Growing old in Tuscany: the story of an elderly Tuscan lady

Selling the home and going into care could happen in England.  I understand Scotland funds residential care.  I do not know the situation in Wales.  As you know there has been much controversy in England about payment for residential care.  Community services for the elderly in the UK is much more developed with community occupational therapy, home help, a district nursing service, day centres.  Old people with only a basic old age pension can apply for income support and there is also a winter fuel allowance, a fixed amount and, I understand, some more is available depending on the outside temperature.  The health services work in partnership with the local authority and the voluntary services to provide a comprehensive range of services to maintain the elderly active in the community.  Local authorities would also have a very well developed social housing policy for the elderly.  People over the age of 60 do not pay prescription charges and are entitled to free public transport.  Services rarely vary throughout England as it is national service.  Local variations may occur depending on the level of support available from the voluntary services. In Italy the number of elderly is forecast to increase to approximately  a third of the population, so the pressure on Government finances from the elderly is greater.  There is much debate on how to care for this section of the population who provide a lot of baby sitting and child minding support to the family.  As you know the management of the NHS in Italy is in the hands of the Regions.  I am learning a lot about services for the elderly through these kinds of stories.  My understanding of the situation in Italy is that apart from hospital care many of the community services available through the Communes are generally means tested.  Some would offer vouchers and some would provide the services.  Here are a few of the services that I know are available to the elderly: Le Case di Riposo for the self sufficient and partly self sufficient, le case albergo: a type of apartment block with communal facilities, le case protette: sheltered housing for the aged, i centri sociali anziani a type of pensioners club normally run by the pensioners themselves, l'assitentenza domiciliare : a home help service sometimes jointly with the ASl or private organisations, il servizio di accompagnamento: accompanying or companion service for people to get around run normally by volunteers, i pasti domicilio: meals on wheels normally provided by the comune, soggiorno di sollievo: therapeutic holidays to the seaside or spas.  There are also discount schems available to the elderly and some of them are well developed and are run by the communes.  Italy has more doctors than than the UK with an average of 700 people per doctor. Regional  spending on care of the lederly varies between the regions.  The latest figures I have seen is that the highest in 2003 was Trentino Alto Adige with €466 per capita and the lowest was Calabria with €19 per capita.  The share of total social resources spent on the elderly was the highest in Campania (40%) , 12% in Calabria, on average 30% in the north. The southern regions tend to give more vouchers and more residential care is provided in the central and northern regions. I know many elderly couple in Italy would sell their homes whilst retaining the "uso frutto" for life to fund a live-in companion.  It is easier to find a buyer as the unit will be offered at a substantial discount.  The Italian Government recognise this kind of property transaction and give a graduated discount on the purchase tax.  In the UK it is now becoming more popular to enter into an equity release scheme.  

I agree with you much of what you say.   One should live the dream when one is fit and healthy.  There are different considerations when you are frail and elderly and require the extended support of the family.  I know a lot of people from the commonwealth who emigrated to the UK in the 50's and 60's who have returned to their home countries as "returned residents" for the reasons you mentionned.

After reading through all the comments on the subject of how to finance "care" in your declining years, Gala's comment :  "The big difference will be the choice of places. If you have enough money, you will be able to afford a nice place and your family will be able to choose the one they think will be the best for you (and for themselves, so that they can come and visit you). Otherwise, you will have to accept whatever is offered and the government will deduct a high percentage of your pension and provide the difference."  stuck in mind because  I took the responsibility of finding a suitable retirement home for my aunt after her husband died.  At the time she was suffering from mild dementia.  She had good financial resources so there was no problem in moving her closer to the remaining family and we found a very nice private retirement home where they could manage her illness. She was reasonably happy there given she'd led a very active, independent life, up until then.   The BIG problem came a few years later when the dementia had developed to such a level where she was no longer able to make decisions for herself and the family was asked by the carehome concerned (in a sympathetic way) to move her on.   She needed a home that could offer a much higher level of care (an EMI Unit in England).  Despite finance not being an issue, she had enough money to see her cared for privately for the rest of her life, finding a private carehome with the right resources to manage her illness and make her comfortable was another matter.   She was not entitled to request entry to any of the national health funded EMI carehomes with their clean modern facilities and trained staff that we'd found in our area.  NO, because she was self funding, (she did receive a non means tested allowance from the government), we were given by the council a list of privately managed EMI carehomes that we could apply to. On inspecting all within 20 miles, we found them to be far more expensive than the council funded homes, and in most cases (not all) the furniture and furnishings were battered and tatty (because of the illnesses and disabilities of the residents), and often smelly and offputting.   The homes were run, of course,  as businesses. We live in an affluent area in the south of England with plenty of resources including homes run by well known private care companies.  In the end we chose a private EMI registered home with wonderful management and staff, but certainly, if my aunt had been in her right mind, she would have been horrified to see her standard of living so reduced.  This is getting very long, and I simply want to point out that if you develop a mental illness in your old age, having finance available to you does not guarantee the best care. I say, enjoy life now, and don’t aim to waste the childrens’ inheritance on what may turn out to be inferior EMI care. For myself, (and dementia runs in the family), I believe if the time comes and I need it, the government will offer better EMI care than any money I have left can buy for me. Sorry to be so depressing !!!!!!!!

The point I was making at the end of my story is that should I decide to retire in Italy I must review my finances as there are different financial considerations e.g:     I will only be entitled to the basic state pension: annual pension increases are available as Italy is in the EU (that is what I am told by my Pensions Advisor).    I will not be entiltled to any of the other financial benefits based on UK residency.    I will not be entilted to contribution-based support available to Italians (INPS).  I am going to study what is available through this website.  http://www.comune.torino.it/en/health/income-support-amounts-av.shtml . I may be wrong! I hope so!    Unless services like meals-on-wheels are available to immigrants on a residence-basis and not on a contribution- basis I will not be able to use them.  (Again I hope I am wrong, the story of this lady has made me more aware!)There are lots of uncertainties and there is not the equiavelent of Citizens Advice Bureau that I can seek help from to guide me through the maze of Italian legislation. I have talked to my Italian lawyers and accountants who tell me that the Italian Government change the law so quickly by Decrees that any advice given to me today may not be valid tomorrow. I must also allow for fluctuations in the future value of Sterling, unless the UK joins the Eurozone.  There are also uncertainties under the Double Taxation Treaty between the UK and Italy on how all my income from all sources will be taxed.  Bearing in mind these uncertainties and the cost of living-in help or residential care in Italy I have decided to review my finances with my pensions/investment advisor during my three months summer stay in London. As regards national comparisons these are at best spurious.  I only stated them for analysis. Conclusions will be drawn by readers taking into account their personal experience mostly.  When I used to lecture on health statistics I always opened my talk with the following: "Statistics are like uderwear, what they hide are more interesting than what they show".  Forgive the rudeness, but is is true.I know and agree that residential care has to be paid for elther in full or partly by the resident, whether in the UK or in Italy,  It is the choices that are available to the residents of the two countries on how to top up their savings that are important.  I have mentioned selling the  freehold and keeping the"uso frutto"  as a way of raising finance in Italy (It is also done in France, my nephew has  just bought a house that way in France).   In the UK equity release schemes have entered the market in a big way recently but they still have to gain popularity.  I helped a family member some 20 years ago to raise an income in that way.  She was 65 at that time and she went on to live for another 20 years and received an income every month for that time.  (The insurance company was really upset!) I received a nice letter from her before her death thanking me for doing this for her! She did not have to rely on anyboby, she lived in her house, but left not as much as she would have in her will but the family did not incur inheritence tax.  In the end the Chancellor paid for it not on a pay as you go basis, but on her death by receiving less inheritence tax.  By contrast my best friend in London, needed money for day-to- day living, my suggestion of an equity release scheme for their their £600,000  house met with such aggressiveness from the wife and we have never spoken since.  They continue to live frugally whilst the value of their home increases (not so much recently).  Had they released £300k for example, they would still continue to live in the house, enjoy a higher standard of living, and have a living-in help and leave no inheritence tax liability.  As it was (before the new inheritence tax change) their heir would have had to pay £116K tax to the Chancellor. So they denied themselves a contribution of £116k from the Chancellor for a higher standard of living!  Selling the home should be the last option, raising finance on a buy-to-let interest only mortgage and letting the house is another possible way.I apologise if at any time if I have given the impression that the UK is better! That was not my intention.  I merely stated that services are better developed in the UK and more integrated between health and social services and that UK social housing policies are also better developed. As an example in the Tuscan village where I have a house there is hadly any social housing and there are 5000 residents!  I hope I did not give the impression that services are more freely available in the UK. If I did my sincere apologies. My journey through the plight of senior citizens in Italy and cultural differences between Italians and I continues everyday: my daughters' nonna and zia (they are Italians) who are in their seventies received yesterday each a bill of €500 for gas.  This is one month's pension.  This is their plight as Italian pensioners and it is very close to home!  They are very proud and will not accept help from us.    

This article hits it right on the nail, the only difference between my true story and this article is that the wages have increased substantially.  A recent article in an Italian magazine indicates that there are some 300,000 eastern european workers in Tuscany, mostly from Romania.  They are doing a great job in caring for the elderly, cleaning or working in the building industry!  It is also true that it is very common in our part of Tuscany to have this kind of help.  Near where I have my Italian house there are three large villas each with a widowed elderly lady with lived-in help from eastern europe.  I recently became aware of this when my estate agent friend told me that these villas have been on the market for 3 years and there have been no takers.  I was also told that the families have taken out loans to finance their upkeep.  With the reccession the market for large villas have virtually collapsed in our part of Tuscany.  Our old lady is little bit lucky because the demand for flats is beginning to show some signs of recovery.  There are also investors who would be prepared to buy the freehold of her flat and leaving her the "uso frutto" until her death. These investors are not too keen on large villas as the return is not that good.  The same investors make their money when the old person dies early.  Pretty gruesome you would say, but I suppose this is life and they are doing the elderly person a favour by letting her keep her home until death.

I agree!