The Hidden Cost of Longevity

Recent analysis* of long-term care spending in Italy highlights a reality that many families already know too well: the financial burden of aging is increasingly carried not by public systems, but by individuals and households.

While public expenditure on long-term care for older people and people with disabilities amounts to tens of billions of euros each year, Italian households spend tens of billions of euros each year on long-term care and support for older relatives.

"These numbers point to a system under strain, where the cost of care is rising faster than the structures designed to support it.," says Francesco Sparaco, Chairman of Threestones Foundation.

“If aging becomes primarily a private burden for families, societies will eventually face a far larger social and economic cost," he adds.

Yet the challenge revealed by these figures is not only financial.

Much of the current response to non-self-sufficiency relies on cash allowances and fragmented services.

While such measures can provide short-term relief, they rarely amount to a coherent or integrated form of support.

Complex needs — cognitive decline, social isolation, loss of autonomy, and emotional distress — are difficult to address through financial transfers alone.

This raises a deeper question: what does it truly mean to support people as they age?

The real challenge of aging is not only how societies pay for care, but how they support people before care becomes unavoidable.

If non-self-sufficiency is treated primarily as an individual or family problem, the burden inevitably becomes unsustainable — economically, socially, and emotionally. Aging, however, is not an exception or an anomaly. It is a predictable and shared stage of life, shaped by demographic trends that affect entire societies.

What is often missing from discussions about long-term care is a stronger focus on prevention, coordination, and meaning.

Research increasingly suggests that wellbeing in later life is influenced not only by access to medical care, but by factors such as social connection, cognitive engagement, purpose, and a sense of belonging.

These dimensions are harder to quantify, yet they play a decisive role in delaying decline and preserving autonomy.

At ThreeStones Foundation, we believe that responding to the challenges of aging requires more than compensating for loss after it occurs.

It calls for research-informed initiatives that strengthen wellbeing earlier, support social participation, and translate knowledge into practical, human-centred approaches.

This does not replace care systems or supplementary funding mechanisms, but complements them by addressing the conditions that make aging more resilient and dignified.

Aging is not a marginal issue for welfare systems; it is a shared stage of life that demands foresight, coordination, and dignity.

The question, then, is not only how societies will pay for care in the decades ahead, but how they can better support people to age with purpose, connection, and dignity — before costs and needs escalate beyond control.

As demographic realities continue to evolve, constructive dialogue between public institutions, private actors, researchers, and civil society will be essential. The challenge of aging is collective. The response must be as well.

*Sources include research from Bocconi University’s Long-Term Care Observatory, OECD analyses, and studies based on the SHARE ageing survey.