01/2024
Overview of disability in care centres
Survey on Disabilities, Personal Autonomy and Situations of Dependency in Care Centres. 2023
In this number...
Information of persons with disability in Spain is essential in order to meet the needs of this group and implement policies and take action to promote their personal autonomy and improve both their quality of life and social integration.
To do so, knowing what disabilities they have, their present circumstances, and understanding their current social reality is primordial.
In 2020, the INE conducted the Survey on Disabilities, Personal Autonomy and Situations of Dependency directed at the population residing in households, offering valuable, broad-based information on these people.
This overview of disability is complemented by the extension of the study to people residing in care centres, where a high proportion have disabilities. This is why in 2023 the INE conducted the Survey on Disabilities, Personal Autonomy and Situations of Dependency in the following care centre types: homes for the elderly, care centres for persons with disability, supervised housing and long-stay psychiatric and geriatric hospitals.
The INE would like to thank all the informants for their collaboration and provide the general public with its findings.
Disability in care centres
Population with disability in care centres
357,894 people with disability reside in care centres
In 2023, of the nearly 380,000 people residing in care centres, 357,894 stated having some type of disability. Most of these people live in a home for the elderly.
Long-stay psychiatric and geriatric hospitals have the largest percentage of persons with disabilities among their residents (96.0%), while those living in supervised housing record the lowest percentage (86.6%).
What portion of the population do they represent?
In Spain. 7.4 of every 1,000 inhabitants are persons with disability that live in care centres. This rate varies by autonomous community, with Castilla y León (18 per thousand inhabitants), Aragón (13.2) and Asturias (12.9) having the highest rates.
On the opposite end of the spectrum we find the autonomous communities with the lowest rates of persons with disabilities in care centres: Andalucía (3.8 per thousand inhabitants), Murcia (3.9) and Canarias (3.9).
Note that the highest rates correspond to regions with the oldest populations.
By disability group
Most prevalent disabilities
Disability is determined by the limitations that these people find in their daily life. In accordance with the International Classification of Functioning, Disability and Health, eight disability groups have been researched: Sight, Hearing, Communication, Mobility, Learning, knowledge application and task development, Self-Care, Domestic Life, Interactions and personal relationships.
The most frequent disabilities among persons with disability are related to basic activities of daily life: self-care, domestic life and mobility. All types of disability affect women more than men.
The most frequent problems in personal care
74.3% of these people have major difficulties washing or drying their whole body, 69.6% state that is hard to follow their doctors’ prescriptions, and 64.3% find it difficult to get dressed or undressed. These problems generally accentuate with age.
How do they rate the aid they receive?
95.6% of persons with disability related to personal care receive satisfactory assistance. 91.3% of persons with mobility problems and 89.3% of persons with learning disabilities also report to be very satisfied.
The greatest lack comes from persons with hearing or visual disabilities, where approximately one in four state they have no aid and need it.
Ageing and disability
The ageing population of Spain is a phenomenon that has a great deal of social and economic consequences, one of which is the increased number of persons with disability, as age is a determining factor.
In fact, half the persons with disability residing in homes for the elderly are over 85 years of age.
More women than men
Two in every three people with disability who live in centres are women.
Under 70, the number of men with disability surpasses that of women, but above this age the trend inverts and the number of women surpasses that of men. These differences become even greater the older they are. For example, in the case of people 85 and over, 3 in every 4 are women.
The importance of aid
96.3% of persons with disability living in care centre have some type of technical or personal assistance.
Elements such as wheelchairs, canes or hearing aids (technical aid) reduce the severity of the disability, much as when care or assistance is received from other people (personal aid).
81.8% of people would have complete disability if they did not have any type of aid; this percentage falls to 56.0% when they do receive aid. The total severity falls in all types of disability if aid is received.
Disease and health status
How do they perceive their state of health?
When we asked persons with disability residing in care centre how they rated their state of health, 42.9% reported that it was good or very good, 39.4% noted it was average, and 17.7% rated their state of health as poor or very poor.
Differences were observed according to the type of care centre where they lived. Persons who lived in supervised housing where the ones who best rated their state of health, while those in geriatric and psychiatric hospitals considered they had a poor state of health.
What chronic diseases do they suffer from?
The most common diseases were osteoarthritis and diabetes. Osteoarthritis affects 34.1%, women (40.4%) more than men (22.4%), whereas 21.3% suffered from diabetes, affecting both sexes equally.
In addition, 15.6% of persons with disability who reside in care centres report that they suffer from chronic depression and 14.6% chronic anxiety. The age group most affected by these is the 65 to 79 bracket, in which one of every five persons are diagnosed with chronic depression and one in six with chronic anxiety.
The prevalence of the most common diseases also differs according to type of care centre. Schizophrenia is the most frequent disease among persons who reside in long-stay geriatric and psychiatric hospitals, epilepsy among residents of centres for persons with disability, and osteoarthritis among persons living in homes for the elderly and supervised housing.
Situation of persons with disabilities
Accessibility
Accessibility issues
A total of 77,229 persons with disability who reside in care centres have difficulty functioning inside them due to the existence of barriers or the lack of adaptations. The place they find most difficult to use is the bathroom (some 20.7% of persons with disability have difficulty).
When they go outside the centre, 27.9% of persons report having difficulty entering or leaving the care centre itself, while 47.9% experience accessibility issues in transportation, buildings or in the public streets.
Those aged 80 and over are those who experience the most accessibility issues.
Discrimination
Most do not feel discriminated against
94.4% of people report they have not felt discriminated against in the last year due to their disability. However, 18,031 persons with disability who reside in care centres have felt this sensation, with 4,500 of them feeling this often or constantly.
It is mainly in social relations, social participation, and leisure and cultural activities where they denote this discrimination, regardless of age. People under 65 also have this perception to a large extent in transportation and people 65 and over in healthcare.
The perception of discrimination is more accentuated in those persons with disabilities related to social interactions, learning and communication.
Free time
How do they spend their free time?
Doing free time activities is important for people who live in care centres, which is why the survey inquires as to what they do or like doing in their free time.
84.9% report doing some sort of activity. The most active are those who live in supervised housing (98.6%), while the least are those living in geriatric and psychiatric hospitals (81.6%).
As far as their hobbies are concerned, we find differences between men and women. Although both like watching television and getting together with other people inside and outside the centre, the men prefer to take physical exercise, such as walking, or listening to the radio, while the women prefer to go to workshops or courses and take arts and crafts classes.
The type of disability limits the option of being able to do activities during one's free time. This limitation affects people with social interaction and relationship problems, communication and learning problems to a greater extent.
How do they deal with new technologies?
29.4% of persons with disability residing in these care centres state they have no problems in using a mobile phone, computer or ATM. This lack of difficulty increases among people from 65 to 79 (38.4% have no problems) and those 80 and over (24.9%).
People having problems related to communication, social interaction and personal relationships are those who find it hardest to deal with new technologies.
In general, they have frequent contact with their friends and family
Most persons with disability residing in care centres are in contact with their friends and family, although not all with the same frequency.
The people most visited or those who most meet with their loved ones are those aged 80 and over, 28.4% of whom see their friends or family every day or almost every day and 46.3% at least once or twice a week. On the other end of the spectrum are the 2.8% of people this age who never see their friends or family and the 8.7% who see them less once a month.
Those who live in residential centres for persons with disability are the one who least frequently see their families, with just 4 in every 10 seeing them every week.
Contact with friends and family is also kept up by telephone. Half of them report talking by phone to their families every week, and even one in 4 doing so on a daily basis. However, this form of communication is not viable for 33.9% of persons with disability living in care centres.
Most people positively evaluate the frequency of contact with their friends and family, with 74.3% considering it to be appropriate.
Personal autonomy
Level of limited personal autonomy
Old age, its disabilities and the organisation of the centre itself have an influence on taking decisions related to personal autonomy.
Out of the 357,814 persons with disabilities residing in care centres, only 8.2% decided what and when to eat, 19.7% decided when to wash themselves and 23.0% when to go to bed and get up. These persons have greater autonomy to decide how and with whom to spend their free time (59.1%) and how to decorate their room with personal items (51.4%).
Other aspects are also limited, such as having the autonomy to take decisions as to how to administer their own money, as only 3 in 10 do so, and regarding their clothes, approximately half decide what to wear.
In general, it is people aged 80 and over who have the most limited level of autonomy, but there are some exceptions, such as when it is necessary to decide who to share a room with, in which case it is people aged 6 to 64 who are who have less decision-making power (only 16.0% do so).
People with disabilities who live in supervised housing participate to a greater extent in decisions related to their personal autonomy than those who live in other types of centres; on the other hand, people with a lower level of personal autonomy tend to reside in long-stay hospitals.
The services they receive
Personal care
They also receive extra care not provided by the centre
Nearly half of persons with disability who live in a care centre say they receive extra personal care not provided by this centre. Among those who do not receive this care, 2.8% declare they would need it.
Seven in 10 who receive outside care do so from hired personnel, and to a lesser extent, from a family member (23.1%) or social services from non-public entities (4.6%). Lastly, there are very few who receive this care from friends.
Nearly all of the persons with disability residing in care centres (95.8%) feel satisfied with the care provided by their own centre or by external personnel and consider it to be sufficient.
Services
Services available in homes for the elderly and care centres for people with disabilities
Almost all of the people who live in homes for the elderly and care centres for people with disabilities have personalised diet control, activities to promote autonomy, rehabilitation, cognitive stimulation, occupational therapy, speech therapy and physiotherapy, in addition to assistance with activities of daily living.
Other services are adapted to the profile and needs of residents, for example, 94.9% of people living in senior centres have medical or geriatric care, while this percentage is 68.6% among residents in care centres for people with disabilities. Psychological or psychiatric care is more common in care centres for people with disabilities (92.4% of people have it) than in homes for the elderly (74.7%).
Registration
Are they registered as residents in the centre?
The municipal registry is an administrative record that is of great importance so that registered people can have access, with all guarantees, to the use and enjoyment of public services of education, health and social services in a given municipality, and to the exercise of the right of suffrage, among other aspects.
Every person who lives in Spain is obliged to register in the register of the municipality in which they habitually reside and must state their habitual residence.
The questionnaire addressed to centres asked whether their admission requirement calls for the mandatory registration of their residents.
23.4% of the centres affirm that their residents must register when they are admitted, with this percentage being higher in public centres (37.2%) than in private centres (19.0%).
The highest percentage is found in centres for people with disabilities, where 31.0% require mandatory registration for their residents. It is worth noting the percentage of public supervised housing that has this requirement (43.2%).
How much do they spend each month on their disability?
The monthly cost of the residence, medications, additional services, etc. represent an expense for persons with disability. This expense increase with age, so the highest expenditure is made by those aged 80 and over, where 33.8% spend between 1000 to 2000 euros a month and 17.5% over 2000 euros. On the other hand are the 19.0% of people of this same age bracket who have no expenditure.
Services in supervised housing
Supervised housing establishments also offer different services to their residents. 86.4% of these people have 24-hour care, 85.2% have access to activities that foster their autonomy and learning and 83.7% have the option of doing cultural or leisure activities.
The least frequent services in supervised housing are hairdressing and chiropody (only 29.7% have them), as well as medical or geriatric care, available at 32.6%.
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