The challenge of making nursing homes a home

A worker in a nursing home does an antigen test on an elderly man. / MARSHAL / EFE

The Government and the communities have come up with a plan to change the care model. Now they need to provide financial resources

Antonio Paniagua

History left behind the concept of a nursing home, a place where helpless people, without resources or family, were taken in. The terminology has changed, but the heirs of those institutions, the nursing homes, continue to preserve reminiscences of other times. The pandemic revealed the vulnerabilities of a model that allowed the overcrowding of users, a circumstance that favored the spread of covid and a very high mortality. That lesson has made the administrations reflect.

The Government and the autonomous communities want to turn the system around 180 degrees. The idea is that the centers adapt to the needs of the elderly who spend the last stretch of their lives in these places, and not the other way around. A shared diagnosis is that the personnel who care for dependents in these institutions are poorly paid and lack the desirable training. Spain thus joins the list of countries that are rethinking their model.

According to data from the Group of the Research Group on Aging of the Higher Council for Scientific Research (GIE-CSIC), it is estimated that in Spain there are 6,240 centers where accommodation and meals are provided to people who, in 82% of cases, they are over 80 years old. All these entities offer 391,000 places, which welcome 281,000 users, of which 70% are women.

"If in Spain they provide about 40 minutes a day in home care, in Denmark they are giving 3.1 hours"

José Augusto García Navarro, president of the Spanish Society of Geriatrics and Gerontology

For the president of the Spanish Society of Geriatrics and Gerontology (SEGG), José Augusto García Navarro, the agreement reached between the Ministry of Social Rights and the autonomous communities "is a first step to advance in long-term care." Both the European Union and the World Health Organization (WHO) are committed to the elderly being able to live in their own home, and when there is no other choice but to go to a residence, it should be as similar as possible to their home .

In light of the approved document, which provides for the creation of units of 15 cohabitants in residences, Spain looks at itself in the mirror of Denmark, where small centers for the elderly and a powerful provision of care at home coexist. "If in Spain about 40 minutes a day are generally provided in terms of home care, in Denmark they are giving 3.1 hours to help the person move, bathe, eat or dress," says García Navarro.


In order to homologate ourselves with the Scandinavians, a notable economic effort must be made. Spain spends 0.74% of GDP on long-term care, while the average for EU countries is 1.5%. But there is even more: the eight richest EU countries spend 2.5% of GDP for this purpose.

With ten votes in favor and nine against, the Government has carried out in the Territorial Council of Social Services a document of minimum requirements whose purpose is the accreditation and quality control of the centers and services that care for dependents. Among the new requirements, it is established that new residences must have at least 65% single rooms and one carer for every two inmates. In addition, the staff ratio should grow to 60%. These are measures that Vicente Rodríguez, a member of the CSIC Aging Research Group, applauds, although he shows his uncertainty about the residences already built. “What is clear is that all this is not going to happen tomorrow. I don't know if it will be so easy to adapt the existing centers, which may suffer from architectural and space organization restrictions, to the new demands to create coexistence units for 15 people”, argues Rodríguez.

“The Government must guarantee that the new model does not cost users a euro more”

Cinta Pascual, president of the Business Circle for Attention to People (CEAPS)

In a model like the current one, with a high participation of the private sector, it is not easy to reconcile service excellence with business profitability. According to CSIC estimates, based on 2019 data, 73% of places are privately owned and 27% public. In the end, public residences are not always managed by workers in charge of the different administrations, so that they occupy only 13% of the places.

“Obviously, the most successful model is the one that focuses on the person, a criterion that is present in the approved document. But person-centered care is very demanding from the point of view of facility requirements. And in that I do not know if all the criteria required by the theoretical model would be met, “adds Rodríguez.

Businessmen maintain that the Executive has given the green light to a plan without accompanying it with a sufficient financial endowment. The Business Circle for Attention to People (CEAPS) is blunt: "The Government must guarantee that the new model does not cost users a euro more," says Cinta Pascual, president of the organization.

Currently, there are 9.4 million people over the age of 65, a figure that, according to experts, will double the number of children in the next decade. According to a recent 'Manifesto to promote healthy aging in Spain', the number of older people in the next ten years will increase by two million more people.

García Navarro calls for better coordination of social services with health services, which requires greater involvement of the Ministry of Health. «Many people arrive at the residences who are in the final phase of their life. The latest studies indicate that they arrive with an average of nine active chronic diseases. One caregiver for every two people is an important step forward, but we still need more.”

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