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MC COVID-19 Governmental Response to the COVID-19 Pandemic in Long-Term Care Residences for Older People: Preparedness, Responses and Challenges for the Future

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MC COVID-19 Governmental Response to the COVID-19 Pandemic in Long-Term Care Residences for Older People: Preparedness, Responses and Challenges for the Future MC COVID-19 Governmental response to the COVID-19 pandemic in Long-Term Care residences for older people: preparedness, responses and challenges for the future Spain Eloísa del Pino, Francisco Javier Moreno Fuentes, Gibrán Cruz-Martínez, Jorge Hernández-Moreno, Luis Moreno, Manuel Pereira-Puga, Roberta Perna Institute of Public Goods and Policies (IPP-CSIC) MC COVID-19 WORKING PAPER 13/2021 Contents 1. DESCRIPTION AND ANALYSIS OF THE ROLE OF THE RESIDENTIAL CARE SECTOR FOR THE OLDER-AGE POPULATION (PRE-COVID19) 3 1.1. Trajectory of LTC until the most recent model 3 1.2. Current arrangements in LTC 4 1.3. Debates around the development of a LTC system 5 1.4. LTC governance 6 1.5. General functioning of the residential care system 8 2. DESCRIPTION OF THE EVOLUTION OF THE PANDEMIC IN SOCIETY AT LARGE, AND IN THE RESIDENTIAL CARE AND HEALTHCARE SECTORS MORE SPECIFICALLY 10 2.1. Evolution of the epidemic 10 2.2. The effects of the epidemic on the healthcare system 14 2.3. The epidemic in the public and political debates 18 3. DESCRIPTION AND ANALYSIS OF THE MEASURES ADOPTED TO ADDRESS THE IMPACT OF THE PANDEMIC ON THE RESIDENTIAL CARE SECTOR FOR THE OLDER-AGE POPULATION 21 3.1. Background of preparedness for the Crisis 21 3.2. General Impact of the Epidemic on the Residential Care Sector and Policy Responses 25 3.3. Ensuring quality healthcare in nursing homes 34 3.4. The recovery of activity and the future of the residential sector 41 REFERENCES 43 MC-COVID19 text of institutionalized older-age care (age Project Coordinators: Coordination mechanisms in Corona- group that appears particularly vulnerable Eloisa del Pino Matute virus management between different in this epidemic context), in Spain as well Francisco Javier Moreno-Fuentes levels of government and public policy as in the rest of the EU-15. This study fo- sectors in 15 European countries cuses on the articulation of resources be- Research Team: tween health and social policies, and aim Gibrán Cruz-Martínez The political and administrative manage- to contribute to improve the effectiveness Jorge Hernández-Moreno ment of the healthcare crisis provoked by of the decision-making process and cru- Luis Moreno the COVID 19 is a key issue in preventing cial aspects in the fight against the pan- Manuel Pereira-Puga the spread of the disease. The Mc-COVID demic. Findings also aim to be useful to Roberta Perna 19 project is set to analyse the socio-san- inform other public policy sectors involved itary co-ordination procedures in the con- in crisis-related situations. https://www.mc-covid.csic.es/ How to cite this publication: Del Pino, E., Moreno Fuentes, F. J., Cruz-Martínez, G., Hernández-Moreno, J., Moreno, L., Pereira-Puga, M. and Perna, R. (2021), ‘Governmental response to the COVID-19 pandemic in Long-Term Care residences for older people: preparedness, responses and challenges for the future: Spain’, MC COVID-19 working paper 13/2021. http://dx.doi.org/10.20350/digitalCSIC/13688 Eloísa del Pino 1. DESCRIPTION AND ANALYSIS OF THE ROLE OF THE RESIDENTIAL Institute of Public Goods CARE SECTOR FOR THE OLDER-AGE POPULATION (PRE-COVID19)1 and Policies (IPP-CSIC) [email protected] 1.1. Trajectory of LTC until the most recent model Francisco Javier Moreno Fuentes Institute of Public Goods The response to Long-Term Care (LTC) needs in Spain has been traditionally and Policies (IPP-CSIC) characterized by a low level of public involvement and a central role of the [email protected] family in the provision and financing of care. Up to 2006, the residual state Gibrán Cruz-Martínez intervention in this domain was structured around two basic programs: a Institute of Public Goods social insurance scheme (granting relatively small amount cash-transfers) and Policies (IPP-CSIC) for workers with LTC needs deriving from accidents at the workplace; and a [email protected] poorly developed system of personal social services run by municipalities Jorge Hernández-Moreno and regional governments, characterized by the deployment of means-test- Institute of Public Goods ed programs targeted to the most disfranchised groups (notably older de- and Policies (IPP-CSIC) pendents without resources or substantive family support networks), and [email protected] fundamentally focused in funding the provision of institutionalized residen- tial care. Luis Moreno Institute of Public Goods and Policies (IPP-CSIC) This highly selective public LTC system, characterized by the extreme heter- [email protected] ogeneity of the level of coverage, as well as of the nature of the services pro- vided across the territory, served only a small proportion of the dependent Manuel Pereira-Puga population. It actually depended on the considerable ability of family net- Institute of Public Goods and Policies (IPP-CSIC) works to absorb and internalize the functions of care of its members. The [email protected] responsibility for the care of dependent relatives fell mainly on women with- in households, a situation that had a considerable impact on the participa- Roberta Perna tion of women in the labor market, and most notably on their personal and Institute of Public Goods professional life opportunities when they assumed the role of caregivers. and Policies (IPP-CSIC) [email protected] The increasing incorporation of women into the formal labor market chal- lenged the Mediterranean welfare regime, notably the central role assigned to women in the provision of care within the household. In this context, the use of undocumented migrant workers (women for the most part) allowed families to set up financially affordable solutions (given the low salaries paid to these women) to the care needs of its members. The implications of this informal market’s substantial growth in recent years contributed to the ques- tioning of the traditionally weak role of public policies in the domain of LTC 1 (Da Roit and Moreno-Fuentes, 2019). Nevertheless, and despite the limita- This series of reports is one of the tions of this situation (unequal treatment to different sectors of the popula- research results of the Mc-COVID-19 project, “MC-COVID19: Coordination tion, low levels of assistance to those in need, precarious working conditions mechanisms in Coronavirus of care providers, poor quality of care due to the lack of qualifications of care management between different levels providers, or strong economic and functional pressures on families espe- of government and public policy sectors in 15 European countries”, cially for those women trapped in the role of caregivers), the inclusion of this funded by the Spanish National topic in public and political agendas did not occur until recent years. Research Council (CSIC) within the CSIC-COVID-19 programme, as well as In the early 2000s, the need to strengthen formal care structures became of the GoWPER project, “Restructuring the Governance of the Welfare State: pressing as informal care-provision structures were increasingly less able Political Determinants and Implications to face the growing LTC demands of an ageing population (e.g. chronic and for the (De)Commodification of Risks”, degenerative illnesses, mental health issues), the growth of the dependent CSO2017-85598-R Plan Estatal de older population, and the changes in the size and structure of the tradition- Investigación Científica y Técnica y de Innovación. al caregiving population. The perception of the inadequate nature of the 3 4 ℅ MC COVID-19 institutional and financial frameworks dealing with LTC needs in Spain im- plied increasing pressures for change in public policies in this domain. The urgent demands arising from these socio-demographic changes set the stage for a substantial reform of this relatively undeveloped welfare area. 1.2. Current arrangements in LTC The 39/2006 Law on the Promotion of Personal Autonomy and Care for Dependent Persons (generally known as the “Dependency Law”) came into force in 2007, establishing the System of Autonomy and Dependency Care (SAAD). This national LTC system recognized the subjective right to social protection for all those who, regardless of their age, can provide proof of a stable residence in Spain for at least five years and who are recognized one of the degrees of dependency established in the Act (Moderate -Degree I-, Severe -Degree II-, and High Dependence -Degree III-). It broadened the scope of the public network of social services, defining a more coherent governance structure for the LTC system, improving the level of cooperation between social and health services in the domain of care for dependent people, and promoting the formalization of employment in the care sector. Although the system is supposed to be mainly service-oriented, it also pro- vides cash benefits to informal caregivers and for personal support. The ideal preference for services was, in fact, soon confronted with the reality of pre-existing and profoundly heterogeneous social services schemes set up by regional and local governments. The strong path-dependency linked to those regional and local care systems strongly contributed to the shape that the SAAD took in every region and city. Those systems were often char- acterized by a close cooperation with private (often non-profit) operators in the care market focused on residential services and a fragile development of public care services. A consequence of that state of affairs was an evi- dent lack of professionalization of care-providers and a weak development of a labor market niche linked to care. Financial restrictions experienced by regional governments, ideological preferences of regional policy-makers, and the social and institutional inclination for cash benefits also contribut- ed to a systematic deviation of the reality from the SAAD’s initial design as a system mostly based on the direct provision of services.
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