The service system for people reliant on care consists of a multitude of home or residential services, as well as allowances and support for families with persons who are reliant on care, mainly the elderly.
The increasing number of elderly people is reaching particularly significant proportions in Veneto, and has led to the definition of policies promoting the welfare of the elderly to prevent a decline in health, to guarantee care for the frail and those who are not autonomous, and to support their families.
Considering the importance of enabling elderly people to live in their family environment, within their own home and social context, and the widespread tendency of families to look after those reliant on care at home, for some years policies have been supporting home care. Residential care is only for those who cannot otherwise be cared for. This guarantees the quality and the appropriateness of measures, as well as the financial sustainability and accessibility of the services.
This requires a search for synergy and collaboration in the planning of services so that resources for domestic care, residential care and healthcare can be channelled in the direction of shared objectives and coordinated interventions in regional planning.
Two strategies to pursue have recently emerged: the first is the centrality of the citizen and their right to free choice; the second is regional planning of resources.
To guarantee the citizen's centrality and free choice, it is necessary to take responsibility for the global care of the individual, and the whole healthcare and welfare system for those reliant on care. Through planning, on the other hand, systems of residential and domestic care are integrated, as defined by the Local Plan for dependent persons. This is an operational tool for regional bodies and interlocutors to attain the objectives and results of regional and local planning.

In 2004 (Note 1), Regione Veneto redefined its home care system. A planning and management framework outlined the roles of Municipalities, Local Health Authorities and regional government in the common goal of promoting and safeguarding the quality of life of those who risk exclusion from their family context. This can be achieved through the creation and continuous development of a composite, well-organised network of policies, resources and measures to support home care and families who care for dependents, and assistance and protection of frail persons.
The home care system consists of a range of opportunities offered to citizens and to families to access social, social health and healthcare assistance, and to support the choice of the dependent person to live at home. The integration of the various components is carried out via the convergence of responsibilities through which, on the one hand, social and health workers help citizens understand their needs and guide them towards accessible resources during the evolving period of care. On the other, citizens make their own choices.
On an institutional level, integration is based on funding, services, professional profiles, diagnosis and care procedures of a health, social and welfare nature, defined in the local plan for home care.
The system of home care is made up of policies promoting home care, designed for the elderly and their families, and policies of support for the home care of dependent people.
Promotional policies have a unitary vision of people's needs, in general the elderly, which goes beyond the network of services and takes into consideration daily life: living, moving around, leisure, sport, keeping healthy, personal care, culture, socialising and maintaining significant social relationships, travelling, safety, and using new technologies. Support for associations for the elderly, social day centres, organised holidays and keep-fit for the self-sufficient are examples of home care policies.
Home care policies cover three areas:

• domiciliary assistance to support the family: social, health and integrated social health domiciliary assistance,
  
• financial support, such as allowances for the people and their families. These differ according to the burden of the care, the kind of care given, and financial situation.
  
• respite for families, that is day centres, temporary admission to residential care, organised holidays for those reliant on care.
  

Interventions of home care to support the family aim at the prevention, maintenance and recuperation of the remaining abilities that allow the person to stay in their own home environment. This allows them to maintain their usual relationship with their own living spaces and memory.
Welfare home care is a service offered to those who need help with personal hygiene and daily tasks. Help includes the supply of meals, cleaning, transport, social and psychological support and the development of processes of resocialisation.
Home care is aimed at different kinds of users, though around 80% of them are elderly people, and the number of users is increasing slowly. In fact between 2006 and 2007 numbers rose from 31,697 to 32,152.
If a user also needs medical or nursing care or rehabilitation, they can request integrated home care (ADI) (Note 2). The user can thereby be given the appropriate care at home, avoiding the inconvenience and expense of a hospital stay. Around 46% of users request ADI and of these 78% are elderly people.
Remote aid/remote monitoring offers help to the elderly and frail. It is a remote monitoring system connected to a 24-hour operator. Every user has a device with a button which, when pushed, sends an alarm to the operator. The centre can then act immediately to activate all the services necessary for prompt intervention. The service is mainly for those at risk because of social or health problems, and for the elderly in particular.
In 2009 24,295 people were connected to the service, up 8.5% on 2006.
Financial aid aims to support families who need assistance with the dependent person, thereby helping to avoid admittance to an institution and to keep the person in their home environment. There are two kinds of service according to the objectives of the individual care project. One is temporary or special intervention which guarantees continuity of care in emergency situations. The other is care allowance (Note 3), which aims at integrating financial resources so that continuity of assistance can be guaranteed for the dependent person.
In 2009 26,463 users, mainly elderly people, received care allowance (Figure 14.3.1).
Day centres and other services, such as planned or emergency admissions, are part of the Region's services for family respite (Note 4). These kinds of intervention are closely connected to the residential care system, with which it is necessary to collaborate to guarantee appropriate solutions for the individual's needs.
Forms of help include vouchers which families can use to pay for temporary stays in a residential home such as residential centres, residential homes with medical care (RSA) (Note 5), and health authority residential centres; and respite allowance, that is financial support offered to a family needing help in a particular period.
The most recent figures, for 2007, reveal that forms of respite were used by 4,888 people, of which 51.9% were disabled adults and 48.1% were elderly people. Respite allowance is mainly used by the elderly, 56.7% of total users, whilst vouchers are mainly used by disabled adults, who make up around 64% of the total number of users.
Social healthcare centres for dependent adults also form part of the home care system. These are day care centres for rehabilitation and occupational therapy for dependent people or those with reduced psycho-physical and relational independence living at home. In 2007 there were 63 day centres in Veneto with a total of 933 available places.

In 2000 (Note 6), Regione Veneto redefined its care model for dependent people who cannot be cared for at home by planning the Region's intensive and extensive residential assistance system in accordance with the 1996-1998 Regional Social Health Plan (Note 7).
Over the last ten years, a complex network of residential services has developed. This is highly integrated with the social healthcare system, is widespread over the region and fulfils the structural and qualitative requirements established at a regional level.
In the model's redefinition, residential services for dependent persons went beyond the traditional "institutions" and "old people's homes" and became Service Centres offering diversified and complex forms of care. These offer a full range of degrees of care, special places for patients in a vegetative state and for those suffering from forms of dementia such as Alzheimer's.
Recently "residential referrals" have been introduced into the system. This is a certificate issued to citizens for access to care in residential and semi-residential services authorised in accordance with current legislation (Note 8). This ensures that citizens are free to choose the residential service which most closely meets their own care needs.
According to data for 2007, there are 275 Service Centres in Veneto. These have a total of 23,800 authorised bed places which are divided according to different kinds of care. There were 19,454 places for those needing a low degree of health care, 4,091 for a medium degree of health care, 140 for the High Protection Alzheimer's section and 115 for patients in a permanent vegetative state.
As well as these places for dependent adults, the residential system offers around 5,000 places for self-sufficient elderly people.
This system responds to regional planning, which is redefined annually to take into account changing needs and the availability of financial resources at a local and regional level (Figure 14.3.2).