Italy is the biggest spender on pensions in Europe
Italy is renowned for its family values, but with one-fifth of the population now over 65 many Italians are outsourcing home care for the elderly to immigrants.
"All our children live abroad, so I had to try and find someone to look after my wife. It was impossible to find an Italian," says retired businessman Giorgio Potsios as he flicks through television channels in his smart Rome town house.
His wife, who underwent major surgery recently, can only nod or shake her head at his choice.
"She cannot walk, she cannot speak and her right side is semi-paralysed," he says, gently holding her hand.
"But being at home here is the most important thing... I needed someone who understood how to help her. There was never any question of sending her to a nursing home."
Mr Potsios found Svetlana, a Ukrainian immigrant, to care for his wife.
Demand for carers
He is part of a growing trend.
In the past, the Italian family has helped provide long-term care for the elderly.
But as families shrink, and few Italians want to work as carers, foreign workers are taking on the job.
"We try and play cards together. Sometimes I read aloud although my Italian's not perfect yet," says Svetlana cheerfully as she describes her average day.
"I make the meals, help the Signora with her physiotherapy exercises and do everything I can to look after her."
Is she qualified?
"No," Svetlana says, looking away.
"But I do have experience in life. Isn't that the same? I looked after my grandmother who was very old, I know how to read someone's gestures and understand their needs. I love doing this job."
Dwindling family networks
"And its not expensive," says Mr Potsios. "I pay her 800 euros ($1,060 or £549) a month. I think that the best care takes place at home with foreign help. That's the reality now here."
In family-oriented Italy, 10% of the elderly in need of long term care are looked after by paid live-in help, compared with under 1% in the UK, Germany or Sweden.
It is still seen as socially and culturally unacceptable to send relatives to nursing homes.
Latest research even suggests the number of Italians in nursing homes is dropping despite the number of over-65s increasing.
Traditionally, the system of welfare support emphasised this social preference by channelling funds directly to family carers rather than to state institutions and social services.
But dwindling family networks and fewer women staying at home mean that many Italians now depend on immigrants.
"This is a very positive phenomenon for us, because our young people in Italy don't want to work as carers and old peoples homes and care homes are not of a very good standard," says Dr Luisa Bartorelli, director of the geriatric department at Sant'Eugenio Hospital.
"We're finding that immigrants are proving to be very good carers. They have the right attitude, because they often come from countries where the older generation has a role in society and is respected much more than here."
Black market labour
But this is often unskilled black market labour - something the authorities are trying to change.
Italian families hoping to claim allowances for dependent elderly relatives will now have to prove carers have legal work permits and qualifications.
A new course for long-term care of the elderly is running at Rome's University Hospital.
The lecture hall is full of non-Italians scrutinising the ageing process of the brain, depicted on a giant projector screen.
They scribble notes diligently.
"I wanted to do this course so I can learn skills, methodology, so I can do my job with confidence," says Hope from Nigeria.
"I've only been working with the elderly in Italy for four months," adds Cecile from the Philippines.
"It's not an easy job working with fragile people ... but I love everything about it. I don't feel as though its just a job, it's also a vocation."
But it is still seen quite differently by Italians.
Caring for the elderly carries little prestige, funding or resources.
Government plans for a national long-term care fund have failed to materialise.
"I don't see how they can avoid massive change in the system. More state resources have to go to long-term care solutions," says Dr Giovanni Lamura, a gerontological researcher.
"Two-thirds of the health budget is spent on hospitals, on highly paid doctors. It's all great for a young population, but that's not the reality we have."
"Foreign workers aren't enough of a solution," Dr Lamura explains.
"People need to start realising that working with old people isn't working with the past. When a population is ageing as fast as ours, investing in long-term care for the elderly is a way of working with our future."