11202 Growing old & ill health in Italy

oh yes the wondeful NHS a tv on every ward but no beds!

[quote=Violetta;105878]A couple of things come to mind whilst reading the interesting replies to what makes an expat stay post. I was wondering whether people - especially those who are of retirement age living in Italy - have given much consideration to growing old and possibly having to cope with ill health here in Italy? Several neighbours of mine have in the past few months had bouts of ill health, two very serious, one poor soul died. And it struck me that for all people say about the NHS, you could be better off being seriously ill in the UK than in rural Tuscany. Beyond our local, excellent GP, who really is on call 24/7, and a simply marvellous individual, I was appalled at the lack of support. No ambulance or hospital pick up for poorly off, extremely old people, I spent quite a lot of time (most willingly, I should add) driving people to and from hospital for out patients appointments, with hospitals often being 40 mins to an hour's drive away.
Also, I could be wrong, but I get the impression that hospitalisation here is only in extreme cases for the very elderly or when the end is nigh. This is supported by all my elderly neighbours who talk of our local hospital as the place people go in to but never come out of. This reminds me of my grandmother in the '60s who said the same of UK hospitals then. Are there such places here in Italy, for example, as hospices for cancer sufferers? Or the invaluable support network that's provided in the UK for carers?
Another example is of a friend's elderly mother, fell and broke her arm at home at 97, hospitalised for a few days before being discharged as the bed was needed. No room in the local convalescent home so she's back at home in the middle of nowhere with her daughter having now moved in to take care of her. We've found a young Philippina woman who will look in daily and help as much as she can (for a fee) but beyond that, there's barely any support and she hasn't even seen a district nurse yet despite having been home a week.
Keeping the old and infirm within the community is something, I'm sure, that's promoted here but I suspect it's as much due to lack of alternatives as a feeling that it's the best approach for the individual.
So have any of us given much thought as to what we would (will?) do should ill health strike. And the posters writing how happy they are with life here, is it for keeps, including old age, ill health, widow(er)hood?[/quote]

I have given considerable thought to this, especially since we will be in our 60's when we move over. I taught quite a few doctors while living near Pisa and and am pretty familiar with the healthcare system. We have friends in Italy whose relatives have been very ill with terminal cancer and know the challenges faced.

I also am friends with quite a few doctors and others in the healthcare system here and all discourage the staying in the hospital for any longer than absolutely necessary. In fact, most try to avoid it at all costs as there are health problems that can be brought about by a stay in hospital!

We live in a rural area now and although we have a local hospital, for problems we have to drive close to an hour to get to the better facility. We do not have a hospice care facility but there is hospice respite care available. Those people who do not have family nearby (including us) and are unable to drive usually have a friend or someone hired to take them to doctor appointments. Those recovering from an illness may go to the convalescent home if there is room; otherwise they go home and hire help, which is not all that different from those who do not have family to rely on in Italy.

You can live your life in fear or follow your heart - the choice is yours!

Interesting thread Violetta and although not related exactly, I read recently that more than 60% of expats in Italy repatriate within 5 years with another 30% repatriating within 10 years. It seems the vast majority are aged between 40 - 60 years and only 4% stay after the age of 65.

I'm not sure how relevant this is to your observations, but it would seem only a very small minority would have the worries of old age and ill health you so rightly highlight.

Having worked in our local hospital I know from first hand experience that many of Violetta's concerns are spot on. Some of my general observations -

- Here in Italy there is not the same level of community support that you would expect to receive in the UK ie there is essentially no community follow up unless you or your family arrange this at your own expense privately. For the majority of ASL, their idea of community support is to provide you with the contact details for a private agency.
- Home visits pre discharge and the provision of any necessary 'equipment' does not happen, the ASL will fund one piece of equipment, you have to buy the rest or find somewhere to rent it privately unlike the NHS where is it all provided free of charge or for a minimal rental fee from the local social serivices or OT service. This includes things such a crutches - here you buy your own.
- Transport to and from hospitals for outpatient appointments or treatment is only provided in extreme case of need, otherwise you pay for a taxi or hope a friend, neighbour or family member will oblige.
- If help is needed with bathing or other personal hygiene issues again you have to rely on family members or pay agency staff, this can also apply to hospital inpatients, many nurses do not consider it their role to help patients wash or even to brush their hair or teeth.
- Re the concerns with hospitalisation, it very much depends upon the nature of the local hospital. Some are geared up in the same way as the major UK hospitals, some are for rehabilitation, others are long stay units where sadly patients await the inevitable, this includes end stage cancer patients. These patients and their family do not receive anything like the Macmillan degree of support you get in the UK, indeed they receive no specialist support even at such a difficult time often being in a general ward with other patients.

So yes, you are right to raise these concerns as I think many assume that being entitled to the same level of care as an Italian equates to being entiltled to the same level of care and support that you would expect in the NHS, this is not the case as the Italians receive an awful lot less than you would get in the UK and unless you have fit and willing family members nearby who could jump in to help out you could be in for a nasty shock!

I agree that the assumption is made by the Italian health service that you will have family close by to help.

There are though plenty of voluntary organisations (in my area at least) which have someone on call to give patients lifts into hospital - they are usually associated with the local Croce Rossa, or informally 'based' in a particular hospital. You only need to volunteer for a particular period (of the week, or the day), so it can be a very small gesture to make very easily. Many of the proper ambulance services are run entirely voluntarily, too.

Another thing, Violetta has mentioned being out in a rural area. This clearly makes everything more difficult (distance from hospital, lack of handy volunteers etc.) and I have known more than one ill Italian who simply decamped from a rural house to a sister or brother who lived in the village or town for the duration of the illness. Family again - you can't beat them!

Just to say that if you have cancer or know someone who has you are far better out of the UK. I read fairly recently on the BBC news website that our care for such patients isn't particularly good here. compared to the rest of Europe

Very good points made.Luckily I've had no experience of Italy's hospitals or doctors but I do wonder whether those who now say they hate the UK will feel the same when or if they are old and sick and living in Italy?

My limited experience of NHS in Cornwall has been good, 2nd baby delivered safetly and with great care in an ambulance with midwife driving out to layby to attend and after that GP visiting daily.

Any time I've had any health scares I've had hospital appointments within 2 weeks! And mum who is 70 had a knee replacement in a private hospital (on NHS) within 1 month of seeing her GP.

Yes in many ways life in Italy is much more enjoyable ; if you are fit and healthy, but we all get old! Its certainly something to think about.

Anne2
From my own and my wifes' personal experiences, then I disagree with some of the comments. I was hospitalised in Ascoli with a broken leg which needed a hip replacement, due to the location of the fracture.
I was taken to the orthopaedic unit by ambulance the same night from Amandola and the specialist was there to see me when I arrived and told me what was needed.
At the hospital, I was looked after very well, considering the lack of funding that the hospitals get, so therefore low staff levels at night.
After the hip replacement, I had a Physio visit every other day for a month, plus a nurse to take the sutures out when required. Crutches were supplied by the local Pharmacy, but we did not have to pay for them.
I agree that you have to make your own arrangements for outpatient visits, but overall most of the care is very good, considering they are trying to work on a lesser budget than the NHS is at the moment.

I wonder if those that have left the UK have a rather rose tinted view of the NHS. Whilst it is wonderful in a serious emergency other situations can be very frustrating. Although we may have a few hospitals in under an hour's drive (live on edge of M25), the chances of being able to park within an hour are very minimal.

Was at the hospital this afternoon waiting by the road for a lift and watched the same cars driving round and round in increasing desperation for somewhere to park - I could see the stress on their faces and also in their driving abilities! And this is not free parking I may add, but at least £2 per hour. The hospital is a major one and not close to any good public transport other than local buses. There would have been plenty of space for more parking, but this was sold off to become a business park.

[quote=juliancoll;105893]Interesting thread Violetta and although not related exactly, I read recently that more than 60% of expats in Italy repatriate within 5 years with another 30% repatriating within 10 years. It seems the vast majority are aged between 40 - 60 years and only 4% stay after the age of 65.

I'm not sure how relevant this is to your observations, but it would seem only a very small minority would have the worries of old age and ill health you so rightly highlight.[/quote]

Having lived in several countries and in quite a few places which were considered "retirement heavens" I have observed the same thing. I believe that, at a certain age, you need to get closer to where you have family and friends. Hired help, although efficient, is not the same thing.

In one of the places in Spain particularly favoured by British ex-pats, they have a branch of a British agency which helps old people. (I can't remember if it is Age Concern, or Saga). Anyway, that seemed to me to be a good idea, although sadly they are mainly engaged in repatriating these British elderlies to the UK because the money has run out, which isn't a lot to do with health care.

In Italy - at least in the more historical ex-pat regions - there are active Church of England ministries (under a Bishop of Florence, I believe), and a part of their activities organises British specific hospital visits and the like.

I certainly don't have a rose tinted view of the NHS having (fortunately) only limited experience through third parties. But my quite well off aunt in her 80s was picked up by ambulance and taken to Barts for her chemo, the MacMillan Nurse visited regularly. The fact that she had no family living within 5000 miles noted and was certainly instrumental in ensuring she wasn't discharged on a couple of occasions from hospital until she was able to manage reasonably well on her own at home. Then it was straight in to the hospice as soon as her GP felt it was necessary and could arrange it. And the NHS wig that a friend's mother currently wears as a result of chemo, is barely discernible from her own hair. Compare that with the shameful looking thing that my dear neighbour was given in Arezzo - it's straight out of an amateur dramatics props' box - and I know where I would prefer to be seriously ill, unless going private.
Yes, we've tracked down a charitable agency to hopefully help in the longer term with my neighbour's mother, it's one that's operated by banca MPS!

I to have experienced Italian hospital care, at our local hospital in Montegiorgio for outpatients and emergency in care at our larger hospital in Fermo, both excellent .And far from wanting to discharge you they kept me in "just to make sure"for far longer than would be expected in an English NHS establishment.

I know Violetta probably doesnt want this to be a long list of comparisions with the English NHS system, we have done that to death in the past on this forum, and it is an interesting topic she has raised. For me I have no fears of being ill here, been there done that.Old age...or older age might be more of a challenge, but I guess we would do what was sensible, sell the larger property, have far less land and move into a village house, much as actually retirees do in the UK, and buy in help as and when we need it. Ive already been invited out on the over 50s village outings, there is a strong sense of community here and I am sticking with it.Would never wish to return to the UK and the dubious pleasures of the English NHS.
A

Goodness, what a worthwhile but depressing thread!

I have experienced both the NHS and Italian hospitals and would say that care was excellent in Italy. Families are expected to help out but I can honestly say that when I was in hospital I was ‘adopted’ by all the other patients families, who were wonderful. They brought me treats, included me in all the goings on, explained anything I did not understand, offered to fetch and carry for me and I am sure would have been happy to give me a lift if I needed one. There was none of the ‘British reserve’ and by the end of my short stay, we were all best of friends and swapping phone numbers and invitations to BBQ’s etc.

I think as long as you can leave your ‘Britishness; behind and are prepared to ask for help, the Italians will look after you very well and be happy to do so.

[quote=Geotherm;105910]Anne2
From my own and my wifes' personal experiences, then I disagree with some of the comments. I was hospitalised in Ascoli with a broken leg which needed a hip replacement, due to the location of the fracture.
I was taken to the orthopaedic unit by ambulance the same night from Amandola and the specialist was there to see me when I arrived and told me what was needed.
At the hospital, I was looked after very well, considering the lack of funding that the hospitals get, so therefore low staff levels at night.
After the hip replacement, I had a Physio visit every other day for a month, plus a nurse to take the sutures out when required. Crutches were supplied by the local Pharmacy, but we did not have to pay for them.
I agree that you have to make your own arrangements for outpatient visits, but overall most of the care is very good, considering they are trying to work on a lesser budget than the NHS is at the moment.[/quote]

Although Ascoli is the same ASUR it is a different ASL and the level of care provided does vary from ASL to ASL even within the same region. In my local ASL you have to purchase crutches, splints, wheelchairs etc unless you fall into one of the exemption categories (based on disability or war veterans etc).

The point I was trying to highlight in my post is that here in Italy, when you get to the point you can no longer care for yourself and require long term care then it is very very different to being here than to being in the UK. Your experience was post trauma and fortunately was short term so a completely different matter - the treatment you received was no less and no more than you would get in the UK if the national guidelines were being followed.
Where Italy is very different is when an individual loses the ability to care for themselves, ie post stroke and the family is expected to step in even as a full time carer if required - district nurses, OT's, health visitors, social workers and residential/nursing homes are few and far between so there is not the long term community support offered. If you have no family close at hand this could prove extremely expensive as you will be paying long term care agencies fees which would soon eat into any pension, especially if the £ v € continues as it is.

Perhaps I have lost touch but I seem to remember that care for the elderly was pretty expensive in the UK too.

Friends of mine, who’s mother developed dementia and had to go into a nursing home were paying astronomical rates for her care. So much in fact that her house had to be sold to pay for it.

In the UK if you have any savings and you need care those savings will quickly vanish. There are residential care homes here in Italy too although I have no idea of the cost.

At least here it may be possible to stay in your own home and employ someone to live in and care for you, which I don’t think is quite so easy nor accepted in the UK?

[quote=Nielo;106051]Perhaps I have lost touch but I seem to remember that care for the elderly was pretty expensive in the UK too.

Friends of mine, who’s mother developed dementia and had to go into a nursing home were paying astronomical rates for her care. So much in fact that her house had to be sold to pay for it.

In the UK if you have any savings and you need care those savings will quickly vanish. There are residential care homes here in Italy too although I have no idea of the cost.

At least here it may be possible to stay in your own home and employ someone to live in and care for you, which I don’t think is quite so easy nor accepted in the UK?[/quote]
Haven't quite got to the dribbling stage yet..but i thought i'd put in my bit.
my wife is currently in hospital in Ascoli Piceno in Pneumologia -thats specialist dept for lung disorders.She has been in there now for over a month,the standards of doctoring/nursing are absolutely excellent and both the lung centres in the marche are points of even international excellence the primario conducting a course in marseille etc.exhaustive and expensive treatment has not been witheld.they will be taking my wife to Ancona to be operated by another leading surgeon in this field next monday,then we'll see from there.My friend who is a lung specialist in Helsinki has wanted to know and follow all that has been done to her and she was "suprised" to find they are using all the latest world protocolls to establish her complaint,so it's not always a case of greener over the hill.
as far as dealing with old age is concerned i don't think there's a lot to choose between countries there are plenty of nursing homes here most if one has a reasonable pension are accessible but just as in the uk these are difficult things to deal with in many cases.As far as being an hour away from the main hospitals i don't really care you just have to consider it as a factor, but doesn't just concern the aged ,you'd be lucky round here for example to make it in time in case of say a heart attack.....but i don't care...

Thank you for your post Sebastiano, I do hope that your wife will soon be on the road to recovery, and heartened to hear she is getting excellent care.

Being old and frail in England, if you own your home and have no dependants, is the quickest route to losing it when you have to pay for Nursing home fees, which are huge for a half decent place. As we found with Roberts mother, life savings are soon eaten up. I cannot compare with the same situation here, but would be interested to hear if others have that experience in Italy.
A

I think that it is normal practice throughout Europe and in many other countries that, if an elderly person needs nursing home care his/her assets are used by the government to pay for the services rendered. Usually, families have to fill out complicated forms where statements need to be made about the wealth of the individual who requires nursing care. That is why, in some families, there is a move to transfer property to younger generations keeping the usufruct of the property. Some governments are not "amused" by these moves.

[quote=Sebastiano;106054]Haven't quite got to the dribbling stage yet..but i thought i'd put in my bit.
my wife is currently in hospital in Ascoli Piceno in Pneumologia -thats specialist dept for lung disorders.She has been in there now for over a month,the standards of doctoring/nursing are absolutely excellent and both the lung centres in the marche are points of even international excellence the primario conducting a course in marseille etc.exhaustive and expensive treatment has not been witheld.they will be taking my wife to Ancona to be operated by another leading surgeon in this field next monday,then we'll see from there.My friend who is a lung specialist in Helsinki has wanted to know and follow all that has been done to her and she was "suprised" to find they are using all the latest world protocolls to establish her complaint,so it's not always a case of greener over the hill.
as far as dealing with old age is concerned i don't think there's a lot to choose between countries there are plenty of nursing homes here most if one has a reasonable pension are accessible but just as in the uk these are difficult things to deal with in many cases.As far as being an hour away from the main hospitals i don't really care you just have to consider it as a factor, but doesn't just concern the aged ,you'd be lucky round here for example to make it in time in case of say a heart attack.....but i don't care...[/quote]

Very best wishes to your wife for a speedy recovery.

As for the heart attack scenario there is the Medivac Helicopter. One landed at the top of our hill recently to collect a heart attack victim, sadly in this case nothing could save the poor chap but the response was very quick. I used to live in the Fens of East Anglia and the time to get to a hospital with A&E cover was worse than here in rural Abruzzo.

I was in a car accident earlier this year, the ambulance arrived very quickly, I was taken to the General hospital in Pescara, where within an hour I had been x-rayed, MRI scanned, had an ECG, been cleaned up, stitched and admitted. I spent three days in hospital and I can not fault the care I received.

One Doctor came to me, he had been told I spoke English so he said very slowly and clearly ‘You speak English, where are you from?’ When I replied ‘England’ we all fell about laughing!

Before I was discharged I underwent every sort of test imaginable to be sure that nothing was overlooked. I expect the care would be the same in England but at least I know how very good it is here in Italy.

I feel sorry for your reindeer if that's you !.....They obviously fed you very well in Ospedale !!!:bigergrin:

I too lived in East Anglia and our nearest hospital with A&E was Addenbrookes. A great hospital but an hour away. You also had to pay for parking and wait an age for an appointment.

My recent encounters with the hospital here have resulted in a hospital inpatient appointment within 2 weeks (and that includes Christmas!). That is absolutely incomparable to the service I got in the UK.

With both parents either in remission or still undergoing treatment for cancer, I know how long they had to wait for their appointments. In fact my father's "dedicated cancer nurse" who he was supposed to call if he didn't get his appointment within 2 weeks never picked the phone up. A bit pointless then really.

I absolutley cannot fault the care here. There is also another difference. Try paying for a private appointment here - you will be shocked at how cheap it is. An ultrasound costs €60 with the results immediately. In the UK it cost me over £100.

I have no experience of care for the elderly (either in UK or here) but they do still have convalescent homes here, where people are sent after a long illness or major surgery. Something routinely done in Germany too which is a wonderful way of recovering.

ooh - and we now have the helipad at Amandola hospital!

[quote=Penny;106070]
I have no experience of care for the elderly (either in UK or here) [/quote]

As someone who in the past has had rather too much experience of caring for elderly family members, and who is now near enough to the age when you start worrying about these problems for yourself, I think that Violetta's original post was very helpful in highlighting matters of very real concern..

Her worries cannot, I think, be answered simply by comparing UK and Italian healthcare facilities. These are to an extent a postcode lottery in either country - and the results of this lottery also vary according to what medical condition you have. And as has been suggested, your own individual personal experience and your personal social support network will also be vital for determining which country and health system you will be happier in towards the end of your life.

I think that staying on in Italy is probably going to be a far better option for those have migrated young, learned fluent Italian (or are bilingual) and acquired a good network of close friends (and ideally family) than it is for those who have none of these experiences. For those who moved to Italy in their 50s or 60s, speak poor Italian and have a small and perhaps weak friendship network, life could become very difficult indeed in old age - particularly for a widow or widower after their partner's death when they have previously relied on each other for close and continuous support in a complementary relationship.

It's also important to remember that health in old age is not just about treatment and care for physical illness and physical disability - it can also often be about mental decline, mental illness, anxieties and depression. We are, for example, moving towards a position where 50% of us will be suffering from dementia by the time we die. In the middle years of decline from dementia, your recent learning and experience and recognition of people often drop away and increasingly only the past and your longest-standing language and acquaintances remain accessible. In such circumstances, to be cared for in the country of your birth, within limits irrespective of the quality of care, might often be less confusing and disturbing than experiencing care in your newly adopted country.