The COVID-19 emergency is characterized by its novel and vertiginous nature. It is an unprecedented situation in which everything is changing incredibly fast. By the time we identify solutions it seems to be too late to implement them.
In Spain, for example, the decree approved by the central government on the 14th of March that declared the state of emergency contained a list of services that must remain open. It included hairdressing salons but, surprisingly, there was no reference at all to social services.
However, six days later, the nursing homes were in the front pages of all the newspapers due to the large numbers of people who became infected and died, prompting the Government to declare social services as “essential services”. Residential and nursing homes rapidly became the focus of attention, with a number of intervention strategies. For example, in the press on March 24 it is reported that the army entered more than 300 care homes in order to disinfect them.
Residential and nursing homes are just one of many long-term care options, and they should really be considered together with domiciliary, ambulatory and day care, as well as telecare and other forms of community-based support. There are many reasons why some people move into residential forms of care, while others remain in their own homes. These may be to do with severity and complexity of needs, preferences and the household situation. However, once someone has moved into a residential home, this does not necessarily mean that they can never go back into their own home, at least temporarily, provided that there is adequate care and support available.
The current situation in Spain suggests that it is particularly difficult to manage a health emergency that requires isolation within a communal living setting, specially when high proportion of people in the setting have high care needs.
In this context, one of the measures that could be considered and promoted is that people who are in residential homes and are in a position to do so, move temporarily back to their own homes, the homes of their relatives or of others who may have capacity to host them. Obviously this requires that there is availability of adequate home-based care and support, and a suitable environment, so that the care and support needs are met and unpaid carers are not over-burdened. It also requires trying to ensure that neither the persons leaving the residential setting nor those who host them are infected.
This measure could potentially reduce some of pressure on residential care homes, by making it easier for them to have more space to protect from infection those who remain, and less pressure on staff. Some families in Spain are doing this now, and it is likely that there are many families who wish that they had had the chance to do it too.
See (in Spanish) https://elpais.com/espana/madrid/2020-03-24/don-rafael-huyo-para-que-no-le-llegara-su-hora.html where there is an example of an 89 year old care home resident who has moved back in with family members.
And (also in Spanish) https://www.diariovasco.com/gipuzkoa/diez-contagios-coronavirus-20200326221440-nt.html, announcement of a set of measures by the regional government of Gipuzkoa that include technical and financial support for families that wish to host care home residents, it also includes a guarantee that people leaving care homes will not lose the right to their place when they wish to return. The rational behind this is that it is easier to guarantee preventative isolation in households than in care homes.
About the author:
Fernando Fantova (Bilbao, 1961) began working in the field of social policy and intervention at the end of the nineteen-seventies, participating in community development projects and initiatives targeted at people with disabilities and families, first as a volunteer and later in a professional capacity. He is a qualified social educator and holds a Bachelor’s degree in philosophy and education (psychology), a Master’s degree in human resource management and development and a PhD in sociology and political science (sociology). Since the middle of the nineteen-nineties he has worked in both Spain and Latin America as an independent consultant on intervention, management and political science. For four years he was a member of the Basque Government, serving as Deputy Regional Minister for Social Affairs and Head of the Social and Health Care Innovation Department. He is the author of ten books and over two hundred articles, papers and chapters, most of which are available at fantova.net.
Suggested citation: Fantova F (2020) Report: Responding to COVID-19 in Spain: Returning from care homes to live with families as an alternative? Article in LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE. Available at https://ltccovid.org/2020/03/26/responding-to-covid-19-in-spain-returning-from-care-homes-to-live-with-families-as-an-alternative/