ROME — As a police officer, Luigi Marzano was used to being in command. He still walks ramrod straight, but at 97 and deep into retirement, his memory is weakening and he has turned over command of his household to a virtual stranger half his age.
Rita Duda, who left Ukraine in search of work, lays out a cafe latte and cookies each day for Mr. Marzano’s breakfast, shops for him and every afternoon after his nap, accompanies him outdoors to a bench on the corner, which he shares with ladies and gentlemen in their 70s and 80s while their caretakers — Ukrainians, Moldavians, Poles and Romanians — catch up on gossip.
Mr. Marzano is one of a growing number of Italians entrusting themselves to an army of foreign workers from Eastern Europe, South America, Asia and Africa who do what families there increasingly can’t or won’t do — take care of their elderly.
Long life and low birthrates have conspired to change family life, which long had been the one institution Italians could count on while history rolled past, with its parade of conquerors and short-lived governments.
Italy’s demographics — and Europe’s as a whole — give new meaning to the term “Old World.”
Twenty-four of the world’s 25 countries with the oldest populations are in Europe, noted a joint report by the European Commission and AARP, a U.S. lobby for the elderly. Japan, with 27 percent of its population older than 60 in 2005, is a shade grayer than Italy’s 26 percent.
Italian life expectancy is 78.3 years for men and 84 for women. But more significantly, Italy holds the world record for the highest percentage of what analysts call the “old old.” One out of every five elderly Italians is over 80.
Meanwhile, incentives to have children are few. Italians joke that by the time their children qualify for scant public day care, they are too old for it. Tax breaks for minor dependents are miserly. Costly housing makes it hard to give a child his or her own room.
Italy, home to the Vatican and predominantly Catholic, legalized abortion in 1978 and Italians upheld the law in a 1981 referendum, despite fierce opposition by the Vatican to abortion. And Italians have long tended to ignore Vatican teaching forbidding contraception.
Now, with so many living so long — and with retirement possible as early as age 57 — Italy is paying the price in medical care, pensions and social security, for having so few children.
While decisions to have one or no children might make for easier lifestyles when young, a generation or two later, the choice means fewer children and grandchildren to help the aged.
“Without Rita, I wouldn’t be able to manage,” said Mr. Marzano, running his cane through his fingers and fretting about how he’ll manage this summer with substitute home companions when Mrs. Duda, a 48-year-old divorced woman, visits her family in Ukraine.
Mr. Marzano outlived his wife, sister, three brothers and a son. His other son lives in the neighborhood with his daughter-in-law, who is in poor health.
On Thursday afternoons when Mrs. Duda is off, a granddaughter comes to keep him company. On Sundays, Mrs. Duda’s other day off, his son’s family brings him lunch, but they don’t stay with him to eat it, Mr. Marzano said.
“I would have thought I would have lived with my son; I would never have thought that it would be like this,” said Mr. Marzano.
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.
Caring for the elderly as a business also makes economic sense for the nuns.
When there were no longer enough children to fill the classrooms, the Disciples of Sisters of Eucharistic Jesus converted a nursery and elementary school in Rome’s middle-class Garbatella neighborhood into a rest home.
“Our mothers stayed at home caring for their mothers and their mothers-in-law,” said Sister Maria Cecilia at the home. “Now women work and don’t even have time to care for their own children.”
The residents, who the nuns call “guests,” pay $1,770 month — a modest sum compared with the United States where monthly costs in a large city can easily top $10,000.
Ninety-year-old Italia Matteucci, elegant in a long pearl necklace, pearl stud earrings, a red cardigan and a wool plaid skirt, pays for her room in the former elementary school from her monthly pension check.
She was living alone in a studio apartment, but “I was afraid that they’d find me dead there some day,” and so she turned to the nuns.
Her 68-year-old daughter has health problems, and her two grandsons, in their 30s, rarely come either, said Mrs. Matteucci.
Many of the caregivers come from countries where families are large and the concept of abandoning the elderly is inconceivable.
“In my country you don’t see this,” said Rosa Elena Floris, an Ecuadorean taking a course for home companions at Rome’s Catholic Sacred Heart University. “We’re always at the side” of the elderly.
Miss Floris cared for an Italian woman for eight years until she died at 89.
“The woman had a son and a daughter, but she almost never saw them,” recalled Miss Floris. “They would call and say, ‘Is everything OK? Did she take her medicine?’ ”
When the university first offered the course in 1999, only foreigners enrolled, said Flavia Caretta, a medical doctor and geriatrics specialist who runs the program. But the course this year had a sprinkling of Italians, suggesting a growth industry offering careers.
The foreign caretakers earn about $1,500 monthly, a handsome amount compared with wages in their homelands, where they earn about 30 percent less if they live in and receive room and board.
Among the remedies for aging societies are raising the retirement age to save on pensions and encouraging bigger families.
This year, German lawmakers voted overwhelmingly to gradually raise the retirement age from 65 to 67 by 2012. Spain uses incentives to encourage people to work beyond 65.
Poland, with one of Europe’s lowest fertility rates, recently began a costly program of tax exemptions, longer maternity leaves and better preschool services to encourage bigger families.
But Italy’s center-left government, pressured by unions, which comprise much of Prime Minister Romano Prodi’s constituency, proceeds in the opposite direction. It promises to undo the previous, conservative government’s reform to raise the retirement age from 57 to 60.
c Daniele Pinto in Rome contributed to this report.