MILAN (Reuters) – Authorities in Lombardy, the northern Italian region at the centre of one of Europe’s worst coronavirus outbreaks, have rebuffed requests to top up health service budgets to cover huge increases in services from homecare operators.

As a result, many operators are unsure if they will be able to pay staff who have looked after COVID-19 patients at home or in nursing homes while the region’s hospitals were struggling to cope with the thousands of patients requiring intensive care.

“The region is leaving health services in limbo like this,” said Massimo Sparpaglione, president of Assedo, an association for companies and cooperative groups in the sector.

Lombardy’s regional government confirmed it had passed a measure this week leaving budget ceilings set before the coronavirus outbreak in late February unchanged until Oct. 31.

However it did not rule out additional measures before the end of October to recognise the “exceptional contribution” of care providers and said it was waiting on possible funding measures by the government in Rome.

Lombardy regional authorities have faced increasing pressure over their handling of the crisis, which has left Italy’s richest region accounting for over half of its 33,000 COVID-19 deaths.

In Italy’s decentralised health system, regional authorities are responsible for hospitals and other health services and agree budgets with operators responsible for running day-to-day services, with penalties for cost overruns.

Maura Zucchelli, a partner in Itineris, a small homecare provider near the town of Bergamo, said the budget decision still left operators facing months of uncertainty.

“They can’t expect us to work double and then wait until the end of October to see if we’ll be paid,” she said.

(Reporting by Emilio Parodi; Writing by James Mackenzie; Editing by Alison Williams)

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