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1 This article was downloaded by: [Universita' Milano Bicocca], [Annalisa Ornaghi] On: 19 January 2012, At: 03:57 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: Registered office: Mortimer House, Mortimer Street, London W1T 3JH, UK Journal of Intercultural Studies Publication details, including instructions for authors and subscription information: The Badanti (Informal Carers) Phenomenon in Italy: Characteristics and Peculiarities of Access to the Health Care System Mara Tognetti Bordogna & Annalisa Ornaghi Available online: 19 Jan 2012 To cite this article: Mara Tognetti Bordogna & Annalisa Ornaghi (2012): The Badanti (Informal Carers) Phenomenon in Italy: Characteristics and Peculiarities of Access to the Health Care System, Journal of Intercultural Studies, 33:1, 9-22 To link to this article: PLEASE SCROLL DOWN FOR ARTICLE Full terms and conditions of use: This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. The publisher does not give any warranty express or implied or make any representation that the contents will be complete or accurate or up to date. The accuracy of any instructions, formulae, and drug doses should be independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims, proceedings, demand, or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material.

2 Journal of Intercultural Studies Vol. 33, No. 1, February 2012, pp. 922 The Badanti (Informal Carers) Phenomenon in Italy: Characteristics and Peculiarities of Access to the Health Care System 1 Mara Tognetti Bordogna & Annalisa Ornaghi Observing and studying the caregiver phenomenon means, above all, analysing female migration, which is a particular characteristic of Italian immigration. In this paper, we examine and describe the informal caregiver phenomenon in Italy, emphasising the role these women play in the family-based welfare system. We describe the phenomenon, or care work, to analyse the role of the caregiver (as resource and as user) in the Italian welfare system. We argue that these women care workers are isolated from the rest of the Italian community and are not sufficiently integrated within the Italian welfare system. Their presence has transformed the Italian welfare system. Keywords: Caregiver Migration; Female Migration; Informal Carers; Italy Observing and studying the caregiver phenomenon means, above all, analysing female migration, which is a particular characteristic of Italian immigration. Since the 1970s women have been the protagonists of Italian migratory flows, a trend that has continued in the new millennium (Favaro and Tognetti Bordogna 1991, Tognetti Bordogna 2003; 2004a, Zanfrini 2004, Ambrosini 2005). From the end of the 1990s however, and exponentially in the new millennium, Italy has faced a type of female Associate Professor Mara Tognetti Bordogna teaches in the area of migration politics in the Department of Sociology and Social Research, University of MilanBicocca. She is the coordinator of the migration politics series published by Franco Angeli. Correspondence to: Mara Tognetti Bordogna, Department of Sociology and Social Research, University of MilanBicocca, Via Bicocca degli Arcimboldi 8, Milano, Italy. mara.tognetti@unimib.it Annalisa Ornaghi is a PhD candidate in Sociology and Social Research, Faculty of Sociology, University of Trento (Italy) and University ParisSorbonne (France). Correspondence to: Annalisa Ornaghi, Department of Sociology and Social Research, University of MilanBicocca, Via Bicocca degli Arcimboldi 8, Milano, Italy. annalisa.ornaghi@unimib.it ISSN print/issn online/12/ # 2012 Taylor & Francis

3 10 M. Tognetti Bordogna & A. Ornaghi immigration, women who, without assistance, look after elderly people who are not self-sufficient or disabled persons. This new migratory phenomenon, defined as caregiver migration, plays an important role in the distribution of care. These women arrive mainly from Eastern Europe, South America (Peru and Ecuador), but also from Morocco. They are often irregularly employed in Italy. Informal caregivers have specific strategies and migratory projects, and are distributed across the national territory (Catanzaro and Colombo 2009). Social scientists do not have a common position on the decline, rebirth or the revival of female care-giving work; they only agree that it cannot be simplistically assimilated to domestic work (Vicarelli 1994, Tognetti Bordogna 2004b). In this paper, we examine and describe the informal caregiver phenomenon in Italy, emphasising the role these women play in the familybased welfare. We describe the phenomenon and analyse the role of the caregiver (as resource and as user) in the Italian welfare system. We argue that these women are isolated from the rest of the Italian community and are not sufficiently integrated with the Italian welfare system. Their presence has transformed the Italian welfare system. Female migration is a salient feature of Italian immigration. This is a relatively recent and extremely important phenomenon. Currently, approximately 50 per cent of immigrants in Italy are women (998,454, 48 per cent of the total in 2008) whereas in the 1960s this percentage stood at around 30 (fewer than 144,000) (Campani 2000, ISTAT 2008). The progressive feminisation of migratory flows (Castles and Miller 1993), not only in Italy (Favaro and Tognetti Bordogna 1991), is a key issue in international sociological research (Sassen 2007). In this paper we examine one of the extremely important components of female migration in Italy, that of the informal carer or badanti. By the term informal carer or carer, we are referring to migrating women who carry out a specific form of caring work: looking after the disabled or after the elderly living alone and who are no longer self-sufficient (Carchedi et al. 2003: 53). The legal definition of these workers according to the European Union (EU) is non-eu origin workers charged with providing assistance to members of the family suffering from pathologies or handicaps that limit selfsufficiency (Ministero dell Interno 2010). Many different sociological theories 2 have been used to explain the feminisation of migration. This paper will focus on macro-structural aspects and, above all, on aspects linked to the organisation and globalisation of the employment market (Wallerstein 1985, Sassen 2002). We will also however attempt to understand and describe migration dynamics based on the new sociology of immigration (Massey et al. 1993), considering three levels of analysis: macro, to study the superstructural causes of migration; meso, to outline the strategies that aim to create, use and reproduce the social capital through relations with local and other immigrants (both left in the country of origin and of destination); and finally, micro relational, to analyse the individual motives of migrating women. This will help us to understand just how important gender roles and differences really are in the migratory processes. Migration entails a reconstruction and redefinition of personal and cultural identity; in these terms, migration is an all-inclusive social fact. One s gender,

4 Journal of Intercultural Studies 11 national or ethnic identity and anxiety about emancipation affect a migrant s entire social reference. This gives rise to a series of consequences ranging from tormented integration, to adaptation over time or to a rejection of assimilation. Immigration came late to Italy, in comparison to other European countries, however, by the 1970s women were already the main protagonists of migratory flows in Italy (Andall 2000, Tognetti Bordogna 2003, 2004b, Zanfrini 2004, Ambrosini 2005). Since the 1970s, there have been two separate phases of migration to Italy (Tognetti Bordogna 2004b). In the first, from the 1970s to the 1990s, a great number of women migrated to Italy to join the field of domestic work and this was the start of the growth of immigration to Italy (Tognetti Bordogna 2003). In this phase, women came mainly from countries such as the Philippines, Eritrea and Ecuador. They left their countries chiefly for financial reasons. They worked full time in the domestic environment with an open-ended migratory plan and their privileged entrance channel was often the Church; they were the so-called colf (or home helps) (Campani 2000, Tognetti Bordogna 2003). Following this wave, measures to restrict the migratory flow were introduced. It was, however, towards the end of the 1990s, and even more so in the new millennium, that a substantial number of women immigrants arrived in Italy and joined the care work sector (Tognetti Bordogna 2003). These women, informal carers who undertake domestic work, come mainly from East European countries and Latin America (Peru and Ecuador in particular), but also from Morocco. Like women in the first phase of migration, these women generally planned to settle down permanently in the new country. Unlike home helps, informal carers tend to have a short or medium-term financial migratory plan. They maintain strong links with their country of origin by mobile telephone, sending goods and belongings or money to their families, using small or large transport companies that offer courier services between Italy and their country on a weekly basis. A black market emerged together with this migration trend; workers arriving in Italy on a tourist visa, would, as these expired, move from one status to another. As research has shown (Catanzaro and Colombo 2009, Tognetti Bordogna 2009), these women have clear migratory plans and strategies; they are initially spread throughout Italy, are often hired on the black market and have to do a lot of commuting. The presence of these workers must be seen in terms of the characteristics of, and reasons for, their migration (Andall 2000, Sassen 2002, Tognetti Bordogna 2004a). Scholars (Vicarelli 1994, Tognetti Bordogna 2004a) fail to take a shared position on the decline and rebirth of this work but they do agree that the informal carers today have distinctive characteristics and features to the previous domestic workers, the colf or home helps, and the two groups cannot be elided in a simplistic way. The increased demand for care workers is common to many European countries but the demand is extremely high in Italy. Besides economic and demographic explanations, the reasons for this increased demand can be traced back to both a reproduction of lifestyles and status, and to the desire to avoid gender and generational conflicts related to domestic work within the family. It is determined

5 12 M. Tognetti Bordogna & A. Ornaghi by socio-demographic factors relating to the family structure, the demand for assistance and the type of social and health welfare system in place. An ageing population combined with a declining birth rate has led to a marked increase in the number of elderly people, and very elderly in particular, who live alone (Mottura and Pugliese 2006). In Italy the number of very elderly (over 80 years old) rose from 1.3 per cent of the population in 1960 to 3.9 per cent in 2000 and 5.5 per cent in 2008 (Tognetti Bordogna 2007b). This ageing phenomenon is accompanied by the chronicisation of diseases, with a related increase in the demand for health care and social assistance services (Pavolini 2005). Another element affecting the care work phenomenon is that an increased number of Italian women are joining the labour market. This means there are more families with two breadwinners (Andall 2000, Reyneri 2005), but there has not been a corresponding division of the caring work between men and women. Thus, care work is still undertaken by women, but while some women have left domestic work Italian women others have joined it immigrant women. This change has not merely meant the replacement of individuals, but, rather, has resulted in broader cultural changes to caring models and social policy. A third explanation for the reliance on care workers is the deep-set cultural convention (Tognetti Bordogna 2003) that the elderly should be looked after by and in the family (Mingione 1997). It is also important to note the inflexibility of the Italian welfare system; it meets overt needs but not the multifaceted needs of the elderly and their families. These factors increase the demand for care work and consequently that of a low-cost immigrant workforce. Given the family-based welfare system in Italy, home help for the elderly is important and informal carers are a vital link in the Italian welfare chain. The informal carer is becoming an increasingly central figure in Italy s social fabric, a backbone of do-it-yourself welfare and an indispensable support to an ageing population. They are also an increasingly integrated component of the family nucleus; informal carers are already a stable fixture in many Italian households. The remainder of the paper examines the extent to which informal carers constitute a sector of the Italian welfare system along with the degree to which they are aware of how it functions. This research is based on more than 600 in-depth interviews from the PRIN 2005 inter-university research 3 and quantitative data to describe the trend over time (CaritasMigrantes 2008, ISTAT 2008). Our basic assumption is that informal carers cannot offer good care to the elderly if they themselves are not in good health and do not become part of the welfare system. After describing the phenomenon of informal carers in Italy, our paper will investigate if and how these immigrant women, who perform the physically and psychologically arduous work of care access the welfare system s health resources for themselves. In other words, the aim of this paper is to describe and analyse the role of the caregiver in the Italian welfare system, both as a resource and a user of the welfare system.

6 Journal of Intercultural Studies 13 Carers in Italy The badanti or informal carer phenomenon began in the late 1990s and exploded in the new millennium. It is a solitary type of migration, a new immigration as defined in sociological literature (Mottura and Pugliese 2006). It consists mainly of women moving alone and, according to estimates (CaritasMigrantes 2008), 57 per cent of these migrants come from Eastern Europe, especially from the Ukraine, Romania and Moldavia; that is, from areas experiencing a significant post-communist crisis (CaritasMigrantes 2008). It is the collapse of the economies in East European countries (Mottura 2003), mainly the Russian economic, currency and financial crisis in the late 1990s that has led to their migration. These migrants tend to be the family s main income earners. Many carers, particularly those from Eastern European countries, were unemployed before leaving, or left a poorly paid job behind. Carers choose Italy as their destination because they have acquaintances already living there or because they have been informed about the possibility of finding work. They are aware that there are not too many alternatives to this work, although, if they decide to stay, their aim is to achieve some form of working emancipation, such as being employed as a worker in rest homes for the elderly, or care work with the curate, paid on an hourly basis. Research has shown that there are various types of carers depending on strategies and individual aspirations; namely, instrumentalist utilitarianist ; familyist and promotionalist (Ambrosini and Cominelli 2004). Some authors identify other carer profiles that, on the basis of the duration of the migratory plan, can be added to the ones above, including: open-ended plan ; longterm ; short-term (Pavolini 2005). It is estimated that there are 774,000 family assistants, or care workers in Italy, of which 700,000 are foreign workers (CaritasMigrantes 2008). CENSIS (2009) suggests that there are a total of one and a half million home helps and informal carers. A significant section, 6.6 per cent, of the population over the age of 65 use a carer (1 in every 15), for a total estimated cost of EU10 billion per year. This amounts to approximately 10 per cent of the health costs sustained by the regions (which pay for health services). They are geographically dispersed, in cities, towns and villages, depending on work opportunities. There are regional variations in the distribution of care workers; with more employed in the north of Italy than the south (48 per cent north; 35 per cent centre; 17 per cent south). The increase in the presence of informal carers in Italy and their distribution throughout the country can be traced back to specific social policy choices. The ever higher outsourcing of services and the increase in the costs of structures for the elderly (RSA Health Welfare Residences) are both factors that promote the growth in the demand for informal care work. Local bodies lay claim to a role in equipping this profession, by making ad hoc training courses available, especially in the last few years when the phenomenon of the informal carer has become more widespread throughout Italy. The significance of informal carers to the health sector can be evidenced by the general amnesty of irregular migrants in 2007, promoted mainly by the local regions

7 14 M. Tognetti Bordogna & A. Ornaghi and the service sector. The 2007 amnesty allowed for the regularisation of non-eu citizens who had no residence permit but were employed as domestic workers or informal carers. Later amnesties (2009 and 2010), while given a different name (flow decree 4 ), also concealed a programmatic amnesty project. According to statistics published by the Italian Home Office (2010), a total of 294,744 applications for regularisation were submitted for the amnesty of 2009, of which 180,408 were for domestic helps and 114,336 for informal carers. As seen in Table 1, citizens from the Ukraine submitted the most applications (37,211), closely followed by Moroccans (36,138) and Moldavians (25,605). The top positions alternate between countries of old and new migration to Italy. The top 10 positions by country of origin represent per cent of total applications (Table 1). The nationality of the amnesty applicants, and their work type, confirms the results of previous studies that show a segregation of domestic and care work (Ambrosini 2005). Care work is overwhelmingly undertaken by women from a few specific nationalities. The mechanism of occupational segregation can be the effect of several external factors such as networking both by friends and relatives already in the care market and by religious institutions, especially in the initial stage of the migratory chains to Italy. Methodology and Research Data As previously mentioned, our research is based on data taken from qualitative interuniversity studies. 5 This involved a total of 682 individuals, of who 596 were women (87.4 per cent) and 86 men (12.6 per cent), located throughout the national territory. Semi-structured interviews were carried out and the questions, of interest for our work here, concerned their access to public or private systems to receive medical Table 1 Top 10 nationalities of origin by number of applications submitted and per cent of total Country of origin Applications submitted Per cent of total Ukraine Morocco Moldavia China Bangladesh India Egypt Senegal Albania Pakistan Top 10 total Other countries Total Note: This table shows total values, no distinction is made between informal carers and domestic helps. Source: Our processing of data from the Italian Home Office (ISTAT 2008).

8 Journal of Intercultural Studies 15 Table 2 Interviews according to territory and gender giving absolute and percentage values Women Men Total Geographical distribution N Per cent N Per cent N Per cent Centrenorth South and islands Total Source: 2005 Prin research Nationality, gender and class in the new domestic work. Changes in the Italian family and evolution of the migratory systems assistance for themselves or a family member. They were asked about the services they obtained, difficulties they encountered and, which needs or requests were met by the system and which were not. All interviews were coded and transcribed in full before analysis. We also used quantitative data from several sources (ISTAT Italian Institute of Statistics, the Italian Home Office and Caritas) to obtain a picture of change over time. The data collected show how the geo-cultural origins of our interviewees differ greatly. Around half the women come from a central-eastern European country, more specifically 12 per cent from Romania and the Ukraine, 10.5 per cent from Poland and 6.4 per cent from Albania. These were followed at a distance by women from the Philippines (9.7 per cent) and Ecuador (5.7 per cent). The main origins of the men are Sri Lanka (26.2 per cent), the Philippines and the Mauritius islands (10.7 per cent), Ecuador and Peru (9.5 per cent). Both men and women are mainly concentrated in the 3544 age range (women 31.9 per cent; men 23.2 per cent). About 30 per cent of women are in the 4554 age group and 24.7 per cent in the 2534 age group. Men, on the other hand, are younger, with 30.5 per cent in the 2534 age bracket and just 23.2 per cent in the 4554 category. These are highly educated people. Of the women, 24.7 per cent are university graduates, as are 10.3 per cent of the men. Among them, 58.3 per cent of the women and 65.5 per cent of the men have a secondary school diploma. The median period of arrival in Italy (Figure 1) peaked between 1997 and 2001 (41.4 per cent women; 29.8 per cent men). This is partly due to the legislative provisions on immigration implemented in those years. An analysis of the data has highlighted some gendered differences relating both to the reasons behind the migratory process and their approach to the caring work. Our data show that in 51.2 per cent of cases female informal carers have two or more children, 25.6 per cent one child and 23.2 per cent no children; interestingly, 7 per cent have four children. Many informal carers begin a migratory path in order to allow their children to finish their studies. Women, then, interrupt their role of care in their country of origin in order to care for an elderly or disabled person in the migratory context. The men s decisions, on the other hand, although also linked to economic reasons, show more individual aims such as optimising human capital and self-realisation.

9 16 M. Tognetti Bordogna & A. Ornaghi Figure 1 Breakdown by gender and median period of arrival to Italy. Source: PRIN Men and women also had different approaches to their work. Women become more involved in the caring side of the relationship, both emotionally and psychologically, and their activities sometimes included housework. Men tended to remain more emotionally detached, seeing their caring relationship as helping the person in their daily activities, particularly those requiring physical strength (for example, if they need lifting into a wheelchair) and capacities, but they rarely did housework. One male care worker, for example, said: I don t think this job is for women, like I do it now. The man is a little heavy, that is not a woman s work. (A., Ukraine, male, 28 years old, in Italy since 2003) Work between Welfare Consumption and Resource 6 The extent to which these care workers interact with the Italian welfare system, both to meet the needs of the individuals they are caring for, but also for their own needs, is important. Access to services is a key indicator of immigrant inclusion (Tognetti Bordogna 2006) and a process that structures and regulates an individual s health (Lynch et al. 2000). The work carers perform however limits their ability to make independent choices of welfare resources and to access the welfare system. This has been likened to other research that found that assisting an elderly person reduces opportunities for contact and increases isolation (Arber and Ginn 1995, Dalley 1996) while creating specific welfare needs due to the demanding nature of the work. Domestic work is arduous both on a physical and psychological level. This has consequences for safety at work. An Italian survey found that 44 per cent of domestic helps and informal carers interviewed had a domestic accident in 2009 (CENSIS 2010). Further, 3,576 accidents involving domestic staff were recorded in 2008, of which two were fatal. These accidents often have physical consequences for the worker (84.5 per cent of cases); mainly bruises or sprains (29.5 per cent), wounds (20.8 per cent), burns (18.8 per cent) and fractures (9 per cent). However, in many cases the damage is slight and does not lead to an inability to work (48.6 per cent). This research demonstrated that carers do not have enough awareness of the occupational hazards and the possible consequences for their own health, as confirmed by the high frequency of imprudent behaviour. In fact, 67.9 per cent of

10 Journal of Intercultural Studies 17 the carers interviewed say that they continue to work even when they are tired or sick (CENSIS 2010). Carers tend to be highly segregated from the rest of the Italian community and this limits their access to the welfare system. Their segregation is mainly a result of care workers being expected to be on duty 24 hours a day. The hours imposed on these women mean that many live in conditions of exploitation and isolation, consequently making them extremely fragile. One woman said: It s incredibly tough staying at home all the time... and so boring being with the elderly... when the grandmother was ill, I woke up at night, I couldn t sleep, and then did what had to be done during the day. It s really hard. (N., Romania, female, 28 years old, in Italy since 2004) Many of these workers also have limited Italian language skills, which makes it more difficult for them to access services. We can see from our data that those classed as having good or excellent language skills (meaning comprehension and oral skills) make greater use of social services (57.1 per cent) than those with lesser or poorer skills (33.3 per cent). Only 9.6 per cent of those with poor comprehension and language skills use services. These carers are aware that these skills are inadequate and a hindrance in the health relationship. They viewed this, for example, as being a decisive factor in the relationship with the doctor. One care worker, when asked if he had ever spoken to a doctor about his employer s health said: Not yet because I don t understand some words still. So I can t speak to his doctor. This is a problem. (N., Sri Lanka, male, 27 years old, in Italy since 2004) Having language skills and abilities is essential for inclusion in the welfare system, because this system has very little or no option for communication outside of Italian. Another factor that isolates the care workers is that when it does become necessary to enter into relations with the welfare system through the admission of their charge to hospital or a rest home for the elderly, the carer is also hospitalised. They remain in hospital and carry out different tasks together with the health professionals. They become the additional carers, who care for or keep the elderly person company when he or she can no longer be kept at home and needs to be hospitalised. This is an extremely isolating experience, as one of our research participants described:... I felt bad because I and my old woman were in hospital and they told me to stay in the hospital 24 hours a day, I started to argue with them and told them no, I can t stay in the hospital 24 hours a day, you have to give me free time too, if you do 24 hours a day you get, you lose your mind. (Z., Moldavia, female, 42 years old, in Italy since 1998) Generally speaking, carers do not interact with services sufficiently, either for their own behalf or for the person they care for. Only 61.2 per cent of carers in this study

11 18 M. Tognetti Bordogna & A. Ornaghi use services while 36.8 per cent do not, and the remaining 2 per cent use only specific services. Given the carers age and the type of work they do, this is a low percentage and the number of domestic accidents they are involved in is indicative that these carers should be more integrated into the welfare system. When they do turn to the welfare system, it is mainly for the person they care for and not for themselves. Given this isolation from the welfare system, the care worker must deal with the illness and health problems of the person they look after without specific skills or knowledge in the field, and with little support from professional health workers. They take over the task of looking after the elderly person and caring for them correctly. They move with and for their employer through the welfare system, in a competent manner. Participants in our research said they speak to the doctor on their employer s behalf and provide psychological support for their charge. They decide when to call a doctor and learn to deal with crisis situations on their own, simultaneously showing the strength of their role but also their need for support. If we analyse this in terms of the welfare production of this individual care worker, what emerges is a profession that is not networked with other resources for the care of the elderly and does not exploit health services to complement their task, particularly where this entails health issues, such as administering medicines, injections or catheter application. These carers hardly ever use the welfare system for their own needs. When they do, they mostly use only the family physician, accident and emergency room and the hospital. They also go to clinics, diagnostic centres and the health authorities, albeit reluctantly and only where there are clear signs of illness. Generally speaking, however, they are satisfied with the treatment received. Did you have any problems in the hospital? No, they treated me well, very well. They explained everything about what I had to do. (A., Moldavia, female, 26 years old, in Italy since 2004) We can therefore see a group of people who use specialised and emergency structures and services when the need is very clear and well defined. They do not act preventively because this would entail high costs, particularly for dentistry. The national health system provides for the health protection of both regular and irregular migrants only in the emergency department of the hospital (with the exception of dental care). In order to be covered by the national health system, and then to have access to a general physician, a worker must be in possession of a residence permit. They have a general physician if legally employed, but more often than not care workers will use the physician of the person they care for. They are likely to use their savings to buy medicine in their country of origin. Similarly, for dentistry they tend to return to their country of origin for treatment because it costs less. What they receive can be used to make up for the lack or failings of welfare in their country of origin. One care worker said: [You were telling me that medical expenses are expensive.] So every now and then, when, say, the medicine is free on the health service, I take a lot in my name and

12 Journal of Intercultural Studies 19 send it off. You send medicine? Yes, I send medicines as my mother always needs it, for high blood pressure, but I send, but I take the same, but I instead take half, half of these tablets and instead... so every month I put a box aside to send off. (V., Philippines, female, 51 years old, in Italy since 1996) In some cases, it is the family of the person cared for who manages these workers health needs, in other cases, the workers themselves understand the importance of prevention and try to implement it. One respondent asked if she had any problems in accessing the health system in Italy said: Last year, I had little problem, not too serious, washing powder, an allergy. Taking antihistamine cure in pharmacy without prescription. Measuring pressure, I do it myself, but normal. Also when C. (employer s doctor) comes, always ask you need something? But I healthy. (V., Ukraine, female, 46 years old, in Italy since 2003) In regards to the other welfare resources, it would appear that their awareness and use of them is closely linked to the needs of the person they care for and the knowledge their (female) friends possess about these services. This research, therefore, shows that these migrating women make very limited use of services for themselves, and more frequently turn to them for the elderly people they care for. They do not network with others but are quite isolated from the rest of the community. When carers do access services, they do not feel they are, or behave like, a part of the welfare system even if political discourse and some choices made by local governments would like to consider them as such yet they perform medical tasks. Discussion and Conclusions The presence of informal carers transforms the Italian welfare system as a whole. It poses questions about the social, health and labour policy and the management of family workloads and individual services. Carers are not part of the welfare system, as public discourse would like, but are merely substitutes for the welfare system. From the empirical data available to us we see that while carers are competent in using services, mostly for the person they care for, they only resort to essential resources or emergency treatment for themselves, even if this type of harmful and arduous work would require greater controls and health care in itself. The presence of these women, albeit in difficult conditions, contributes to changes in the Italian welfare system and, particularly, policies involving the elderly population (Carchedi et al. 2003, Tognetti Bordogna 2006, 2009). These women are part of a new welfare system, outsourcing the task of caring for the elderly by keeping it within the family, while also helping with diagnostic and treatment tasks. They have forced the creation of a welfare system that on the one hand makes savings, reducing the costs borne by the family, and on the other is not able to adapt

13 20 M. Tognetti Bordogna & A. Ornaghi services to changes in demand or to the types of solutions that families create independently. A welfare system is thus generated that uses the migratory presence in an instrumental fashion, reinforcing the segregation of care work that, in order to survive, makes recourse to underpaid more flexible work and an increasingly poor level of professionalism performed by what some authors (Mingione 1997) call the new proletariat of services : temporary and poorly, or not at all, protected workers. Our monetary-type social system often leads to an incorrect use of the financial resources of the social market. Despite this, the presence of these workers throughout Italy helps optimise local welfare systems, and public decision-makers can no longer ignore them; they can even influence central government, as we have seen, with the approval of the necessary regularisation. The use of this care work has specific implications for the welfare system. There is a focus on individual rather than community-wide solutions. First, for instance there is a reduction in public home help services as families increasingly resort to informal carers (Mottura and Pugliese 2006). Second, the use of care workers means that there are few admissions to rest homes for the elderly and a related shortening of waiting lists for hospices for seriously ill elderly citizens, as the high financial cost of these structures is in competition with the low cost of an illegal informal carer. Health welfare residences are resorted to only when the elderly person can no longer be managed at home (Tognetti Bordogna 2006). Third, there is a change in the relationship with the service system as everything is individualised rather than directed towards a network of public resources. Carers therefore give rise to both a care market and socio-assistance policies and their strategic design; this is because an exclusive and isolating relationship is created by the context and the services. We can therefore see how their presence contributes to the transformation of the Italian welfare system, and initiates changes linked to a lack of home assistance and also the high costs that a family would have had to sustain if they accessed the private service market. Thus, carers on the one hand relieve the care work, and, on the other, make its management more complex by favouring home care and creating more space for individual preferences. Besides altering and affecting the service system, their presence also gives families a role as employers, something that most are not accustomed to. The presence of these informal carers highlights the limits of the welfare system and, importantly, forces the public decision-maker to rethink the Fordist welfare system. Notes [1] Although this paper is the result of shared work, for formal purposes, it is attributed to the authors equally. [2] The theories underlying this study refer to the neoclassic paradigm that sees grounds for international migration in the differentiation of levels of supply and demand for work in different countries. Instead, the Marxist paradigm highlights how immigrants, falling into the lower segments of the employment market, become a structural element of the capitalist

14 Journal of Intercultural Studies 21 expansion process. Finally, structuralist theory sees a relationship between the constant increase in the numbers of female immigrants and the global division of carer work, mainly performed by migrating women. For a more extensive study of these different approaches, see Sassen (2002, 2007) and Zanfrini (2004). [3] For this study, we will use qualitative data from the PRIN 2005 research project Nazionalità, genere e classe nel nuovo lavoro domestico. Cambiamenti nella famiglia italiana e evoluzione dei sistemi migratori (Tognetti Bordogna 2009). [4] The flow decree sets the maximum number of non-eu foreign citizens allowed annually to work in Italy. [5] For this study, we will use qualitative data from the PRIN 2005 research project Nationality, Gender and Class in the New Domestic World. Changes in the Italian Family and Evolution of the Migratory Systems. [6] We refer to these carers as women, even though both women and men perform this work, because of the small number of male carers. Works Cited Ambrosini, M., Sociologia delle migrazioni. Bologna: Il Mulino. Ambrosini, M. and Cominelli, C., Educare al futuro. Il contributo dei luoghi educativi extrascolastici nel territorio Lombardo. Milano: Ismu. Andall, J., Gender, migration and domestic service. The politics of black women in Italy. Aldershot: Ashgate. Arber, S. and Ginn, J., Gender differences in informal caring. Buckingham: Open University Press. Campani, G., Genere, etnia e classe. Migrazioni al femminile tra esclusione e identità. Pisa: ETS. Carchedi, F., Mottura, G. and Pugliese, E., Il lavoro servile. Milano: Franco Angeli. CaritasMigrantes, Immigrazione. Dossier Statistico Roma: Anterem. Castles, S. and Miller, M.J., The age of migration. International population movements in the modern world. London: Macmillan. Catanzaro, R. and Colombo, A. eds., Badanti & Co. Il lavoro domestico straniero in Italia. Bologna: Il Mulino. CENSIS, Rapporto sulla situazione sociale del Paese. Milano: Franco Angeli. CENSIS, Dare casa alla sicurezza. Rischi e prevenzione per i lavoratori domestici. Roma: CENSIS. Dalley, G., Ideologies of caring: rethinking community and collectivism. London: Macmillan. Favaro, G. and Tognetti Bordogna, M., Donne dal mondo. Strategie migratorie al femminile. Milano: Guerini. ISTAT, La presenza straniera in Italia. Roma: ISTAT. Lynch, J.W., Smith, G.D., Kaplan, G.A. and House, J.S., Income inequality and mortality: importance to health of individual income, psychosocial environment or material conditions. British medical journal, 320, Massey, D.S., Arango, J., Hugo, G., Kouaouci, A., Pellegrino, A. and Taylor, J.E., Theories of international migration: a review and appraisal. Population and development review, 19 (3), Mingione, E., Sociologia della vita economica. Roma: Carocci. Ministero dell Interno, Report conclusivo dichiarazione di emersione. Governo Italiano. Available from: [Accessed 30 June 2010] Mottura, G., Necessari ma non garantiti. I fattori di vulnerabilità socio-economica presenti nella condizione di immigrati. In: F. Carchedi, G. Mottura and E. Pugliese, eds. Il lavoro servile. Milano: Franco Angeli, 6182.

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