On a sunny afternoon in Monterotondo, north of Rome, Estela (not her real name) will heave her elderly charge down a steep flight of stairs and onto the street outside. They may take a few slow steps together arm in arm, or sit quietly side by side, watching the world go by.

Estela is contracted to work just a few hours a day but in reality she works closer to 24, including Thursday afternoons and Sundays, when workers like her are entitled to time off. Nonnino