Analysing Long Term Care policies. The case of Spain and Sweden

Abstract

We analyse approaches to Long Term Care (LTC) policies generally, using Spain and Sweden as examples. Notwithstanding their differences in, especially, family life, their service coverage is little different, although Sweden relies heavily on municipalities for service delivery, whereas Spain has a more complex administration. A major problem for LTC is to assess needs of older people. Use of macro demographic information top-down often results in catastrofic scenarios. Policies about LTC should also use a bottom-up perspective, with micro information about older people. Bottom-up perspectives suggest less severe consequences of ageing for LTC, by including information about resources and needs, complaints and problems of families and services. Bottom-up knowledge exists among social workers, particularly in less urbanised areas where social services function better; especially in Sweden, less so in Spain. The problem is how to feed the political process with this information. In both countries, the covid-19 pandemic revealed big shortcomings in social services and health care – most of which was known beforehand – and worst in major urban areas. Interventions in both Spain and Sweden proved insufficient, or mis-directed. Regrettably, the pandemic did not change public LTC projections: There is a need for both top-down and bottom-up perspectives in future reforms of LTC, also to reduce family care burdens.