Spain: Older people in care homes abandoned during COVID19 pandemic

A new report by Amnesty International Spain, Abandoned: The lack of protection and discrimination against older people in care homes during the COVID-19 pandemic in Spain, reveals that the measures taken by the authorities to respond to the COVID-19 pandemic in Catalonia and Madrid have been inefficient and inadequate and have violated at least five human rights of the care home residents.

As of 15 November 2020, 40,749 people had died from COVID-19 in Spain according to data from the Ministry of Health. At first, several studies estimated that around 70 per cent died in care homes. At present, the central government is expected to publish a report according to which this percentage would be between 50 and 47 perrcent.

I live 300 metres from the care home and every time I looked out onto the balcony it was terrible to know that my father was dying so close and I couldn't hold his hand, say goodbye to him
Elena Valero whose father died in a care home

"In care homes, the right to health, life and non-discrimination of the older people has been violated. Furthermore, the authorities' decisions have also had an impact on the right to private and family life and the right to a dignified death," said Esteban Beltrán, Director of Amnesty International in Spain.

The denial of the right to health to older people is strongly linked to austerity measures and under-funding of health care in Spain. The decade of health and social cutbacks has undermined the public health system, deteriorating access, affordability and quality of health care.

The effects of the dismantling of the public health care system have been felt in Madrid and Catalonia in the care of older people in residential homes during the peak of the first wave of the pandemic (in March and early April) in several ways: on the one hand, the lack of protection for the staff working there, who were not provided with Personal Protective Equipment (PPE) or PCR tests. And on the other hand, many of the care home residents did not have adequate health assistance, were excluded from referrals to hospitals across the board and did not receive the assistance they needed in the care homes either, despite the "medicalisation" announced by the authorities. In addition, many care home residents have been virtually cut off from the outside world and their families for weeks on end.

Care homes are not car parks for elderly people
Estaban Beltrán, Amnesty International

"A health emergency is no excuse for not providing adequate care for older people. Care homes are not car parks for elderly people. Human rights, including the right to health, cannot depend on the degree of dependency. The authorities must protect them," said Estaban Beltrán.

Too little, too late

Despite some improvements in certain areas in recent months, some of these human rights concerns regarding older people are ongoing and continue in the second wave of the pandemic we are experiencing. Family visits are still not fully guaranteed, and in practice they continue to depend on the decision of individual care homes. In addition, the provisions in the regulations in the Madrid and Catalonia referral protocols, which recommend treating older people in the care homes and not transferring them to hospitals, proved discriminatory and have not yet been changed. Furthermore, adequate measures to strengthen the staffing levels to meet the needs that may arise in light of the risks of high pressure on healthcare are yet to be taken.

"We did not prepare ourselves adequately, we believe that there was scientific information from other countries to understand the significance and seriousness of the situation," explains the deputy chairperson of the Spanish Society of Geriatrics and Gerontology (SEGG), who also says that "we believe that if measures had been taken earlier, they would have made it possible to prevent the spread of the virus to many care homes so quickly. We should have been able to make progress in informing, training the teams, we should have somehow been better prepared".

The measures adopted by the Autonomous Community of Madrid and the Government of Catalonia (Generalitat) were developed and implemented ineffectively and failed to provide adequate access to health services for older people living in care homes. The Community of Madrid and the Generalitat took different measures, unevenly and without clear criteria of intervention or success thereof and failed in their implementation. Moreover, neither administration adopted alternative measures to ensure adequate medical assistance for care home residents.

The combination of lack of personnel, resources and the forced isolation of care home residents due to suspicion of COVID-19 produced a clear deterioration in the care home residents
Amnesty International

The lack of response from the authorities is at odds with the tremendous effort made by health and care home staff during these months, despite the inefficient measures and lack of resources. Thanks to their tireless effort and dedication, the situation of many older people in care homes has been more humane and, in some cases, they have been able to receive better care.

Unprotected and under-resourced staff

The virus spread very quickly in care homes because care workers are in constant contact with care home residents and they did not have protection. This lack of protection also led to a large number of staff casualties, which has had an impact on the care of older people in care homes and on health care management.

Diana, a worker at a public care home in Madrid, says that when the pandemic began in mid-March, "as they didn't give us PPE, we decided to make our own PPE, out of fortune or glory, gowns with rubbish bags, tights, plastic caps…we didn't have any kind protection”.

Right to health, life and non-discrimination violated

The practical decision not to refer sick older people to hospitals was generally implemented in an automated manner, across the board, without carrying out individual assessments. In Madrid and Catalonia, this practice was carried out through different screening mechanisms. There were elderly care home residents in need of medical care who could not access adequate treatment of possible COVID-19 or other pathologies they were suffering from either in the hospital or in the care home, despite what the authorities announced. In both Autonomous Communities there were times when no hospital admissions were made, and the few referrals that did occur were the exception and sometimes fatally late. This discrimination seriously undermines their rights. Amnesty International has also collected testimonies that showed the obstacles that also existed on the part of the emergency services for health transport (SUMMA and SEM).

"The combination of lack of personnel, resources and the forced isolation of care home residents due to suspicion of COVID-19 produced a clear deterioration in the care home residents, not only physically but also emotionally. We have documented cases of care home residents who arrived at the hospital suffering from dehydration and malnutrition, in a very bad condition," said Estaban Beltrán.

Right to private and family life and a dignified death denied

At the height of the pandemic, care home residents were confined to their rooms for long periods, sometimes for several weeks at a time. The restriction that resulted from the de facto confinement in care homes accompanied in most cases by a lockdown in their rooms for an indefinite period, added to the lack of effective supervision by the national (Public Prosecutor's Office) and regional authorities (inspection services) meant that the rights to private and family life of older people were violated simply because of their place of residence.

Elena Valero lost her father in March in a care home in Madrid. "He was not referred to a hospital despite being seriously ill. He was dying for four days. In desperation, I spoke to the doctor to get a referral, but the doctor told me that they had been forbidden to refer to hospitals those sick in care homes, that they could only put him on oxygen and palliatives until his body could take it. It was awful because I live 300 metres from the care home and every time I looked out onto the balcony it was terrible to know that my father was dying so close and I couldn't hold his hand, say goodbye to him.”

It is urgent to take appropriate measures to get over this second wave

In this context, and in the face of the second wave of the pandemic, the authorities, particularly in Madrid and Catalonia, must take urgent action to ensure that any decision to combat the pandemic respects human rights, particularly the rights to life, health and non-discrimination of older people living in care homes.

In the short term, the autonomous communities need to ensure that decisions on health care in care homes are made on the basis of individual assessments. Any provisions in the referral protocols of Catalonia and Madrid which may lead to discriminatory measures should be removed now. In addition, regular contact between family members and care home residents must be guaranteed.

In the longer term, the government needs to take forward a national law that sets a standard for care homes guaranteeing the rights of older people living throughout Spain. Likewise, the Public Prosecutor's Office, and especially the Prosecutor of the Chamber for the Protection of the Disabled and the Elderly, must closely monitor the situation in care homes and drive accountability investigations when abuses or irregularities occur. A decisive commitment to the public health system is also necessary to guarantee equality, meaning a greater investment of resources.

Web action at www.actuaconamnistia.org

Amnesty International has launched a web action targeting the Departments of Health and Social Affairs of the Autonomous Communities in its online activism centre www.actuaconamnistia.org to ensure that concrete measures are urgently implemented to protect the human rights of older people living in care homes.

Background information

According to data provided by the Autonomous Community of Madrid, from 8 March to 1 May, 5,828 people died with coronavirus or compatible symptoms in care homes. This represents 43.46% of the total number of deaths to that date in the Community of Madrid (the data is not broken down either by age, gender and/or disability).

In Catalonia, according to data from the Catalan government, from 1 March to 15 November 2020, 7,045 elderly people living in care homes died from COVID-19 or compatible symptoms (46.9% of all deaths in Catalonia from Covid-19, 15,013).

Amnesty International notes that the fact that the majority of the elderly people live in private or subsidized residences in no way diminishes the State's obligation to guarantee the protection of their human rights. This includes the duty to protect against human rights abuses by third parties, including companies.

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More info and interviews request: Angel Gonzalo, Head of Media Amnesty International Spain. agonzalo@es.amnesty.org +34 630 74 68 02.

Media audiovisual resources, report and summary in Spanish: https://nube.es.amnesty.org/index.php/s/yKEgPgyGHSfCpba