Adelina Comas-Herrera (Girona, 1972) directs the Global Long-Term Care Observatory, a platform to support transnational learning on how to improve care systems based on lessons learned from the pandemic. After monitoring Covid-related mortality in nursing homes in more than twenty countries, this researcher from the London School of Economics and Political Science concludes that in Spain – and in general in Europe, the United States and Canada – more people died than in many Asian countries because it was slow to react, because these centers had a shortage of staff, low levels of training and, furthermore, most of them are poorly designed.
“The larger the residences, the more risk there was for the resident to die, and having shared rooms and bathrooms also had an impact,” exemplifies Comas-Herrera, who a few days ago participated in the New Longevity conference organized by the “la Caixa” Foundation.
And he assures that, far from improving, the situation in nursing homes has worsened because employees with more training, such as nurses and nursing assistants, are moving to the health system that pays better. Also noteworthy is the fact that in Spanish residences there are many people with a fairly low level of dependency who, with more intensive home care or intermediate equipment, could remain at home.
If the nursing home model doesn't work, what do we do with the people who need care?
Strengthen support in the community with services such as home care, personal assistants, day centers and other local infrastructure that can support. In Spain there is little support infrastructure and home care offers few hours so that the person receiving it can stay at home if they have a medium or high level of dependency.
In an increasingly aging society, with smaller families and fewer potential caregivers, how do we prevent dependent people from being left unattended?
In other parts of the world it has long been no longer assumed that the family will take care of everything. Care must be professionalized. Daughters cannot take care of their fathers; That has become obsolete with its incorporation into the workforce and economically it does not make sense. Family care, which seemed free, has a significant cost. If you have to provide 6 or 8 hours of care a week you can make it compatible with work, but if you have to provide 20 or 40 hours, it is impossible. According to studies from the United States and Germany, the penalty for a few years of caregiving translates into five more years of low income and much worse pensions as you age. And these women are going to need public pensions because they will not have been able to contribute the same as if they had continued their professional careers.
But professional care is expensive. Who finances them?
It is an area where it is important to have an insurance function. Not everyone will need care. Many people die without needing them, others need them for a few months and others for years. As a society we have the possibility of insuring ourselves against this risk, of making an economic contribution to ensure that those who need it can have them. The Spanish Dependency Law already goes along those lines, what happens is that it covers little of the high costs that families who need care have. It is a good base but needs more funding.
How much would have to be invested?
In Spain the public contribution to dependency in terms of GDP is very low compared to other OECD countries, and even more so for a country that is very aging. At least the percentage of GDP allocated to this should be doubled to reach what the countries that are better in this area invest.
Another problem that grows with aging is unwanted loneliness. Are residences the solution to socializing in old age?
The residences are for people with very high levels of dependency. To combat loneliness there are other possibilities. For example, supported housing. The key is that they are in the center of the towns so that people can maintain their ties with the community. In England there is a housing complex with care next to the house where older people live, many are widows and widowers, and they walk to the shops, go for walks, have community areas for activities... They are very good alternatives for who do not have high levels of dependency but do need support to live independently. There are also volunteer initiatives, such as the Great Friends program in Spain.
What would be your ideal model for aging?
Not just residences, not just these homes, not just home support, not just personal assistants. We need a good combination of these elements and day centers to serve people who have very different needs.
How would you organize it?
Residences can respond to people with very intense care needs. But for those who want to be at home there are other ways to do things. In Finland and England there are those who are welcomed by a family that responds to their support needs. There are many things we can do. Thinking about residences as the only model is very limited. And they are very expensive because you pay for accommodation for someone who already had a home and who perhaps with a little support would not have to leave it and pay to live somewhere else.
Most people want to age at home. What would it take to make it a reality?
A key piece would be to modernize and improve day centers to make them more attractive and provide better access to therapeutic activities, from exercise to nursing control. In Singapore, integrated care centers are being created in each neighborhood that have this dual function of care, prevention and rehabilitation for people who are at risk of dependency.
Can technology help?
Technology can help us detect when the person needs to be cared for - for example with sensors - and facilitate tasks, but it cannot replace human care.
In the case of residences, what is the ideal model?
I like Danish. All the residences are actually apartments where people have their own living room, kitchen, exit to the outside... and some even a second bedroom for family members to visit. Those who live there pay rent like any tenant and receive care through their local home care system. They have separated the real estate part of care to clarify how the system is financed and I think it is good because the role and values of real estate investors are different from those of care providers, and in many countries it is the former that offer the seconds. Separating both activities is very intelligent because it allows people to live in a place that is their real home, without losing their identity or their rights as happens when they enter a residence, where they lose their privacy, their family life and even their rights. to the medical care he had when he lived in the community.
After years praising achievements in longevity, voices are now being heard reminding us that it is not synonymous with more years of quality of life. What is your opinion?
It worries me. We have a low-quality care system and we are afraid of needing it, so we avoid the issue and its improvement. If we had an image of other types of more pleasant centers, perhaps we would have more desire to do it well.
