The first chapter of the Charter, dedicated to the protection of the dignity of elderly people, establishes two important principles: «1.1 The elderly person has the right to determine himself in an independent, free, informed and conscious manner with reference to life choices and the main decisions that concern him. 1.2 It is the duty of family members and those who interact with the elderly person to provide him, due to his physical and cognitive conditions, with all the information and knowledge necessary for free, full and conscious self-determination".

Rights and duties here combine to work towards a context where freedom of choice is not an empty word, a right on paper. And at the same time one of the biggest problems of elderly life is identified: the deprivation of the possibility of choosing. The comment on the two articles explains it well: «In old age we often enter into a cone of shadow, apparently determined by health conditions and frailty, but in reality the expression of a prejudice of ageism, according to which elderly people no longer have ability to make autonomous decisions, as well as the ability to independently manage one's own life. It is necessary to distinguish an assessment of physical or cognitive dependence from the presumed inability to make decisions, often transformed into implicit disqualification.

The fact that an elderly person has lost some physical and instrumental abilities to live daily life (washing, eating, using money, means of transport, etc.) must not automatically turn into a judgment of inability to decide, and be automatically replaced by the decisions of the family, caregivers or support administrator, abuses which occur for example when the elderly person is prevented from choosing the type and quality of food, from having their own identity documents or electronic payment".

I make a note here starting from the debate on the green pass, on the mandatory vaccination, which has animated the pages of the newspapers in this time of pandemic, due to the concern about the limits to personal freedoms. Well, there wasn't a single line about the much more radical lack of freedom among the elderly, especially institutionalized ones. A recent investigation by the New York Times, dated September 11, 2021, describes the use of antipsychotic drugs systematically administered to the elderly

guests of the nursing homes, the mechanisms for circumventing the law, the reasons and the effects. This is a tragic use of chemical restraint, extended to 21% of nursing home residents in the United States. One of the shortcuts used, for example, is to diagnose schizophrenia, used in 1 in every 9 elderly people in these facilities, while at the general population level the figure stops at 1 in 150, a huge discrepancy. Over 200,000 seniors in US nursing homes have received diagnoses and “treatments.” The phenomenon is not new if you consider that it was investigated by a senatorial commission from 1976 with the eloquent title: "Nursing Home Care in the United States: Failure in Public Policy".

Chemical restraint is also widespread in Italy. Its exact dimensions are not known, but it represents a truly scandalous example of deprivation of personal freedoms. It is the abyss into which many elderly people fall in structures, especially illegal ones, which use chemical restraint to solve the problems of staff shortages, opaqueness of the organic plan, use of precarious employment between different retirement homes and so on. The Commission for the reform of care for the elderly, through the Charter, wants to reaffirm the rights of the elderly, denouncing abuses and envisaging the new horizon in which the future of the elderly should be placed. The condemnation of restraint is also clear in the art. 3.6 “The elderly person has the right to safeguard their psycho-physical integrity and to be protected from all forms of physical and moral violence and improper forms of physical, pharmacological and environmental restraint, as well as abuse and intentional or unintentional negligence ”.

The relevant comment even proposes the possible solution: «The fight against all improper forms of physical, pharmacological and environmental restraint appears particularly important.

This protection should be ensured regardless of whether violence, abuse or neglect occurs at home, within an institution or elsewhere.

The most effective form of prevention of this type of abuse is not represented by the use of mere forms of technological control such as the use of video cameras, but by the possibility of cultivating the life of relationships and interaction with the outside by the for

elderly women: the presence of visitors and volunteers constitutes the best protection against abuse that can occur in closed spaces."

These considerations pushed the Commission to propose a way to reform the RSAs. I quote here a passage from my presentation of the reform plan to President Draghi on 1 September: «1) the RSAs must be residences open to the family, to volunteers, to civil society, having within them the possibility of hosting day centres, of telemedicine, centers providing local services and integrated home care. The degree of openness and exchange with the outside world becomes one of the accreditation and quality assessment criteria of the individual structures. This is intended to avoid the fearful and widespread condition of isolation and loneliness in the future, which unfortunately occurred with the Coronavirus pandemic. As part of the care continuum and in relation to hospitals, RSAs can take on a role in transitional care, with a view to the final reintegration of the rehabilitated and stabilized elderly person into their home. 2) Precisely for this change in function, the standards of personnel, mandatory equipment and the healthcare, nursing and rehabilitation staff necessary for the proper functioning of the RSA are reviewed. 3) These advances will require a review of the tariff system on the one hand but also transparency and the obligation to publish the staffing plan on the other."

Three changes are therefore promoted: the absolute requirement of the opening of the structure to the outside as an accreditation criterion, the change in the function of residential care as part of a continuum in dynamic equilibrium as a transitory moment and not as a terminal station, the rigorous control and transparency of the organic plant, as well as its appropriate enhancement. Fighting illegal construction also means demanding that all structures are open and totally transparent, accessible and permeable, in and out. One of the most significant violations of the elderly person's freedom of choice is the physical impossibility of meeting or leaving these structures, within a regime that can correctly be defined as prison.

I would now like to return, for a second example, to articles 1 and 2 which protect the freedom of choice of the elderly. Where to live your old age? This is one of the fundamental choices to be protected: that of staying at home. Too often it is the relatives who decide, or even the support administrators, who too casually sometimes take on skills that reduce the elderly person to the role of an implicitly forbidden person. But even worse, too often the choice is dictated by the total lack of home care services, or by the economic impossibility of accessing them. If on the one hand the vast majority of elderly people choose to stay at home, we see that many obstacles combine to make this difficult, even arduous or impossible in the presence of illnesses and disabling conditions, or the difficulties and wishes of relatives and guardians. What does the Charter say about this? Article 1.9 sets out the principle according to which «The elderly person has the right to remain in their home for as long as possible».

This is a profound reform which is already evident from the title: "the home as a place of care for the elderly". The reason is simple and I believe incontrovertible: for those who are advanced in years, the home is the place of their affections and their memory, of history and experiences. Losing it means losing your memory, as Camilleri wrote, abandoning your roots and, ultimately, yourself.

However, it happens that the elderly often lose their home for family reasons, for economic reasons, especially due to lack of services. The Commission has explored, in collaboration with ISTAT, the topic of the conditions of the over 75s. Without dwelling on the findings of the study, now published, I would only observe that in that age group there are over a million elderly people with serious motor and activity difficulties physical and instrumental aspects of daily life, without family help, public or private, living alone or with an elderly spouse. What freedom of choice do these people have if we do not protect them with adequate social support at home? Think of architectural barriers, houses without elevators, steep mountain centers, in short, the difficulties of those who live without accompaniment. For these reasons the Commission recommends an unprecedented strengthening of the so-called ADI, Continuous Integrated Home Assistance. Article 1.10 provides that «The elderly person, in the event of lack or loss of his/her home, has the right to access adequate economic benefits to be able to

have adequate housing." The relevant comment explains that «the right of the elderly person to remain in their home, as well as to move freely both in private and public spaces, requires a growing commitment to the removal of architectural barriers, an intervention very often conditioned by regulations and complex and cumbersome administrative procedures, which actually end up undermining people's right to mobility. The right to a home and housing must also take the form of the right to immediate access to a home at a subsidized rent in the event of eviction or homelessness. It is not uncommon for the occurrence of improper hospitalizations associated with economic causes or other social problems, which lead to personal suffering and inconvenience for the elderly and unjustified economic costs for the community. The lack of and inadequate support from social and health services often translates into an objective violation of the right to live in one's own home: think of the hundreds of thousands of elderly people limited by architectural barriers, the most common of which is the lack of an elevator. for those who live on high floors."

Much more is contained in the first section but, in summary, I have indicated the two extreme examples that describe this first chapter well: from the right not to suffer violence, abuse and restraint to the possibility of being able to stay at home and choose how and with whom to live. The necessary radical reform starts from these needs.