Spain is expected to become one of the oldest countries in Europe by 2030 and the world’s second oldest country by 2050, behind Japan. In 2019, 20% of Spaniards were in the 65+ age group and the latter is expected to account for more than 30% of the population, or more than 17.5 million people, in 2050. The decline in the birth rate as well as the increase in life expectancy are the main factors behind Spain’s ageing.
The ageing of the population has a particularly marked effect in the «deserted» regions of Spain, i.e. the areas that have suffered from significant depopulation in recent years. Indeed, for several decades, a significant portion of the population, mostly of working age, has been emigrating from these areas to the main urban centres (Madrid and coastal areas), generating therefore a profound demographic imbalance between regions.
As a result of these trends, the elderly population in Spain will continue to grow while the working-age population is likely to remain unchanged or even decline.
Life expectancy in Spain – including at age 65 – is already one of the highest in the EU. In 2018, life expectancy at birth was 80.7 years for men and 86.3 for women, while in the EU27 these were 78.2 and 83.7, respectively. Life expectancy at age 65 was also higher in Spain for both men and women and is projected to rise from 19.5/23.5 years (EU-27: 18.1/21.6) in 2018 to 22.9/26.3 years (EU-27: 22.4/25.6) in 2060.
In the period 2013-2060 the share of people aged 80+ in the Spanish population is expected to grow from 5.5% to 14.9% (EU-28: 5.1%-11.8%), i.e. to more than double with most of the growth happening after 2030. Over the same period, the old age dependency ratio – i.e. the percentage of 65+ compared with the 20-64-year-old population – will rise from 28.3% (EU-28: 29.9%) to 58.9% (EU-28: 55.3%).
Under an assumption of no policy change the Ageing Report scenario suggests that public expenditure as share of GDP would rise from 0.9% to 2.2% (EU-27: 1.6%-3.1%) by 2070. The impact of a progressive shift from the informal to the formal sector of care in Spain would entail an estimated increase by 167% in the share of GDP devoted to public expenditure on long-term care (128% on average for the EU27).
Spain introduced regulations for a long-term care (LTC) system at the end of 2006, which recognised the right to social protection for dependent people. The Spanish LTC system therefore guarantees universal coverage (on the basis of cooperation between the central administration and the Autonomous Communities) and is integrated into the network of regional and municipal social services. While service oriented, the system also provides cash benefits for personal support and to informal carers. In practice, it relies on a combination of public benefits and informal care. Prior to 2007, LTC in Spain was primarily provided by informal carers (mostly women).
The main LTC services available in Spain include: technical assistance (e.g. telecare, telemonitoring, etc.), home care, day/night care centres as well as residential care.
- Technical assistance is offered to persons with a moderate degree of dependency who live at home.
- Home care services provide help with personal care and can be approached as a support service for the informal carer of someone with a high degree of dependency.
- Day care centres have a twofold objective: ‘improving and maintaining the highest possible level of personal autonomy and supporting families or informal carers’ (Article 24 of the Law on the Promotion of personal autonomy and care for dependent persons – LAPAD). Night care centres also offer a crucial respite service to carers but they are much less common than day centres.
- Finally, residential care may be permanent if it becomes the dependant’s main residence (only valid for second and third degrees of dependency), or only temporary (g. short stays for convalescence, holidays and illness, or to provide some rest for informal carers).
Institutional LTC service providers include regional and municipal centres, as well as private sector institutions (Rodríguez Cabrero et al., 2016). The providers forming part of the System for Autonomy and Care for Dependency (SAAD) network must be accredited by the Autonomous Regions. Home care services tend to predominate over institutional services in the country. According to the SAAD, 32.3% of beneficiaries received home care services (tele-assistance, home care), compared to 13.3% of beneficiaries receiving residential care (21% if day/night centres are included) at the end of 2017.
The 65+ and 80+ population with dependency account respectively for 72.2% and 54.5% of all beneficiaries of the system. It is important to note the central place of women in the LTC system who are the main beneficiary group, both in relation to the total population (53.4%) and (particularly) in relation to the population aged 65 and over (73.8%) as well as the main provider of care (62.4% of the caregiving population).
Implementation of the LTC system in Spain was practically on hold between 2012 and 2015 due to fiscal consolidation policies, resulting from the economic crisis. These have led to cuts in public expenditure, which have negatively affected the extent of coverage, the level of protection and the quality of benefits, especially in relation to community-based and cash benefits. Over its 10 years of existence, the performance of the SAAD has demonstrated positive aspects, such us the creation of a system of universal coverage for situations of dependency, support to informal carers and an expansion in community-based services (as opposed to residential services). Yet, waiting lists to access LTC benefits remain long, the quality of certain jobs in social services is deficient, coverage across Autonomous Communities can be unequal, financial commitments by the central administration are decreasing and coordination between social and health services in the field of dependency remains problematic.
Number of carers
The care model in Spain is principally familialistic, female dominated, informal and time intensive. According to the OECD (Colombo et al., 2011), Spain has one of the highest prevalence of informal carers (15.3% of the population or more than 7 million people) and is among the highest-ranked countries in the OECD in terms of the number of hours dedicated by informal carers (more than 20 hours per week). More recent estimates point out that 15.7% of dependants over 65 years of age receive mixed care (formal and informal), with the rest receiving only informal care (Minguela and Camacho, 2015). According to Bouget et al. (2016), in 2010, 62.4% of those who regularly took care of dependent relatives/friends aged 15 or over were women (60.2% in the EU-28). More than half of them (51%) had a low level of education, and 47% were over the age of 50. Other sources emphasise that there are three times more informal female carers than male, a figure that rises to 4.5 times for those under 65 years of age. Those between the ages of 30 and 65 assume over 80% of the burden of care (Durán, 2015).
Recognition and definition of carers
Spanish legislation on the Promotion of Personal Autonomy and Attention to people in a situation of dependency (Law 39/2006), recognises the status of a carer as a person who, exceptionally, provides care to a spouse or relative by consanguinity, affinity or adoption, up to the third degree of kinship, for at least a year. Both the carer and care recipient should live under the same roof.
Some of the country’s autonomous communities (e.g. Valencia) have adopted more progressive definitions to include informal carers who provide care to someone outside of the family.
Carer support services are included in both the “Social Services Reference Catalogue” (2013), and the System for Autonomy and Care for Dependency (SAAD) of the Law on the Promotion of personal autonomy and care for dependent persons – LAPAD.
Access to respite care
The services currently available in Spain and allowing respite for the carer include:
- Day/night care centres: While these services are aimed at dependent people, informal carers also benefit from them. Day care centres aim to both “improve and maintain the highest possible level of personal autonomy and supporting the families or carers” (article 24 LAPAD) and enable work-life balance for carers. Although this service has spread significantly over the last decade, its availability tends to vary between the Autonomous Regions. Night care centres offer a respite service which, while much less widespread than day care centres, are primarily designed as a support service targeted at informal carers.
- Residential care services provide another type of respite in the form of temporary convalescence stays, holidays and illness, or rest for informal carers (article 25 LAPAD).
- Home assistance services can also be viewed as a form of support for the carer of people with a high degree of dependency (article 23 LAPAD).
- Finally, technical help (e.g. home tele-assistance, one of the most requested benefits) is another good instrument to ensure the autonomy of people with moderate needs. Subsidies are also available for home adaptation.
Social inclusion of carers, access to education and employment
The Spanish system of carers’ leave arrangements provides three possibilities of leave under the Social Security institutional framework (Ministry of Health, Social Services and Equality, 2015):
- Short-term leave. Two days, which can be extended to four if travel is required, in order to care for family members (up to the second degree) regardless of their age, who have suffered an accident or serious illness, hospitalisation or outpatient surgery. The leave is fully paid for by the employer.
- Long-term leave. These are reductions of the working day to care for family members (up to the second degree) due to old age, accidents, serious illness or disability. The reduction can last for up to 2 years (unless where extended by collective bargaining). For public servants, this can be extended for up to 3 years. This leave is unpaid but the first year is fully included in the calculation of pension contributions. An employee’s job is safeguarded for the first year of leave, after which a position of equal professional level is guaranteed.
- Reduction of working hours to care for a child suffering from cancer or other serious illness requiring long-term hospitalisation. This type of leave is available to parents and enables them to reduce their working hours by up to 50% to care for a child in the above-mentioned situation. The leave may last until resolution of the illness or until the child reaches 18 years of age. In order to be eligible for this leave, both parents must be in employment or self-employed, and only one may benefit. The leave also concerns adopted children or those in the stages leading to adoption. The loss of income is compensated via a subsidy amounting to 100% of the base salary for the provision of temporary incapacity benefit from professional contingencies, or common contingencies in proportion to the percentage by which the working day is shortened. The initial duration of of the leave is one month, which can be extended for two-month periods for as long as caregiving is required (this must nevertheless be certified by the national health system).
- Reduction of working hours for self-employed people caring for a child under the age of 7 or other dependent family members. This benefit, in force since 2015, allows a self-employed with caregiving responsibilities toward a kid under 7 or other dependent family members, and who hire a full or part-time employee on a permanent or temporary basis (no less than 3 months; at least 50% FTE for part-time employees) in order to ensure the continuity of their business activity to benefit from a compensated paid leave of up to 12 months. The compensation amounts to 100% of the social security contributions of the self-employed person (or a proportion of that for part-timers).
There are cash benefits for informal care at home and for personal assistance, as well as a cash benefit linked to the purchase of services. These cash benefits and their amounts are granted according to the person’s degree of dependency and economic resources.
Cash benefits include the following:
- Non-contributory family benefits for children with disabilities: the family of a child below the age of 18 and with a degree of disability above 33% can expect an annual financial allowance of €1,000. For a child above 18 and with a degree of disability of 65% or more, or 75% or more with a need for a carer, the family will receive €4,415 and €6,623 respectively per child per year. The dependent child must live in the family home and his/her annual income must not exceed the minimum wage.
- Severe disability pension: This is contributory Social Security benefit includes an additional allowance allowing the disabled person (under the age of 65) to remunerate their carer. The allowance amounts to 50% of the pension (Article 196.4 of the Social Security Act).
- Carer allowance: this allowance aims to compensate the informal carer for their work and the costs of care in the family setting. The informal carer must be a spouse or family member (up to third degree of relation) living in the same household as the dependent person before the request for support is submitted. The benefit is only granted to non-family members under exceptional circumstances. The allowance is means tested and its amount depends on the degree of dependency of the care recipient. In 2015, the amount ranged between €153 and €387.64 per month (Ministry of Health, Social Services and Equality, 2015).
- Financial allowance for personal assistance. This benefit allows to hire a personal assistant, for a number of hours, in order to increase the autonomy of the dependent person, irrespective of their degree of dependency. The amount of the benefit depends on the degree of dependency and the economic capacity of the beneficiary. In 2015, it varied between €300 and €715 per month (Ministry of Health, Social Services and Equality, 2015).
- Financial allowance to contract a service. This benefit allows to contract the service allocated in the Individual Care Programme (e.g. home help services, day/night care centres or residential care services). It is granted when public care services are unavailable and private services must be bought. The amount ranges between €300 and €715 per month, depending on the degree of dependency and the economic capacity of the beneficiary.
Financial benefits for personal assistance and external services are provided directly to the beneficiary, although in practice they often contribute to improving the informal carer’s work-life balance.
In addition to the above-mentioned financial benefits, a few tax exemptions or tax credits are available, including:
- Tax credit per child or dependent family member with a disability of 65% or more. This is deducted from taxable income. The credit is €9,000 per person with a disability of 65% or more, or €12,000 if also requiring third party help (Article 60 Act 35/2006).
- Tax deduction per child or dependent family member with a disability (negative tax). This is a deduction from the tax amount for taxpayers who are employed or self-employed, and who have made social security contributions during the financial year. The deduction is up to €1,200 per year per disabled person (Article 81bis Act 35/2006).
- Some Autonomous Communities also apply tax deductions for disabled family members’ expenses. These deductions depend on the taxpayer not surpassing certain levels of taxable income.
It is important to note that the combination of cash benefits and benefits in kind is often not possible, except for services allowing to prevent situations of dependency, to promote personal autonomy and for tele-assistance.
- Mortality and life expectancy statistics, Eurostat, 2020
- Caixa Bank Research, April 2020
- The 2018 Ageing Report, Economic and Budgetary Projections for the EU Member States (2016-2070), EC, 2018
- ESPN Thematic Report on Challenges in Long-Term Care, Luxembourg, EC, 2018
- ESPN Thematic Report on work–life balance measures for persons of working age with dependent relatives, Luxembourg, 2016
- Joint Report on Health Care and Long-Term Care Systems and Fiscal Sustainability, EC, 2016
- Adequate social protection for long-term care needs in an ageing society, European Commission, 2014
Last Updated on January 19, 2021