Home care in Spain.

The progressive aging of the population in Spain, as in other developed countries, has caused a series of health and social problems for which existing infrastructures have been found wanting. Increased life expectancy is a major root cause of this situation. In Spain's aged population (one of the oldest in Europe), women live an average of 82 years, whereas men live around 74 years. This aging trend will continue to the point that at the end of the first quarter of this century, the current approximate figure of 17% of the population being older than 65 years will reach 33%. These figures were provided by the government agency Instituto de Mayores y Servicios Sociales IMSERSO (Institute for the Elderly and Social Services). As the 21st century began, care services for older person and dependent persons were skewered and myriad and spread out over the public sector through social security, government health services, and different social health agencies. On the other hand, a large part of the care of this dependent population followed a tradition and was in the hands of families and relatives. Most of these caregivers were, and are today, women. In 2004, the Ministerio de Trabajo y Servicios Sociales (Ministry of Labor and Social Services) published a study on dependent persons in Spain. This concluded that 6.44% of the Spanish population (2,782,590 persons) needed support of some kind to carry out activities of daily living. All this support by the public services outlined previously did not meet demand. According to Alzheimer Europe (www.alzheimer-europe.org), in Spain, only 1% (at the turn of the current century) of the elderly was receiving government home care services and that the vast majority of elderly dependent people had to rely on "informal carers," that is family members. The report also adds that the main aim of the social service networks at the time was to keep the elderly in their homes for as long as possible. Yet with all its problems, home care for the elderly and the attempt to keep elderly dependent patients at home with the best quality of life had evolved in Spain as in other countries as one answer to the gaps in social and medical care. This obviously was not a radical concept at the beginning of the 21st century as home care was, and is, a common situation in Spain where care of the elderly traditionally has been seen as a family obligation. Alzheimer Europe quoting Larizgoitia Jauregui, 2004, states that a 2001 survey found, however, that "only 24% of the population believe that children will continue to bear the responsibility for caring for their elderly parents in the future and the number of elderly people living alone is steadily increasing" (p. 1). It should be noted that the Spanish Civil Code (Book1), again quoted by Alzheimer Europe, states that all citizens are entitled to health protection and that the spouse and children of elderly dependent people are responsible for their maintenance, which covers everything that is essential for sustenance, shelter, clothing and medical assistance. The extent of the maintenance to be provided depends on the means of the providers and the needs of the dependent person. . . . The main criterion of the social service network is to keep the elderly in their own environment for as long as possible. (p. 2) In this context of a dependent population covered by a series of laws and regulations at different levels-among them the central government (i.e., Social Security), regional Autonomous Communities (the 17 administrative areas into which Spain is divided), and local services-the Law of Dependency was passed on December 14, 2006, and came into effect on January 1, 2007. Commonly known as "La Ley de la Dependencia" (Law of Dependency), its full title in Spanish is "Ley de Promocion de la Autonomia Personal y Atencion a las personas en situacion de dependencia." Its official English translation used by Spain's government agencies such as the Ministerio de Trabajo y Asuntos Sociales (Ministry of Labor and Social Services) is "Law on the Promotion of Personal Autonomy and Care for Dependent Persons. …