The Catalan government fines nursing homes for violations with more than five million euros.

BarcelonaPoor medication management, inadequate or insufficient diets, poor hygiene, and failure to guarantee continuous care for residents are just some of the reasons why nursing homes in Catalonia have been sanctioned. Falsifying data, ignoring warnings from the administration, and obstructing inspections and the provision of information to families are also contributing factors. Since 2020, the total amount of fines has reached €5,321,733, according to data provided to ARA by the Department of Social Rights in response to a request submitted through the Catalan government's transparency portal. While the number of sanctioned residences is not specified, with the exception of 2020 and 2024, the number of sanctioning proceedings exceeds one hundred in all other years. However, the department allows residences that have rectified the infractions to invest the fine amount in facility improvements.

Data on violations and the penalties imposed on nursing homes conceals the names of the facilities, their capacity, and whether they are privately or publicly managed (3% of available places). Furthermore, in this post-pandemic period, thirteen nursing homes have been ordered closed, the vast majority for not being officially registered and offering services illegally or for other reasons. failure to comply with adaptability regulationsThe suspension of service has also been signed for six other care facilities, where residents had to be transferred to other centers until the problem was resolved.

In 2020, when the outbreak of the Covid pandemic ravaged the residents of these centers, the Generalitat (Catalan government) imposed fines totaling €908,000 and seven centers were closed (half of all closures during the analyzed period). The following year, fines rose to €119,200 and four centers had to close due to very serious violations. In 2022, fines reached €1.47 billion, a figure that decreased in subsequent years, settling at almost €1.2 million in 2023 and €600,000 the following year, according to department data. Both 2022 and 2023 ended with one center closed each year.

It should be noted that more than a year can pass between the opening of an investigation and the imposition of a sanction, as centers have time to rectify any deficiencies detected. "There are red lines, such as the mistreatment of people, the violation of rights"These are direct sanctions," explains the inspections department. For less serious deficiencies, if "there is room for improvement, warnings are issued," continues the professional, who affirms that the fines "are not intended to raise revenue," but rather to encourage management to "get their act together." They emphasize respecting the wishes of the residents and advise replacing pureed food with textured options or allowing residents to leave at their convenience. Often, however, even good intentions clash with staff shortages in care homes, forcing them to organize themselves around strict schedules based on shifts. One in seven inspections results in a fine.

The department's inspection service staff remains unchanged at 29 professionals (mostly women), who are responsible for inspecting at least one thousand authorized residential facilities annually, as well as other resources such as day centers, residences for people with disabilities, mental health facilities, and supported housing for victims of gender-based violence or young people leaving foster care. The staff is small, but according to the same sources, efforts are being made to expand it. They emphasize that the department also relies on inspections from the Health Department and a team of technicians who do not issue official reports during visits but who commission inspections of "secondary facilities." The department denies the "false rumor" circulating among family members that inspections are always carried out after notifying the center's management. However, it is acknowledged that inspections are always conducted in the company of center staff, and that workers and residents are encouraged to meet privately. Inspections for granting business licenses are by appointment only, but for both those prompted by complaints (from families, workers, or the press) and those initiated by the inspectors themselves, they arrive unannounced. The average inspection lasts about seven hours—from breakfast to afternoon nap—and includes examinations of bedrooms, kitchens, dining rooms, bathrooms, and the hygiene of utensils. If the inspector deems it necessary, visits are also conducted at night. The visit serves to get a feel for the atmosphere of the facility and verify whether residents' personalized plans are being followed or if activities are being carried out. Contracts and records are also requested. The service states that inspectors have compiled a list of approximately 40-50 residences requiring special monitoring, which serves as an internal alert system to maintain closer oversight even after a satisfactory inspection. At the other end of the spectrum, they are monitoring around one hundred centers where no serious complaints have been filed and no irregularities have been detected in previous inspections. It is in these establishments that inspectors find the greatest "cooperation".

Crisis of confidence

The deaths of residents during the first waves of Covid led to a loss of confidence in nursing homes, which came under intense media and political scrutiny. In recent years, complaints from families have doubled, but most do not result in any sanctions. Food is one of the main sources of complaints, but so is the loss of clothing, notes Jordi Sánchez, director of social services at the ombudsman's office, who points to medication errors as the most worrying issue for the organization. For organized families of residents, however, the most distressing problem, aside from the menus, is what they perceive as inadequate medical care due to a lack of doctors and nurses. The president of the 5+1 Coordinating Committee, María José Carcelén, denounces the "non-compliance" and manipulation of figures by some nursing homes. nurses "to reach the required ratios"At this point, the inspectors respond that, ultimately, having a designated primary care center (CAP) in the care homes has helped both to improve care and to reduce medication errors. During the visit, the inspectors check if there are any pills left on the floor after meals to verify that the prescribed guidelines have been followed.

The increase in life expectancy and the way families are organized today have led to a change in the residents. While a few years ago most residents were still sufficiently independent, now more than 80% have dementia or serious mobility problems, and neither the care homes nor the staff are prepared for this new profile. The sector acknowledges this, and for the inspectors, it means that families are looking for a social and healthcare service, which, according to regulations, is not a care home.

ACRA, the association of large care homes, defends the inspectors' actions in monitoring the service and even acknowledges the potential sanctions for infractions, but warns that these are "an absolute minority" and in no case "can they tarnish" the excellent work of the professionals.

Carcelén is highly critical of the inspection process, accusing it of being "complicit" with the care homes, of hiding and filing away infractions or staff shortages. "The people in care homes are people who have rights, and this is not being taken into account," she states.