La valutazione della disabilità ai fini del riconoscimento dell’indennità di accompagnamento nel soggetto ultra-sessantasettenne

Older people, the fastest growing part of population, are at the highest risk of acquired disability or cognitive decline and, as a consequence, their claim to receive support services, among which the Attendance Allowance for permanent personal assistance, is increasing. This benefit was introduced in the Italian Civil Incapacity system with the law 18/1980 and some relevant innovations were added with the Law 508/1988 and the Decree 509/1988. From a medico-legal point of view, these regulations, define on the one hand the necessary requirements to get a pension (non-contributory), that is physical and or mental disease determining the incapacity for work and, for infra-18 and over-65-year olds, require the “persistent difficulties” to carry out the “tasks and activities” proper to their age. On the other hand, the Law n. 508/1988 identifies also the necessary conditions to get the Attendance Allowance, for those who are unable to get around and/or are unable to carry out daily life activities without the permanent help of a caregiver.Therefore, these regulations specifically provide, first of all, the recognition of the highest level of severity of the “persistent difficulties” concerning the “tasks” and “activities” of the over 65s (prerequisites) and then the judgment for the Attendance Allowance. However, there are considerable difficulties with the assessment of this kind of disability. In fact, we have specific references about incapacity for work indicating the evaluation path and the guide for the rating of permanent impairment (Ministerial Decree 5 February 1992), but there aren’t specific normative and assessment indications about the ability to perform “tasks and activities” in over-65-year-olds (age requirement has become over 67s since January 2019) which allows the risk of a wide evaluating discretion.Italian institutions, like Ministry of Health or INPS (Italian Institute of Social Security) and others officially involved, have attempted to explain and clarify the above-mentioned rating process, but with unsatisfactory results and in some cases even with regressive ones, producing real distortions and interpretative stretches. The author, therefore, after presenting the medico-legal issues for the evaluation of older adults’ disability based on the current regulations, also criticizes the widely found practice of using an atypical, not multidisciplinary, comprehensive geriatric assessment made only for this purpose and elaborate by a single specialist. In fact, the results of a geriatric assessment, like any other Health Certification, is useful to complete the medical history of the subject alleging disability and, therefore, it must be validated by a proper and extensive medico-legal evaluation