Caring Connections: Immigrant Caregivers and Long-Term Elderly Care in Italy

This paper investigates the impact of migrant-provided home-based care on elderly health in Italy, analysing hospitalisation frequency, duration, and mortality. Using an instrumental variable approach to mitigate endogeneity between local health status and migratory flows, we show that migrant-provided home-based care reduces the frequency of hospital admissions (extensive margin) and their duration (intensive margin). Regarding the former, a one percentage point increase in the immigrant-to-elderly population ratio leads to a 4% decrease in long-term and rehabilitation (LR) stays, with no effect on acute stays. Concerning the latter, we find that a similar change in the migrant inflows translates to a 1.5% reduction in admission duration, with LR admissions reaching a 3.3% decline. These effects primarily stem from traumatic injuries, musculoskeletal disease, and genitourinary disorders, particularly linked to home-based mobility and treatment management. Our back-of-the-envelope calculations suggests that a 1.3 percentage point increase in the migrant-to-elderly population ratio registered in our analysis period could potentially reduce LR elderly hospitalisation costs by approximately 8% and yield annual public budget savings equivalent to around 0.59% of total hospitalisation expenditures