Dependence and personal autonomy

The situation of dependency not only affects older adults but can manifest at any time in life and span the entire age structure of the population.  

There are situations of dependency that appear at the moment of birth, or after an accident, due to an illness in adult life or over time as people age.   

Do you want to know how the dependency situation affects the person and the performance of their personal autonomy? We continue telling you… 

Dependency situation 

Dependency is not a new phenomenon and has always been present in a person’s life, but it was not until relatively recently that different public organizations focused their efforts on serving the group of people in a situation of dependency. 

The Council of Europe defines the situation of dependency as: 

A state in which people find themselves who, for reasons linked to the lack or loss of physical, mental and intellectual autonomy, need assistance or important help in order to carry out the ordinary acts of daily life and, particularly those related to personal care. (2000).

In this sense, Oliveira et al. (2014) establishes that the condition of dependency contains internal and external determinants. The former is characterized by the health conditions and the type of illness of the person, and the latter by the barriers and facilitators in the environments.  

Legal recognition 

It was not until 2007 that the situation of dependency was regulated in Spain through Law 39/2006, of December 14, on the Promotion of Personal Autonomy and Care for people in a situation of dependency.  

This standard distinguishes two key concepts: autonomy and dependence. The first is defined as: 

The ability to control, cope and make, on one’s own initiative, personal decisions about how to live in accordance with one’s own norms and preferences, as well as to carry out the basic activities of daily living. (p.8) 

And the second definition is: 

The permanent state in which people find themselves who, for reasons derived from age, illness or disability, and linked to the lack or loss of physical, mental, intellectual or sensory autonomy, require the attention of another or other people or important aids to carry out basic activities of daily living or, in the case of people with intellectual disabilities or mental illness, other supports for their personal autonomy. (p.9) 

Classification of the dependency situation 

At first, the law distinguished degrees and levels of dependency, but after a modification in 2012, only 3 degrees were distinguished. 

• Grade I or moderate dependence for the person who needs help to perform several ABVDs, at least once a day or has needs for intermittent or limited support for personal autonomy. 
• Grade II or severe dependency for the person who needs help to perform several ABVD’s two or three times a day, but does not require the permanent support of a caregiver or has extensive support needs for personal autonomy. 
• Grade III or great dependence when the person needs support to perform several of the ABDL’s several times a day and, due to their total loss of physical, mental, intellectual or sensory autonomy, they need the indispensable and continuous support of another person or have needs of generalized support for their personal autonomy.  

Services and benefits 

People who are recognized as dependents, and depending on the degree assessed, may be eligible for a series of resources and/or benefits established in the standard.

• Services to prevent the situation of dependency and promote personal autonomy: economic benefit linked to the service. 
• Telecare: financial benefit for care in the family environment and support for non-professional caregivers. 
• Home help service, Day and Night Center and Residential Care: financial provision of personal assistance 

17 years later 

Dependency care is a matter of general interest for citizens, since, at one point or another in our lives, we will end up being in a situation of dependency. 

After 17 years since the entry into force of the standard, its evolution has been uneven, distinguishing 6 clear phases: 

• 1st Take-off Phase: From its launch until mid-2011 where there was uneven development depending on the territory and due to financial insufficiency.  
• 2nd Phase of cuts: It began in 2012 and lasted until 2015. This period is characterized by a strong budgetary restriction and the combination of measures to restrict rights for people in a situation of dependency, such as the elimination of public contributions for family caregivers or the elimination of compatibilities between services, among others.  
• 3rd Recovery Phase: Starting in 2015 and with the entry into the system of all the people assessed with Grade I, the development of the law began to gain a certain pace. 
• 4th Phase of slowdown: The extensions of the budget cut in 2018 caused a new slowdown of the system, causing the number of people with recognized rights waiting for care to increase again. 
• 5th Phase of system setback: The COVID-19 pandemic in 2020 caused a setback in 2 aspects. On the one hand, in the new valuations and, on the other hand, by the implementation of new services or benefits.  
• 6th Phase of deployment: The Shock Plan for the agency begins. After its third year, there has been a significant increase in the number of people served and the recovery of some rights. However, despite having increased financing
• of the General State Administration, the Autonomous Communities have not responded in the same way, which is why the plan has not met all of its objectives.  

In short, the global balance of dependency remains negative. Not only are people with the right not attended to when the Law’s application calendar has already ended, but access and the real content of the services and deadlines are highly determined by the community of residence, giving rise to serious inequalities.