Spain

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 2024, 20.4% of Spaniards (approximately 9.9 million people) 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[1]. The decline in the birth rate as well as the increase in life expectancy are the main factors behind Spain’s demographic changes. Spain’s total fertility rate was around 1.1 children per woman in 2025, one of the lowest in the European Union, contributing to demographic ageing and long-term population change. [2]

As of 31 December 2024, approximately 6.3 million older people were estimated to have Long-Term Care (LTC) needs, yet just over one third (34.23%) were enrolled in formal care and support services. Among the 2.1 million individuals who registered, around 1.6 million were aged 65 and above. [3]

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. On 1 January 2024, the old-age dependency ratio was estimated at approximately 33.9% in the EU, while in Spain it reached 30.8% indicating fewer than three working-age adults per older person.[4]

Life expectancy in Spain – including at age 65 – is already one of the highest in the EU. In 2024, life expectancy at birth was 81.3 years for men and 86.6. for women, while in the EU-27 these were 79.2 and 84.4, respectively.[5]

Life expectancy at age 65 was also higher in Spain for both men and women and reached 21.87 years in 2024 (19.87 for men and 23.64 for women) and is projected to rise to 22.9/26.3 years (compared with the EU-27 estimate: 22.4/25.6) by 2060.[6]

In the period 2022-2060 the share of people aged 80+ in the Spanish population is expected to grow from      6.0% to 14.9% (EU-27: 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 33.3% (EU-27: 29.9%) to 64% in 2060 (EU-27: 55.3%)[7].

Under an assumption of no policy change, the Ageing Report scenario suggests that public expenditure as share of GDP would rise from 0.8% in 2022 to 1.7% by 2070 (EU-27: from 1.7% in 2022 to 2.6% in 2070). The impact of a progressive shift from the informal to the formal sector of care in Spain would entail an estimated increase by 108% in the share of GDP devoted to public expenditure on Long-Term Care (48% on average for the EU-27)[8].

[1] Consejo Superior de Investigationes Científicas Informes, Envejecimiento en red, Número 34, Octubre 2025, Un perfil de las personas mayores en España 2025. Indicatores estadísticos básicos. Pag 4 – https://envejecimientoenred.csic.es/wp-content/uploads/2025/10/enred-indicadoresbasicos2025.pdf 

[2] INE – Instituto Nacional de Estadística – Indicador Coyuntural de Fecundidad según lugar de nacimiento de la madre proyectado 2024-2073, 2024 https://www.ine.es/jaxiT3/Datos.htm?t=36769#_tabs-tabla 

[3] European Social Network – European Social Service Index, Spain, Factsheet for 2025 https://www.esn-eu.org/social-services-index/2025/spain 

[4] Eurostat, Statistics Explained, 2024 – https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Population_structure_%20and_ageing 

[5] Eurostat, Life expectancy by age and sex, 2024 – https://ec.europa.eu/eurostat/databrowser/view/demo_mlexpec__custom_19658249/default/table

[6] Instituto BBVA de Pensiones, La esperanza de vida en España supera ya los 84 años, 2025 – https://www.bbvamijubilacion.es/blog/la-esperanza-de-vida-en-espana-supera-ya-los-84-anos/ 

[7] 2024 Ageing Report, Spain’s Country Fiche, 2023 – https://economy-finance.ec.europa.eu/document/download/392994f2-c025-4066-bea8-f65cf4bcd411_en?filename=2024-ageing-report-country-fiche-Spain.pdf

[8] European Commission, 2024 Ageing Report: Economic and Budgetary Projections for the EU Member States (2022-2070), 2024 – https://economy-finance.ec.europa.eu/document/download/971dd209-41c2-425d-94f8-e3c3c3459af9_en?filename=ip279_en.pdf 

Prior to 2006, LTC in Spain was primarily provided by informal carers (mostly women). 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. The financing comes from the National and Regional general budgets and co-payments by the beneficiaries, according to their income and assets, and according to the type of service received. It is financed jointly by central government and the regions. Each regional government may establish a wider set of benefits for its residents.

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 (e.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 (Sistema para la Autonomía y Atención a la Dependencia – SAAD) network must be accredited by the Autonomous Regions.

Home care services continue to predominate over institutional services in the country. As of 2025, the most frequently combined benefits within the SAAD are tele-assistance, home help services and the cash benefit for family care. Tele-assistance and home help are now the most used services, accounting respectively for 25.3% and 19.4% of all benefits provided.[1]

The cash benefits cover informal care at home, personal assistance, and the purchase of services. The level and amount of this financial support is granted according to people’s degree of dependency and economic resources. Beneficiaries do not have discretionary use of cash benefits. In the case of the cash benefit for informal care at home, the care must be provided by family members; however, as of 2023, the requirement for the caregiver to be a relative has been flexible to allow “persons close to the circle of care” in cases where professional services are unavailable, particularly in rural or depopulated areas[2]. Households can choose informal carers freely, so long as they meet the requirements: the benefit is granted if the beneficiary has been cared for by non-professional carers in the year prior to the application, and only if there is no suitable formal care available. The amount received may be reduced to reflect compulsory co-payments (depending on the beneficiary’s income).

Although progressively decreasing, the cash benefit for informal care at home continues to play a central role within the SAAD. Excluding tele-assistance and services aimed at the prevention of dependency and the promotion of autonomy, this cash benefit currently represents 41.8% of all services and benefits provided. Similarly, the cash benefit linked to the purchase of services, is received by 10.48% of beneficiaries. Overall, the SAAD is an LTC system that supports and complements the traditional family care system, which remains the backbone of care for dependent people[3].

As of late 2024, the people aged 65+ and 80+ population with dependency account respectively for 73.29% and 54.02% of all beneficiaries of the system[4]. 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 as 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 with 142,466 persons on the “waiting list for services” as of the end of 2024[5]. 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.

A recent development in Spain is the elaboration of a new public policy on care in the framework of the gender equality agenda, namely the national Co-Responsible Plan. The Co-Responsible Plan is housed in the Secretary of State for Equality and against Gender Violence of the Ministry of Equality and aims to initiate a path towards guaranteeing care as a right in Spain, from the perspective of equality between women and men. Within this framework, the gender equality agenda regarding care will be guided by the commitments adopted in the Strategic Plan for the Effective Equality of Women and Men 2022-2025. This is expected to be achieved, in particular, by its four objectives linked: “Towards the recognition of the right to care and the socially just redistribution of care responsibilities and time”, including to:

1. Make visible, recognise, and give social value to care as an essential work for the sustainability of life.
2. Reorganise, strengthen and expand care services prioritising its universality, quality, public nature and decent working conditions. As well as adapting the services to the territory, giving special attention to its provision in rural areas.
3. Professionalise precarious care.
4. Advance in the development of work-life balance and share responsibilities between women and men.

An Advisory Board for care has been established as a space for stable deliberative participation. It has a consultative and non-formal nature and its purpose is to advise the Ministry of Equality on the proposal, design and promotion of regulatory frameworks and public care policies from a dual perspective: priority attention to social emergency situations and to the establishment of political, social and institutional conditions that facilitate the configuration of the future state care system.

[1] Ministerio de Derechos Sociales, Consumo y Agenda 2030, La Dependencia avanza hacia el modelo de proximidad: el 56% de las prestaciones se dan ya en los hogares y en el entorno más cercano. 2025 – https://www.dsca.gob.es/es/comunicacion/notas-prensa/dependencia-avanza-modelo-proximidad-56-prestaciones-se-dan-ya-hogares 

[2] BOE, Real Decreto 675/2023 – https://www.boe.es/buscar/doc.php?id=BOE-A-2023-16651 

[3] Asociación Estatal de Directoras y Gerentes de Servicios Sociales, XXV Dictamen del Observatorio Estatal de la Dependencia, 2025 – https://directoressociales.com/wp-content/uploads/2025/03/INFO-GLOBAL-XXV-DICTAMEN-2024-v5_compressed.pdf

[4] Ibidem.

[5] Ibidem.

Number of carers

The Spanish care model is principally familialistic, female dominated, informal and time intensive. Informal care work therefore continues to dominate the social structure of care in Spain. According to the InCARE Report, there were more than 62,000 informal carers in the country                     in 2022, 84% of whom were women. More than half of them (51%) had a low level of education, and 47% were over the age of 50[1].

According to the OECD, Spain has one of the highest prevalence of informal carers 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)[2]. 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.[3]

Foreign workers represent a large portion of those who provide care to dependent people in the home. According to the OECD, as of 2024, about 33% of workers in the LTC sector are immigrants[4]. Migrant workers represent a particularly large proportion of live-in care workers. As of 2023, in Spain, more than half of live-in carers were foreign-born.[5]

[1] InCARE IMSERSO and Matia Foundation, Short report: Long-Term Care landscape in Spain. InCARE project, 2023.      https://incare.euro.centre.org/wp-content/uploads/2023/05/InCARE_Short-Report_Spain_16052023_Final.pdf 

[2]  Colombo et al., 2011.

[3]  Minguela and Camacho, 2015.

[4]OECD, Health at a Glance, 2025 https://www.oecd.org/content/dam/oecd/en/publications/reports/2025/11/health-at-a-glance-2025_a894f72e/8f9e3f98-en.pdf

[5] OECD, Beyond applause? Improving Working Conditions in Long-Term Care, 2023 – https://www.oecd.org/content/dam/oecd/en/publications/reports/2023/06/beyond-applause-improving-working-conditions-in-long-term-care_4523ea50/27d33ab3-en.pdf

Recognition and definition of carers

Spanish legislation on the Promotion of Personal Autonomy and Attention to people in a situation of dependency (LAPAD – 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. However, as of 2023, Royal Decree 675/2023 has flexibilised this requirement, allowing persons close to the circle of care (e.g. neighbours or friends) to be recognised as caregivers in specific settings, such as rural or depopulated areas[1]. 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).

[1] BOE, Real Decreto 675/2023 – https://www.boe.es/buscar/doc.php?id=BOE-A-2023-16651

Identification of carers and assessment of their needs

Informal carers can subscribe to voluntary insurance through the social security system. From April 2019, the Social Security contributions for these caregivers are fully financed by the State through IMSERSO, ensuring their future pension rights (retirement, disability) without personal cost to the carer[1]. The resulting allowance must be used to compensate informal carers for their work and the costs of care in a household setting. In practice, these amounts cover only a very small part of the costs of care. However, the public administrations do not usually check whether the money received by the beneficiaries goes towards these expenses.

[1] IMSERSO, 2025 – https://imserso.es/en/detalle-actualidad/-/asset_publisher/n1oS8lWfrx6m/content/a-partir-del-1-de-abril-de-2019-se-recupera-la-financiacion-de-las-cuotas-del-convenio-especial-de-los-cuidadores-no-profesionales-de-las-personas-en-situacion-de-dependencia-a-cargo-de-la-administracion-general-del-estado/20123

Multisectoral care partnerships

The Spanish LTC system is built on a “co-governance” model between the Central Government (Ministry of Rights and Social Inclusion) and the 17 Autonomous Communities to ensure a “continuum of care”. A key development in 2024-2025 is the strengthening of the “Board of Territorial Cooperation” (Consejo Territorial de Servicios Sociales), which coordinates the financing and quality standards of the SAAD. Additionally, the new “State Strategy for a New Care Model 2024-2030” promotes partnerships with the third sector (NGOs) and private providers to decentralise care, particularly through the “Rural Bridge” projects aimed at isolated areas[1].

[1] Ministerio de Derechos Sociales, “Estrategia estatal para un nuevo modelo de cuidados en la comunidad. Un proceso de desinstitucionalización (2024-2030)”, 2024  – https://estrategiadesinstitucionalizacion.gob.es/

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.

Access to information and advice

Information and advice for carers are primarily managed at the local level through Municipal Social Services. The current “State Strategy for a New Care Model 2024-2030” (“Estrategia Estatal para un nuevo modelo de cuidados 2024-2030”) aims to reinforce information and orientation points to ensure universal accessibility to the system[1]. Some Autonomous Communities have established “Oficinas de Vida Independiente” to provide direct advice on procedures and resources[2]. However, administrative complexity remains a major barrier: in 2023, 40.447 people died while on the dependency waiting lists, highlighting significant gaps in the system’s ability to provide timely support[3].

Carers’ mental and physical health

While the LAPAD Law recognises the importance of the carer’s well-being, specific health programs remain fragmented across regions. The “State Strategy for a New Care Model 2024-2030” (“Estrategia Estatal para un nuevo modelo de cuidados 2024-2030”) officially recognises the physical and emotional strain of informal care as a structural challenge[4]. Furthermore, the “Mental Health Action Plan 2025-2027” (Plan de Acción de Salud Mental 2025-2027) prioritises mental health prevention also for family caregivers[5].

Training and recognition of carers’ skills

To ensure quality, the Spanish LTC system has three instruments: (a) a national and regional regulatory system; (b) formal ex ante quality controls; and (c) good practices. Concerning informal carers, the common accreditation criteria in terms of training were regulated in 2009 by the CISAAD in order to guarantee the quality of care. However, there is no published evidence on any evaluations of informal care conducted by the regional public sector. Only a few non-governmental organisations in the area of dependency are developing systematic projects to evaluate informal care. Despite its importance, the supply of training for informal carers is still scarce and varies between the Autonomous Communities.

Social inclusion of carers, access to education and employment:

Carer’s leave

The Spanish system of carers’ leave arrangements provides three possibilities of leave under the Social Security institutional framework.

• Short-term leave. Five days of paid leave per year (extended from two), which can be extended in case of travel, 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 requiring home rest. The leave is fully paid for by the employer.[1]
• 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. Under the 2023 update, this right can be extended up to the age of 23, or 26 if the disability exceeds 65%.[2] 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 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).

Cash benefits

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 2025/2026, for a child above 18 and with a degree of disability of 65% or more, the annual amount is €5,647.20, and for those with 75% or more with a need for a carer, the family will receive €8,470.80.      The dependent child must live in the family home and his/her annual income must not exceed the minimum wage.[3]
• 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. Following Real Decreto-ley 675/2023, the minimum amounts have been established and the maximums increased. As of 2023, maximum monthly amounts are €180 (Grade I), €315.90 (Grade II) and €455.40 (Grade III)[4]. 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.
• 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 2023, the maximum monthly amounts are €313.50 (Grade I) and €757.25 (Grade II and III)[5].

• 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 current maximum amounts are €315.50 (Grade I), €445.30 (Grade II) and €747.25 (Grade III)[6].

 

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.

[1] Real Decreto-ley 5/2023 – https://www.boe.es/buscar/act.php?id=BOE-A-2023-15135

[2] Ibidem.

[3] Real Decreto-ley 8/2023 – https://www.boe.es/buscar/act.php?id=BOE-A-2023-26452

[4] Real Decreto-ley 675/2023 – https://www.boe.es/buscar/doc.php?id=BOE-A-2023-1665

[5] Ibidem.

[6] Ibidem.

[1]  Ibidem.

[2] Federación Vida Independiente – https://federacionvi.org/contenido/oficinas-de-vida-independiente/

[3] Asociación Estatal de Directoras y Gerentes de Servicios Sociales, XXV Dictamen del Observatorio Estatal de la Dependencia, 2025 – https://directoressociales.com/project/xxv-dictamen-del-observatorio-estatal-de-la-dependencia/

[4] Ministerio de Derechos Sociales, “Estrategia estatal para un nuevo modelo de cuidados en la comunidad. Un proceso de desinstitucionalización (2024-2030)”, 2024 – https://estrategiadesinstitucionalizacion.gob.es/

[5] Ministerio de Sanidad, Plan de acción de salud mental 2025-2027, 2025 – https://www.sanidad.gob.es/areas/calidadAsistencial/estrategias/saludMental/docs/Plan_accion_salud_mental_2025_27.pdf