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The Spanish population has undergone a major ageing process, with the proportion of people over 65 years increasing from 14% in 1991 to 16.6% in 2007: 7.6 million people, of whom 2.1 million (27.8%) were over 80 years old. Population studies indicated that, in the next 10 years, the over-65 age group will grow by the greatest percentage (see Exhibit 2), by 19.2%, adding 1.44 million people. Thus, within 10 years, there will be around 9 million Spanish people over 65 years.
Day centers were regulated both by local councils and each of Spain’s Autonomous Communities, according to the Department of Social Affairs and the Dependency Act. These regulations governed the architecture of day centers and the permits required to open them. The “Promotion of Personal Autonomy and Care Act,” covering persons in situations of dependency and their families, more commonly known as the “Dependency Act,” funded services for those who have a disabling illness or accident, or reached old age. More than 200,000 people (those most in need, representing 15% of the 1.3 million dependents) will benefit from this support. The Act was intended to be comprehensive and gave priority to “telecare” (remote assistance), home help, and day care centers, and “exceptionally,” paying a salary to the family caregiver.
The Act established three types of dependency:
Grade I. Moderate dependence: When the person needs help, at least once a day, to perform various basic activities of daily life, or needs intermittent or limited support for their personal autonomy. These people qualify for telecare.
Grade II. Severe dependence: When the person needs help two or three times a day to perform several basic activities of daily living, but does not want the continued support of a care-giver, or has extensive support needs for their personal autonomy.
Grade III. Total dependence: When the person needs help several times a day to perform various basic activities of daily life, due to total loss of physical, mental, intellectual, or sensory faculties; needs essential and continuous support from another person; or has widespread support needs for their personal autonomy.
The Spanish State (Central Administration) pledged more than 400 million Euros, rising annually to reach 2,212 million in 2015. The Autonomous Regions matched these amounts. The users paid 35% of their pension. Families who could afford to pay 90% of the cost must do so.
The supply of social services for older people has grown steadily in response to increased demand. The number of home-service users increased by more than 160,772, while telecare users multiplied more than threefold. The number of places in day care centers also trebled, by more than 44,627, and nearly 90,000 new places were created in residential centers.
The private sector handled 59% of those in day centers (37,433), either through placements financed at market price or those contracted by public administration (who receive public funding through the contracted rate). The first group (purely private) accounted for 37% of the total places (23,475), while the second (contracted places) represented 22% of the total (13,958). Public centers numbered 537 and private centers 757, thus maintaining the larger proportion of private centers over public ones. However, the public centers increased their share of the total to 41% in 2008. The growth of public day care centers was slowed by recession, with a halt on opening new centers. Many centers quickly closed their doors because the business has not been profitable, mainly because many of them were managed by medical staff with no experience or motivation for management.
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