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The Care Challenge in Barcelona During Uncertain Times
From Ildefons Cerdà's innovative proposals in the mid‐nineteenth century, which would result in the famous grid‐like urban structure that is so characteristic of the city, to the transformations for the Barcelona ’92 Olympic Games and to the present day, Barcelona has shown it is a creative city that is open to change. Today, all kinds of phenomena that characterize our times are once again forcing the city to not only consider ingenious urban planning changes, taking into account that the space available in the city is limited, but more especially – and concerning this chapter – the redesigning of services for people and examining the interaction between the physical and social aspects.
In recent years the Area of Social Rights of the Barcelona City Council has been equipped with a unit of talented economists, geographers, and sociologists to comprehensively address social challenges the city is facing. This unit works as an intersection between social work practitioners (social and educational workers, psychologists), who stay on the field, and politicians, who have to make evidence‐based decisions in coherence with their ideology. To do this, it is key to have access to data, statistical knowledge, and appropriate theoretical approaches to understand the trends behind change. Experience reveals us that being aware of interactions between urban space‐oriented social policies, such as inclusive urbanism planning, and individual‐oriented policies (e.g. income guarantee schemes or social, health, and educational policies) can help policymakers to make effective and efficient decisions.
In the current uncertain times, Barcelona is experiencing a demographic phenomena that requires new approaches if it is to be adequately dealt with (Ajuntament de Barcelona 2018b). The city's population is getting older (Various Authors 2020). In a city with over 1.6 million inhabitants, the people aged 65 or over represent 21.3% of the population (almost 350 000 people), while people aged 75 or over represent 11.2%. Demographic projections (Ajuntament de Barcelona 2018a) foresee progressive ageing with population concentrations in the 75–79 age group. By 2030, it is estimated that 8.3% of the population will be 80 years old or more. So the city is facing a crisis in care that mainly concerns how to tackle the care of senior citizens today, because there will be increasing numbers of them, they will be older and they will be in increasingly dependent situations. Today, we urgently need to adapt the city's social model, basing it on innovative policies that, in the short and medium term, improve the sustainability of care for an ageing population. How is Barcelona preparing to deal with this challenge?
Using data from 2018 (Ajuntament de Barcelona 2018a), in Barcelona there are 13 000 places in elderly care homes (42% 0f them are public). There are around 6000 people on the waiting list for public‐sector places (only open to people with a high degree of dependence). Half of these people continue to live in their own homes while they wait for a place. However, it seems like that most of the city's elderly people will live the maximum possible amount of their lives in their own homes, either because they wish to do so or because they do not have access to a place in an old people's home, and only some of them will be able to receive care at home through public services. Furthermore, there is also the fact that in Barcelona today there are more than 90 000 people aged 65 or over who live alone (76.2% of them are women) and if we look at an even older age group, 75 or over, we see that there are nearly 58 000 (80% of whom are women). These single‐person dwellings represent 13.6 and 8.7% of Barcelona households, respectively (BCNEcologia 2019).
Home care service has therefore become a priority challenge. The recent COVID‐19 crisis will clearly add weight to this priority. The current model used for elderly care homes will probably have to be reconsidered. The crisis has exposed major shortcomings in service quality, and above all, characteristics that are far from optimal for dealing with epidemics or pandemics, for example, an architectural design based on small, shared rooms, which is incompatible with social distancing and confinement measures. The following sections deal with how to organize care for senior citizens who are still living in their own homes in Barcelona: from the more traditional model to the new proposals that are now being implemented.
Care for the Elderly and Dependent Population
According to the city's socio‐demographic survey in 2017, in Barcelona there would be 117 000 people with a significant lack of personal autonomy who would need help to carry out everyday activities. We are referring to people who suffer from a specific illness, those who have some type of disability, and senior citizens who have lost personal autonomy due to the ageing process. Approximately half of these people would need regular help.
Administrative records indicate that 67 000 people are recognized by Act 39/2006 on the promotion of personal autonomy and care for dependent persons as having a degree of dependence or, where they do not have this, receiving the city's municipal Home Care Service (in Catalan Servei d’Atenció Domiciliària, SAD); 85% of them are 65 years old or over. The SAD is a Barcelona City Council service that provides personal care and, in certain cases, support for cleaning and maintaining the home, for people who find it difficult to carry out everyday activities, who have difficulties with social integration or who lack personal autonomy. The service is mainly provided in people's own homes, although it may also involve accompanying the person when they leave their home for some purpose. This is not a universal service; it involves prior professional evaluation by Social Services Centres. The SAD has nearly 19 000 users. Around 77% of them are senior citizens over the age of 75 (BCNEcologia 2019), and it is estimated that in 10 years’ time, this group will have increased by 11%.
In the last decade, the SAD has grown exponentially, with the introduction of the above‐mentioned Act. The service is provided by three private companies through 4000 professional staff. It involves the provision of 4.5 million working hours a year, with a total cost to the City Council of over €80 million (it is the second‐largest public contract in terms of expenditure). Today it is an extremely feminized service (90% of the professional staff are women) and it has notable levels of precariousness: 71% of them are part‐time workers, as it is very difficult to plan a full day's work, given that most of the care work is carried out in the mornings, and the wages are most commonly between €600 and €800 a month, which is in no way enough to live in a city like Barcelona. Furthermore, this type of work does not usually receive social recognition, although it certainly deserves it. The work is varied and less structured than the work carried out in elderly care homes. It requires flexibility and adaptability, and needs specific skills for working in the intimate space of the person concerned and dealing with complex situations (e.g. moving bodies with reduced mobility or coping with behaviours associated with psychological disorders or fragile mental health); it is a rather solitary job that involves inefficient journeys between people's homes, which has negative effects on the worker's health (GESOP 2017). The COVID‐19 situation has shown more clearly how significant this work is, as well as the need for giving it adequate recognition and reducing precariousness.
Another institutionalized way of providing care for elderly people in their homes is a financial benefit that provides support for non‐professional caregivers. In other words, someone with a recognized degree of dependence according to Act 39/2006 can apply for this benefit if the person caring for them is a member of their family circle that lives with them; this person is a non‐professional caregivers who, during the last year, has dedicated a large proportion of their time to carrying out these care tasks.1 At present, another 15 000 people in the city receive this benefit, which is a responsibility of the regional government.
In addition to these services, there are a large number of formal and informal services that are outside the care work financed using public funds and which unfortunately lie outside our exhaustive knowledge. We refer to the care work carried out by a dependent person's relatives or people from their close circle (without any pay or the support of any benefits). We are also referring to paid care work that is directly provided by the market, through companies or even directly by a non‐professional caregiver (often without an employment contract). In all of these cases, there is still a significant gender bias, because women essentially carry out this work. Outside the family circle, there are also