Abstract
In recent decades Spain has made an effort to expand services for older persons. First this was mainly in traditional institutional care, later in home help and lately also in other minor community services such as tele-alarm. These efforts have not been geographically uniform. Needs and social contexts (living alone, multigenerational households) also vary regionally, resulting in spatial inequality.
Objectives: To find out whether social services respond to needs of older people and to specify user profiles of these services. We also analyse if responses vary across regions and how different regional models of care target older persons in need.
Data and methods: We use the nationally representative Survey of Living Conditions (IMSERSO) 2006 with a sample of 3,507 individuals aged 65+ years living in the community. Two kinds of services are treated separately: direct personal care and household help and services of prevention and promotion of active ageing. We use binary logistic regression analysis.
Results: Direct care: there is considerable spatial variation in domiciliary care coverage: coverage rates may vary by a factor of three between regions. There is a mismatch between the needs of the population and the provision of services: 84% of persons with disability in personal care do not receive any service, but 7% of the population without any disability receive them. In areas where coverage is low, it is solitary living that mostly determines use of services, with higher use rates in large urban areas. In preventative services there is also considerable spatial variation; regions with low coverage rates tend to provide these services to older people who live alone.
Policy implications: In general, social services for older adults in Spain are mainly for solitary people, that is, persons who are socially vulnerable rather than physically frail. The lower the coverage rate of a region, the more their services focus on solitary older people. With increasing coverage rates, proportionally more socially vulnerable persons and persons with physical needs are provided for. If minor services like tele-alarm, currently varying widely, were more accessible, this might reduce inappropriate use of social services by older people. It also seems that public services for older people in Spain might benefit from a more adequate balance between needs primarily due to frailty and needs contingent upon solitary living and loneliness.