Wednesday, July 6

This is how the post-pandemic residences must be: neither hotels, nor hospitals, “this is the moment to prepare ourselves”

Neither hotels, nor hospitals: homes, houses, homes. This is how the nursing homes of the future post-pandemic should be, according to the model presented by the Association of Directors and Managers of Social Services this Monday in Madrid. “No one was prepared for what happened in 2020, but this is the moment, now we have the opportunity to prepare”, defended José Manuel Ramírez, president of the Association. Afterwards, they met with the director of the Imserso (which belongs to the Ministry of Social Rights), Luis Barriga, a former member of the Association’s board of directors, to introduce him. Between both parties there is harmony and it seems that they can reach a “hopeful” consensus, according to Imserso sources after the meeting. Directors and Managers are also going to talk these weeks with the communities and with actors in the sector, in which the association has been a benchmark for almost 30 years. The objective is to present a consensus document in October to implement the autonomies, with competencies in the area, and private companies.

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The residences have gone from being “asylums” in the late Franco period, to “large centers of their own” in the 80s, then “small establishments designed for non-dependent people” in the 1990s, and currently places “highly institutionalized designed for the older population. advanced “. “All this in a single generation,” Ramírez has reviewed. So they argue that it can continue to evolve, become something more like “homes”, and have other characteristics such as individual rooms almost by default, small living units, proximity to the usual neighborhood and accessibility for families.

A good part of the European funds for the recovery that the Ministry of Social Rights remains can go to the remodeling of the residence system after the COVID-19 crisis. 29,408 elderly people died of coronavirus in these types of centers between March 2020 and January 2021, according to government data, more than 9,859 of them without diagnosis. In April 2021, when the situation in the residences was already controlled thanks to the vaccines that ministry approved 730 million for the “care economy”, 482 of them for the care of the elderly and dependents. This item of 482 includes the generation of a new residential model. The Ministry also launched in the General Budgets a “shock plan” for the dependency system, which represents 6,000 million euros in the next three years. Spain needs to create some 70,000 places of public and concerted residences to cover the current demand and reach the parameters recommended by the WHO, according to the Association’s calculations. And it will go further: by 2035, 26.5% of the Spanish population will be over 65 years old.

Imserso sources tell that in the meeting held by Barriga and the presidents of Directors and Managers, both parties have agreed on the approach. “This review and the development of the new model of residential care and proximity services will be strongly marked by criteria that appear in the Association’s document, such as the guarantee of the rights of the elderly, absolute respect for their dignity. and care focused on people and their life project at home “, say these sources. They confirm that they hope to open a “great debate” in the coming weeks with three tables of dialogue, one social, another territorial and another with civil society, to address “profound changes that seem impossible to postpone”, from the “maximum consensus” and “in the shortest possible time “.

Would the pandemic have been dealt with better like this?

At the presentation press conference was Alberto Reyero, former Minister of Social Policies of the Community of Madrid with Citizens. Reyero resigned from the post months after his clash with the Community Presidency and with the Ministry of Health was known, because the latter denied the transfer of the elderly from nursing homes to hospitals in the worst of the first wave. In conversation with, Reyero believes that “the change of model is necessary with or without a crisis.” Would we have dealt with the crisis better with the centers like this? “Last year was a tsunami and we have to strengthen the dependency sector to better resist any contingency. With more funding. We need a strong social sector and well served by the national health system. That is essential. It has not worked properly. “, he adds, agreeing with a change of model that transcends the residential system and is committed to the” personal autonomy of the elderly. ”

One of the bets of this new paradigm is that, since residences are understood as “houses”, and not as hospitals, there are no health services located there, but rather that users have access to public health in the same way as other citizens. Wasn’t it precisely a ruling in Madrid last year that residences were not medicalized? It is a very slippery subject, answers the ex-counselor. “A residence is the home of the elderly. And that must be attended by primary care in normal circumstances and in the hospital when necessary. The pandemic demanded a higher health care precisely because we were facing a contagious disease and the residents were not treated in hospitals “.

This modern model is easier to implement in newly built residences, but in those that already exist, public and private, “it can be done. It is difficult to carry out works, adapt infrastructures, even from the late Franco period. where possible and that money from European funds is invested in reforms that do not turn the centers into hospitals or hotels “, pointed out Gustavo García, member of the Association and main editor of the document.

10 points, until the residences disappear

What the Association proposes is developed in a decalogue. The first point would be that the new residential model “start at home”: that individualized care plans for requesting benefits and services are made more flexible. “We all want to live in our own home for as long as possible”, so the adaptation of the residential model involves fostering care at home, and that the move is the last thing, but for this we must adapt to the needs of each person. The second point is the “proximity”: that older people can stay in a center in their town or neighborhood if they have to intern. “If they are deprived of the right of proximity, they are deprived of citizenship,” García pointed out. So for this they propose that, like the town councils, they prepare reports on issues such as environmental impact, that they make them impact on coexistence and urban planning forecast to reserve spaces for this purpose.

The third point is the boost to family coexistence. “Family access to the resident’s room and to the center’s services”, and even that they can stay to eat, “it is not the same to go to visit the grandfather in the room than for the grandfather to invite you to eat. In addition, There is no greater exercise of transparency, for the wars that have taken place over some residences on whether they were good at eating or not. The fourth would be create “a homely atmosphere“: a minimum of 75% of individual rooms per institution, not less than 15 square meters. With the possibility of bringing their furniture and belongings. Currently, there is no data on the number of residences that have individual rooms, but they are something “exotic” that reaches that percentage. In this area they also contemplate what they call “living units”, made up of no more than 15 people, “which is already a lot”, because it is not comfortable to have to eat every day with 50 or 100 people in a room, they explain, the latter must also be diverse, not only joining highly dependent people with people with the same condition.

The fifth point is the personalized attention. “A reference professional for no more than 5 residents”. Sixth, “that the dignity of the person is respected“In other words, they should not be infantilized by promoting the same” repetitive “activity for everyone:” Who gives their grandfather paintings to draw and then hangs them in the hallway, as is done in many centers? If many older women like to crochet, it is a psychomotor activity as well. “This would also include eliminating restraints, for example to wheelchairs. The seventh, collaboration with the Public Health System, home hospital care in residential centers, “on equal terms with those who live in their homes.”

The eighth point refers to “Well-endowed, qualified and paid staff.” This can be an opportunity, they recall, for job creation. Salary increases in the sector of between 15 and 20% on average. In 2008, the Interterritorial Council approved that there should be 47 workers for every 100 residents; In this new text, they propose that it reach 50, that is, one worker for every two residents. As a ninth point, they point out the need to “establish quality levels in residential centers, agreed upon and evaluated”. They have prepared a table with indicators on a 100 point scale, which can be used for this purpose.

The tenth point looks to the future: what the requirements to enter are relaxed and, in the long term, residences disappear. “We must overcome the 65-year-old criterion to define the need for residential centers,” they point out, because the 65-year-olds who attend are anecdotal and, however, the situation of 50-year-olds with disabilities who would need to live does exist. with their parents, users of residences, and they are not allowed. Regarding the disappearance of the residences, “it would be the logical outcome of this trajectory” that they enumerated, from the asylums to the current institutionalized centers. “Many things have to change and we may not see it, but I want to think that it is the future”, that no elderly person has to leave their home to live in dignified conditions at the end of their life, said Ramírez.