Nursing homes are one of the most critical areas of care in the coronavirus pandemic, making them one of the most dramatic points of struggle in the current period. The situation in Madrid is especially dire, revealing the magnitude of the problem with absolute clarity. As of 26 March (the day on which the latest data was released), 50 percent of the 2,090 deaths registered in Madrid came from nursing homes. This compelled the army to intervene, which at once began to search for corpses abandoned in these homes. Today, La Sexta cited a shocking report according to which 3,000 of the 10,000 deceased in the entire country are old people coming from said residences. We interviewed Nuria, LAB union representative from the Álava residential sector, about this situation.
How did this happen?
Nursing home residents, it is true, are far more vulnerable. They are of old age, dependent on care in many cases, and have a lifetime of medical problems. I recall, for example, workers exposed for years without protection to asbestos or other substances in their professional lives, causing severe respiratory problems. The spread of the coronavirus will be lethal to them. But this vulnerability is only part of the reason why nursing homes are being decimated in this pandemic.
Residences across the country are largely privately owned. Do you have proof that this is the case?
It is my understanding that indeed, according to the data provided by the IMSERSO, of the 5,457 residences in Spain, about 75 percent are privately owned. This means that there are more than 4,000 centres in the private sector, as opposed to about 1,400 public ones. The drive of companies in the sector to acquire new residences is notorious. There are several groups such as Sanitas, Caser, Vitalitas, Colisee, Domus VI (a French group that manages 198 residences with 25,000 residents), whose sole activity is buying centres. According to the DBK consultancy, 4.5 billion euros worth of transactions were made in the elderly care business in 2019, a number that continues to increase.
In Álava and in the Basque Country, is the situation similar to the rest of the country?
In Guipúzcoa and Vizcaya the residences are larger, most of them house over 100 residents, and the majority are private or combined. They also have better working conditions, with 200 fewer hours of work per year and a monthly pay almost €500 than in the rest of Spain. In Álava, there are several public residences and a lot of private ones. 85 percent of the private residences have less than 50 rooms and among those, half have less than 30 rooms. This number includes communal houses. The large residences are managed by the companies mentioned above and the small ones or the communal houses are small companies or family businesses.
What are the working conditions in public residences and especially in private ones?
In public residences there is every usual profession, such as doctors, physiotherapists, social workers, nurses and so on. They must all have a degree, and work in the areas they are trained for. The salary of a geriatric care nurse, working long shifts, is around €2,000 per month.
In private residences, a distinction must be made between those that have state-subsidised places and those that don’t. The former require a degree, whereas the latter ask only for professional accreditation. In most cases, they don’t even check for that!
Private residences of more than 50 residents typically have all the usual professions. Of course, with fewer contract hours and a higher workload than in the public sector, this has its consequences. The nursing assistant, for example, will often be the one who administers the medication, because the nurse does not have time due to the high patient-to-nurse ratio.
In private residences with less than 50 rooms, doctors and nurses, if their services are offered at all, are hired on an hourly basis. They are contracted for fewer hours which means the services are worse. Some care homes do not even have daily services.
In communal houses, with a maximum number of 14 residents, the services are even worse. The nurse from the nearest health centre usually visits.
The workers in the residences are mostly women, in many cases immigrant women, and their contracts and conditions are bordering on illegality. However, they cannot refuse. Their families here and their families in their home country depend on that money.
The salaries of female workers in the private sector in Álava amount to 997€ per month, pre-tax. In some months they may be paid more, but not much more. They can work no more than 1,792 hours per year.
What is a typical working day like at the residence?
It is very intense. You have to get up, clean, shower, medicate the residents, make the beds, take the residents to the bathroom, first meal shift with the bedridden, second meal shift with the physically able. We continue like this in the afternoon, nonstop until dinner. At night, 90 percent of the time, there is only one person on shift. They do the laundry, iron clothes, clean the common areas, and twice per shift make rounds and help change the residents’ posture (move them in bed or from bed to chair) if they have booked in for it, prepare breakfast so that you only need to add milk. It might not seem like much on paper, but in many private residences work begins at 7am, when many residents start to wake up, and there are only two people to help the 20 to 30 residents get up and clean. In comparison, public residences have 6 or 7 workers to do the same job.
Ana Sastre, ELA delegate vividly describes her work to El Salto [an alternative newspaper in Spain]: “Our daily work begins with stress” – she complains – “we have 15 minutes per person, in that time you have to lift the blinds, help them wake up, say good morning, get them up, take them to the toilet, clean them, dress them; and in the case of men, shave them. We are always running around and the magic word is: ‘wait’.”
How is the coronavirus pandemic affecting you in your work, both in residences and in the domestic care service?
In both sectors it has become clear that privatisation has only made these sectors more precarious. The ratios – number of residents per worker – make it very clear. The centres have a greater workload since it is necessary to exercise extreme caution and hygiene, while staff numbers stay constant or even fall, since the workers are getting sick and in this pandemic situation there are no workers available. The protocols are very generic and there are no material means to combat the contagion. The clearest example is the Sanitas private residence where 18 residents have died and dozens of relatives and workers have been infected.
In the Domestic Care Service (Servicio de Ayuda a Domicilio, SAD), it is even worse since they go from house to house and only have one or two protective gowns, a set of shoes and some vinyl gloves to go around every house. Yesterday a company distributed paper masks, about eight single-use units, to be used and reused. Other companies don’t even have that.
If the situation of precariousness and overwork for years has caused mobilisations to dignify our working conditions, and with it residents’ living conditions, this pandemic is revealing that precariousness and the absence of protective materials have deadly consequences for the elderly, the workers, and our families.
How does this situation affect female workers?
Women workers in both sectors are scared. They are afraid of getting infected and of infecting other people, whether they are residents or their families. I want to underline the great concern that they convey due to the responsibility they assume doing precarious work, without proper security measures.
There are residents who have been infected, have even died, but when a person is well taken of, and this happens, you do not feel guilty since you have done everything you could. You are sorry, but you do not feel guilty about that death. But right now the carers are overworked, exhausted, and they do not have access to PPE. When the people they are meant to take care of get sick or die, they feel guilty. They were telling me this last week, they call me crying because of the guilt they feel. They are bearing a great mental burden.
Attention to the elderly, who are in a situation of dependency, is a social necessity. What is the price that residents pay per month?
The price is set by the Provincial Council for public and combined residences. Private residences can set the price they want.
There are residences starting from €2,000 per month for a shared room, to €3,000 or more for a single room.
An example of how public money is used for this purpose: Pablo Neruda Residence, is a public centre with private management. The Council pays the company €148.01 plus VAT per day per resident, resulting in an approximate monthly payment of €5,500. A public residence that is well equipped with workers and equipment costs the Council, according to its website, €6,000 per month per resident; a difference of €500 per month. However, the salaries of women workers in privately managed residences like Pablo Neruda, where they serve older people and work longer hours, are €800 less per month. There is no need to comment on the profit this overhead is going towards.
The advocates of care for dependants as a public service claim that the Provincial Council, which has full powers in this area, has not created a single new place in public residences in the last 21 years, is it true?
Yes, it is true. What they do is arrange places in private residences. Even the City Council has reduced rooms, transforming the Arquillos residence into a soup kitchen.
The lack of public places and the high cost for working families leads to the fact that, according to the Dependency Law Observatory, 30.7 percent of the total benefits provided by the Dependency Assistance and Assistance System are for the provision of care in the family environment. This benefit in no case exceeds €500. 18 percent opt for home help service and 13 percent for residences.
This pandemic and its impact on the residences has brought to light a twisted situation that the workers, 90 percent of them women, knew perfectly well and were fighting to transform with the support of the families, the pensioner movement and society. Economic groups and companies that commercialise this social need show contempt for care work, traditionally performed for free at home by women. The struggles such as that of the residences in Vizcaya, after a long strike, managed to take a step forward and dignify their conditions. The Guipuzcoan workers’ long strike has been suspended due to the pandemic, but their continued determination shows that they will achieve their objectives. In Álava, workers are treading the same path towards the struggle.
Those amongst the elderly that have been killed by this pandemic expose the ‘consideration’ that capital and its political representatives have for them. We have heard statements by representatives like Christine Lagarde of the European Central Bank, who have said that the elderly are a problem because we live too long, we collect pensions, we demand public services. In their minds we represent an economic deadweight; because we “waste” resources and we are not productive.
After a life of work, most of the time in poor conditions, we become dependent beings, in need of help. A yardstick for measuring the degree of civilisation and development of a society is how it treats its elderly and children. The guarantee of a rest in conditions worthy of the last stage of life constitutes an inalienable social right. However, capital, with the connivance of its political representatives, has made this social need a very lucrative business that is based on three pillars: the exploitation of women workers, the robbery and mistreatment of the elderly, and the plundering of public coffers. The pandemic has made this sinister business and its terrible consequences visible and exposes all those responsible. Workers and experts are warning that "residential deaths are the tip of the iceberg of a care system that prioritises the economy over the rights of people towards the end of their lives."
As Raúl Camargo, a scholar in this field who was a Podemos deputy in the City of Madrid’s previous legislature, affirms in his interview with El Salto: "Everything that is coming to light now is Dante-esque, but it can worsen even more."
Transfer all residences that have received public money into public hands!
Working conditions and wages in the private sector must be raised to those in the public sector!
Close all private residences that do not meet decent or essential working conditions for women workers, and transfer residents and workers to a public facility!
Create enough public rooms in residences to meet social needs!