The aging of the population has long been an issue that needs to be addressed. The question is how best to care for the elderly. The trends in recent years, also in Ticino, are clear: the number of inhabitants over 65 years of age since 1981, as reported by the Statistics Office, has almost doubled, now reaching 81 (data from 011) , of which 2020 are over 41.952 years old. Conversely, from 75 to 2010 the number of beds in homes for the elderly increased by 2018%, going from 11,1 to 4045, reaching 4493 in 4576. According to the LAnz-LACD 2020-2021 integrated planning, by 2030 it could there will be a need for another 2030 seats, or 2000% more than the current ones.
But is the elderly home really the only solution? Actually, no. People over 65 today are different from those of decades ago, as are social structures. Basically, they enjoy good health for longer, thanks to advances in medicine, as well as the improvement of living conditions and the decrease of people in strenuous professions. Raffaele De Rosa, director of the DSS, speaks of a "comprehensive and holistic" approach, as well as "innovative from the point of view of its reference time frame: up to now the sectoral planning of the services regulated by the LACD had a framework period of four years. This Planning extends this period of time to ten years, equating it to that of homes for the elderly".
Tertianum in Lugano
Even the structures for the elderly have changed, with the creation of protected apartments, such as those of Tertianum. «In our model they are located in a residential structure with various services, from catering to entertainment such as the hairdresser. Then there is of course the health part, with the health services provided by our medical department. Our claim throughout Switzerland is: "here I want to live", because here you live, there is quality of life, starting from food to hotel service, up to the social aspect with various entertainment programs for different types of people elderly. They are completely autonomous people and live independently, perhaps with nursing help», explains the group manager for Ticino and Valais Stefan Brunner. In Ticino there are 300 people living in protected apartments, 24 in the medicalized part, with 24-hour assistance.
The Lugano structure of Tertianum specializes in the short and long-term hospitalization of Alzheimer's patients: it is estimated that in Ticino there are around 7-8000 units and many live at home. «To make them autonomous for as long as possible, we carefully evaluate the guest's biography and plan the daily activities based on their "life story". The goal is to make them relive positive moments from their past, to stimulate them to stay active. Also with music and aroma therapy we try to calm them down. The aim is to make them feel at ease in a familiar environment», explains the director Nicola Russo, who highlights how the external sensory garden has a considerable importance in contributing to the well-being of the guests.
Rivabella Magliaso Residence
«The concept of place of life leads our customers to move to our residence in serenity, as it is a real and genuine place, not an abstract and constructed reality. Our task is to guarantee all the services they need, from a hotel and health point of view», explains the director of another structure which has been engaged in Ticino for some time in offering an alternative to the classic elderly home, Alexander Aleman di Rivabella Magliaso Residence. It includes 47 rooms and 50 beds in the main building and 26 apartments, from 1 ½ up to 4 ½ rooms. «Ours is to all intents and purposes an open house which, at the same time, welcomes and allows people to be themselves. Our philosophy puts the person at the centre, with his needs, his requirements and his desires. This is the key to our success, we want our guests to really feel at home and in the family».
Opera Prima
Then there is the solution that allows you to stay at home with a domestic worker, also called a caregiver. It is estimated that in Ticino there are around 1000-1200. Opera Prima, which has been working in the field of carer placement and coordination since 1998, helped sign 2021 contracts in 135. Director Fulvio Manghera helps us draw a portrait of them: «They are often foreign women who first passed through Italy, where they learned customs and language, and then understood that in Ticino they find better working conditions. Those of Swiss nationality are above all day caregivers: perhaps they are people who have raised their children and thus return to the world of work. Initially, the elderly find it difficult to accept someone into the home. Then they understand the need and become attached to it».
One of them, Halyna, with twenty years of experience, when we ask her about her role, lets herself go to stories of great humanity and love.
SUPSI studies on the third age
The elderly have changed and will evolve again in the future: he has no doubts about it Stefano Cavalli, from the SUPSI Senior Competence Center, who together with his colleague Laurie Corna received a mandate from the DSS to analyze this aspect, which was then included among the qualitative chapters of the aforementioned new Planning 2021-2030. They will be better educated, and 'overall they will benefit from a relatively comfortable economic situation. They will also have had less linear career trajectories, more often interrupted by periods of unemployment or precarious employment, than in previous cohorts. This may have repercussions on the economic situation and health. They will live longer as a couple but will have fewer children than they do now. With less contact with family members, they will attach importance to ag
And they will increasingly want to stay at home, thanks also to the development of home automation technology which will allow household appliances or services such as lighting, heating, shutters to be managed from an app. With remote assistance, even relatives can monitor the situation and intervene in case of need. De Rosa also notes the importance of this type of aids. «I would like to underline the fact that the elderly, thanks to their increasingly active role, represent a precious resource for our society. Their experience and their contribution in terms of knowledge and experience in municipal, cantonal politics and in other important groups, associations and institutions offers an added value from which we all benefit. I would also like to recall the important contribution of the elderly in the context of support for many families who, thanks to the contribution of parents and grandparents, find support in the context of family-work reconciliation, giving life to a real encounter between generations » , he adds.
Senior homes are not always perceived positively. Despite the progress over the years, underlined by Laura Tarchini, communication and marketing manager of Pro Senectute: «The elderly homes in the area have made a great effort in recent years to offer a service that is as suitable as possible for the needs of elderly people. Let's think, for example, of the fact that double rooms almost no longer exist: structures with more individual spaces have been favored. An attempt has also been made to make them as familiar and welcoming a place as possible, even though they have to remain a medical facility, for example by paying attention to the furnishings. They are therefore no longer perceived as in the past, as a negative place and the people who live there are generally satisfied». But not everyone wants to go, and skeptics have increased with the pandemic.
«Entering a home for the elderly is often a traumatic event due to the loss of one's daily life and the little things that make one feel good. At Rivabella we work every day with passion and competence to guarantee the well-being of our guests, who have spent their lives in total freedom, often traveling and experiencing different realities from ours, accustomed to high quality standards», underlines Alexandre Aleman.
In any case, even for relatives it is never easy to decide to place an elderly person in a structure, as confirmed by Elena Crivelli, who five years ago was forced to make this choice for her mother. “I tried to keep her at home as long as possible, with a carer. She didn't want to end her days in a nursing home and I respected her choice. But then the needs increased, and the resources, economic and human, were no longer enough».
A common problem. Many already feel guilty about choosing the solution of a caregiver and not personally taking care of their elderly relatives, explains Manghera. “Relatives try to do it on their own, then sometimes they arrive exhausted and ask us for help in a hurry. In the end, however, in some cases, to cover the span of 24 hours, more people are needed and the means are no longer sufficient. At that point you have to resort to the elderly home. Often the sense of guilt diminishes because you know you have done what you could.
them close friends. They will be increasingly active, connected and will make use of new technologies, will continue to attach great importance to spirituality, individualized and lived in private and will show greater openness to topics considered taboo in the past and will accord great importance to values such as autonomy, self-determination and personal fulfilment".
"But after all, even the elderly home costs money, better an apartment with a caregiver," underlines Halyna. Or, Brunner insists, a solution like Tertianum. «Those who come to live with us often don't even have to move to the most medicalized area, because they have access to the necessary nursing services. He doesn't have the shock of having to leave the house and we also see more serenity in the children ».
"I would not oppose the offers that exist in the area," observes De Rosa. «With a view to subsidiarity, it is important that there is this complementarity, also thanks to initiatives of a private nature. Under this denomination we find interesting examples of housing units inserted in a context such as to allow for as long as possible an independent life at home».
For Brunner, however, a public-private partnership is what will make it possible to lower costs: «Among other things, will all those investments for elderly homes really be needed over the years? For the first time with the pandemic, employment has dropped. And then the baby boomer generation will pass.
«The new Planning is innovative, as well as for its contents, also for its reference time frame, i.e. 2030 for all three sectors», adds De Rosa. "While remaining a dynamic document, it allows for an interpretation of quantitative and qualitative needs with this horizon, and confirms the principle of home maintenance for as long as possible".
Like other possibilities, Pro Senectute, for example, also welcomes intergenerational neighborhoods, with «neighborhood initiatives (through neighborhood concierges) with the aim of developing aggregative and participatory projects with a view to social activation, in which people become protagonists of a change in favor of the community». Aleman, on the other hand, is asking for a transport network designed exclusively for the elderly.
