The new residences: single room, small groups and more caregivers

Government and autonomies, with the opposition of the PP, Catalonia and Euskadi, agree on a radical change of model for the new centers for the elderly and, in seven years, for the old ones

Alfonso Torres

All new residences for the elderly or disabled, whether public or a private one that wants to arrange their services, must be small, have practically all individual rooms, will work around very small groups of people living together (of an almost homelike size) who will have their own common spaces and caregivers, the staff ratio will grow by up to 60%, they must pass permanent quality controls, the resident's access to healthcare will be the same as that of any neighbor in the area, the inmates will be the ones who say how they want to live and decorate their stays, they will have a voice and a vote in the operation of the center, and they will see how restraints or 'pills' are banished forever from their lives to keep them easily controlled. This is how the new centers will be, but the current ones will also end up being very similar, which will have a maximum period of seven years (until December 2029) to adapt to the main demands of the new model.

The Ministry of Social Rights, led by Ione Belarra, and the regional authorities have closed today, after tense and tough negotiations, an agreement that could be described as revolutionary in a country that has an increasingly aging population. Gathered in the Territorial Council of Social Services, they have agreed by majority on a new document of minimum requirements for the accreditation and quality control of the centers and services that care for dependents, with special prominence of the new model of residences for the elderly and disabled, but also with notable changes in home care, day centers and telecare.

The agreement has had the vote against four of the autonomies of the PP (Madrid, Murcia, Andalusia and Galicia), who consider it maximum and without financing, and Catalonia and Euskadi, who believe that it invades powers. The socialists of Extremadura and Castilla-La Mancha, who a month ago blocked the agreement by joining the popular veto, have swelled the yes after obtaining guarantees that some 4,000 million of European funds will be allocated between 2023 and 2026 to finance the reforms and precise adaptations in old residences.

The change of model is not unrelated to the social scandal unleashed after learning about the unfortunate conditions in which people lived in many nursing homes in this country, brought to light by the terrible mortality caused in these centers by the coronavirus pandemic. Overcrowding, lack of personnel and qualification of caregivers, disconnection with public health services, dehumanization, neglect or lack of quality controls were some of the most repeated evils, which led to the closure of some residences and hundreds of complaints before the courts.

The new minimums seek to say goodbye to the old concept of asylum and inaugurate the collective home, where the general rule will be family size and personalized attention. These are some of the most important changes:

Units of 15 cohabitants

A place the closest thing to a home. It will be the basic organizational structure of each residence. Groups of stable cohabitants with that maximum number, with the same caregivers and educators and their own facilities (living room, dining room, kitchen), internet connection and rooms personalized and decorated to the taste of the users. The model reduces anxiety and depression, reduces the use of psychotropic drugs and increases mobility and relationships.

65% single rooms

The new residences must have at least 65% single rooms with adapted bathrooms and the rest double rooms. They can be personalized with the resident's objects and furniture. In the case of the current ones, this requirement will not be mandatory for those with less than 35 beds and the minimum number of individual rooms may not exceed 25% in cities and 10% in rural areas.

One caregiver for every two inmates

A progressive schedule is established for the increase in direct care personnel for residents, which by 2029 should have achieved a growth of 60% in centers for the elderly and 20% in those for the disabled (where it is already more demanding today). The ratio of nursing homes will go from 0.27 caregivers per resident to 0.43 in no more than seven years, which means that there is practically one caregiver for every two inmates.

Cap of 120 places

The size of new residences will shrink. The macrocentres are over. The cap will be 120 places in the facilities for the elderly located in the cities and 50 in those for the disabled. Retirement centers in rural areas may not have more than 75 inmates and those in towns may not exceed 90.

goodbye to restraints

Within a maximum period of three years, no center for the elderly or disabled may use physical, mechanical or pharmacological restraints to immobilize or control its residents. The exception, if any, will be a situation of urgent need in which the resident, a caregiver or a third party is in physical danger and other less aggressive alternatives have been exhausted.

Connected to social life

The new centers must be close to spaces for social and community activity. Nothing to isolate the elderly, the preference is urban land. Inmates will have the same access facilities to health centers and public hospitals as the rest of the residents of their neighborhood.

live as you like

The centers must carry out personalized coexistence plans, paying attention to the life and leisure preferences of the resident, in order to give them the necessary support and care. They should also offer you help with making a living will and collecting your last wishes.

residents council

The management of the center will create an advisory, consultative body with powers to make improvement proposals that will be made up of representatives chosen by and among the residents (and, where appropriate, also by relatives).

public evaluations

The agreement obliges the inspection services of the autonomies to evaluate the quality of operation and compliance with the minimum parameters in all the centers, evaluations that will be public and that will have an impact on the signing or renewal of concerts.

Family involvement

Family members and close friends will be given prominence in the process of adaptation to the center, there will be permanent communication channels, meetings for the periodic exchange of information and visits will be free whenever desired.

Staff trained and establishes

Personnel at all levels will have to have accredited professional qualifications, will receive training plans and more funding will be given to centers that reduce temporary work and part-time work for their staff. All will have to be registered with Social Security or in the self-employment regime.

Reinforcement of home care

Although the bulk of the agreement focuses on residences, it provides for many measures to reinforce home care for dependents, since their home is the place where the vast majority of older Spaniards want to reside. The assistance will be given through small local teams, which will attend to the same people from the same areas to minimize displacement and rotations and to be able to provide a more personal and familiar treatment. The agreement plans to increase the workforce enough by 2023 to be able to meet a minimum ratio of 7.20 workers for every 1,000 hours of monthly assistance. The coordinators of this service must make at least one home visit to the beneficiary each year and the caregivers will have 5% of the time to organize the service.

Improvement of day centers

The day centers for the elderly and those for the disabled will have a notable increase in staff before December 31, 2023. The former will increase the ratio of staff per client by 31% (up to 0.25), which means a professional for every four residents, and the latter will increase the workforce in the same period by 36% (up to a ratio of 0.30), or what is the same, three professionals for every ten users.

Telecare relaunched by artificial intelligence

The new telecare will give the same importance to the relationship with the customer and their emotional situation as to merely assistance aspects, leaving behind the device connected to the fixed telephone line and evolving towards 'internet of things' devices and sensors that are already in the day to day of many homes or will be in the short term. There may be activity detectors, falls detectors, door opening detectors, medication dispensers or geolocation outside the home, for example. Large-scale data control and the application of artificial intelligence will make it possible to obtain information and detect significant changes in the behavioral patterns of the person in a situation of dependency, facilitating personalized and proactive care.

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