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Mrs. Duda and others, paid for by the elderly’s children or by the elderly themselves, are Italy’s fast-growing substitute for “assisted living” facilities, which are nearly nonexistent in this country.

Putting grandma or grandpa in a nursing home when they no longer are self-sufficient hasn’t caught on much here, possibly because Italians tend to distrust institutions.

So the emphasis here remains on the home, even though home is likely to mean home alone.

In 1950, Italy had five adult children for every elderly parent. Now five has shrunk to a statistical 1.5, and by 2050 there won’t even be one adult child for every elderly person, said Antonio Golini, a demographer at Rome’s La Sapienza University.

So dependent have Italians become on the foreign caregivers that when the government offered an amnesty a few years ago for illegal aliens, it placed no limits on the number of foreigners a family could employ if the workers cared for elderly.

Mr. Golini has crusaded for years for Italians to have more children, accept more immigrants and work longer.

“My terror is that we will reach old age abandoned,” Mr. Golini, 69, said in an interview.

Italy’s “grayest” region is Liguria, in the northwest, where 27.5 percent of its population is over 65. There is a waiting list for a program that provides elderly with $475 a month to help pay for home companions.

“Old people, and especially those who are alone and not independent, are going to be one of the emergencies Italy will have to face in the future,” said Massimiliano Costa, Liguria’s commissioner for social policy.

Emilio Mortillo, a bioethicist at Aging Society, a think tank in Rome, pointed out that some parts of Italy’s affluent north have more retirees than workers and predicted that Italians will have to increasingly rely on immigrants to help them cope.

But immigration is relatively new to Italy, and surveys show many Italians blame immigrants for crime.

So some elderly, fearful of admitting foreigners into their homes, turn to another old fixture of Italy — nuns of the Roman Catholic Church.

Waiting for nuns to serve her dinner at the Pius X home for the aged in Rome, 83-year-old Maria Laura Riva De Filippis said her daughter didn’t want a foreigner to care for her mother at home.

“And rightly so. You hear so many stories about them, my daughter would say,” said Mrs. De Filippis. “My daughter said I could live with her, but she kept telling me: ‘I leave for work at 8 a.m. and you’ll be alone all day.’ ”

Since nuns labor for God instead of a paycheck, room and board at homes for the elderly run by religious orders cost much less than at traditional nursing homes.

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