Sociosanitary Legal and Economic Aspects in Nursing Homes for the Elderly in Spain
Abstract
:1. Introduction
2. Material and Methods
2.1. The Spanish System for Autonomy and Care for Dependency
2.2. Spanish Legal Regulations of the Nursing Homes
2.3. Variables Analyzed in the Regulations for Nursing Homes
2.4. Statistical Analysis
3. Results
3.1. Comparative Analysis of Nursing Homes Requirements
3.2. Regulation of Health Staff Requirements in the Nursing Homes
3.3. Effect of Regulation on Price and Coverage
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Acknowledgments
Conflicts of Interest
References
- Jesu, J.; Rogero-Garcia, J.; Garcia, G.; Mari, M.; Prieto-Flores, M.-E.; Rosenberg, M.W. Health services use by older people with disabilities in Spain: Do formal and informal care matter? Ageing Soc. 2008, 28, 959–978. [Google Scholar]
- Leon-Munoz, L.M.; Lopez-Garcia, E.; Graciani, A.; Guallar-Castillon, P.; Banegas, J.R.; Rodriguez-Artalejo, F. Functional status and use of health care services: Longitudinal study on the older adult population in Spain. Maturitas 2007, 58, 377–386. [Google Scholar] [CrossRef]
- Rodriguez, T.M. La atención centrada en la persona. Enfoque y modelos para el buen trato a las personas mayores The Person-centred Care (PCC). Approach and models to the good treatment of the elderly people. Soc. Y Utopía. Rev. De Cienc. Soc. 2013, 41, 209–231. [Google Scholar]
- Pinazo-Hernandis, S. Impacto psicosocial de la COVID-19 en las personas mayores: Problemas y retos. Rev. Esp. Geriatr. Gerontol. 2020, 55, 249. [Google Scholar] [CrossRef]
- Departamento de Sanidad, Bienestar Social y Trabajo Decreto 111/1992, de 26 de Mayo, de la Dipu—TACIÓN General de Aragón, por el Que se Regulan las Condiciones Minimas que han de Reunir los Servicios y Establecimientos Sociales Especializados. Available online: https://www.boa.aragon.es/cgi-bin/EBOA/BRSCGI?CMD=VEROBJ&MLKOB=473489974439 (accessed on 2 February 2023).
- Ahmed, A.; Hall, K. Negotiating the Challenges of Aging as a British Migrant in Spain. GeroPsych 2016, 29, 105–114. [Google Scholar] [CrossRef]
- Serrano, J.P.; Latorre, J.M.; Gatz, M. Spain: Promoting the Welfare of Older Adults in the Context of Population Aging. Gerontologist 2014, 54, 733–740. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Lazarus, J.V.; Mark, H.E.; Anstee, Q.M.; Arab, J.P.; Batterham, R.L.; Castera, L.; Cortez-Pinto, H.; Crespo, J.; Cusi, K.; Dirac, M.A.; et al. Advancing the global public health agenda for NAFLD: A consensus statement. Nat. Rev. Gastroenterol. Hepatol. 2021, 19, 60–78. [Google Scholar] [CrossRef] [PubMed]
- Jimenez, L.; Fernández Carriedo, J. Decreto 14/2001, de 18 de Enero, Regulador de las condiciones y requisitos para la autorización y el funcionamiento de los centros de carácter social para personas mayores. BOCyL n.o 2001, 17, 392. [Google Scholar]
- Social Assistance Dynamics in Europe: National and Local Poverty Regimes-Google Libros. Available online: https://books.google.es/books?hl=es&lr=&id=v_xhpOgZSq8C&oi=fnd&pg=PP6&dq=+Spain,+social+services+are+a+part+of+the+welfare+state+that+varies+geographically+between+societies+and+provinces,+and+even+municipalities+within+the+same+province&ots=NkMoU4DeiH&sig=2_q-Tm7HO3r3XMk3NfojClRlfiA#v=onepage&q&f=false (accessed on 2 February 2023).
- Gough, I. Social assistance in southern Europe. South Eur. Soc. Polit. 1996, 1, 1–23. [Google Scholar] [CrossRef]
- Subirats, J. Multi-level Governance and Multi-level Discontent: The Triumph and Tensions of the Spanish Model. Territ. Democr. Justice 2006, 175–200. [Google Scholar]
- Regional Economic Development: A Review. Andrea Ascani, Riccardo Crescenzi, Simona Iammarino. Available online: http://www.ub.edu/searchproject/wp-content/uploads/2012/02/WP-1.3.pdf (accessed on 2 February 2023).
- EBOOK: Health Policy and Economics: Opportunities and Challenges-Peter Smith, Mark Sculpher, Laura Ginnelly-Google Libros. Available online: https://books.google.es/books?hl=es&lr=&id=rS9EBgAAQBAJ&oi=fnd&pg=PA223&dq=+Spanish+territorial+government+as+a+decentralized+model+of+territorial+organization+generates+significant+dysfunctions+and+inequalities&ots=-gkWlQJwBP&sig=3eUnvCjq0VZANhl3dlmUDHM9qQM#v=onepage&q&f=false (accessed on 2 February 2023).
- Iammarino, S.; Rodriguez-Pose, A.; Storper, M. Regional inequality in Europe: Evidence, theory and policy implications. J. Econ. Geogr. 2019, 19, 273–298. [Google Scholar] [CrossRef]
- Aja, E.; Colino, C. Multilevel structures, coordination and partisan politics in Spanish intergovernmental relations. Comp. Eur. Polit. 2014, 12, 444–467. [Google Scholar] [CrossRef]
- Guillén, A.M.; León, M. Regional Welfare Regimes and Multi-level Governance. Span. Welf. State Eur. Context 2016, 113–134. [Google Scholar]
- Rudnicka, E.; Napierała, P.; Podfigurna, A.; Męczekalski, B.; Smolarczyk, R.; Grymowicz, M. The World Health Organization (WHO) approach to healthy ageing. Maturitas 2020, 139, 6–11. [Google Scholar] [CrossRef] [PubMed]
- Prieto-Flores, M.E.; Fernandez-Mayoralas, G.; Forjaz, M.J.; Rojo-Perez, F.; Martinez-Martin, P. Residential satisfaction, sense of belonging and loneliness among older adults living in the community and in care facilities. Health Place 2011, 17, 1183–1190. [Google Scholar] [CrossRef]
- Martínez, T.; Suárez-Álvarez, J.; Yanguas, J.; Muñiz, J. Spanish validation of the Person-centered Care Assessment Tool (P-CAT). Aging Ment. Health 2015, 20, 550–558. [Google Scholar] [CrossRef]
- Cegri, F.; Orfila, F.; Abellana, R.M.; Pastor-Valero, M. The impact of frailty on admission to home care services and nursing homes: Eight-year follow-up of a community-dwelling, older adult, Spanish cohort. BMC Geriatr. 2020, 20, 1–13. [Google Scholar] [CrossRef] [PubMed]
- The Ethical, Legal and Social Issues of Pandemics: An Analysis from the EU Perspective-Iñigo de Miguel Beriain-Google Libros. Available online: https://books.google.es/books?hl=es&lr=&id=04J0EAAAQBAJ&oi=fnd&pg=PR8&dq=+SARS-CoV-2,+ethical-legal+dilemmas,+deep+inequalities++in+nursing+homes+or+day+center&ots=a-8dQEO9bE&sig=wHf70ktiStedOn9pn7n_uP-QbGU#v=onepage&q&f=false (accessed on 2 February 2023).
- Subbian, V.; Solomonides, A.; Clarkson, M.; Rahimzadeh, V.N.; Petersen, C.; Schreiber, R.; DeMuro, P.R.; Dua, P.; Goodman, K.W.; Kaplan, B.; et al. Ethics and informatics in the age of COVID-19: Challenges and recommendations for public health organization and public policy. J. Am. Med. Inform. Assoc. 2021, 28, 184–189. [Google Scholar] [CrossRef]
- Galarneau, C.; Yearby, R. Racism, Health Equity, and Crisis Standards of Care in The COVID-19 Pandemic. St. Louis Univ. J. Health Law Policy 2020, 14, 211. [Google Scholar] [CrossRef]
- Costa-Font, J.; Patxot, C. The Design of the Long-Term Care System in Spain: Policy and Financial Constraints. Soc. Policy Soc. 2005, 4, 11–20. [Google Scholar] [CrossRef]
- Sarabia-Cobo, C.; Pérez, V.; de Lorena, P.; Hermosilla-Grijalbo, C.; Sáenz-Jalón, M.; Fernández-Rodríguez, A.; Alconero-Camarero, A.R. Experiences of geriatric nurses in nursing home settings across four countries in the face of the COVID-19 pandemic. J. Adv. Nurs. 2021, 77, 869–878. [Google Scholar] [CrossRef]
- Pérez-Durán, I.; Hernández-Sánchez, A. Transparency in nursing home services before and during the COVID-19 pandemic in Spain. Rev. Esp. Cienc. Polit. 2021, 77–109. [Google Scholar] [CrossRef]
- Wu, B. Social isolation and loneliness among older adults in the context of COVID-19: A global challenge. Glob. Health Res. Policy 2020, 5, 27. [Google Scholar] [CrossRef] [PubMed]
- Singh, A.; Misra, N. Loneliness, depression and sociability in old age. Ind. Psychiatry J. 2009, 18, 51. [Google Scholar] [CrossRef] [PubMed]
- Cabrero, G.R.; Gallego, V.M. Long-term care in Spain: Between family care tradition and the public recognition of social risk. In Reforms in Long-Term Care Policies in Europe Investigating Institutional Change and Social Impacts; Springer: New York, NY, USA, 2013; pp. 201–219. [Google Scholar]
- Barrett, D.H.; Ortmann, L.W.; Dawson, A.; Saenz, C.; Reis, A.; Bolan, G. Public Health Ethics: Cases Spanning the Globe. In Public Health Ethics Analysis 3; Springer: New York, NY, USA, 2016. [Google Scholar]
- Spijker, J.; Devolder, D.; Zueras, P. The impact of demographic change in the balance between formal and informal old-age care in Spain. Results from a mixed microsimulation–agent-based model. Ageing Soc. 2022, 42, 588–613. [Google Scholar] [CrossRef]
- Gorgemans, S.; Urbina-Pérez, O. New legal forms in health services: Evaluation of a Spanish public policy. Health Policy 2022, 126, 802–807. [Google Scholar] [CrossRef] [PubMed]
- Does State Regulation of Quality Impose Costs on Nursing Homes? on JSTOR. Available online: https://www.jstor.org/stable/23053758?casa_token=Jk0A6PYVbukAAAAA%3A4vaJkntskjn450_iX2bALMlvz3y1b7A8c96VfpW3C33rG6L3GJv7bESPu7RHPK1uWMPDskk4xsihgAJxlIRiRWRYXhz6oKxOXTrER0_VQH4Ee6Whg6g (accessed on 27 February 2023).
- Clement, J.P.; Bazzoli, G.J.; Zhao, M. Nursing Home Price and Quality Responses to Publicly Reported Quality Information. Health Serv. Res. 2012, 47, 86–105. [Google Scholar] [CrossRef] [Green Version]
- Herr, A.; Hottenrott, H. Higher prices, higher quality? Evidence from German nursing homes. Health Policy 2016, 120, 179–189. [Google Scholar] [CrossRef] [Green Version]
- Heger, D.; Herr, A.; Mensen, A. Paying for the view? How nursing home prices affect certified staffing ratios. Health Econ. 2022, 31, 1618–1632. [Google Scholar] [CrossRef]
- Grabowski, D.C. Medicaid reimbursement and the quality of nursing home care. J. Health Econ. 2001, 20, 549–569. [Google Scholar] [CrossRef] [PubMed]
- Pittrow, D.; Krappweis, J.; Rentsch, A.; Schindler, C.; Hach, I.; Bramlage, P.; Kirch, W. Pattern of prescriptions issued by nursing home-based physicians versus office-based physicians for frail elderly patients in German nursing homes. Pharmacoepidemiol. Drug Saf. 2003, 12, 595–599. [Google Scholar] [CrossRef] [PubMed]
- BOE.es-BOE-A-2006-21990 Ley 39/2006, de 14 de Diciembre, de Promoción de la Autonomía Personal y Atención a las Personas en Situación de Dependencia. Available online: https://www.boe.es/buscar/doc.php?id=BOE-A-2006-21990 (accessed on 19 September 2022).
- BOE-A-2011-3174 Real Decreto 174/2011, de 11 de Febrero, por el que se Aprueba el Baremo de Valoración de la Situación de Dependencia Establecido por la Ley 39/2006, de 14 de Diciembre, de Promoción de la Autonomía Personal y Atención a las Personas en Situación de Dependencia. Available online: https://www.boe.es/buscar/doc.php?id=BOE-A-2011-3174 (accessed on 2 March 2023).
- Resumen Normativa de Residencias. Summary of Residence Regulations. Prepared by the Spanish Society of Geriatrics and Gerontology (SEGG). Available online: https://www.segg.es/media/descargas/Cuadro_resumen_SEGG_Normativa_Residencias_Rev.17junio2020.pdf (accessed on 2 February 2023).
- ORDEN de 28 de julio de 2000, Conjunta de las Consejerías de la Presidencia y de Asuntos Sociales, por la que se Regulan los Requisitos Materiales y Funcionales de los Servicios y Centros de Servicios Sociales de Andalucía y se Aprueba el Modelo de Solici. Available online: https://www.juntadeandalucia.es/boja/2000/102/1 (accessed on 2 February 2023).
- Decree 111/1992, of 26 May 1992, of the Diputación General de Aragón, Regulates the Minimum Conditions that Specialized Social Services and Establishments Meet. Available online: https://www.boa.aragon.es/cgi-bin/EBOA/BRSCGI?CMD=VEROBJ&MLKOB=473489974439 (accessed on 2 February 2023).
- Resolución de 22 de Junio de 2009, de la Consejería de Bienestar Social y Vivienda, por la que se Desarrollan los Criterios y Condiciones para la Acreditación de Centros de Atención de Servicios Sociales en el Ámbito Territorial del Principado de Asturias. Available online: https://sid-inico.usal.es/legislacion/resolucion-de-22-de-junio-de-2009-de-la-consejeria-de-bienestar-social-y-vivienda-por-la-que-se-desarrollan-los-criterios-y-condiciones-para-la-acreditacion-de-centros-de-atencion-de-servicios-socia/ (accessed on 10 December 2022).
- Institut d’Estudis Autonòmics-Decret 86/2010, de 25 de Juny, pel Qual S’estableixen els Principis Generals i les Directrius de Coordinació per a L’autorització i L’acreditació dels Serveis Socials D’atenció a Persones Grans i Persones amb Discapacitats. Available online: https://intranet.caib.es/sites/institutestudisautonomics/ca/n/decret_862010_de_25_de_juny_pel_qual_sestableixen_els_principis_generals_i_les_directrius_de_coordinacio_per_a_lautoritzacio_i_lacreditacio_dels_serveis_socials_datencio_a_persones_grans_i_pers (accessed on 2 February 2023).
- BOC-2000/062. Viernes 19 de Mayo de 2000-619. Available online: http://www.gobiernodecanarias.org/boc/2000/062/001.html (accessed on 2 February 2023).
- Order EMP/37/2010, of March 18, uses the criteria and regulates the procedure for the accreditation of social service centers for the care of dependent persons. Available online: https://repositorio.unican.es/xmlui/bitstream/handle/10902/14090/GomezNavamuelA.pdf?sequence=1&isAllowed=y (accessed on 2 February 2023).
- Order of 04/06/2013 of the Regional Ministry of Health and Social Affairs, which amends the Order of 21/05/2001 of the Regional Ministry of Social Welfare, regulates the minimum conditions of the centers intended for the elderly in Castilla-La Mancha. Available online: https://www.castillalamancha.es/sites/default/files/documentos/pdf/20131217/orden_04-06-2013_modif_condiciones_minimas.pdf (accessed on 2 February 2023).
- Decreto 205/2015, de 15 de Septiembre, del Régimen de Autorización Administrativa y de Comunicación Previa de los Servicios Sociales y del Registro de Entidades, Servicios y Establecimientos Sociales. Available online: https://noticias.juridicas.com/base_datos/CCAA/559238-d-205-2015-de-15-sep-ca-cataluna-autorizacion-administrativa-y-de-comunicacion.html (accessed on 6 December 2022).
- Ficha Disposición. Available online: https://dogv.gva.es/portal/ficha_disposicion_pc.jsp?sig=0816/2005&L=1 (accessed on 6 December 2022).
- Decree 298/2015, of November 20, Approves the Regulation of Authorization, Accreditation, and Registration of Care Centers for the Elderly in the Autonomous Community of Extremadura. Available online: https://www.castillalamancha.es/sites/default/files/documentos/pdf/20131217/orden_04-06-2013_modif_condiciones_minimas.pdf (accessed on 2 February 2023).
- Orden de 13 de Abril de 2007 por la que se Modifica la de 18 de abril de 1996 por la que se Desarrolla el Decreto 243/1995, de 28 de Julio, en lo Relativo a la Regulación de las Condiciones y Requisitos Específicos que Deben Cumplir los Centros de Atenció. Available online: https://politicasocial.xunta.gal/es/conselleria/normativa/orden-de-13-de-abril-de-2007-por-la-que-se-modifica-la-de-18-de-abril-de-1996 (accessed on 2 February 2023).
- Decreto 27/1998, de 6 de Marzo, Por el Que se Regulan las Categorías y Requisitos Específicos, de los Centros Residenciales de Personas Mayores en La Rioja. Available online: https://web.larioja.org/normativa?n=243 (accessed on 6 December 2022).
- Law 11/2002, of December 18, 2002, on the Regulation of the Activity of Social Action Centers and Services and the Improvement of Quality in the Provision of Social Services in the Community of Madrid. Available online: https://www.comunidad.madrid/en/transparencia/informacion-institucional/planes-programas/plan-calidad-e-inspeccion-materia-servicios-sociales-0 (accessed on 2 February 2023).
- Lexnavarra. Available online: http://www.lexnavarra.navarra.es/detalle.asp?r=28700 (accessed on 6 December 2022).
- Autorización e Inspección de Centros y Servicios.-Legislación-Bizkaia.Eus. Available online: https://www.bizkaia.eus/home2/Temas/DetalleTema.asp?bnetmobile=0&dpto_biz=3&idioma=CA&Tem_Codigo=7031 (accessed on 2 February 2023).
- INEbase/Economía/Cuentas Económicas/Contabilidad Regional de España/Últimos Datos. Available online: https://www.ine.es/dyngs/INEbase/es/operacion.htm?c=Estadistica_C&cid=1254736167628&menu=ultiDatos&idp=1254735576581 (accessed on 27 February 2023).
- Servicios Sociales Dirigidos a Personas Mayores en España. Diciembre 2020-Instituto de Mayores y Servicios Sociales. Available online: https://imserso.es/el-imserso/documentacion/estadisticas/servicios-sociales-dirigidos-personas-mayores-espana/servicios-sociales-dirigidos-personas-mayores-espana-diciembre-2020 (accessed on 2 February 2023).
- Imserso-Inicio-Instituto de Mayores y Servicios Sociales. Available online: https://imserso.es/web/imserso (accessed on 2 February 2023).
- Parker, C.; Barnes, S.; Mckee, K.; Morgan, K.; Torrington, J.; Tregenza, P. Quality of life and building design in residential and nursing homes for older people. Ageing Soc. 2004, 24, 941–962. [Google Scholar] [CrossRef] [Green Version]
- Serda, M.; Becker, F.G.; Cleary, M.; Team, R.M.; Holtermann, H.; The, D.; Agenda, N.; Science, P.; Sk, S.K.; Hinnebusch, R.; et al. Trivsel og Boligform. Afdækning af boligmæssige trivselsfaktorer hos ældre i plejeboliger. Uniw. Śląski 2007, 7, 343–354. [Google Scholar]
- Moon, M. What Medicare Has Meant To Older Americans. Health Care Financ. Rev. 1996, 18, 49. [Google Scholar] [PubMed]
- Chang, J.; Peysakhovich, F.; Wang, W.; Zhu, J. The UK Health Care System. United Kingd. 2011, 30, 2019. [Google Scholar]
- The French Social Security System-Sickness, Maternity, Paternity, Disability and Death Branch. Available online: https://www.cleiss.fr/docs/regimes/regime_france/an_1.html (accessed on 28 February 2023).
- Canada’s Health Care System-Canada.ca. Available online: https://www.canada.ca/en/health-canada/services/canada-health-care-system.html (accessed on 28 February 2023).
- Germany Commonwealth Fund. Available online: https://www.commonwealthfund.org/international-health-policy-center/countries/germany (accessed on 28 February 2023).
- Derechos Sociales Y Agenda, M. DE III. OTHER PROVISIONS MINISTRY OF SOCIAL RIGHTS AND AGENDA 2030. 2022. Available online: https://www.boe.es/diario_boe/txt.php?id=BOE-A-2022-13580 (accessed on 2 February 2023).
- Diaz Veiga, P.; Sancho, M. Unidades de Convivencia. Alojamientos de personas mayores para “vivir como en casa”. Inf. Portal Mayores 2012, 132, 16. [Google Scholar]
- Miralles, A.; Rey, C. Evolución del modelo de atención residencial, una propuesta de centro de mayores. Gerokomos 2015, 26, 132–136. [Google Scholar]
- Serda, M.; Becker, F.G.; Cleary, M.; Team, R.M.; Holtermann, H.; The, D.; Agenda, N.; Science, P.; Sk, S.K.; Hinnebusch, R.; et al. Well-being, the Decision making process in residential care facilities and accommodation in Denmark. Uniw. Śląski 2007, 7, 343–354. [Google Scholar]
- Age-friendly Housing-Julia Park, Jeremy Porteous-Google Libros. Available online: https://books.google.es/books?hl=es&lr=&id=RPWfDwAAQBAJ&oi=fnd&pg=PT7&dq=nursing+homes+having+green+areas+(gardens,+terraces,+balconies)+since+the+contemplation+of+these+areas+stimulates+the+senses+and+allows+the+establishment+of+relationships+and+bonds+of+friendship+among+residents.+&ots=2BtEEk6YDy&sig=2OsGPAoX1kA0c9HaEtuyKm2BG8Y#v=onepage&q&f=false (accessed on 3 February 2023).
- Marcus, C.C. Gardens and health. Acad. Des. Health 2000, 5, 61–69. [Google Scholar]
- Healing Gardens: Therapeutic Benefits and Design Recommendations-Google Libros. Available online: https://books.google.es/books?hl=es&lr=&id=YRY1WejQok8C&oi=fnd&pg=PA1&dq=nursing+homes+having+green+areas+(gardens,+terraces,+balconies)+since+the+contemplation+of+these+areas+stimulates+the+senses+and+allows+the+establishment+of+relationships+and+bonds+of+friendship+among+residents.+&ots=ycv_A4FPu9&sig=QvAHRKb63ImUGDIjJw3SolZEuCM#v=onepage&q&f=false (accessed on 3 February 2023).
- Fundamentals of Planning Cities for Healthy Living-Avi Friedman, Alexandra Pollock-Google Libros. Available online: https://books.google.es/books?hl=es&lr=&id=p5SaEAAAQBAJ&oi=fnd&pg=PT22&dq=2022+importance+of+nursing+homes+having+green+areas+(gardens,+terraces,+balconies)+since+the+contemplation+of+these+areas+stimulates+the+senses+and+allows+the+establishment+of+relationships+and+bonds+of+friendship+among+residents.+&ots=ASqymwwkHL&sig=1n-B0fz1qUNx9xHJ7bTlSuUF_Vo#v=onepage&q&f=false (accessed on 3 February 2023).
- Amunarriz, G.; Alcalde-Heras, H. Towards an Integrated Care Organisation from a CEO Perspective. Int. J. Integr. Care 2020, 20, 1–15. [Google Scholar] [CrossRef]
- Van Steenwinkel, I.; Dierckx de Casterlé, B.; Heylighen, A. How architectural design affords experiences of freedom in residential care for older people. J. Aging Stud. 2017, 41, 84–92. [Google Scholar] [CrossRef] [PubMed]
- Chuang, Y.H.; Abbey, J.A.; Yeh, Y.C.; Tseng, I.J.; Liu, M.F. As they see it: A qualitative study of how older residents in nursing homes perceive their care needs. Collegian 2015, 22, 43–51. [Google Scholar] [CrossRef] [PubMed]
- Palan Lopez, R.; Mazor, K.M.; Mitchell, S.L.; Givens, J.L. What is Family-Centered Care for Nursing Home Residents With Advanced Dementia? Nurs. Clin. 2022, 57, 259–271. [Google Scholar]
- Española De Geriatría Y Gerontología, S. Observatorio de personas Mayores VEJEZ, NEGLIGENCIA, ABUSO Y MALTRATO La perspectiva de los mayores y de los profesionales. Soc. Española De Geriatría Gerontol. 2004, 58, 9–221. [Google Scholar]
- Hamiduzzaman, M.; Kuot, A.; Greenhill, J.; Strivens, E.; Isaac, V. Towards personalized care: Factors associated with the quality of life of residents with dementia in Australian rural aged care homes. PLoS ONE 2020, 15, e0233450. [Google Scholar] [CrossRef] [PubMed]
Autonomous Communities of Spain | Legal Regulations | References |
---|---|---|
Andalucía | Order of 28 July 2000, jointly issued by the Regional Ministries of the Presidency and Social Affairs, regulating the material and functional requirements of the Social Services and Social Service Centers of Andalusia and approving the application form for administrative authorizations. | [46] |
Aragón | Decree 111/1992, of 26 May 1992, of the Diputación General de Aragón, regulates the minimum conditions that specialized social services and establishments meet. | [47] |
Asturias | Resolution of 22 June 2009, of the Department of Social Welfare and Housing, which develops the criteria and conditions for the accreditation of social services and care centers in the Principality of Asturias. | [48] |
Baleares | Decree 86/2010, of 25 June 2010, established the general principles and coordination guidelines for the authorization and accreditation of social services for the care of elderly and disabled persons and regulated the requirements for the authorization and accreditation of supra-insular residential services for these sectors of the population. | [49] |
Canarias | Decree 63/2000, of 25 April, regulates the organization, authorization, registration, inspection, and regime of infractions and sanctions of centers for the elderly and their internal rules. | [50] |
Cantabria | Order EMP/37/2010, of 18 March, uses the criteria and regulates the procedure for the accreditation of social service centers for the care of dependent persons. | [51] |
Castilla-La Mancha | Order of 04/06/2013 of the Regional Ministry of Health and Social Affairs, which amends the Order of 21/05/2001 of the Regional Ministry of Social Welfare, regulates the minimum conditions of the centers intended for the elderly in Castilla-La Mancha. | [52] |
Castilla y León | Decree 14/2001, of 18 January, regulates the conditions and requirements for the authorization and operation of centers of a social nature for the elderly. | [12] |
Cataluña | Decree 205/2015, 15 September, on the regime of administrative authorization and prior communication of social services and the Registry of Entities, Services, and Social Establishments. | [53] |
Comunidad Valenciana | Order of 4 February 2005, of the Department of Social Welfare, which regulates the system of authorization and operation of specialized social services centers for the care of the elderly. | [54] |
Extremadura | Decree 298/2015, of 20November, approves the Regulation of authorization, accreditation, and Registration of Care Centers for the elderly in the Autonomous Community of Extremadura. | [55] |
Galicia | Order of 13 April 2007, modifying that of April 18, 1996, which developed Decree 243/1995, of 28 July 1995, regarding the regulation of the specific conditions and requirements to be met by centers for the care of the elderly. | [56] |
La Rioja | Decree 27/1998, of 6 March, regulating the categories and specific requirements of Residential Centers for the Elderly in La Rioja. | [57] |
Madrid | Law 11/2002, of 18 December 2002, on the Regulation of the Activity of Social Action Centers and Services and the Improvement of Quality in the Provision of Social Services in the Community of Madrid. | [58] |
Murcia | Decree 69/2005, of June 3, established the minimum conditions to be met by publicly or privately owned residential centers for the elderly. | [59] |
Navarra | Regional Decree 209/1991, of 23 May, developing Regional Law 9/1990, of November 13, on the system of authorizations, infractions, and penalties in Social Services matters. | [60] |
Basque Country | Order of 4 February 2005, of the Department of Social Welfare, regulating the authorization and operation of specialized social services centers to care for the elderly. | [61] |
Dining rooms (required minimum area) |
Kitchens (required minimum area) |
Living room (required minimum area) |
Visiting room (availability and required minimum area) |
Chapel and/or mortuary (availability) |
Outdoor recreation area (availability) |
Room customization |
Hairdressing area (availability) |
Lift (number and availability) |
Sanitary mobilization cranes (availability) |
Sociocultural activities program |
Doctors ratio * (healthcare staff) |
Nurses ratio * (healthcare staff) |
AN | AR | AS | BA | CAN | CANT | CLM | CyL | CAT | C.VAL | EXT | GAL | MAD | MUR | NAV | P.VAS | RIOJA | |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Dining room dimension | 2 m2 per user min. 15 m2 | - | 2 m2 per user | 2 m2 per user min. 30 m2 | 2 m2 per user min. 15 m2 | 2 m2 per user | ≤ 45 places-30 m2 46–80 places -40 m2 More than 80 places- 80 m2 | - | - | - | - | 2 m2 per user min. 30 m2 | 1 m2 per user a dimension not less than 10 m2 | - | - | - | - |
Kitchen dimensions | 15 m2 | - | 12 m2 | ≤25 places- 5 m2 ˃25 places 12.5 m2 | 10 m2, increasing 0.5 m2 for every 30 users | 12 m2 | 20 m2 | 10 m2 | min. 8 m2 max. 50 m2 | 19 m2 | - | - | - | - | - | - | ≤40 places greater than 12 m2 ˃40 places more than 20 m2 |
Living room dimensions | min. 30 m2 2 m2 per user | 1.8 m2 per user | min. 15 m2 2 m2 per user | min. 30 m2 1.8 m2 per user | min 30 m2 | min 30 m2 1.50 m2 per user | min. 25 m2. If there are ≤45 places, 2 living rooms; if there are between 46–80 places, at least 3 living rooms and if there are more than 80 places, at least 4 living rooms | min 30 m2 (5.60 m2 per user | More than 25 places, at least 2 living rooms | - | 1.8 m2 per user; if there are less than 15 users, there must be a 30 m2 room | min. 30 m2 1.80 m2 per user) | minimum 12 m2 (1.80 m2 per user) | - | 2 m2 per user. If there are less than 25 seats, the room must have a minimum of 12 m2 | - | minimum 20 m2 |
Visiting room | min.15 m2 There will be one room for every 60 users | - | - | - | - | In all residential centers, there must be a visiting room | All residences will have at least one visiting room | - | - | - | - | - | - | They will have a minimum area of 12 m2 | - | - | - |
Wake chapel/Mortuary | More than 60 places—at least one room for a coffin | There will be a room if there is no funeral home in the municipality | - | - | More than 60 places; if there is no funeral home in the municipality, there will be a room in the residences | More than 50 places; if there is no funeral home in the municipality, there will be a room | There will be a wake room if there is no funeral home in the municipality | - | - | - | There will be a room if there is no funeral home in the municipality | If the residence has more than 60 places, there will be a room | In centers with more than 100 places | It is mandatory to have a room in municipalities where there are no funeral homes | - | In residences with more than 70 places | wake room of at least 10 m2 |
Outdoor recreation area | if it is not may, these areas inside of the home must situate in the center, less than 50 m from the parks and gardens public. | - | - | The center’s residential must count with landscaped zones. The center residential must situate near gardens/parks public. | Shall count on spaces exterior landscaped whenever possible | - | The residences shall count on gardens in their interior | - | - | The zones will have one surface minimum of 3 m2 per username | - | - | -- | - | - | - | - |
Room customization | - | - | It is possible | It is possible | - | - | It is possible | - | It is possible | - | - | It is possible | - | - | - | - | - |
Hairdressing areas | - | - | - | - | - | In centers ˃50 places, there will be a space dedicated to the hairdresser | This service will be available in centers with more than 80 beds. | - | - | The creation of an area dedicated to the hairdresser is contemplated | - | - | - | - | - | - | - |
Lifts | minimum 1 lift for every 60 users | - | - | Minimum 1, increasing to 1 per every 65 users | - | - | 2 elevators in residences with more than 45 beds | - | - | - | - | -- | - | Minimum 1 lift | - | - | Minimum 1 elevator if there are more than 40 places |
People mobilization cranes | Enough number for people who needs them | - | - | - | - | - | - | - | Enough number for people who needs them | Enough number for people who needs them | - | - | - | - | - | - | - |
Program of sociocultural activities | - | - | - | - | - | - | - | - | - | All residential centers must have an annual program of sociocultural activities. | - | - | - | Residential centers must have an annual program of sociocultural activities | - | All residential centers must have an annual program of sociocultural activities. | - |
AN | AR | AS | BA | CAN | CANT | CLM | CyL | CAT | C.VAL | EXT | GAL | MAD | MUR | NAV | P.VAS | RIOJA | |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Doctor ratio | - | - | - | - | - | - | Residences with more than 45 beds with the physical presence of a doctor 5 h a week, which will gradually increase by 1 h per week for every ten residents or fraction, up to residences with 119 beds. Those with 120 beds or more with 17 weekly hours of the physical presence of a doctor, increasing by eight weekly hours for every 20 users or fraction. | Residences with up to 25 users will require a minimum service of 1 h per day. Additionally, for every 25 users or fraction, a service of one more hour per day will be made. | - | At least 3 h per week for every ten places or a fraction in centers with less than 100 places. In centers with more than 100 places, 10 h per week for every 25 places or a fraction. The minimum weekly benefit will be five hours. | One doctor | In centers with fewer than 40 assisted places, the localized presence of a doctor must be available 24 h a day. | - | In residences with up to 40 users, a minimum service of one hour per day will be required. In addition, for every 20 more users, the doctor will provide a service of one more hour per day. | - | Establishes the ratio of doctors based on the degree of dependency that the residents of their residential centers have. | It establishes the ratio of doctors based on the level of occupancy of its residential centers. Level 1: there will be a doctor 20 h/per week Level 2: there will be a doctor 40 h/per week Level 3: there will be a doctor 60 h/week Level 4: there will be a doctor 80 h/week |
Nursing ratio | - | - | The ratio of 0.025 per user in a situation of degree II dependency and 0.035 per user in a situation of degree III dependencies. | - | - | - | Mini-residences with 20 weekly hours of the physical presence of a nurse. Medium-sized residences with 40 weekly hours of the physical presence of a nurse. Large residences with more than 80 beds with 40 weekly hours of the physical presence of a nurse will increase by 20 weekly hours for every 40 users or fraction. | Up to 25 users will require a minimum service of 2 h daily. One hour per day will also be provided for every eight users or a fraction. | - | Minimum of 8 h per week for every ten places or fraction proportionally. In a center with a high dependency unit: nurses with physical presence 24 h a day. | One nurse for every 25 residents | In centers with fewer than 40 assisted places, there must be a localized presence of a doctor and a nurse 24 h a day. Those with a higher number of assisted places, in addition to the localized presence of medical personnel, must have the physical presence of a nurse 24 h a day. - A nurse with a minimum service of 1 h daily for up to 40 users. Additionally, every 20 users or fraction will be provided for one more hour a day. A graduate in nursing with a permanent presence in the center. Nursing: Grade 0 and I= 0.027, Grade II and II= 0.032. You will have a nurse in the following proportion: Level 1: 60 h/week. Level 2: 80 h/week. Level 3: 100 h/week. Level 4: 160 h/week. | - | A nurse with a minimum service of 1 h daily for up to 40 users. Additionally, every 20 users or fraction will be provided for one more hour a day. | A graduate in nursing with a permanent presence in the center. | Nursing: Grade 0 and I = 0.027, Grade II and II = 0.032. | A nurse in the following proportion: Level 1: 60 h/week. Level 2: 80 h/week. Level 3: 100 h/week. Level 4: 160 h/week. |
Price (EUR /Year) | Coverage Rate | Requirements | GDP Per Capita | |||||
---|---|---|---|---|---|---|---|---|
Public Places | Subsid. Places | Public Places | Subsid. Places | Total | Facilities | Human Resources | ||
Andalucía | 18,000.00 | 20,098.32 | 1.96 | 1.02 | 2.98 | 8 | 0 | 17,545 |
Aragón | 19,461.52 | 19,461.52 | 3.91 | 2.70 | 6.61 | 2 | 0 | 26,642 |
Asturias | 16,349.15 | 16,349.15 | 2.99 | 2.63 | 5.63 | 5 | 1 | 20,947 |
Baleares | 24,022.84 | 23,798.37 | 1.95 | 0.99 | 2.94 | 6 | 0 | 21,551 |
Canarias | 25,334.93 | 30,189.22 | 1.15 | 1.62 | 2.76 | 5 | 0 | 17,199 |
Cantabria | 19,767.76 | 19,767.76 | 3.26 | 1.44 | 4.70 | 6 | 0 | 22,048 |
Castilla y León | 15,980.59 | 15,980.59 | 5.91 | 1.95 | 7.86 | 4 | 2 | 22,925 |
Castilla La Mancha | 16,365.66 | 16,049.74 | 4.93 | 1.99 | 6.92 | 11 | 2 | 19,257 |
Cataluña | 20,414.34 | 20,414.34 | 3.10 | 1.25 | 4.35 | 4 | 0 | 27,745 |
C. Valenciana | 21,960.00 | 21,960.00 | 1.80 | 0.90 | 2.70 | 7 | 2 | 20,780 |
Extremadura | 15,591.57 | 15,591.57 | 3.79 | 2.91 | 6.71 | 4 | 2 | 17,834 |
Galicia | 18,000.00 | 18,252.00 | 1.83 | 1.10 | 2.94 | 6 | 2 | 21,730 |
Madrid | 19,000.00 | 20,407.15 | 1.86 | 2.50 | 4.36 | 3 | 0 | 32,332 |
Murcia | 19,200.00 | 20,987.50 | 1.42 | 0.90 | 2.33 | 6 | 2 | 19,692 |
Navarra | 13,349.07 | 22,136.43 | 2.24 | 2.18 | 4.42 | 2 | 1 | 28,822 |
Basque Country | 27,342.67 | 34,721.45 | 2.79 | 1.02 | 3.81 | 4 | 2 | 30,338 |
La Rioja | 10,423.57 | 22,936.08 | 2.52 | 2.38 | 4.90 | 6 | 2 | 25,666 |
Price (Public Place) | Coverage Rate (Public Price) | Price (Subs. Place) | Coverage Rate (Subs. Place) | GDP Per Capita | No. Req. Related to Facilities | No. Req. Related to Human Resources | |
---|---|---|---|---|---|---|---|
Price (public place) | 1.000 | ||||||
Coverage rate (public price) | −0.3264 | 1.000 | |||||
Price (subs. place) | 0.6685 | −0.4964 | 1.000 | ||||
Coverage rate (subs. place) | −0.5768 | 0.4275 | −0.4164 | 1.000 | |||
GDP per capita | 0.0064 * | 0.0199 | 0.2817 | 0.1863 | 1.000 | ||
No. requirements related to facilities | −0.0421 *** | 0.1760 * | −0.1746 ** | 0.4092 * | −0.4610 | 1.000 | |
No. requirements related to human resources | −0.3046 *** | 0.2541 | −0.1136 ** | 0.0094 | −0.1385 | 0.2550 | 1.000 |
Public Places. Price (Thousand EUR/Year) | Subsidized Place. Price (Thousand EUR/Year) | |||||||
---|---|---|---|---|---|---|---|---|
R1 | R2 | R3 | R4 | R1 | R2 | R3 | R4 | |
Dining rooms | −1.52 ** | −0.78 ** | ||||||
(0.48) | (0.35) | |||||||
Kitchens | −7.42 ** | −2.02 ** | ||||||
(1.48) | (0.45) | |||||||
Living room | −9.85 ** | −11.50 ** | ||||||
(1.64) | (2.90) | |||||||
Hairdressing area | 2.05 | 5.64 ** | ||||||
(1.87) | (1.60) | |||||||
Visiting room | −4.80 ** | −12.10 ** | ||||||
(1.01) | (5.02) | |||||||
Chapel and/or mortuary | 8.19 ** | 3.40 | ||||||
(1.81) | (5.43) | |||||||
Sanitary mobilization cranes | −0.51 | −3.97 | ||||||
(1.65) | (4.94) | |||||||
Lift | 4.19 ** | 9.90 ** | ||||||
(1.78) | (2.34) | |||||||
Room customization | 4.41 ** | 7.71 | ||||||
(1.44) | (4.31) | |||||||
Outdoor recreation area | 2.94 | 13.46 | ||||||
(1.72) | (8.15) | |||||||
Sociocultural activities program | −1.50 * | −4.80 ** | ||||||
(0.34) | (1.75) | |||||||
Ratio of doctors | −2.35 * | −5.88 * | ||||||
(1.10) | (2.45) | |||||||
Ratio of nurses | −7.41 * | −3.33 * | ||||||
(1.93) | (1.50) | |||||||
Requirements for facilities | −3.05 ** | −3.14 ** | −3.15 ** | −3.09 ** | −2.92 ** | −2.60 ** | ||
(0.58) | (0.50) | (0.59) | (0.69) | (0.59) | (0.65) | |||
Requirements for human resources | −4.38 ** | −4.11 ** | −4.11 ** | −2.35 ** | −2.08 ** | 2.05 ** | ||
(1.20) | (1.18) | (1.23) | (0.42) | (0.23) | (0.24) | |||
GDP per capita | 0.32 ** | 0.31 ** | 0.27 | 0.27 | ||||
(0.07) | (0.07) | (0.32) | (0.28) | |||||
Coverage ratio (public or subs.) | −0.91 | −0.92 | −1.10 | −1.10 | ||||
(0.88) | (0.92) | (1.77) | (1.77) | |||||
Constant | 29.96 ** | 20.58 * | 21.88 ** | 21.57 * | 28.89 ** | 15.67 | 33.13 ** | 25.44 * |
(2.08) | (8.20) | (3.36) | (8.26) | (6.23) | (9.69) | (5.17) | (9.40) | |
N | 17.00 | 17.00 | 17.00 | 17.00 | 17.00 | 17.00 | 17.00 | 17.00 |
R2 | 0.90 | 0.79 | 0.76 | 0.76 | 0.71 | 0.79 | 0.72 | 0.77 |
F-test | 27.16 | 30.45 | 30.85 | 29.59 | 31.82 | 32.41 | 32.01 | 31.74 |
p-value | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 |
Public Places. Price (Thousand EUR/Year) | Subsidized Place. Price (Thousand EUR/Year) | |||||||
---|---|---|---|---|---|---|---|---|
R1 | R2 | R3 | R4 | R1 | R2 | R3 | R4 | |
Dining rooms | −2.64 ** | −0.30 | ||||||
(1.03) | (0.99) | |||||||
Kitchens | 2.20 | −0.09 | ||||||
(2.19) | (1.12) | |||||||
Living room | 1.71 ** | 3.20 ** | ||||||
(0.54) | (1.05) | |||||||
Hairdressing area | 2.20 ** | 3.22 ** | ||||||
(1.05) | (1.17) | |||||||
Visiting room | 3.19 ** | 4.18 ** | ||||||
(1.80) | (1.43) | |||||||
Chapel and/or mortuary | 2.61 | 0.46 | ||||||
(2.05) | (1.05) | |||||||
Sanitary mobilization cranes | 0.89 ** | −0.80 | ||||||
(0.28) | (0.91) | |||||||
Lift | 21.81 | −0.67 | ||||||
(2.30) | (0.66) | |||||||
Room customization | −0.54 | −0.22 | ||||||
(2.02) | (1.03) | |||||||
Outdoor recreation area | 2.08 ** | 0.87 ** | ||||||
(0.40) | (0.23) | |||||||
Sociocultural activities program | 1.82 | 1.19 ** | ||||||
(1.31) | (0.47) | |||||||
Ratio of doctors | 0.30 | 0.97 | ||||||
(0.81) | (0.78) | |||||||
Ratio of nurses | −1.27 | −1.83 | ||||||
(3.09) | (1.58) | |||||||
Requirements for facilities | 0.60 * | 0.57 * | 0.61 * | 0.14 * | 0.16 * | 0.15 * | ||
(0.28) | (025) | (0.28) | (0.07) | (0.07) | (0.07) | |||
Requirements for human resources | 0.20 | 0.18 | 0.18 | 0.07 | 0.05 | 0.05 | ||
(0.36) | (2.37) | (2.38) | (0.19) | (0.16) | (0.17) | |||
GDP per capita | 0.04 | 0.03 | −0.00 | 0.02 | ||||
(0.08) | (0.08) | (0.04) | (0.04) | |||||
Public price (public or subs.) | −0.08 | −0.08 | −0.07 * | −0.08 * | ||||
(0.08) | (0.08) | (0.03) | (0.03) | |||||
Constant | 4.62 ** | 4.08 ** | 3.79 ** | 3.79 ** | 2.29 * | 2.39 * | 4.05 ** | 3.56 * |
(1.00) | (1.47) | (1.32) | (1.01) | (1.02) | (1.01) | (0.82) | (1.25) | |
N | 17.00 | 17.00 | 17.00 | 17.00 | 17.00 | 17.00 | 17.00 | 17.00 |
R2 | 0.68 | 0.69 | 0.65 | 0.66 | 0.74 | 0.78 | 0.72 | 0.73 |
F-test | 25.72 | 25.74 | 25.76 | 25.78 | 21.83 | 22.83 | 22.81 | 22.26 |
p-value | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 |
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Vilaplana-Prieto, C.; Gómez Martínez, C.S.; Echevarría Pérez, P.; Legaz, I. Sociosanitary Legal and Economic Aspects in Nursing Homes for the Elderly in Spain. Int. J. Environ. Res. Public Health 2023, 20, 4928. https://doi.org/10.3390/ijerph20064928
Vilaplana-Prieto C, Gómez Martínez CS, Echevarría Pérez P, Legaz I. Sociosanitary Legal and Economic Aspects in Nursing Homes for the Elderly in Spain. International Journal of Environmental Research and Public Health. 2023; 20(6):4928. https://doi.org/10.3390/ijerph20064928
Chicago/Turabian StyleVilaplana-Prieto, Cristina, Carmelo S. Gómez Martínez, Paloma Echevarría Pérez, and Isabel Legaz. 2023. "Sociosanitary Legal and Economic Aspects in Nursing Homes for the Elderly in Spain" International Journal of Environmental Research and Public Health 20, no. 6: 4928. https://doi.org/10.3390/ijerph20064928