Stay updated on our activities

SOCIAL SUPERBLOCKS: proximity home care services

Back

Countries

Spain

Policy areas

Efficiency of the state organisation and service deliveryHuman resources management

Organisation name City Council Barcelona

Contact person: LLUêS TORRENS MéLICH

ltorrens@bcn.cat

Home Care Services (HCS) is a basic social service based on the Social Services Law. Barcelona Municipal Institute of Social Services is responsible for implementing and offering these services. The service’s basic goal is to improve people’s quality of life, by increasing their possibilities of keeping their home and by boosting or maintaining the independence of individuals being cared for as well as their families. The service is aimed at individuals and families with difficulties carrying out their daily life activities, integrating socially or living independently:

  • individuals in a situation where they lack independence in carrying out basic daily life activities or with cognitive deterioration;
  • individuals or families in a situation of social risk caused by lack of capacity for or habits in self-procurement and relating to their surroundings. It may also be a lack of capacity for or habits in family and home organisation, caring for family members – especially infants – and relating to their surroundings;
  • individuals and families in vulnerable situations.

HCS consists of offering support for daily activities carried out for the individual’s or family’s home. In some cases, the services including support for home cleaning and maintenance.

2018 saw more than 24 000 users, with the City Council spending over €83 million on the HCS. The direct employment generated by the service consists of more than 5400 family care workers, cleaners, and coordination and support staff. It is the outsourced municipal contract that has created work for the biggest number of people, and the second biggest in terms of financial volume.

Home care work (Servei d’Ajuda a Domicili – SAD) is characterised by:

  • a workforce that is over 90 % female and around 50 % of immigrants;
  • a high degree of job insecurity in terms of part-time and fixed-term contracts: 45% temporary contracts, 72 % part-time contracts (days out of 30 or fewer weekly hours);
  • low wages, almost all below €1000 a month net in 14 payments and many well below €800;
  • high levels of absenteeism and staff rotation, leading to an insufficient degree of professionalism in the sector.

By means of an invitation to tender, Barcelona City Council contracts services from companies and social entities with experience and solvency in home care. The organisation of the service and the work carried out by suppliers involves the allocation of services and tasks to professionals through a fixed schedule of specific days and hours, and by assigning each user a contact worker. Fulfilment of hours and presence at home are the two central elements of the service.

Data gathered points to the sustainability of home care improvement through the pilot project compared to the situation before its launch. When it comes to users and service, the pilot projects appear sustainable.

With the same number of service hours or service intensity per user, users appear more satisfied. The challenge of the growing population of senior citizens leads to the belief that it is necessary to make the most of this proximity and team-based care model, to provide more ongoing and stable care for older people. The community created should also become something that provides care consistency for older citizens. The external signs resulting from proximity care, stability and continuity of the team of professionals, and the personal relationships beginning to form, indicate that users are more and better connected in ‘superblocks’, suffering less loneliness and isolation. This community helps create sustainability.

In relation to work, the pilot projects are more sustainable.

Time spent directly working with users increases as travel time decreases. Team members have full or almost full-time contracts and almost all of them are hired permanently. The model demonstrates that turnover will be reduced. In terms of salary costs, the increased job security seems to increase initial employment costs (better salaries), but should in turn reduce additional costs, both internally and social costs associated with job insecurity (health, unemployment costs, reassignment, etc.). In financial terms the service is being examined as to whether, given that it is of greater value, it will need to have a higher invitation to tender cost in the future. This was anticipated to be the case, but until the 2020–21 invitation to tender was approved, the data was not available. The increased service price is justified by the greater social value of the service.

The model can be adapted or adopted by other councils responsible for home care services. Reducing the size of the intervention area into social superblocks will allow the model to be replicated with any population size, particularly those of more than 6000.

During the exploratory stage, the service diagnosis was elaborated and shared within the council and with the main sector stakeholders. It is likely that the solution to most cases of dependency in the city will need to be home care, as it is predicted that by 2030, 400 000 people over the age of 65 will be in need of care. There are only 13 000 spaces in residential care, with 6000 people on the waiting list. The concept of care apartment blocks or distributed residences is emerging, in which each home is the equivalent of a room in a care home.

Benchmarking has been performed and, from among the best practices identified, the Buurtzorg experience and new models of organisational management proposed by Frederic Laloux are being explored more detail. Buurtzorg is a Dutch organisation that specialises in managing home care services, based on the work of self-managing teams linked to proximity areas. Although the workers at Buurtzorg are healthcare professionals (nurses) and the context is not the same as for home care, the aim is to adapt the home care model for Barcelona’s Servei d’Ajuda a Domicili (SAD – Home Care Service).

Also interesting

2023-24
Federal Ministry of Finance (Bundesministerium für Finanzen, BMF), Federal Chancellery (Bundeskanzleramt, BKA)

The Once-Only Principle in the Family Allowance

Context The Once-Only Principle ensures that citizens and businesses provide data to public administration only once, while public bodies exchange this data when requested and in compliance with the relevant…
Austria
Administration of revenuesDigital Government
2023-24
Ministry of Interior

Automated decision-making as a building block for public administration reuse: ‘Development of the Automatic Public Administration Decision-Making (automatikus közigazgatási döntéshozatali – AKD) System building block’

Context The Government Decision 1328/2020 on the adoption of the medium-term National Anti-corruption Strategy and action plan for the period 2020–2022 required the development of an automated system to improve…
Hungary
Digital GovernmentEfficiency of the state organisation and service deliveryEthics and integrity (including procurement, transparency, anticorruption, anti-fraud, organised crime, internal control)Human resources managementState governance and better policy makingSustainable development
2023-24
AMA – Administrative Modernisation Agency

Mosaico

Context The Portuguese government, through the Agency for Administrative Modernisation (AMA), is committed to modernising public services and improving citizens’ experiences. This effort is driven by the recognition that public…
Portugal
Small and medium-sized enterprises, social enterprises and other sectors
See all articles