The numbers don’t lie: we are living longer, but we are having fewer children. With a population pyramid radically different from that of decades ago, Spain has become one of the longest-living countries in the world, a trend that is only increasing: if in 2020 those over 65 years of age numbered 9.4 million, it is estimated that by the middle of the century there will be 16. In the last 20 years alone, they have increased by 40%, according to data from the National Institute of Statistics, until they represent almost a fifth of the total population. Figures that necessarily imply another truth: the greater the age, the greater the number of people in a situation of dependency, and therefore the greater demand for professionals specialized in covering a wide range of needs.
Now, what situation are you in? the dependence in Spain? A report by the Association of Directors and Managers of Social Services, presented on Tuesday, has warned that 11 autonomies cut their spending on dependency in 2011 compared to the previous year, taking advantage of an increase in funding by the central government. In December 2021, there were a total of 1,415,578 people officially recognized as dependents, of whom 193,436 still did not receive any benefit, despite being entitled to it. The differences in management between the different communities give rise to very heterogeneous waiting lists, with Catalonia at the head (31.77% of recognized dependents), followed by the Canary Islands (27.87%) and La Rioja (27.33%). ), while Castilla y León barely registers 1.49%, according to Europa Press (all of them are among those that cut their contribution last fiscal year). The excessive waiting time when processing benefit applications is, according to the specialists consulted, one of the shortcomings of the system, along with the lack of information and excessively complex bureaucratic procedures.
Challenges and challenges of dependency
“The System for Autonomy and Care for Dependency (SAAD) is a system of enormous depth, and its implementation and optimization process will never be definitive,” says Juan Sitges, director of Caser Foundation, which in turn identifies three major shortcomings when it comes to improving its effectiveness: “Firstly, the disparity between autonomous communities regarding demand management, especially regarding resolution times; an unequal development of services and benefits between the autonomies and the difficulties associated with financing”. A procedure that can exceed two years of waiting and that negatively affects the quality of life of dependents and their families. Accessing these services is also even more difficult if you live in a rural environment, since migration from the countryside to the city and the problems associated with an empty Spain complicate access to aid related to dependency.
Improve care for people in situations of dependency necessarily involves reinforcing coordination with (and between) the autonomies, “since there is evidence that the autonomous communities do not cooperate or share techniques, information or results, which puts the development and sustainability of the system in a complex situation. It is necessary to integrate and have an overall vision”, says Sitges. “The focus must be on quality and satisfaction, on best practices and on mistakes. And it is important to prioritize and be realistic in the face of the complex economic and social situation that we have had to live through”. For this, he insists, the level of information transparency must be increased; increase social and health coordination (and move towards a user-centered system); standardize the catalog of services and benefits, as well as the regulations; and seek long-term sustainable financing systems.
He knows in depth all the sides of the coin.
“Since the foundation, we have detected what we call the “disconnected population”, which is a large group of people with support needs to maintain their personal autonomy but who have not requested dependency aid, mainly due to ignorance, lack of support and due to the complexity of the system itself”, adds Sitges. The Caser Foundation also has a free telephone number for information on dependency and disability, 900 102 180.
Most demanded professional profiles
To speak of dependency is to speak of an enormously wide range of situations and needs that make very different interventions necessary, from telecare to home help, day and night centers and residential care. “The deficit of professionals related to dependency is very large; especially of doctors and, very especially, of nurses, some deficiencies that have been revealed in recent months”, recalls Sitges. But also, he points out, geriatricians, psychologists, social workers or physiotherapists. Beyond university degrees and/or master’s degrees focused on the field of dependency, to work as a caregiver or geriatrician it is necessary to be in possession of an accrediting official title, such as a technician in Social and Health Care, Auxiliary Nursing Care or Care for People in a Dependency Situation, in addition to certificates of professionalism in socio-health care for dependent people at home or in social institutions.
In any case, the specialists demanded in the dependency area are very numerous, and depend on the needs of each person. In home care, for example, caregivers play a fundamental role, dealing with three main profiles: “On the one hand, people who need sporadic accompaniment and help, several hours a day, to carry out their tasks daily, from personal hygiene, help dressing, mobility or medication control; then, there are those who have gone through a hospital process and need support in their recovery; and finally the cases of degenerative diseases, where the family seeks continued support and a care professional who mostly ends up living in the same home”, explains Roberto Valdés, co-founder and CEO of I take care.
Another of the services that are usually provided at home is physiotherapy, since many people cannot travel to a clinic weekly. Some specialists whose work is focused on “improving the quality of life of these patients through the practice of mobility, coordination and balance exercises”, illustrates Krupa Agate, director of the FEM Clinic in Valencia and a specialist in urogynecology. These are people who often have chronic pain, muscle weakness and reduced mobility due to diseases such as osteoporosis, arthritis, arthrosis or dehydration of the joints. “In urogynecological physiotherapy, for example, we can highlight treatments that improve symptoms of urinary and/or faecal incontinence, chronic pelvic pain or genital prolapse, which are so common in older people.”
Beyond doctors, nurses and nursing assistants, nursing homes hire specialists from other areas that are also in high demand for their clinical team, such as psychologists or, above all, occupational therapists, “a key profile to organize and carry out the activities of the centers and for the comprehensive stimulation of the elderly”, says José Ramón Díaz, founder of gransliving, a senior residence search engine. The work of the psychologist, for his part, focuses on helping the patient cope with social isolation, abandonment or the feeling of loneliness that many suffer when their social circle is reduced (and which has been accentuated due to the pandemic) and others. changes caused by old age.
But Díaz highlights a lack above all: that of the speech therapist. “It cannot be that most of the centers for the elderly have people with dysphagia (difficulties in swallowing and eating, a pathology that affects between 40 and 78% of institutionalized elderly people) and do not have a speech therapist, who is one of the main specialists for your treatment. Many times it is subcontracted, but that is usually done by families with money to pay for an external speech therapist”. And he ends by making a reflection: “It is important to see beyond the physical limitations of an elderly person, because many times the greatest lack is inside them. When you’re older, you carry over a lot of things from your adult life, both physical and psychological. And if the ghosts come out at that age, it is necessary to have support to lead a decent quality of life.”
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