Residents and staff at a workshop at Élite, a care home in Malaga city. Migue Fernández
Ageing population means beds in residential homes for the elderly must triple by 2037

Ageing population means beds in residential homes for the elderly must triple by 2037

With only 2.4 places per 100 retirees - half the WHO recommendation - Malaga province is one of the worst areas of Spain for bed provision

Nuria Triguero


Friday, 13 October 2023, 13:17


It is common to hear of an ageing population as something negative, when in reality it is a consequence of something tremendously positive for humanity: to increase life expectancy. Many more people reach very advanced ages and are still in good health. But for others as the years go by, the incidence of serious and limiting diseases increases - just look at the increase in Alzheimer's and other types of dementia. Declining health that creates dependency issues is the most common reason for moving into a care home.

Currently in the province of Malaga including the Costa del Sol there are 313,000 over-65s with more than 79,000 having surpassed 80. Demographic projections from the National Institute of Statistics (INE) say that, by 2037, the increase in the over-65 population in Malaga will be almost 60%. That's nearly half a million seniors, with 130,000 already over 80. Is Malaga province ready to meet their care needs? If guided by the World Health Organization's recommendations, the answer is no.

WHO's index sets a coverage ratio to calculate the proportion of residential places for senior citizens in any given place. The ratio is simply the number of beds per 100 inhabitants over 65 and WHO sets this at five. Malaga had only 2.5 when the last demographic report was published in 2020 by the Spanish National Research Council (CSIC), ranking Malaga as the ninth Spanish province with the lowest capacity in care homes in proportion to its elderly population. Andalucía's average ratio is 3 and the nationwide average is 4.2.

The province has 123 care homes with a total of 8,200 places (data provided by Andalucía's social services and dependency agency). To reach the recommended ratio of five, the province would need to almost double its current capacity (7,460 more beds). Then, if the INE population projections are taken into account, within fifteen years almost 25,000 places will be needed. Conclusion: capacity has to be tripled to comply with WHO.

"Malaga is among the main provinces needing beds, only behind Alicante, Valencia, Barcelona, Madrid and Seville," said Juan Manuel Pardo, director of the Living division of Jones Jang Lasalle in Spain. Some projects are under way in the province, adding 472 more places before the end of the year, according to this consultant.

The main operators in the sector and investment groups are interested in Malaga as a focal point for new projects for care homes, but there are also barriers.

"In the current situation, developing new projects is more difficult due to the increase in construction and financing costs, so a greater increase in rates charged, starting with the subsidised places, would boost investment," said Pardo. In any case, he is clear that demand " is outstripping supply".

A lack of subsidised places

The general diagnosis is clear: there is a lack of care homes for the elderly and that will continue. The reality is more complicated. The shortage is greater for public and subsidised places, which are financed by the regional government in whole or in part via the dependency law. In the province there are 51 privately run homes with funding agreements with the regional government, totalling 2,674 places, in addition to 42 day centres with 855 places. Similarly, there are the two residences directly managed by the authority (El Palo and Estepona) with a total of 385 places. In contrast, there are over 5,140 private places.

Alejandro González is the owner of two nursing homes in Malaga city: Residencia Pinares de San Antón and Centro Residencial Elite. He also belongs to the board of directors of CECUA, a business association for care providers. His two centres have 70 places, half subsidised and half private.

"Is there a bed shortage? It depends on what beds and what user profile we are talking about. What is missing are subsidised and public places, for users with reduced financial means. In private residences, finding a place is not so big a deal, unless you are looking in a very specific area of Malaga city," he said.

His centres are among those with more reasonable prices: about 1,800 euros per place per month (the most expensive can reach 3,000 euros).

Patricio Jesús Fuentes is director of the Buen Samaritano (Good Samaritan) centre, managed by the charity Cáritas. He is also the representative in Malaga for Lares Andalucía, the Andalusian association of residences and care services for the elderly run by charitable organisations.

"The reality is that we find ourselves with a very high demand for subsidised places that cannot be met by supply," he stated. His residence has some places funded by the regional government and other "social" places, which Cáritas allocates to users with no resources, but who have an urgent need to be admitted to a home and are still stuck in the dependency law queue.

"Getting a subsidised place can take a long time. From the moment your dependency status begins to be processed until you are assigned a place, it can take six months. And there are many situations in which the person cannot wait that long," he explained.

Andalucía's social services and dependency agency highlights that "an unprecedented expansion of places is being implemented in homes and day centres for the elderly and disabled". It added: "This year there are 1,500 more places available for older people alone in Andalucía. In Malaga there are more than 300."

"From 2019 to 2023, 4,553 new places have been added to care for people in a situation of dependency in Andalucía, of which 757 places have been created in Malaga province; of those, 479 are intended for the care of the elderly and 278 for the disabled," added sources.

Fuentes acknowledged that the regional government "has tackled the matter, granting more subsidised places". "As a shock tactic we value it positively. The 1,500 new places will help ease the waiting list. The process for allocating places is also being worked on," he added. However, he pointed out that it is not enough for the regional government to increase the number of subsidised beds without increasing the budget to finance them.

There is a third way to access dependency aid, in addition to public and subsidised places: a benefit system linked to the service. This is aid to "contribute to the financing of said service" that the regional government grants in those cases "in which it is impossible to access the public or subsidised service appropriate to the person in a situation of dependency". The amount of the benefit is set based on the assessed degree of dependency, the financial capacity of the applicant and the hourly care required.

Meanwhile, the supply of luxury, private homes continues to grow on the Costa del Sol. The trend is clearly linked to the arrival of Europeans with good pensions.

"In addition, we will see other trends such as 'independent living' projects: residential complexes for retirees without any type of medical assistance, which also cater to foreign demand. The Flag in Estepona is the prelude to what we will see in the coming years," said Juan Manuel Pardo.

Homely centres and community-based living: the future of elderly care

"We have to assume that the residence model and the approach used to care for our dependent elderly people must change," said Patricio Jesús Fuentes of Lares Andalucía. Not only does he say it - it is pending approval in law as an agreement on dependency care across the Spanish regions.

The agreement's text marks important changes: aiming for centres to become smaller, more homely places, divided into shared living units of no more than fifteen or twenty residents and with more staff.

The agreement also establishes a strategy for community-based care, which seeks to avoid or delay as much as possible the moment when a person can no longer live at home.

"The idea is to leave the centres for serious care cases and to support home care much more, with a more comprehensive, more community-based intervention approach," explained Fuentes.

Not everyone likes this road map. There are regions against it and private operators complain of the ensuing increase in costs. Fuentes feels these changes "can greatly improve care for dependent people", but he points out that it will take "courage and leadership" to implement them. More money too. He believes increasing staff ratios and reducing the size of care homes will result in an increased cost per place of 15 to 20 per cent. "In Andalucía we are far behind other regions in changing to such a model."

Alejandro González is one of the critics of the new model for elderly care, especially the reduced groups in community living. "Has anyone asked older people their opinion, if they want to always see the same 15 or 20 faces? Has a study been done to find out how it would benefit them? It would seem much more important to me, for example, that care homes were required to have outdoor space."

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