The hardships of home care: "I work with fentanyl patches for pain"

BarcelonaMarcial González Rodríguez is 60 years old and has been confined to a wheelchair for 42 years. When he was young, he had the idea of climbing a tree and fell fatally into the void in Torre Baró, the Barcelona neighborhood in the film. The 47 Where the houses were built haphazardly on the mountainside, and the views of the city are spectacular, but getting there requires patience. However, every day, Monday through Friday, a municipal home care worker visits his home. She stays for a maximum of an hour and a half. She takes him, washes his body, combs his hair, dresses him, gives him breakfast, and leaves him sitting in his wheelchair until a friend puts him back to bed at two in the afternoon. Three hours later, his sister prepares him a lunch and dinner that serves him until the next day.

One morning, however, the municipal worker didn't show up. "That day, no one got me out of bed, and I had to clean myself with wipes," says the man, who tries to extend the time the journalist visits his home so he won't be alone again. Marcial says he's grateful for this municipal service: "If not, I don't know what I would do." But he also says they make him feel very bad.

When his assigned caregiver is on vacation or unable to work—a situation he says happens often—he already starts to tremble. "In a month, they can send me a different person every day. They've come to wake me up at 7:30 in the morning in the middle of winter, when it's still dark, or at 12:00 noon, even though they put me back to bed at 2:00 in the afternoon," he laments. He also explains that, sometimes, the caregiver forgets her keys to enter his house, and he, understandably, can't get up and open the door. One blunder after another. "They get on my nerves," he says, exasperated.

Amparo Quintana, 57, is one of the estimated 15,000 home care workers in Catalonia. "Today I had six services. They were all elderly people. I washed their clothes, changed their bed sheets, put on the washing machine, hung out the laundry, cooked..." she lists everything she's done, without giving it too much importance. To all this, of course, we must add going from one place to another, from house to house. She works in Sant Feliu de Llobregat. "Some days I travel eleven kilometers."

Amparo has a 66% disability. This is indicated by her Generalitat (Catalan government) identification card, which she shows to prove she's not lying. "I have fibromyalgia and I apply 50-microgram fentanyl patches every three days for the pain." She continues to work because, she argues, someone has to earn money at home. She's divorced and lives with a 25-year-old son with Asperger's and dyslexia who's looking for work but can't find it. With a seven-hour workday from Monday to Friday, she earns less than €900 net per month. "With a pension, I'd earn even less." Her non-contributory disability pension will be €564.70 per month.

Fear of reporting

In February, fed up with everything, Marcial filed a complaint with the Barcelona Ombudsman's Office. "The complaints we receive are only the tip of the iceberg, because few people dare to file a complaint. Both users and workers are highly vulnerable," says the Ombudsman, David Bondia. Some fear losing their services, and others losing their jobs. Bondia believes it is a priority to improve home care services and has already made several recommendations to Barcelona City Council. Last year, the Spanish government approved a national strategy for a new care model that prioritizes home care over residential care. However, this is only in theory. The practice is much more complicated.

Home care (SAD) is a mandatory service within the portfolio of social services. That is, everyone who needs it has the right to access it. It depends on the city councils in municipalities with more than 20,000 inhabitants and on the regional councils in those with fewer. But it is the Department of Social Rights that finances 66% of its costs and, at the same time, receives state funds for this purpose. Last year, it allocated no less than €136 million of the €355 million it transferred to local governments to pay for basic social services. A total of 69,474 people were served.

"The woman who comes from the City Council," as SAD workers are popularly known—almost all of whom are women—does not actually work for the council in most cases. Eighty-five percent of basic social services areas have SAD outsourced, according to a July 2022 study by the Catalan Institute for the Evaluation of Public Policies (Ivalía). In fact, since the Dependency Law was passed in 2006, the number of companies and entities providing this service has continued to grow: there are 569 registered in Catalonia, according to data from the Generalitat (Generalitat). However, the majority of the pie is concentrated in the hands of a few, especially in Barcelona, ​​​​highlights another 2019 report by the Health and Aging Foundation of the UAB.

In Barcelona, ​​the service is provided by the cooperative Suara Serveis, which in 2024 received €50 million from the City Council for this purpose, and the company Servisar Servicios Sociales—linked to the residential giant DomusVi—which received €39.6 million, according to a response from the city council to a Transparency request from the ARA (Argentine Association of Workers' Associations). This year, the City Council is putting the service out to tender again, and everyone is suddenly in a hurry: due to the large volume of business at stake and because the collective bargaining agreement governing the sector has expired, leaving employers and unions unable to reach an agreement. The Department of Labor attempted to mediate last week and has called a new meeting for June 26. The situation of the workers and, incidentally, of course, the quality of the service will depend on the outcome.

To find out what daily life is like at the SAD (Sanitary and Security Services), the ARA (Argentine Association of Autonomous Communities) accompanied three workers during their workday in Barcelona, ​​​​without the company they work for knowing. The day starts badly for one of them: "They didn't even tell me you would come at that time, nor can my husband go for a walk now," an indignant woman answers through the intercom, refusing to open the door. It's the first time she's been to this home because the usual caregiver is on sick leave. And yes, it's true, it might not be the best time to walk a grandparent: it's eight in the morning on an ordinary March day and it's chilly. But she does what she's told.

The controversial time package

The worker has no choice but to stay on the street, sitting on a bench, waiting for the next service: "With the salary I get, I don't have to go to a bar." At least, she consoles herself, she'll be paid for the hour she didn't work. On other occasions, when the user cancels the service with 24 hours' notice, she's equally stuck on the street and on top of that has to pay the company for the time missed, working outside of her working hours. This is what's called "banking hours," which is one of the points of contention between unions and employers.

"It's as if a sales assistant had to work an extra day because no customers have come into the store and she hasn't sold anything all day. What's the caregiver's fault if a service is canceled and she's not assigned another?" asks Jaume Adrover, secretary of social services for UGT Catalunya. The underlying problem is that the administration only pays companies per hour of service provided.

In Barcelona, ​​all SAD workers use the eDomus app, which monitors their working hours, indicates which users they should care for each day, and calculates the theoretical travel time from one address to another. In that case, the app says the journey takes eight minutes. However, the second caregiver, accompanied by the ARA, has already been walking briskly for fifteen minutes and hasn't yet reached her destination. In total, it will take twenty minutes, twelve more than the app calculates. "If this were an exception, nothing would happen," she comments. The problem is that it's recurrent. And the only solution is for the user to have less time on duty or extend their workday. One of the two loses.

At the address, behind the front door, there's a City Hall sticker that the worker must scan with the app to confirm that she's arrived. But no matter how hard she tries, she can't: the app gives an error. Another classic. How desperate, and the minutes keep passing. In the house lives a woman with paralysis in one arm and one leg who can barely walk and who waits patiently to be gotten out of bed. She needs to be washed, dressed, and meals prepared...

"I've already told the company a thousand times that my workday ends at 2:30 p.m. because I have to pick up my son from daycare at 3:00 p.m. But despite this, they always assign me shifts that end at 3:00 p.m. One day I went to a grandfather's house, was there for ten minutes, and then had to leave. The man stayed," says another caregiver who is a single mother. In fact, according to the unions, single mothers, separated women with dependent children, victims of gender-based violence, or foreigners are the women who most often work in home care services. "Most don't know their rights or can't afford to go on strike because earning 50 euros less means they can't pay their electricity bill," explains Montserrat Garcia, a representative of the CGT (General Confederation of Workers' Unions).

Mónica Vázquez Ruiz, for example, is 43 years old, a single mother with a 14-year-old daughter, and works for the SAD (Sad) (Social Development Assistance) in several municipalities in the Maresme region. To get from one town to another, her father drives her and waits on the street for each service to finish. "It's hard to find another type of job where I don't have to work on the weekend. When my father can't take me, I don't know what I'll do," she laments. She earns 900 euros net per month.

Few full-time contracts

Yolanda Roldán Mercedes is Peruvian and earns slightly more: 1,011 euros net per month. She works at Sant Just Desvern, and her work week is 32 hours, Monday through Friday, from 8 a.m. to 3 p.m. She says she requested a full-time job because she is 65 years old and wants to earn the maximum contributions: "They told me I would have to work from 8 a.m. until late at night, with no fixed schedule."

In theory, no more than two hours can pass between one service and the next, unless the company and the worker agree otherwise, according to the collective agreement for SAD workers. And this is precisely what many companies do, according to the unions: requiring the worker to accept this condition in writing. In fact, this is one of the sector's problems: the difficulty of securing a full-time contract because work is concentrated in the morning, when dependents need to be woken up and washed, and in the evening, when they need to be fed and put to bed. This obviously contributes to staff turnover.

The Ministry of Social Rights estimates that, in five years, Spain will need an additional 260,000 caregivers to ensure care for dependent people. In other words, there is undoubtedly a shortage of staff. "There isn't a shortage of caregivers, there are too many scoundrels," says Pilar Nogués, president of the SAD union, who believes there would be enough workers if working conditions were decent. Her union is demanding the municipalization of the service, meaning an end to outsourcing and for it to become part of the multidisciplinary social services team.

"It's all very well to say that everything should be made public, but that's pure demagoguery," counters the director of the State Observatory on Dependency, José Manuel Ramírez Navarro, who points out that at the end of 2023, there were still 296,431 people waiting to be cared for or assessed as dependent. In his opinion, this would be the priority.

Be that as it may, what is most urgent now is to approve a new collective agreement before the Barcelona City Council puts the service out to tender again. Both employers and unions remain entrenched, after more than two years of negotiation. Currently, workers are paid the minimum interprofessional wage, or slightly more. Alonso.

Sources of funding

In fact, Toni Rivero, head of aging consulting and projects at the UAB's Health and Aging Foundation, confirms that "city councils' prices are very tight." "Sometimes I see tenders and wonder how it's possible that administrations set such a low maximum bidding price and yet some companies still apply." Barcelona City Council has announced that it intends to increase the SAD budget by €53.5 million, but has declined to comment until it puts the service out to tender again.

Spain currently spends 0.8% of GDP on the care of dependent persons, a lower percentage than other European countries. "What a country can spend depends on what it allocates to pensions and other services. And Spain spends a lot on pensions," says Sergi Jiménez-Martín, professor at Pompeu Fabra University and researcher at the Foundation for Applied Economic Studies (Fedea), to clarify that the calculation is not that simple. In his opinion, the key is to have "a tax dedicated solely to dependency" or to have "what is collected from inheritances be strictly dedicated to that." In short, the budget "should not depend on whether the politician in power considers it important or not."