ITALY

General section on Independent Living

1.1. Overall implementation of Article 19

Implementation of this article is found to be inadequate.

1.2. Choice of living arrangements

Disabled adults cannot freely choose their living arrangements. There are still segregated settings (social care institutions, psychiatric hospitals, group homes and other) for disabled adults (incl. older people with disabilities) and children.

1.3. Deinstitutionalisation strategy

The country does not have a deinstitutionalisation strategy. There has been limited progress on this topic in the last 5 years.

According to respondents, funds provided by the EU are still being used for renovation or building of new institutions for disabled people in Italy.

1.4. Access to mainstream services

Access to mainstream services requires improvement concerning education (primary, secondary and tertiary), housing, health care, public transport and culture. Access to employment in the open labour market is described as inadequate. There is a law protecting disabled people from discrimination in the labour market, but its implementation is inadequate.

1.5. Access to personal assistance

Italy has a personal assistance system (PA system) in place to help facilitate inclusion of disabled individuals in the community. The details of the PA system will be provided in the following pages.

When there are regional differences in the PA system, this will be stated clearly, according to the information available.

General information about the PA scheme/policy

2.1. Personal assistance scheme: general information and corresponding legislation

Access to personal assistance (PA) in Italy is, in general, described as inadequate. The scheme is available in different forms on the local level. In Tuscany PA is delivered as a pilot project, which has been running for 10 years. PA is codified as an item of service in a more general legislation. Access to the scheme for disabled people in rural or remote areas depends on the region. Those in residential care do not have access to the scheme.

Depending on the region there can be restrictions on what PA can be used for. There is a waiting list to access PA, but the overall number of PA users has increased in the last 5 years. Positive changes have been made to the legislation/policy affecting access to PA in the last 5 years.

2.2. Funding of Personal Assistance

The scheme is funded both by the state and by regional or local authorities. In some regions PA is also funded on a project basis. It is paid through direct payments, such as personal budgets.

While the funding allows users to employ assistants from the open labour market and to hire services not directly related to personal care, the PA budget is generally not sufficient to cover the users' needs in practice. Family members are allowed to be paid as PAs.

The scheme is limited by a cost ceiling per user. Users whose support needs exceed this cost ceiling are being directed to residential care.

The PA funding covers additional employment costs, including, employer’s contributions, payroll work and other administrative costs. It is unclear if any other costs are covered as well.

Based on the survey responses it is unclear if receiving personal assistance restricts the users’ eligibility for any other benefits, support and/or services.

No research has been carried out on the costs of PA in the county.

2.3. Eligibility and needs assessment procedures

People of working age (18-65) with physical or sensory impairments, as well as those of them over 65 years of age are eligible for PA in Italy. The budget does not decrease after 65 years of age.

Access to the PA scheme requires medical certification of the applicant as a prerequisite for applying. The scheme is provided irrespective of individual or family income, family situation, including marital or insurance status. The user’s level of social activity, including involvement in paid work, volunteering and/or education does not affect their eligibility for the scheme.

Both the eligibility and the needs assessment are led by professionals such as doctors, social workers and psychologists. The assessors do not receive any training on the Independent Living Philosophy or the social model of disability.

According to the responses, people do not have access to adequate information or peer support, before and during their assessment

The assessment is done in the form of an open-ended interview or dialogue. It covers the needs for assistance in all areas of life, including family, intimacy education, employment and leisure to a certain extent.

The assessment is repeated over a fixed period of time.

Following their assessment, the applicants are ranked through a point-based system. A certain scoring needs to be achieved to receive assistance. The number of assistance hours per user is limited.

In general, the assessment procedure is not considered straightforward and transparent. A disabled person can appeal (file a complaint against) the outcome of their procedures. The appeal procedure is not considered effective, straightforward and transparent. Based on the survey responses it is unclear if legal aid or other types of support for are available during this process. The appeal procedure entails additional expenses for the user.

2.4. Characteristics of PA provision and recruitment

Users can freely choose who provides their PA, but the responses indicate they are not always sufficiently informed about their choice of providers.

Assistance can be provided by non-governmental organisations, including disabled people’s organisations (DPOs), user cooperatives, or disabled people can employ a PA directly. The exact choice of provider might depend on the region.

A person can freely select and hire their assistance, and they can hire more than one assistant, depending on the funding available. The user cannot, however, keep their assistance when moving to a different region or local authority within the country or when moving to another country. The quality of provision is not monitored.

PA users are not provided with training how to manage their PA.

Supported decision making is not available for those who need it to manage their assistance. Peer support is available.

People with intellectual disabilities are not allowed to manage their own assistance.

2.5. Working conditions of assistants

The user determines the times when assistance is provided, without any restrictions. The PA system is based on budget and not on hours. Provision of assistance is not bound to a particular setting, so the users can freely decide where and how to access assistance.

The users need to account for their use of assistance. Support to meet these administrative requirements is not available. Contingency arrangements, if assistants become unavailable, are not available.

Personal assistance is not recognised as a profession. No specific qualifications are necessary for people to work as PAs. Assistants can receive training on providing PA if it is paid for by the user, and it is provided by other assistance users.

The wages of personal assistants are protected by minimum wage regulations and personal assistants are entitled to benefits such as social security and paid leave (annual, sick and parental).