The Spanish long-term care system reaches majority of age: A narrative review of evidence and lessons obtained.

BACKGROUND

Spain has one of the highest life expectancies at 65-years-old among OECD countries, yet only half of these years are expected to be in good health. Thus, many older people require support for carrying out activities of daily living. In response, the Spanish government established the Spanish long-term care (LTC) system in 2007.

OBJECTIVE

To review the published evidence from the analysis of the first 18 years of existence of the system.

METHODS

This study adopts a narrative literature review approach, drawing from academic and policy-oriented research on the Spanish LTC system.

RESULTS

The LTC system has improved the wellbeing of its beneficiaries -particularly in terms of health- and has reduced healthcare costs by lowering hospital admissions and primary care visits. However, it suffers from chronic underfunding and design flaws. Financial sustainability remains a challenge, especially due to low central Spanish government contributions and regional disparities. Nonetheless, the LTC system has yielded significant economic returns through job creation and increased female labour participation. LTC benefits have also influenced family decisions: reducing savings, increasing the supply of informal caregivers and delaying early retirement. The COVID-19 pandemic exposed structural vulnerabilities, particularly in residential care. Moreover, while the navigation across the LTC system ensures horizontal equity, inequity is documented in the form of providing the benefits.

CONCLUSIONS

After almost two decades of the Spanish LTC system, evidence calls for adequate and stable financing mechanisms to achieve sustainability. It should also expand towards service-based care, integrate with healthcare, and systematically measure quality-of-life outcomes.