Introduction

The rapid ageing of populations in western countries since the mid-twentieth century and the profound social and epidemiological transitions that have occurred over this time are leading us to a new paradigm for dependent elderly people (Lee, 2011) and a new set of guiding principles for contemporary health reform: the importance of increasing accessibility to services, the need to offer quality care and the need to guarantee the financial sustainability of social care schemes (Council of the European Union, 2003; Huber et al., 2011). In the course of history, dependent elderly people in western societies have received care according to a variety of models that have in turn reflected our changing social values (Parkin, 2003; Shahar, 1997; Hirshbein, 2001). Since the mid-twentieth century and mainly as a consequence of the rapid increase in the number of older people in the world, welfare states have been obliged to design more specific social and healthcare policies. In Europe, the implementation of international recommendations after the First World Assembly on Aging (Vienna, 1982) paved the way for a specific plan of action for policy makers responding to the challenges of an ageing society.

In this context, services for long-term care must be understood as the set of activities carried out by informal caregivers (relatives, friends or neighbours) and formal caregivers (health and social service professionals) and intended to provide the best possible quality of life for dependent people according to their individual preferences, allowing them the highest possible degree of independence, autonomy, participation, personal fulfilment and human dignity (WHO and Milbank Memorial Fund, 2000). The definition of long-term care is invariably tied to the concept of dependency – long-term care is about best-quality care, whether formal or informal, and whether provided by health professionals or by professionals in social services. Obviously, dependency is not exclusively a characteristic of the elderly, although it is well documented that in Spain the elderly make up the largest group of dependent people (i.e., 1,462,292 (68 per cent) out of a total of 2,141,404 dependent people are in the 65+ age group). In this chapter, therefore, we will focus on the elderly population and on formal long-term care services rather than informal care (Huber et al., 2011; Rodriguez Cabrero, 1999).