November 2006, first term of former socialist president José Luis Rodríguez Zapatero. The Minister of Labor and Social Affairs stood on the platform of the Congress of Deputies: “No Spaniard will be alone,” said Jesús Caldera, about the “most important social norm of the beginning of this century.” He was referring to the new law on dependency and promotion of personal autonomy that would come into force a month later. The norm that recognized for the first time in all of Spain the universal right to help for people who have lost their independence has come of age and is preparing for its first major reform. If things go as planned by the Ministry of Social Rights, it will be this year.
The “true revolution from a social point of view” that Caldera was selling has not been a bed of roses, but rather a roller coaster of successes and failures, describes Julia Montserrat, a doctor in Economics and an expert in the field of health care. dependence. “The bureaucratic procedures, the ridiculous amounts of benefits, together with the low intensity of the services and the impossibility of compatibility make a system low cost little effective in meeting the needs of people in a situation of dependency,” summarizes the State Association of Directors and Managers of Social Services in its latest report, which takes stock of these two decades.
Since 2020, 126,133 people have died while waiting for their help, according to official data collected by the association, which estimates that since the law came into force the figure may rise to 900,000. The files take 330 days on average to process when by regulation the period should not exceed 120, the report highlights, although the delay has been reduced by almost 100 days since 2019. However, 18 years later, there are only two communities, Euskadi and Castilla y León, which comply with the established times. The number of people awaiting a resolution is decreasing, but it is slow: 2024 will close with more than 290,000 unattended users, waiting for some type of procedure. There are 4,782 fewer than in 2023.
“The damage that is caused to people who have died on a waiting list is unacceptable,” assesses Pilar Rodríguez, who was involved in the preparation of the 2004 white paper on care for people with dependencythe prelude to the law, and is now president of the Pilares Foundation for Personal Autonomy. The Supreme Court opened the door this year for the first time to recognize post-mortem aidso that the heirs are reimbursed for the expenses they were paying with their resources due to not having guaranteed access to benefits. The long waits, Rodríguez points out, are a deterrent for some families: “People sometimes don’t even ask for it because they know in advance that it takes time and that it is confusing. It seems that it has been assumed when it is a right that must be claimed.”
Positively, as a counterpoint, remember that “Spain was part of a movement in Europe to consolidate rights, on a par with Germany or France.” “It was a very important milestone but it was born a little bit on the shoulder. The idea was good, although perhaps it was hasty,” he continues. “If you look at it with perspective, in 2006 there were barely 300,000 people with some type of benefit and now we are at one and a half million. There is an important jump that must be highlighted. Not everything is failure, although perhaps it has not worked as we wanted,” analyzes Julia Montserrat. Before the law, coverage depended on social services. There were no homogeneous obligations throughout the State.
The law was slow to start – users in the least dependent grades were not covered until 2015 – and with just five years It suffered very harsh cuts that have conditioned it until today. Clauses that are heirs of that crisis are still in force. For example, financial assistance for home care can be delayed for up to two years without penalty, although it has been repealed in most communities.
In 2006 there were barely 300,000 people with some type of benefit and now we are at one and a half million. There is an important jump that must be highlighted. Not everything is failure, although it may not have worked as we wanted.
Julia Montserrat, doctor in Economics and expert in the field of dependency
The Government intends to definitively banish this measure in the reform of the law that has already been drafted, although it has not yet been brought to the Council of Ministers. Sumar accuses the socialist part of the coalition of delaying this step. Another of the still operational residues of that royal crisis decree was the incompatibility of benefits, which is also put to an end. “It cannot be that with a community approach a person has the right to only one service. You need to have the right to a combination of services because the community environment requires a day center, requires time for home help, requires telecare,” said the general director of Imserso, Mayte Sancho, a few weeks ago. Several communities had eliminated this measure, but not all.
The “strangulation” of 2012
“The financial strangulation, which began in 2012 as a consequence of the cutback policy applied by the Rajoy Government and will last for almost four years until 2015, was a real disaster,” analyzes the State Association of Directors and Managers of Services Social. Not only were they “budgetary restrictions” but these were combined with “measures restricting rights”, such as the two-year waiting period, the reduction of hours of home help – which was not raised again until 2023 – or the end of compatibility between different features.
The dependency sector is, almost two decades later, a pressure cooker that must respond to an unstoppable demand, which is sustained by precarious professionals and which keeps users – dependent people and their families – financially suffocated. Only a small part of the people within the Spanish dependency system are institutionalized – they concentrate 42% of the economic resources although they are a minority of 12.3%; Those that do not also need to be cared for and public coverage “does not reach every day for all the sufficient hours,” the experts warn.
In Spain, the system has been expanded by the private part and “you always have to complement it: either someone in the family stops working or if you have money you hire someone on your own to cover you where the public is not enough,” he recalls. Montserrat. This situation is repeated in 80% of cases, according to data from the Institute of Seniors and Social Services (Imserso), dependent on the Government. There are 2.13 million people who have requested a long-term care benefit in Spain, according to the latest data. The figure has grown 12% in five years.
Public spending per dependent decreases
In 2020, the Government launched a shock plan whose results are already reflected in the data: the system has served, since it was implemented, 287,636 more people. The Ministry of Social Rights has injected 600 million euros more per year into the ministries between 2021 and 2023. State funding had plummeted to 15% in 2015 after accumulating years and years of falls. It now stands at 30%, although it has not yet reached the percentage of 2019. The competition is autonomous, but the financing is tripartite: the communities, the State and the users, who bear a co-payment since the start of the dependency law. . It was never considered a universal and free right like healthcare or education.
However, the report from the State Association of Directors and Managers of Social Services highlights that the average public expenditure per dependent person has been reduced by 121 euros in the last year: “It will stand at 5,982 euros, which confirms the drift low cost undertaken by the autonomous communities in the benefits and services they offer.” “We detected that cheaper prescriptions are being prescribed because what the State pays does not depend on the cost of the benefit but on the person’s degree of dependency. That is, a day center, a residential place or 30 hours of home help are financed the same way,” explains expert Julia Montserrat.
“Turning around this transatlantic that is dependency services is difficult, but that does not mean that we do not have to continue trying,” says the president of the Pilares Foundation. The reform of the law, defends the Ministry of Social Rights, seeks to advance a change in model – for example, the family is equated with the relational environment as a consequence of changes in family models – together with a deinstitutionalization strategy that the Minister Pablo Bustinduy’s team presented before the summer to prioritize staying at home over large residences.
Graphics Raul Sanchez.
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