Background information about dementia and home care services
In Spain, the provision of home care services is in the stage of development with about 20% of communes offering such services. However, this is not sufficient to cover demand and it is estimated that only about 1% of the elderly receive home care services provided by the government. The main aim of social services network is to keep elderly people in their homes for as long as possible.
The vast majority of elderly dependent people have to rely on services provided by informal carers. Care of elderly and dependent people tends to be seen as a family obligation. However, according to a survey carried out in 2001, only 24% of the population believe that children will continue to bear the responsibility for caring for their elderly parents in the future and the number of elderly people living alone is steadily increasing (Larizgoitia Jauregi, 2004)
Legislation relating to the provision of home care services
The Spanish constitution states that all citizens are entitled to “health protection”. The General Health Law of 1986, which saw the creation of the National Health System, also states that access to health services is a citizen’s right.
In the Spanish Civil Code (Book 1), it is stated that the spouse and children of elderly dependent people are responsible for their maintenance and care which covers everything that is essential for sustenance, shelter, clothing and medical assistance. The extent of the maintenance to be provided depends on the means of the providers and the needs of the dependent person. The obligation to provide maintenance comes to an end when the provider dies or when their wealth has fallen to such a level that continuing to do so would mean having to neglect their own needs or those of their family.
Brothers and sisters also have an obligation to provide maintenance but they come after spouses and descendants, but this obligation is limited to what is absolutely necessary Kerschen et al., 2005).
Citizens’ do not have a legally established right to social services. The provision of such services is at the discretion of the Autonomous Administration. Access rights are governed by legislation at the level of the autonomous communities.
The main criterion of the social service network is to keep the elderly in their own environment for as long as possible. The main social services are therefore aimed at maintenance in the home. There is also a residential type network. These services generally concentrate on attending the dependent elderly who live alone. The need is also recognised to help subjects with few resources.
Organisation and financing of home care services
Health care services are organised by the autonomous communities. Each community has a Health Service and draws up a Health Plan which outlines which activities are necessary in order to meet the objectives of its own Health Service. Amongst other services provided by the health services of the autonomous communities, there is primary care which includes health care in the home and care specifically for the elderly.
Home care services are free for people who are on the minimum pension. People who have an income twice as high as the minimum pension must pay for the services whereas those on an intermediary income must pay a certain amount which is calculated on the basis of their income.
Health care is funded exclusively through general taxation and not through social security contributions. Home social services are financed jointly by the Ministry of Social Affairs, the regional ministries of Social Welfare and the municipalities. Home visits by general practitioners and primary care nurses are funded through the Public Health Service. In addition to government provided services, voluntary associations and not-for-profit associations such as the Red Cross also provide social home care services (Carrillo, 2005).
Kinds of home care services available
Home care services include primary care social services, social work, assistance with household tasks, meals-on-wheels and tele-alarm services. However, these services are not available in all the autonomous communities.
In practice, home care services are more or less limited to household tasks (which also includes laundry and shopping). This seems to be based on the choice of the elderly people many of whom think that personal care should be carried out by the family. This opinion seems to be shared by carers who often prefer to receive formal assistance with household tasks rather than personal care (Valderrama et al., 1997 in Larizgoitia Jauregi, 2004).
Meals-on-wheels is a services that is only available in the cities of Malaga and Cordoba Andalusia) and in the city of Lerida (in Catalonia). Teleassistance and telealarm services are offered in at least 10 of the autonomous communities. In Andalusia, Castilla-Leon, Valencia, a service exists which consists of helping to adapt the home to the needs of the dependent person. (Imserso 2004 in Larizgoitia Jauregi, 2004).
- Esteban Carrillo (2005), WHHO International Compendium of Home Health Care : http://www.nahc.org/WHHO/WHHOcomptext.html
- Kerschen, N. et al. (2005), Long-term care for older persons. In Long-term care for Older People – conference organised by the Luxembourg Presidency with the Social Protection Committee of the European Union, Luxembourg, 12-13 May 2005
- Larizgoitia Jauregi, A. (2004), National Background Report for Spain , EUROFAMCARE: http://www.uke.uni-hamburg.de/extern/eurofamcare/documents/nabare_spain_rc1_a4.pdf
- Ylieff, M. et al. (2005), Rapport international – les aides et les soins aux personnes dementes dans les pays de la communauté européenne, Qualidem, Universities of Liège and Leuven.
Last Updated: mercredi 15 juillet 2009