Ana García Mendoza is a worker of the Fundación Pilar de Madrid, a psychologist in the master's degree in community work and project technique. It helps the elderly at home. García participated on 27 November in the days organized by the Irauli care association in Azpeitia (towards a Basque public and universal care system).

He says that, even if we are subjects, the elderly have to remain masters of themselves and today we do not let them do so. For Madrid, these are two fundamental concepts: rights and dignity. Garcia refers to the care model they have already worked before the pandemic and recognizes that they have invented nothing. However, in the midst of a pandemic, we have spent a year, if we compare the model shown by the worker of the Pilar Foundation with what we now have, their claims are easier to shake. Reading García’s reflection is an interesting exercise to delve into how far we are from a model worthy of care for dependent elderly people.

We have brought to the following pages a summary of the conference that Madrid gave in the November days:

Older people have rights and responsibilities. To be assisted in cases where they need it, as well as to exercise their right to decide. One thing happens in this society: when the person is dependent we decide everything for them, they lose autonomy. It is important to have the right to decide on your own life. He must participate.

They have a right to interesting lives. Care, impossibilities and limitations are at the center of life. The lives of families also revolve around care. We all need an interesting life.

They have the right to a non-exemplary life. Why is health and safety mandatory? Can't the elderly have unhealthy habits? We do not let them get out of that scheme and they are entitled to it.

They have the right to take the risk. Life is a danger. Nursing homes are closed during the pandemic. I risked and went to the cafeteria. We don't let older people take the risk. We are very sponsoring, paternalistic. The model we propose assumes risks. Everyone is not worth the same thing.

The care model has two dimensions. One of them is the care that puts the person at the center. Baga, you have to know the person and adapt the services to it, not the other way around. To know and accept their peculiarities. The current model does not. Secondly, one has to know the person from his/her point of view: age, gender, health report, origin, socioeconomic level... But in addition, each one has his/her own values, beliefs, past... We will design care plans based on his/her abilities and desires. If we do not focus on capabilities we will always talk about limits, we will always compensate for limits (and that too has to be done). Encourage transfer, autonomy and independence. He can decide, you can't change that because he's dependent. When they have problems at a functional level, for example when they need help to move or clean, we help them very well, with good will, but we crush their autonomy and independence. Or we don't ask them for an opinion or we do everything for them. By playing like this, we are not taking into account their abilities.

In addition to the dimension that places the person at the center, we will highlight the section that refers to the integration of integral care in the community. There are a thousand services, of all kinds, cultural, health, housing… When there are so many windows to access services, young people also worry about managing all that, imagine how the elderly person feels first and foremost what the administration offers! I heard the relatives of an old man say that he had not asked for such a service because it would be a mistake to start doing so. We must offer all services at once.

Each service looks for itself and doesn't want to see that much more services are offered in the community. I am referring to the diversity of services offered by the administration, associations, volunteers, the market, etc. Our proposal is to make the entire catalogue of services available to the community.

Therefore, our active aging paradigm is health, safety and participation. We forget the third leg. Do we evaluate, and when we do, we ask whether your wishes have been fulfilled? No, we don't ask. We'll count how many times they've fallen.

The journey made in the field of disability in the field of autonomy is interesting. The shift from the medical model to the social model is impressive. Before we had to take care of the patient, the disability was healed, now they are not ill, it is the citizens. Their capacities must now be strengthened. We also have to consider the elderly as a citizen in order to be able to work. Now we take care of it, it's a more caring view. Besides caring, we have to help, so people are more active and our relationship is more horizontal.

All of this is not just said by us, international organizations are saying the same thing, the World Health Organization says that the care model has become outdated and proposes a change of model. It also says that custody has to be a public good. The institutions of the European Union are also along the same lines, defending a model in which the person is at the centre, a quality care, which is available.

Someone will say that scientific evidence is needed to wager on such a model. Well, there are: less depression, better mood, less boredom, families are better, workers are better... and those models are economically sustainable.

In conclusion, I will summarise the main thrust of this speech in one sentence: They own themselves. And I'm going to stress that older people have to have stimulating projects. I'm from home to home caring for older people and the next project is this: I've known that a woman with many physical limitations really likes pies. So next time we're going to make a cake together.

“People have forgotten us, we have forgotten the goal”

Psychologist Ana García

“Why do we need a change in the care model? Society changes, and ‘guava’ models age. If we look far back, we will see how we supported ourselves in an era and solve the problems together. There were also institutions, especially those from the Church. They were private forms of protection, not rights-based. In Europe, wars ended and the welfare society came along, states took care of well-being. A universal rights-based system was created, not a private model.

Are current times better or worse? It has its pros and cons: we have lost mutual support, individualism has won and we have left the responsibilities in the hands of others.

Why do we have to change the system that we have? We have moved from a model of unorganized care, of care resolution in the intimate environment, to a normative system, structured, formalized, that contemplates services from a technical point of view. All of that is necessary, but the goal is people. We have been forgotten about people, we have been forgotten about the goal. Now there's service in the center, not person. It's time to take what was good in the previous model and what is good in the current one.

What do we propose? It is nothing new that we are proposing, we are trying to materialise what we have absorbed in each other. We call our model ‘model based on integral care and with the person in the center’. Dignity and rights are the two main concepts.”

Iñaki Lasagabaster

“Who can order the resident of the elderly’s house to stay closed in the room?”

Iñaki Lasagabaster is a professor of administrative law at the UPV/EHU. He is alarmed by what has happened in the nursing homes in recent months: to change residence to the mother without communicating it to relatives; to reduce visits; to close in the bedroom so that the virus does not become infected… The professor wonders who can make these kinds of decisions. It has analysed the Social Services Act and concluded that the public administration is intervening on issues where the rules are very vague. He recalled that family members, as well as non-residents, have rights.

Like Ana García Mendoza, Lasagabaster gave the conference in the days organized by the Irauli care association in November.

Lasagabaster considers that residences are a big and strategic issue. In his speech, he referred to the interventions of public administrations during the pandemic and its legal coverage. Here is the summary of the talk:

I am ashamed of what is happening, of the policies being pursued by the public administration that you feel close to.

Why have I been ashamed? I've read extraordinary things. A 91-year-old resident was in a private residence and had the habit of travelling for two hours a day, according to the same source. They were locked in the room. But how was he ordered into the room and not let her out? How have you been left in those conditions?

Another example is what happened in the Spanish state. I read that a person from the landlord in the residences said that he would never forget what he had seen in a residence and that the doctor pointed his finger at him saying: “morfi, morfi, morfi…” That is, the doctor, along with the head of the elderly's home, decided who was going to be admitted to palliative care. The others would stay in the residence and treat them with morphine, that is, they would die in the residence. Why was that decided? Who and how?

So I started looking at death data in the Basque Country. I wanted to look at Bizkaia and I realized that the Foral Council of Bizkaia said that the data was provided by Osakidetza. If we talk about transparency, it would be logical if we could know the data, but the answer was that Osakidetza gives them. Well, then I found out that Osakidetza did not give data for territories. There was no way to find out the data! Data were filtered at a certain point. From a democratic point of view, such a situation creates great pain. Did I want to continue the topic and fight for the data?

In the face of these facts, the authorities do not respond, neither do the courts, nor does society.

In matters of much less importance, the courts have been called upon. When it was ordered that more than six people could not be gathered on the street, the decision was taken to court and the High Court of Justice found the decision illegal on the grounds that it violated its right of assembly. It is one thing that there are six people on the street and another that many people get together for a particular purpose. The meeting of six people on the street does not reach the category of right of assembly. However, the matter was brought to court. Meanwhile, people have died in homes and nothing happens, they are locked in the room and nothing happens. I stood out.

With regard to the interventions of the public administration, I would now like to work on two things: the principle of legality and the regulation of residences.

Principle of legality. There must be a rule enabling the public authorities to intervene. Let's take the example of teaching. When are the kids going to go to school? What rights do families have? Can the child be punished? Can you touch it? Education is an area of multiple relationships and the legal system is also complex. In the residences there are workers, users, family members… How are we going to legally formulate all these relationships? Who can order the resident to stay locked in the room? They have rights! Many of the rights cannot be exercised, because they have disabilities, but those in wheelchairs also have their rights.

Law 12/2008 on Social Services. All social services are concentrated in this law. I do not think it is appropriate. There are many and very important issues. Residences should be a special law. I have already mentioned the principle of legality. Well, in the law I have missed the administration explaining what powers it has when it intervenes in a home. It does not specify which authority it can exercise. A friend of mine has learned that, although the residents have not told them anything, in Vitoria-Gasteiz they have moved their father to another residence. Who decides to change residence to residence? And also without telling the relatives? You may have to change the care model, because there are things that can't be done otherwise, but I'm not going to start talking now about model change. What I say is that the law does not specify how those in power should intervene.

The Foreign Ministers have almost exclusive competence in the area of Residences. In 2009, a paragraph was added to the 2008 Act. In Bizkaia (perhaps also in Gipuzkoa and Álava), more detailed rules have been drawn up, which I have read in order to know what powers the Member has and how the speeches can be carried out. I have found a single rule on this and mentions the term ‘administrative unit’. They don't show up relatives or residents! A friend told me another event. The mother-in-law had asked for a change of residence, but they were organized without taking into account the opinion of her mother-in-law. My friend went to the Council to clarify the situation. Is that decided by the administrative unit? Does the 91-year-old have to cry for a time of transfer to a residence he has not chosen? Why and who has decided? What rights do residents and families have? There is no legal regime to support these agreements. Another example is that of visits. By COVID-19 family members can visit twice a week and the same people must always come. There is no standard for this. A rule should indicate why the reduction is being made. The Member brings out a simple resolution and it is enough.

In conclusion, I should like to make a few comments on this subject:

A special law is required for residences: The parties directly concerned should be involved in the drafting of the law. The law must have a vision of public service. Social services are said to be complementary between the private and the public system. Look, we have to defend public services, also in the residential sector.

We must indicate who has the power in that law. Regarding private management there are fifteen articles in the current law and there is the importance given to the private. On the other hand, I was surprised at the way in which the sanctions and infringements regime has been dealt with. I understand that housing management is complex, users are in a special situation, but what importance does it attach to the area of sanctions and infringements? I think it is the section that has the least interest.

The conditions of workers must be taken into account. Here (Gipuzkoa) I was on strike. It was also held in Bizkaia. How can workers be kept in these conditions? Social services are of no use if staff are not working in proper conditions. Why the rule if workers have ten minutes to clean residents?

Where are the residences? They have to be in the city, downtown. Many are almost on the mountain, far away. Others are built where there is hardly anything. They build the residence where the land is cheaper and as the land gains value as it urbanizes, they are sold. In the urban plans, one must design the place where the residences are built, that is, in the centers, and not in the places that interest the private hands”.