one – that addresses just the needs of the most deprived people in society (Costa 2007a and b). In this context, a middle-class family rarely asks social services staff for help because it is seen as a resource accessible only by poor and excluded people, not by “normal people with normal care needs”, as often declared. Moreover, most of the families with care needs cannot access other social services because they are strongly means tested (vouchers and care allowances for instance). This limitation generates great disappointment in the population (Cerea 2007).

  • 10  I would like to thanks Giovanni Poletti and Giovanna Perucci for the time they devoted to answerin (...)

30A description of a very recent experience in local regulation of this private market in Milan, in a neighbourhood called Niguarda, provides a fitting conclusion. In this neighbourhood a housing cooperative called Abitare formed by three historical cooperatives operates (the oldest, founded in 1894, being the Società Edificatrice Niguarda, owns more than 2.700 dwellings). In 2010, new resident and member of the cooperative who works as a psychologist at Piccolo Principe, an organization based in Milan working in personal services, suggested to develop a project called Con Cura (literally “With care”) to overcome many of the failures associated with the private care market. The project aims to find the best care solutions for each family living in the neighbourhood and at the same time to create employment occasions for women and men who wish to work in care. The idea is to develop a new and very context based professional figure, the “neighbourhood badante”, a person that, when properly trained, can work for more than one family/person who live in the same area (in order to minimize the time and the costs of moving from one house to the other) whereby the cost can be divided among several households. The housing cooperative trains care workers (focusing especially on sensitive issue such as the importance of privacy and intimacy of users and their families), attempt to best match families and workers according to the profile of the persons involved, help with administrative procedures, conduct follow-ups concerning relations between employers and employees, give advice on practical issues concerning care and provide replacement care workers in case of need. Furthermore, the project is enhancing many families’ awareness of being in need of help and support to take care of dependent family members properly10 and most of them are middle-class households that would never normally seek public support for this. Con Cura is on the way (December 2012) and has to be further developed in order to evaluate its efficiency but it is a good example of how and to what extent local agencies (in this case private ones) can resolve many dilemmas involved in this market at a very local level, counting on precious resources like trust and good social planning.  

Brief conclusions and gender implications

31 As shown, growing long-term care needs in Italy are nowadays coped with little formal public services and much more with informal care provided by family members and with the help of private assistants, the so-called “badanti”, be they formally employed or not. These assistants, mostly women and migrant, are filling the gaps of the Italian welfare system representing a sort of private welfare or “hidden welfare” (Gori 2002) as they (and the private market in which they are involved) have not been the object of significant public steering actions (Costa 2012) at the national level. Local administrations tried and go on trying to regulate this arrangements with policy instruments to solve some of the dilemmas that this specific market pose but without a larger institutional framework and without specific funding these attempts are not supportive enough to change the profile of a profession that is not socially recognized, is badly paid and that provide very few opportunities to move up in the social ladder (Parente 2012). All these aspects have clear negative gender implications: personal assistant are women and migrants, a condition that expose them to a double form of economic and social discrimination (Piazzalunga 2011) in the Italian society. Working long hours and been dependent of a single (problematic) family or individual can create enormous difficulties to those women who have to organize their lifes to care continuously, sacrificing their personal and private lives, with no time and chances to look for other job opportunities in a very segmented and segregating employment market (Parente 2012). Occupational segregation for caring workers is in some way consubstantial and functional to the maintenance of the status quo, to the inertial and poor Italian long-term care policies. Migrant women are paying for this inertia and for the public under representation of caring work and caring needs even if working as a badante can be attractive for those who migrate from poorer countries trying to improve their life condition.   

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Notes

1  The main countries of origin for personal assistants has changed over the years. Nowadays they come mostly from Eastern countries such as Ukraine and Moldavia but also Poland, Rumania and Bulgaria and from South-Central America (Fullin, Reyneri and Vercelleri 2009),

2  The first mention of the badanti, as “assistants to members of a family affected by pathologies and/or by handicaps reducing their autonomy, is to be found in art. 33, Act nº 189/2002, the so-called “Bossi-Fini Act” on immigration (Barbera, Alessi, Bertocchi 2007).

3  The cost of a badante varies between 700 and 1200 euros per month, according to the most recent surveys (Costa 2007c, Spanò 2006). The introduction of a National Contract for domestic workersandfamily assistants induced a 30% increase in such cost in case of co-residence.  

4  Just to give one example, a survey carried out in Lombardy throughout public services users, showed that 56% of them employed personal assistants (Costa 2007a).

5  Even if they are also used to assist dependent people in hospitals or residential settings to fill the gaps in formal care or just to stay with patients during the day or at night when formal staffing is reduced.  

6  Catholic Italian workers association, present throughout the country.

7  The fact that at the beginning of the 2000s the Italian government acknowledged the important social role played by migrant care workers, introducing preferential entrance conditions in the country for them, is related to the lobbying of civil society actors (mainly Catholic organizations as well as NGOs with a left-wing political orientation) (Van Hooren 2008) that claimed specific recognition of these “meritorious” migrants.

8  For further information about Catholic organizations in this particular sector of Italian work market see Andall (2004) and Zanetti Polzi’s analysis on Caritas’ role (2004).

9  The costs of illegality for employers and personal assistants are badly paid jobs, skill waste effects, high risk of over exploitation, low consumption standards, no incentives for training courses, and the promotion of black or grey labour markets (Chiuri, Coniglio & Ferri 2007).

10  I would like to thanks Giovanni Poletti and Giovanna Perucci for the time they devoted to answering my questions and suggesting new ways of analyzing such a complex issue as how to cope with severe care need in a contexts characterized by scarcer and scarcer resources.  

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Giuliana Costa, « Private Assistants in the Italian Care System: Facts and Policies », Observatoire de la société britannique, 14 | 2013, 99-117.

Référence électronique

Giuliana Costa, « Private Assistants in the Italian Care System: Facts and Policies », Observatoire de la société britannique [En ligne], 14 | 2013, mis en ligne le 01 février 2014, consulté le 18 novembre 2017. URL : http://osb.revues.org/1536 ; DOI : 10.4000/osb.1536

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Auteur

Giuliana Costa

Professeur associée en sociologie au Politechnico de Milan

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Observatoire de la société britannique

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