Care for dependents: between vocation and job insecurity

In Spain, the dependent care sector is facing a silent but urgent crisis: there is a shortage of qualified professionals, while demand continues to grow . The accelerated aging of the population— one in three people will be over 65 by 2050 , according to the INE (National Institute of Statistics and Census)—is putting pressure on a system that is unable to meet basic care needs. This shortage is due to multiple causes: unattractive working conditions (low salaries, long hours, temporary contracts); a low social status of care work—still associated with the domestic and female sphere—and vocational training that, although available, does not always adapt to the day-to-day realities of nursing homes, day centers, or home care.

For experts, the problem is not just one of quantity, but of qualifications: there is an increasing need for a technical, human, and specialized profile, capable of supporting (and that is a key word) everything that a situation of dependency entails, including complex processes such as dementia, Alzheimer's, disability, or end-of-life.

It's, of course, a vocational profession, but sometimes that's not enough. Alexandra Cortés (47) completed the Intermediate Degree in Care for People in Dependent Situations in 2021 at the Son Llebre Integrated Vocational Training Center in Marratxi (Balearic Islands). At the time, she was running (and still is) a souvenir shop in Mallorca, and although she was offered a job, her personal situation prevented her from accepting it: "Economically, it's not very well paid; the salaries are low, and someone with a family to support can't afford it," she explains in a telephone conversation. "It was worth it for me personally, because I grew a lot as a person, but it's a profession that's not widely recognized or valued," she adds. She continued her training (she completed a Higher Degree in Social Integration) and continues to refuse to give up, hoping to pursue it in the future.

A diverse but insufficient training

The training path for those wishing to work in care for dependent individuals is currently structured at different levels, although not always with the necessary coherence or flexibility. The most recognized route is the aforementioned intermediate vocational training cycle, which qualifies for work in residential homes, homes, day centers, or social institutions. This qualification includes modules on home support, hygienic and psychosocial care, telecare, and communication support, but many professionals point out that it does not always offer sufficient real-life practice or address in-depth issues such as mental health, dementia, or palliative care.

Furthermore, the system includes professional certificates, managed by the SEPE (Spanish State Employment Service) and the autonomous communities, such as the Social and Health Care Certificate for Dependent Persons in Social Institutions or the Social and Health Care Certificate at Home. Although these certificates are a key tool for qualifying people without prior training, their application varies widely across regions and sometimes lacks continuous training.

The recent Vocational Training Law introduced a new grade classification—from A to E—that seeks to organize this offering: from micro-training (grade A) to vocational training cycles (grade D) and specialization courses (grade E), allowing each individual to progressively advance along their professional path. However, the actual rollout of this model is still underway, and many centers are calling for greater coordination between training pathways, the labor market, and the new demands of caregiving.

Support beyond assistance

For Roberto Pascual, the intermediate level of vocational training was a bridge to later studying Social Education at the University of the Balearic Islands. But he also says it helped him empathize with dependent people: "I knew about them, of course, but I wasn't aware of what their situation entailed. You have to go beyond welfare and accompany the person, because there comes a time when you start thinking about how you would like to be cared for." And, like Cortés (a fellow student), he calls for improved visibility and social recognition.

Caring for a dependent person requires a wide range of technical and emotional skills that guarantee an essential mantra: person-centered care. "There are, of course, those related to the physical care of the dependent person (transferring and/or changing posture, hygiene, administering medication, communication, and support with feeding, among others), but also skills related to emotional and psychosocial support, assistance in managing and organizing the environment, and coordination with other services" involved in caring for the dependent person, recalls Margalida Poquet, director of the Son Llebre CIFP.

Poquet emphasizes the importance of so-called soft skills in supporting the person receiving care: empathy, active listening, and the ability to establish secure bonds are, in his opinion, just as necessary as the other skills. "For example, showering a person requires a thorough understanding of existing techniques, but it's essential to implement them while ensuring physical and emotional safety for the person, because it's an extremely intimate act where the person feels very vulnerable."

This person-centered care involves comprehensive support that takes into account both the family and community environments. For Amalia Rivas, a gerontologist specializing in the care of caregivers, "it's essential to address their relational world, because being dependent doesn't mean they stop being a person: they still have tastes, rights, relationships... You have to be attentive to who they are and what they are like, in order to adapt your care to that person." "Caregivers must know how to connect all of this with family relationships: children, nieces, nephews, grandchildren... These are relationships that must be strengthened for the benefit of the person. And that requires professional training to know how to do it," she adds.

From a healthcare perspective, it's important for caregivers (or rather, female caregivers, given the existing gender gap) to have basic knowledge that will enable them to deal with any illnesses they may encounter, such as high blood pressure or diabetes. And, of course, they should refer the person to healthcare professionals whenever necessary, "because unless you're a nurse, you're not going to reach that level."

Caring for the caregiver

According to the experts consulted, the well-being of caregivers remains largely absent from the public conversation about the long-term care system. The endless hours, high emotional and physical demands, rotating shifts, and temporary work make this profession one of the most prone to burnout.

“There is a significant emotional and physical impact that is ignored and unrecognized at the institutional level,” warns the director of Son Llebre, who denounces the widespread lack of supervision and emotional support programs. She says there is too much reliance on the vocation of caregivers, without providing them with real tools to avoid burnout and sick leave due to mental health problems. Solutions exist, but they require commitment: from training in ergonomics and psychosociology to implementing support groups, self-care programs, and organizational measures that recognize the caregiver's right to be cared for.

Rivas, for her part, emphasizes that this support is equally urgent for informal caregivers, often family members who take on the task without prior preparation, resources, or guidance. "There are many informal caregivers who find themselves in this situation overnight, and they don't really know how to do it, what to do, and much less do they feel supported in this process," she points out.

Ensure professional care

Until 2008, caregiving work in social and healthcare facilities (mostly senior residences, day centers, and other centers for people with disabilities) did not require formal training in Spain. This meant that, in practice, many people accessed these positions without formal qualifications, relying solely on their previous experience or specific training offered by NGOs, city councils, or private academies, with no official validity or consistent content. Therefore, the most common profile was that of women who came from the domestic sphere, with precarious, poorly paid jobs and no clear career path.

The passage of the Dependency Law in 2006 marked a turning point: for the first time, the right of dependent persons to receive professional, quality care was recognized, requiring the system to regulate and certify the competencies of those working in this field. This regulation did not come until 2008, with the creation of the professional certificate in social and healthcare care, paving the way for a professionalization that the sector had been waiting for decades and that was gradually being implemented. Thus, holding the professional certificate in social and healthcare care for dependent persons in social institutions—or its equivalent, such as the intermediate level—is mandatory in all public or private residential centers starting January 1, 2023.

On the other hand, the Ministries of Education and Equality are already working on developing a new intermediate vocational training qualification focused on caring for non-dependent individuals . This training aims to dignify and professionalize the care provided to minors and non-dependent adults at home, thus contributing to improving their working conditions and reducing the gender gap.

However, the qualification has generated some controversy among nursing associations, which believe it could overlap with their own professional competencies. "In my opinion, this is because the person-centered approach to care has not yet been fully embraced," Poquet argues. "Yes, there may be situations in which different professional profiles perform similar tasks, which can lead to discomfort (...), but we believe the solution lies in reclaiming the professional role of the caregiver as a separate entity, dignifying it and demanding clearer and more unambiguous regulations."