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The European Social Network (ESN) has always been committed to a person-centred approach in the provision of care and support in the community. In the face of the impact of the Covid-19 crisis on community health and social services across Europe, ESN’s CEO Alfonso Lara Montero has co-authored a declaration supporting a necessary change in the long-term care model in Spain. While the declaration was drafted against the difficulties faced by care professionals to support the most vulnerable in Spain, which has become one of the most affected countries, the analysis and the proposals made may be applicable to many other European countries.

This health crisis has revealed the inadequacy of care systems to cope with the vast numbers of already fragile and vulnerable people who have become sick as a consequence of the pandemic. The analysis of this situation should help us identify and assess potential risks to inform future actions in community care. This analysis may include ensuring continuity of care, coordination between services but also between health and social care systems, addressing who is responsible for what, and balancing values and care with people’s health and freedoms.

In the pursuit of a more effective and supportive model of care in the community for the most vulnerable, the authors of this document would like to share the following considerations.

Regarding domiciliary care

  1. Ensuring that people can be supported at home

This crisis has revealed the lack of visibility and means, such as protective equipment, for practitioners working in domiciliary care.

  1. Ensuring comprehensive and integrated care

Vulnerable adults should be provided with the possibility to stay in their own homes and communities for as long as possible. Therefore, it is crucial to advance a comprehensive and integrated model of domiciliary care that integrates and coordinates the stakeholders involved in adult social care: families, general social services, domiciliary care, primary and secondary healthcare, the home and care employment sectors, personal assistants, volunteers, local services and community organisations. Ensuring the sustainability of such model will require specific investment if the system is to respond to the wishes of people and their families and to prevent the implementation of institutional solutions.  

Regarding residential care

  1. Acknowledging, caring for, and training practitioners

We acknowledge and value the heroic efforts made by care workers in care homes, carrying the responsibility of protecting older people from a disease to which they are uniquely vulnerable. Huge risks are being taken by care workers in the absence of adequate protection and more carers falling ill. It is essential to support and care for care workers, acknowledging their work is essential, supporting them with training in integrated social and relational skills, investing in the necessary equipment for carers and improving organisations.

  1. Investing in sufficient and adequately trained carers

There is a shortage of care workers, who are often poorly paid. This is not new, but this health crisis has shown more than ever that addressing this should be made a priority. While inadequate pay is not the only reason or condition to assure quality, the current mindset needs to change.

  1. Ensuring everyone’s right to public health care

People who become ill in care homes have the right to public health care, whether primary or specialist health care, and should not be deprived of this right because of advanced age or their degree of disability. 

  1. Transforming the residential care model

There needs to be a change in the way older people and people with disabilities in need of support are being housed. Some countries have opted for a split model of housing and care. The housing model ensures individuals’ own space, privacy and person-centred support, streamlines public spending, and distances itself from the traditional model of institutional care. 

  1. Ending institutional care

It is hard to imagine a living arrangement more poorly suited to a highly communicable disease outbreak than one in which large numbers of older people live in close proximity. Therefore, it is crucial to advance towards a person-centred care model that promotes individual choice and support.

  1. Designing environments for a meaningful life

This involves new models of architectural design, organisational and management formulas that are as close as possible to living in one’s home. These models encourage living environments based on guaranteeing privacy, assuring personalised care, reducing staff turnover, and organising meaningful activities per people’s choice and in contact with the community.

Regarding old age and disability stereotypes

  1. Acknowledging that older people and people with disabilities are heterogeneous groups

This involves eradicating stereotypes that promote a distorted, negative and uniformed view of older people and people with disabilities. While aging is associated with decline and there are older people in need of care and protection, many are autonomous and care for their parents, partners and grandchildren. Something similar can be said of disabled people, who are often associated with their disability ignoring their assets, strengths and contribution to society.

  1. Promoting support based on rights and responsibilities

This involves rejecting paternalistic language that argues that society owes older people care in return for their contributions; in virtue of their vulnerability, the respect that society owes to the elderly or the intrinsic value of old age. Instead, the authors think that every individual should be treated alike with their rights and responsibilities.

To sum up, we would like to highlight the need of:

A new model of long-term care

This crisis has revealed the need to review the current model of long-term care to provide responses that are global, adapted to the needs and rooted in the community. Public financing should also adapt to this new reality.

Building communities of care

The current situation can become an opportunity to achieve better care for the people who need it, progressing towards communities of care that commit to ensure that the participation of the most vulnerable becomes a priority.


Co-authored by Alfonso Lara Montero, Chief Executive Officer at European Social Network