More than 1.5 million Spaniards need help. Some because they can no longer fend for themselves, others for illness, others for the simple advance of age. Their well-being depends on the dependency care system, a series of services and benefits established in 2006 and intended for the assistance of citizens who need to be cared for. But today, experts lament, the system languishes while waiting for a government to reactivate it economically and socially. Since 2012, the cumulative cut in dependence amounts to 5,000 million euros, leaving out 250,000 Spaniards of a coverage to which they are entitled by law. In that administrative limbo, 80 Spaniards die a day. There are 30,000 a year, according to the State Association of Directors and Managers of Social Services.
The three major services that the system provides (home care, day centers and residences) are theoretically co-financed between the State and the Autonomous Communities. In practice, according to different estimates, the autonomies support about 80% of the cost. The problem, different agents in the sector agree, is again the lack of financing. "The best investment that the administration can make is in dependence," says José Manuel Ramírez, director of the Association of Directors and Managers of Social Services and the State Observatory for the Unit. "When a road is made it is said to be an investment, but when home help is made or residences are built it is said to be an expense."
In the middle of Carlet, a Valencian municipality of about 15,000 people, is La Llum, a center for people with physical and physical functional diversity. Publicly owned, the complex has 34 places and has been managed since 2001 by the private company. "We have worked with different government teams and have always found the collaboration of the City Council," explains Lucia Paricio, delegate of social services at the regional address Levante de Clece, the company that manages the service.
Paricio is proud of the ties that La Llum weaves with the inhabitants of the small town, of agricultural tradition and very focused on the cultivation of orange. "There is a lot of integration with people's lives," he says. To achieve this objective, the center organizes recurring days open to schools, workshops for parents with children with functional diversity, visits to the market and occupational centers, excursions … "In addition, on December 3, Diversity Day Functional, we carry out extraordinary activities in collaboration with the Consistory ", expands Paricio.
Public ownership, private management
Although the essential aspects of the system are public (access, assessment of the degree of dependence, prescription and follow-up of each case), the services are provided, in general, by private companies that concur in competition for their management. This public-private collaboration is the most frequent alternative, a model in which the administrations (councils, town halls, autonomous communities) establish via technical specifications the technical and economic conditions of these services.
This document also establishes, among others, assistance criteria, schedules, ratios, tasks, executions or composition of the workforce, in addition to the price charged by the successful bidder, an amount that varies substantially in the different autonomous communities. For example, today, the hourly price of the home care system is 13 euros in Andalusia for 30 in the Basque Country, according to the State Association of Entities of Home Care Services. Javier Sigüenza, its director, claims that administrations should break down and justify that price: "It has to be enough to pay workers and cover direct costs," he understands. "It directly affects the service and the dignity of the sector."
The system has dried. In the last seven years, the autonomous communities receive 285 million less per year, which brings the accumulated bankruptcy to 3,154 million euros, according to the Association of Directors and Managers of Social Services. The shortage leads 250,000 people to a long wait for the benefit to which they are entitled. Another 150,000 await the assessment of their dependence. "Behind the figures there are faces, people who suffer," laments Ramírez. "If companies, professional and scientific organizations and unions had rowed together, I think there would be no such waiting list or such terrible cuts."
Social agents agree that it is urgent to inject funds. If the state pact were fulfilled, which includes an injection of 415 million euros for the unit, 68,000 dependents would be served and 16,000 new jobs would be created, according to calculations by the State Observatory for the Unit. For Ramírez, the fate of this refinancing should be clear. "What is the priority? Increase the amount paid per hour of residential place and home help and let the people who are on the waiting list die? Or do we start reducing it? I prefer the attention to more vulnerable people And then the relatives would come, especially women, who take care of others, "he argues. An eager refinancing that could also lead to an increase in the hourly price offered by the Communities and additional services for caregivers, such as physiotherapy and psychological care, aimed at safeguarding their health.
Different services and realities
Another of the problems facing the sector is the improvement of the conditions of its employees, around 540,000, according to data from CC OO, and mostly women. Currently the agreements are not negotiated separately for each benefit, an aspect that employers and unions expect to solve as soon as possible. One of the most thorny issues is the partiality of working hours and hours, especially in the home help service. Ramírez indicates that this phenomenon is directly related to the specifications prepared by administrations. "The time in Andalusia is worth the same in the Alpujarra Granadina, with scattered homes and greater displacements for caregivers, than in the neighborhood of La Unión de Málaga, where people live in a block and the auxiliary has only to go down the floor This must be detailed in the technical and administrative conditions of the contract. ad hoc according to the territory ". According to the employer, these problems of home care occur more in villages or empty regions; in cities, the organization and logistics, therefore the hours, can be better anticipated.
"We must put in value the important self-sacrificing work that these employees do, which are also 90% women and work with salaries of around 900 euros per month," says Ramírez. And he ends up insisting: "Dependency investment creates more than double direct, stable and non-relocatable jobs. Even for emptied Spain."
Public-private collaboration gives rise to other centers focused on the care of dependent people with various problems:
- Residences for people with altered behavior. For people over 18 years of age who have a mental disorder that, due to their severity, cannot be treated solely by primary care.
- Residences for people with physical disabilities: They attend hospitalization or semi-training. Its objectives are care, capacity building, autonomy promotion and personal and social development.
- Centers for people with mental disabilities: Dedicated to the care of people with mental disabilities who, due to their severity, require help with the tasks of daily life. They work in hospitalization, half board and outpatient.
- Women's protection centers: Destined to welcome and provide social, psychological and legal assistance to women and their minor children who are in a serious situation of abuse. The maximum stay is six months.
- Addiction care centers. They provide individual and / or group care, on an outpatient basis, to people with problems of abuse or dependence on alcohol or other drugs. They also treat addictions such as gambling and smoking.
- Child protection centers. They welcome children who already have any of the guardianship or custody measures.
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