Open Access Research article

An ecological study on the relationship between supply of beds in long-term care institutions in Italy and potential care needs for the elderly

Gianfranco Damiani1*, Simona C Colosimo1, Lorella Sicuro1, Alessandra Burgio2, Alessandra Battisti2, Alessandro Solipaca2, Giordana Baldassarre2, Roberta Crialesi2, Giulia Milan2, Tiziana Tamburrano2 and Walter Ricciardi1

Author Affiliations

1 Department of Public Health, Università Cattolica Sacro Cuore, Rome, Italy

2 Health and Assistance Unit, Italian National Institute of Statistics, Istat, Rome, Italy

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BMC Health Services Research 2009, 9:174  doi:10.1186/1472-6963-9-174

Published: 24 September 2009



The ageing population in Europe is putting an ever increasing demand on the long-term care (LTC) services provided by these countries. This study analyses the relationship between the LTC institutional supply of beds and potential care needs, taking into account the social and health context, the supply of complementary and alternative services, along with informal care.


An observational, cross-sectional, ecological study was carried out. Statistical data were obtained from the Italian National Institute of Statistics and Ministry of Health. Indicators, regarding 5 areas (Supply of beds in long term care institutions, Potential care needs, Social and health context, Complementary and alternative services for the elderly, Informal care), were calculated at Local Health Unit (LHU) level and referred to 2004.

Two indicators were specifically used to measure supply of beds in long term care institutions and potential care needs for the elderly. Their values were grouped in tertiles. LHU were classified according to the combination of tertiles in three groups: A. High level of supply of beds in long term care institutions associated with low level of potential care needs; B. Low level of supply of beds in long term care institutions associated with high level of potential care needs; C. Balanced level of supply of beds in long term care institutions with potential care needs. For each group the indicators of 5 areas were analysed.

The Index Number (IN) was calculated for each of these indicators.


Specific factors that need to be carefully considered were highlighted in each of the three defined groups. The highest level of alternative services such as long-stay hospital discharges in residence region (IN = 125), home care recipients (HCR) (IN = 123.8) were reported for Group A. This group included North regions. The highest level of inappropriate hospital discharges in (IN = 124.1) and out (IN = 155.8) the residence region, the highest value of families who received help (IN = 106.4) and the lowest level of HCR (IN = 68.7) were found in Group B. South regions belong to this group. The highest level of families paying a caregiver (IN = 115.8) was shown in Group C. Central regions are included in third group.


Supply of beds in long term care institutions substantially differs across Italian regions, showing in every scenario some imbalances between potential care needs and other studied factors. Our study suggests the need of a comprehensive rethinking of care delivery "system".