Dependence and personal autonomy: vital balance

The situation of dependency not only affects older adults but can manifest at any time in life and across all age groups in the population.  

There are dependency situations that appear at birth, after an accident, due to an illness in adulthood, or simply with the passage of time as people age.   

Do you want to understand how dependency affects a person and their ability to live autonomously? Keep reading... 

Dependency Situation

Dependency is not a new phenomenon—it has always been part of human life—but it is only relatively recently that various public institutions have begun to focus their efforts on addressing the needs of people in situations of dependency. 

The Council of Europe defines the situation of dependency as: 

A state in which individuals, due to reasons related to the lack or loss of physical, psychological, or intellectual autonomy, require significant assistance or support in order to carry out everyday life activities and, in particular, personal care tasks. (2000).

In this sense, Oliveira et al. (2014) states that the condition of dependency involves both internal and external determinants. The former are characterized by a person’s health conditions and type of illness, while the latter involve environmental barriers and facilitators.  

Legal Recognition

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

This law distinguishes two key concepts: autonomy and dependency. The first is defined as: 

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

And the second as: 

The permanent state in which individuals, due to age, illness, or disability—and linked to the lack or loss of physical, mental, intellectual, or sensory autonomy—require the attention of another person or significant support to perform basic activities of daily living, or, in the case of people with intellectual disabilities or mental illness, other supports for personal autonomy. (p. 9) 

Classification of the Dependency Situation

Initially, the law distinguished between degrees and levels of dependency, but after a 2012 amendment, only three degrees are recognized. 

• Degree I or Moderate Dependency applies to individuals who need help performing several basic activities of daily living (BADLs) at least once a day, or who require intermittent or limited support for personal autonomy. 
• Degree II or Severe Dependency applies to individuals who need help performing several BADLs two or three times a day but do not require permanent caregiver support, or who need extensive support for their personal autonomy. 
• Degree III or Major Dependency applies to individuals who need help performing several BADLs multiple times a day and, due to total loss of physical, mental, intellectual, or sensory autonomy, require continuous and essential support from another person or generalized support for personal autonomy.  

Services and Benefits

People recognized as dependent, according to their assessed degree, may access a range of resources and/or benefits established by law.

• Services for the prevention of dependency and promotion of personal autonomy: economic benefit linked to the service. 
• Tele-assistance: economic benefit for care within the family environment and support for non-professional caregivers. 
• Home help service, day and night centers, and residential care: economic benefit for personal assistance. 

17 Years Later

Care for dependency is a matter of public interest since, at one point or another in our lives, we will likely experience some form of dependency. 

After 17 years since the law’s implementation, its evolution has been uneven, showing six distinct phases: 

• 1st Phase – Takeoff: From its launch until mid-2011, there was uneven development depending on the territory and due to financial insufficiency.  
• 2nd Phase – Budget Cuts: Beginning in 2012 and lasting until 2015, this period was marked by severe budget restrictions and rights limitations for dependent individuals, such as the elimination of public contributions for family caregivers and the removal of compatibility between certain services, among others.  
• 3rd Phase – Recovery: Starting in 2015, with the inclusion of all individuals assessed with Degree I, the development of the law began to gain some momentum. 
• 4th Phase – Slowdown: The extension of reduced budgets in 2018 caused another slowdown in the system, leading to an increase in the number of people entitled to care who remained on waiting lists. 
• 5th Phase – System Regression: The COVID-19 pandemic in 2020 caused setbacks in two aspects: first, in new assessments, and second, in the implementation of new services or benefits.  
• 6th Phase – Expansion: The “Shock Plan for Dependency” began. After its third year, a significant increase in the number of people served and the recovery of some rights was observed. However, despite increased funding
• from the General State Administration, the Autonomous Communities have not responded in the same way, so the plan has not achieved all of its objectives.

In conclusion, the overall balance of the dependency system remains negative. Not only are people with recognized rights not receiving care even though the law’s implementation calendar has ended, but access and the real content of care services are largely determined by the region of residence, resulting in serious inequalities.