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29 October 2025 | Country Update
Strengthening the Dependency Care System to improve the quality of life for individuals with irreversible diseases
5.8. Long term care
Long-term care can take the form of inpatient care in dedicated long-term hospital beds or “single-specialty” geriatric hospitals, or as part of the services provided in the context of Law 39/2006 for the Promotion of Personal Autonomy and Assistance for Persons in a Situation of Dependency (namely SAAD).
When it comes to dedicated long-term hospital beds, which cover palliative care needs, either in chronic patients or patients with cancer, the SNS has 8532 long-term care beds that represent 7.5% of public beds, and 77% of long-term care beds in the country, according to 2020 data (Ministry of Health, 2022d).
When it comes to SAAD, services are provided through a network of social centres and services available in the ACs, including regional public institutions such as nursing homes, services provided by the municipalities, and national reference centres for support of specific causes of disability, as well as accredited partner private centres. ACs have the responsibility to set up this network of providers where NGOs and not-for-profit institutions are considered as priority partners. Priority in access to services is determined by the assessment of the applicants’ degree of dependency and financial assets. Services are co-paid according to the type of service required and the ability to pay.
The benefits package comprises the following services: a) promotion of personal autonomy and prevention of dependency; b) tele-assistance; c) home aids (housekeeping, personal care, day-centre, and specialized day-care services); and d) residential services (nursing homes for dependent older people or residential stays for dependent persons, adapted to the type of disability).
In addition to care benefits, there might also be financial benefits, based on the degree of dependency and financial status. Financial benefits are mainly linked to support the provision of services outside the SAAD network, as follows: a) financial benefits linked to purchasing services outside the network when there is no public or private partner centre available to provide the benefits; b) financial benefit for care provision within the family when a relative is acting as principal carer; it would only apply when the applicant is being nursed at home, provided that physical and living conditions for care are met; and c) financial benefit for paid personal care assistance, intended to support the hiring of professional services.
According to December 2022 consolidated figures, SAAD has recognized benefits to 1 290 608 individuals. As for the composition of services, 70.1% of benefits have been personal services and 29.9% have been financial benefits, resulting in 1.34 benefits per beneficiary (MDSyA2030, 2023a). The total cost of the system at the end of 2022 reached close to €10 000 million, which represents an expenditure of €8321 per beneficiary (MDSyA2030, 2023b). The development of the SAAD has resulted in an increase of professionals working in the social sector; thus, since 2016 the number of workers has increased by 47%, from 460 000 workers in 2016 to 677 000 in 2022 (MDSyA2030, 2023c).
The Spanish Council of Ministers has approved a Royal Decree-Law to fulfil the purpose of the Law 3/2024 aimed at improving the life of people with amyotrophic lateral sclerosis (ALS) and other high complexity and irreversible conditions, such as motor neuron diseases other than ALS, prion diseases or non-responding spinal muscular atrophy.
This decree creates a new dependency category “Grade III+” for those with full dependence in basic activities and need of instrumental and personal assistance due to respiratory problems and dysphagia. The law guarantees a minimum state-funded protection of €4,930 per month for each person in Grade III+ and raises maximum amounts for home and personal assistance to €9,859. In order to meet these payment obligations, the Spanish Government has allocated budget supplements amounting to €500 million for 2025.
The decree also outlines the application procedure, with the medical evaluation completed within one month, and the official resolution issued within three months, valid nationwide.
More information (in Spanish): Ministry of Health press release https://www.sanidad.gob.es/gabinete/notasPrensa.do?id=6778
Royal Decree-Law 11/2025 https://www.boe.es/diario_boe/txt.php?id=BOE-A-2025-21205
Law 3/2024 https://www.boe.es/diario_boe/txt.php?id=BOE-A-2024-22438