Dra. Sacramento Pinazo: "The added value of care cooperatives is not just a matter of "warmth" in care, but a structural change"

Dr. Sacramento Pinazo-Hernandis has developed an extensive research career in the field of gerontology and collaborates with national and international organizations in analyzing the challenges arising from population aging. She is part of the board of directors of the Pilares Foundation, which works in the comprehensive care of the elderly. For decades, she has been researching how to build more inclusive societies for all ages and highlights the need to provide new solutions, such as those offered by care cooperatives.

Catalonia, like most of Europe, is facing an accelerated process of population aging. In your opinion, what are the main social and care challenges that this reality will pose in the coming decades?

— The available demographic data paint a picture of profound transformation in Catalonia. The current 19.3% of the Catalan population is over 65 years old, and future projections point to 21.9% in 2030, 26.1% in 2040, and 28.9% in 2050. This would place the group of people over 65 close to 2.5 million people. But it's not just an increase in the number of elderly people, but also an aging of the elderly group itself (what is called super-aging). There have never been as many people over 80, 90, and even 100 years old as there are today, and the proportion will continue to grow in the short term because the generations of the baby boom of the sixties and seventies are entering this stage with better health than previous generations. This increases the prevalence of severe dependency, chronicity, and multiple pathologies.

Thus, the outlook does not seem very encouraging.

— Furthermore, there has been an inversion of the population pyramid: in 2010 the aging index was around 112 elderly people for every 100 people under 15 years of age; in 2020 it rose to 143. This means there is a smaller base of active population and potential family caregivers available. To this data, we can add that, according to the CCOO Observatory of the Elderly (2023), 16.5% of people over 65 years of age are at risk of poverty or social exclusion.

There is increasing talk about person-centred and community-rooted care models.

— Currently, there is already a shortage of residential places and home care services in the face of growing demand, and the need to transform the model is on the table, to move from a system centered on institutionalization to one based on support at home and in the community (following the Deinstitutionalization Strategy). In fact, the recent Law 10/2025 of the Agency for Integrated Social and Health Care of Catalonia explicitly includes this objective: to promote alternatives to residential admission in accordance with the personal will to develop one's life project at home for as long as possible.

— But, of course, how can one continue to live at home if the necessary support is not available? At the Fundació Pilares, we have been emphasizing for years that most people who need support wish to continue living in their own homes, integrated and participating in their community environment, which requires different services than purely institutional ones. This is why the Model of Comprehensive and Person-Centered Care (AICP) emerged, promoted in Spain mainly by the Fundació Pilares. And, from here, different resources have appeared to bring care closer to the home environment, such as care cooperatives.

Do you think care cooperatives can offer a different response to aging compared to more traditional care models?

— The added value of care cooperatives is not just a matter of "warmth" in care, but a structural change, because it transforms who makes the decisions (from external, business management to co-management with the care recipient). There is also another important change: the way of financing, based on the social economy instead of external private capital. And, finally, the place where the service is provided changes: it goes from services developed mainly in institutions - residences - to care articulated around the person's home, that is, in their home and community.

— However, these are still minority and limited-scale experiences, and no rigorous evaluation results with representative samples are known. Furthermore, the relationship between care work and female labor precarity should be highlighted. In the dependency sector, the workers are predominantly women, and in the domestic sphere, more than 40% are of foreign origin, which adds layers of vulnerability (administrative status, language, support networks).

It is often said that to take good care of the elderly, we must also take care of the professionals who attend to them. To what extent do the working conditions, participation in decision-making, and well-being of caregivers influence the quality of care that dependent individuals receive?

— The working conditions and well-being of caregivers directly influence the quality of care received by care recipients. The average salary of domestic and care workers barely reaches 1,000 euros per month, while only four out of ten receive the severance pay they are entitled to, and occupational diseases are not even recognized. Added to this is a structural problem that is particularly relevant in scattered territories in different parts of Spain and much of Catalonia: home help workers may have to visit two or three villages in half a day without travel time counting as effective working time. Thus, a female caregiver may spend eight hours away from home but only be paid for four or five.

— These conditions generate high staff turnover, which erodes a central element of the person-centered care model: the continuity of the bond, the knowledge of the biography, rhythms, and preferences of each person being cared for. When this bond is constantly broken due to job insecurity, care tends to become more mechanical and less personalized.

It is, therefore, evident.

— The well-being of caregivers also conditions the quality of care, and there is a great accumulated physical and emotional burden. Reports on care in Spain indicate that women caregivers accumulate a greater total workload than men and live in a permanent regime of double presence, which has significant costs for their health. This situation is exacerbated in the professional sector by the lack of institutional recognition and, in the case of digital care platforms, by the loss of autonomy: the algorithmic management of work and one-way reputation mechanisms drastically restrict the ability of female workers to negotiate salaries or conditions, which hinders collective organization.

It is also a matter of justice.

— An exhausted, poorly paid caregiver, with no recognized time or real ability to decide how to organize her work, can hardly sustain good treatment, adequate care, and the emotional availability required for accompanying a person in a situation of dependency. For this reason, the same models that advocate for the participation of female caregivers in decision-making (for example, care cooperatives) start from the premise that improving their working conditions is not only a matter of social justice towards them, but a prior and necessary condition for person-centered care to cease being a merely declarative objective and become a real practice.