Alzheimer's: nursing home admission fees are covered by the National Health Service.

Social welfare services for patients with Alzheimer's disease are a burden on the National Health Service (NHS) because they are inextricably linked to healthcare services. Any other solution would conflict with Article 30 of Law No. 730 of 1983, which places the National Health Fund under "the costs of healthcare-related activities connected to social welfare services," and with Article 3, paragraph 3, of the Prime Ministerial Decree of February 14, 2001 (Guidelines and Coordination Act on Social and Healthcare Services), which provides for the free provision of "social services of healthcare relevance."

This was established by the Milan Court of Appeal (ruling no. 1644 of 2025), which, having been called to adjudicate on the opposition to a payment order of over €26,000 for the residential care home admission of a patient suffering from Alzheimer's disease, declared the care contract null and void "due to its violation of mandatory provisions." This is in accordance with the position according to which:

- the activity performed on behalf of a person seriously affected by Alzheimer's disease admitted to a healthcare institution can be classified as healthcare activity, since it is not possible to determine the healthcare portions and deduct them from the assistance portions, given their close correlation, with the former clearly prevailing over the latter, as they are in any case aimed at protecting the citizen's health (Cassation, ruling no. 4558 of 2012);

- pharmacological treatments administered continuously to individuals with serious chronic psychopathology hosted in facilities equipped with the equipment and specialized personnel suitable for carrying out rehabilitation therapies are included in healthcare-related social and welfare services (Cassation, ruling no. 2276 of 2016).

This approach is not unanimously shared. It is sufficient to cite Supreme Court of Cassation Order No. 13714 of 2023, which states that "the patient's condition" must be taken into account when assessing the prevalence of the healthcare component over the assistance component. Therefore, the order argues, "it is necessary for healthcare treatment to be closely linked to assistance, aimed at slowing the progression of the disease and limiting its degeneration, especially in more advanced cases, which may lead to self-harming behavior or behavior potentially harmful to others." It is also understood that "if it is excluded that [...] the social assistance service is inextricably linked to the healthcare service, it is legitimate for part of the hospitalization fee to be paid by the patient."