What is Spain’s Ley de Dependencia?

Spain’s Dependency Law (Ley de Dependencia) was passed in 2006 under the Zapatero government.

It was essentially put together in order to try and construct a social, psychological and financial framework of support for dependent people. In the words of the law itself, the aim was to: “to regulate the basic conditions that guarantee equality in the exercise of the subjective right of citizenship to the promotion of personal autonomy and care for dependent persons.”

To do this, it created the System for Autonomy and Care for Dependency (SAAD), and the benefits and services offered were put in place to give dependent people not only more support but dignity.

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However, the law (and system) has been dogged by backlogs and delays ever since. In 2021 the Spanish government injected hundreds of millions into the system to try and improve performance, but recent reports in the Spanish media suggest that things have barely improved — as of December 31st 2023 there were 296,431 people still on the waiting list.

How does the Dependency Law work?

The support available depends on the level of dependency, something which is examined by a medical expert and then graded on a scale. In theory, the dependency level can be changed depending on how the recipient’s needs develop over time.

The law outlines the Basic Activities of Daily Living (ABVD) that the SAAD is designed to assist with: “the most basic tasks… which allow them to function with a minimum of autonomy and independence, such as: personal care, basic domestic activities, essential mobility, recognising people and objects, finding their way around, understanding and carrying out simple orders or tasks.”

The three degrees of dependency are as follows:

• Moderate dependency (1st degree) – someone who needs help once a day to complete basic activities.
• Severe dependency (2nd degree) – someone who needs help 2/3 times a day to complete basic activities.
• Great dependency (3rd degree): someone who needs ongoing, permanent assistance to manage their basic needs and activities.

What are the different types of dependency?

Dependencies can be wide-ranging and often have crossovers. The law defines dependency as “the permanent state of people who, for reasons of age, illness or disability, and linked to the lack or loss of physical, mental, intellectual or sensory autonomy, require the care of another person or persons or substantial help to carry out basic activities of daily living or, in the case of persons with intellectual disabilities or mental illness, other support for their personal autonomy.”

So the four main dependency categories are physical, mental, sensory, and mixed.

• Physical – disability or mobility issues due to age, injury or illness, that makes someone dependent on another for physical support.
• Mental – when a mental condition (such as dementia, for example) means a person is no longer capable of making decisions or problem solving and rely on someone else to do it for them.
• Sensory – a loss of a sense, such as blindness, makes someone dependent on another for help.
• Mixed – someone who suffers from two or more types of dependency

What does the law offer to dependent people?

Essentially care, whether in the home or at a residency centre, or financial assistance for people caring for loved ones.

The degree of dependency is tied to the care coverage:

1st degree: 10-20 hours/month
2nd degree: 21-45 hours/month
3rd degree: 46-70 hours/month

The average amount of home help is 33.8 hours per month, which rises to 57.9 hours for 3rd degree dependencies.

The financial benefit received by those who care for a dependent relative at home is €240.17 — €369.6 in the case of 3rd degree decencies.

The average amount of state benefit linked to a residential place for 3rd degree dependents is €575: less than a third of the real cost of these services.

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Why is the law trouble-ridden?

However, as progressive as the legislation is on paper, in reality things haven’t worked out like that.

In 2023 alone, 40,447 people died while waiting to be assessed or cared for. This works out to 111 people dying a day in Spain while on the Dependency Law waiting list.

As of 31 December 2023 there were 296,431 people still on the waiting list. The time it takes to even process a dependency application and arrange care intervention takes almost a year (324 days).

But these failures aren’t for a lack of trying (or more specifically, money) by the government. In 2021, Spain’s Ministry of Social Rights approved a shock plan that increased state funding for the SAAD to the tune of €600 million. This money was mainly used to try and resolve the backlog in case applications and widen the coverage of benefits offered.

However, the plan hasn’t really worked as anticipated.

This seems to be for two main reasons: firstly, the complexity of the procedures taking a patient from application to dependency diagnosis and finally to care — in other words, slow bureaucratic processes getting in the way.

Secondly, the cutting of funding at a regional level has made an already overwhelmed system even more stretched.

Much of the money for the Dependency Law comes from regional authorities, and in 2023 nine regions reduced their funding for dependency services, including Catalonia (by 57.3 million), Andalusia (51.6 million), Valencia (40.6), Madrid (15 million), Extremadura (11), Asturias (10.8), Cantabria (8.7), Castilla y León (7.4) and Murcia (1).

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