The Spanish Long-Term Care System: Deployment, Restructuring Processes and Future Challenges

Abstract

Since the implementation of the Dependency Law in 2007 the nature of the Spanish long-term care system (LTCS) shifted from an assistance based-model to a universal one. Despite this undeniable legal improvement, it was not put into place effectively because of the general cutbacks and delays to access the rights. This article examines in-depth the Spanish long-term care system deployment, the restructuring processes undertaken owing to the 2008 economic ‘shock’, the system’s shortcomings and its future challenges. It is based on case study analysis. The analysis of the changes focuses on four dimensions: the system`s nature and principles, the access to the rights, the services provision, and organisation, management and funding. The study scrutinises workers and recipes of public services, legislative reforms, and the social and institutional impact of the crisis according to interviews carried out to key informants. The outcomes display a double process of system expansion-contraction: the first, during the system’s deployment, which was followed by a second phase of retrenchment or contraction, centered on the cost containment restructuring process and the reinforcement of the family-based nature of the system, along with a process of re-familiarisation and re-commodification.