Dependency does not only affect older adults; it can arise at any stage of life and affect people across the entire age spectrum of the population.
There are situations of dependency that arise at birth, or following an accident, due to an illness in adulthood, or as time goes by, as the people are getting older.
Would you like to find out how a situation of dependency affects a person and their ability to live independently? We’ll tell you more
Situation of dependency
Dependency is not a new phenomenon and has always been a part of people’s lives, but it is only relatively recently that various public bodies have begun to focus their efforts on supporting people in situations of dependency.
The Council of Europe defines a situation of dependency as:
A condition affecting people who, for reasons linked to a lack or loss of physical, mental and intellectual autonomy, require significant assistance or support in order to carry out the ordinary activities of daily living and, in particular, those relating to personal care. (2000).
In this regard, Oliveira et al. (2014) state that the condition of dependency involves both internal and external determinants. The former are characterised by a person’s health status and the nature of their illness, whilst the latter are characterised by barriers and facilitators within their environment.
Legal acknowledgement
It was not until 2007 that the situation of dependency was regulated in Spain through the Law 39/2006 of 14 December on the Promotion of Personal Autonomy and Care for People in Need of Care.
This standard distinguishes between two key concepts: the autonomy and the dependence. The first one is like:
The ability to manage, cope with and make, on one’s own initiative, personal decisions about how to live in accordance with one’s own standards and preferences, as well as to carry out the basic activities of daily living. (p. 8)
And the second one goes something like this:
The permanent condition experienced by people who, for reasons relating to age, illness or disability, and linked to a lack of or loss of physical, mental, intellectual or sensory autonomy, require the care of one or more other people or significant assistance to carry out basic activities of daily living or, in the case of people with an intellectual disability or mental illness, other forms of support for their personal autonomy. (p.9)
Classification of the level of dependency
Initially, the law distinguished between different degrees and levels of dependency, but following an amendment in 2012, only three degrees are now recognised.
- Grade I or moderate dependency for people who need help carrying out various activities of daily living (ADLs) at least once a day, or who require intermittent or limited support to maintain their personal independence.
- Grade II or severe dependency For people who need help carrying out various activities of daily living (ADLs) two or three times a day, but who do not require the constant support of a carer or need extensive support to maintain their personal independence.
- Level III or high dependency when a person requires support to carry out several of the Activities of Daily Living (ADLs) several times a day and, due to a total loss of physical, mental, intellectual or sensory autonomy, requires the essential and continuous support of another person or has generalised support needs in order to maintain their personal autonomy.
Services and benefits
People who are recognised as dependants, depending on the assessed level of dependency, will be eligible for a range of resources and/or benefits set out in the regulations.
- Services to prevent dependency and promote personal independence: a financial benefit linked to the service.
- Telecare: financial support for care provided within the family setting and support for informal carers.
- Home help service, day and night care centre, and residential care: personal care allowance
17 years later
Care for people in need of support is a matter of general interest to the public, as, at one time or another in our lives, we will all find ourselves in a situation where we require such support.
Seventeen years after the regulation came into force, its development has been uneven, with six distinct phases:
- Phase 1: Take-off: From its launch until mid-2011, when development was uneven across different regions and due to insufficient financial.
- Phase 2 of the cuts: It began in 2012 and continued until 2015. This period was characterised by severe budgetary constraints and a combination of measures restricting the rights of people in need of care, such as the abolition of public funding for family carers and the removal of the possibility of combining different care services, amongst others.
- Phase 3 of recovery: From 2015 onwards, with the inclusion in the system of all those assessed as Grade I, the implementation of the law began to gain momentum.
- Phase 4 of the slowdown: The extensions to the budgets, which had been cut in 2018, led to a further slowdown in the system, causing the number of people with recognised entitlement awaiting care to rise once again.
- Phase 5: System rollback: The Covid-19 pandemic in 2020 led to a setback in two areas. On the one hand, in terms of new assessments, and on the other, in terms of the roll-out of new services or benefits.
- Phase 6 of the roll-out: The Emergency Plan for Care Dependency is now under way. After its third year, there has been a significant increase in the number of people receiving care and the restoration of certain rights. However, despite the increase in funding
- Whilst the Central Government has done so, the autonomous communities have not responded in the same way, meaning that the plan has not met all its objectives.
In short, the overall picture regarding care provision remains negative. Not only are those entitled to care not being provided for now that the timetable for implementing the Act has come to an end, but access to care, the actual content of the care provided and the timeframes involved are largely determined by the local authority in which the person resides, giving rise to serious inequalities.
