Long-term care in Spain: Difficulties in professionalizing services

ABSTRACT

The aim of this article is to analyze the difficulties in professionalizing the long-term care system in Spain. Since 2006, the new Spanish law has recognized care as a subjective right, and regulations are being designed to create a framework for its professionalization. Nowadays, family remains the most important group of providers who care for their elders, and women remain the main informal caregivers. Why do families resist using public long-term care services and professional carers included in the new law? The hypothesis highlights sociocultural factors as an obstacle to professionalization of long-term care services in addition to political and economic factors. The results show qualitative data about expectations, preferences, and discourses that women caregivers have in relation to their responsibility. The empirical material includes 25 interviews with different profiles of caregivers and six focus groups with family caregivers. The article suggests that the Spanish ideal of care is a problem for the professionalization of services because the family remains as the main provider of care—without specific skills, knowledge, and abilities.

KEYWORDS:

• Aging
• family
• gender
• home care
• ideal care
• residential care
• social care

Funding

This article received support from the Instituto de la Mujer y para la Igualdad de Oportunidades, Ministerio de Sanidad, Servicios Sociales e Igualdad, Gobierno de España.

Notes

¹ The LAPAD is a law on personal autonomy and dependent care.

² Before the LAPAD, other regulations covered the social services, but they were regional in nature, leading to a great variety of systems.

³ The Spanish model is complex. Its design is a mix between the Nordic model (universal coverage, social service management, and funding with taxes and contributions) and the Continental model (recognition of the subjective right, assessment of the level of dependence, freedom of choice, and regional decentralization of planning and management) (Rodríguez Cabrero & Marbán Gallego, 2013).

⁴ But there is a lack of definition of the concept of professionalization in the LAPAD. In that sense, the references to the professionalization that were included in LAPAD are quite vague and are limited to identifying professional care with care that is not provided by family members. Also, the LAPAD included a section devoted to defining the quality of service, but it only mentions the need for progress in quality employment and the need to define training requirements.

⁵ According to the National Institute for Statistics, between 2008 and 2012 work opportunities rose by 48.7% in the subsector of “Social services activities, without accommodation” and by 16.4% in the subsector of “Services in residential establishments.”

Additional information

Funding

This article received support from the Instituto de la Mujer y para la Igualdad de Oportunidades, Ministerio de Sanidad, Servicios Sociales e Igualdad, Gobierno de España.