The goal of ALTERCARE is to explore housing initiatives for older adults (existing or in development) that are proposed as alternatives to the current model of organizing care at home or in assisted living facilities. We aim to locate and analyse locally and community-oriented initiatives that innovate in residential options for older adults, in order to overcome the difficulties and the dilemma of choosing between aging at home or in an institutionalized environment, particularly when a loss of autonomy arises during the aging process.
These alternatives must be analysed within the context of the current policy for the deinstitutionalization of long-term care, as outlined in the European Care Strategy (European Commission, 2022) and the Spanish government's Deinstitutionalization Strategy (Ministerio de Derechos Sociales y Agenda 2030, n.d.). Current policy is geared towards promoting older adults remaining in their own homes as they age, an approach that has serious limitations because homes are not always adapted and because it is difficult to secure the necessary care, whether from family or professionals, in one's own residence. In the CAREMODEL project, which we are finalizing, we have been able to observe the tensions present in the current social organization of care in Spain. Keeping older adults at home leads to the precarization, familiarization, and feminization of care provision and, without a robust public policy capable of creating and funding adequate resources, the home becomes a space that reproduces territorial, gender, age, origin, and social class inequalities.
In recent years, Spain has seen a notable increase in longevity, in line with global demographic trends. According to statistical data from the Continuous Municipal Register (INE), as of January 1, 2022, there were 9,479,060 people over the age of 65, representing 19.97% of the total population (47,475,420). Life expectancy at birth is 85.7 years for women and 80.4 for men (83.1 years on average), making Spain the country in the European Union with the highest life expectancy, despite the impact of the pandemic which reduced these figures. In 2021, the number of healthy life years at age 65 was 18.7 (17.4 for men and 19.9 for women), representing 87.5% of the life expectancy at age 65 (90.8% for men and 85.1% for women) (Ministry of Health, 2023). As Alex Kalache (2015) points out, a new life stage has been born, a transition between adulthood and old age that has never existed before.
The projections from the National Institute of Statistics for the year 2035 are clear: there will be more older people, and one in four people will be over 65, a proportion that will be higher in rural areas. Not only are there and will there be more older people, but the way of aging has also changed, with a predominance of individuals who are independent, active, and healthy. Today's older adults have been protagonists and active agents in the economic, social, and political development of our country, achieved, to a large extent, through their work and their struggles for democracy. Their educational level has improved significantly, as many of them have completed secondary education and over 10% have a university degree. This contrasts with the situation in 1970, when illiteracy affected 18% of older people and only 5% had secondary or higher education. Furthermore, they have been able to benefit from the social protection system, which has provided access to healthcare and pensions, among other dimensions. Another relevant aspect to consider is the number of older people living alone in Spain, which, although lower than in other countries, is steadily increasing: it currently affects 29.4% of women and 15.8% of men. Households consisting of couples without other residents are also numerous, reaching 51.6% for men and 34.7% for women (Pérez et al, 2022).
Associated with old age, the need for care for those who have lost their autonomy, entered a state of dependency, and require third parties to perform basic activities of daily living must also be addressed. This generates challenges of dimensions that are still not sufficiently clear: in the final stage of life, situations of frailty and dependency with a high degree of complexity, intensity, and duration must be faced. This impacts the long-term care model, which must be transformed to adapt to new needs (Díaz and Sancho, 2020; Sancho and Martínez, 2021). We have extensively confirmed that most people wish to age at home and do not want to depend on their children or be a burden. We also observe a strong rejection of nursing homes as they are currently organized. The pandemic has exposed the failure of the traditional nursing home model, as well as the weakness of public policies, which do not allow people to remain at home in situations of aggravated dependency and lead to unwanted institutionalization. It has also highlighted the lack of social and healthcare coordination, which not only had lethal impacts during the pandemic but also harms the daily lives of those who require care and those who provide it (Comas-d'Argemir and Bofill, 2022).
ALTERCARE proposes enhancing the value of housing for older people as an alternative to institutionalization, one that accounts for regional disparities and does not lead to the precariousness and refamiliarization of care. Locally based, community-oriented senior housing with services constitutes a viable alternative that meets the needs of recipients and their right to be cared for, regardless of their financial ability to access a diverse and sophisticated market of care resources. Consideration must also be given to older adults who need to leave their usual homes for various reasons (loneliness, costs, lack of accessibility) and who can manage the aging process in this type of accommodation.