# Cost and quality of nursing homes in Spain?



## Tortuga Torta (Jan 23, 2016)

I'm looking far down the road, and wondering about my and my wife's life's endgame. 

I'm curious what the state of nursing homes/senior living options in Spain. My wife's grandmother lived in this type of facility in El Escorial, and so I saw it very briefly some years ago (she's passed on now). The room was very simple and reminded me more of a hospital room than a residence, and she shared it with another lady. I did not get to visit the "common areas" of the facility. Her grandmother was severely visually impaired and indigent, so I think her situation was in part funded through ONCE or some other disabled persons fund. 

But that's about all I know about nursing homes in Spain. Does anyone have a sense for the how much they typically cost, and the quality of life there? Obviously, there will be a range, but I'm trying to get a sense for that range.


----------



## Lynn R (Feb 21, 2014)

You could take a look at a site like this one, which shows residencias all over Spain - many of them display their prices (per month) but some don't.

https://www.inforesidencias.com/centros/buscador/residencias

I know very little about the quality, except that the wife of someone I know was admitted to a local one last year (a privately run establishment) after suffering from dementia for several years and being cared for at home by her husband. He is very happy with the quality of the care she is receiving.


----------



## kalohi (May 6, 2012)

I have a friend whose mother was in a senior living type arrangement for several years until she recently passed away. She had broken her hip and could no longer walk, so she had to give up living on her own. Mentally she was fine.

She had a shared room, meals, access to all activities at the center, and some assistance with self care. For that level of care it cost something like 1500€ a month. I know there was a higher level of care available, but I don't know the cost. 

They were very happy with the center.


----------



## nigele2 (Dec 25, 2009)

My MIL recently went into a residency. Cost 1600/month shared, 2000/month single.

She recently had a stroke to go with some other serious issues (heart/lungs/diabetes) and now dementia entering the equation. With lack of mobility and no movement of her left-hand side we couldn’t manage the situation at home. At the residency they are well equipped to feed her and clean her.

The room is ok and there is TV and a side room with sofa.

Despite when investigating being shown therapy facilities and activities, and my MIL always saying they are very kind and that she is OK (please note IMHO and experience most inmates give a positive reaction but you need to look into their eyes to see the truth), it is a place to die and not a place to live, let alone recover any ability. There are simply not enough people (those that exist are indeed very kind).

Luckily we are 10 minutes away and she escapes for several hours every day. Either to the beach or back home.

I had tried to discuss rehabilitation, but the concept doesn’t exist here from what I can see. As always the family must carry the burden – and if you have no family …………………….

We investigated a hybrid solution using helpers and a day centre – but the day centres near us (Cadiz) could not offer any wheelchair transport.

In the resicency even those inmates with mobility sit around lonely and bored waiting the end. 

In summary I’d be budgeting 4000+ a month for a residency. And if my health deteriorated such that it impacted my basic mobility and brain I’d want my vodka and paracetamol at hand. 

Like most I wouldn’t want to be a burden on the next generation but I’m guessing many expats will not have family nearby in any case. We were told by my MIL’s doctor that the place was not a prison. Sadly for many it is exactly that.

Sorry to sound negative but this is a subject many seem not to want to take seriously so I think Tortuga, your forward-thinking is a great example to us all.


----------



## Tortuga Torta (Jan 23, 2016)

Thank you, everyone: I appreciate the info.


----------



## Tortuga Torta (Jan 23, 2016)

nigele2 said:


> My MIL recently went into a residency. Cost 1600/month shared, 2000/month single.


Thank you very much for the very specific info. Very helpful.


----------



## Tortuga Torta (Jan 23, 2016)

nigele2 said:


> My MIL recently went into a residency. Cost 1600/month shared, 2000/month single.


Thank you very much for the very specific info. Very helpful.


----------



## nigele2 (Dec 25, 2009)

Just an update on planning for the end of your life in Spain.

My MIL (Spanish) went into hospital from her residence and is still there after 5 days. Immediately there was a need (an obligation) to have 24 hour family cover. Having a large Spanish family we can just about do that (not easy as they are not local) and sustain it for a week.

The old lady next to my MIL had a son there to feed her and request hygiene things as required. Sadly he had to return home to sort his own son (he was away for 4 hours). While he was absent his mother had food arrive but no nursing staff showed any concern as to her inability to feed herself. When my wife fed her a doctor turned up and demanded to know why her family were not in attendance. It was made clear where the responsibility lied.

For those who may in their last days find themselves isolated in Spain they need to consider this. Obviously being fluent in Spanish would seem essential. And having access to a support network (Near us you can hire people to help you 24 hours a day (a benefit of a poor economy?) but it costs and depends on availability).

I’ve heard some say that they would hop back to the UK but as in my MIL’s case strokes do not often give you prior notice. And as in the case of my MIL’s neighbour (in hospital) the ambulance doesn’t always take you to the nearest hospital to your home, or that nice private one you pay for.

On the residency I mentioned and gave prices for above, a doctor offered that my MIL’s residency was one of the best two in the Cadiz region. Makes me wonder what the others are like?


----------



## nigele2 (Dec 25, 2009)

For Tortuga and anyone interested: An update just so the prices I offered above are not misunderstood. 

We are now going to move my MIL back home. Clearly being in the residency is having a very negative impact on her. We have consulted doctors, specialists, and relations of current and former inmates, and all agree you can expect nothing but deterioration in a normal residency such as this (And a travelling specialist assured us this was one of the best two residencies in the Cadiz region).

All point out and are concerned about the impact having my MIL (with mental and mobility issues) cared for at home will have on the rest of the family. And clearly that is a consideration. If nothing else we will lose our lounge as MIL will need bed, crane, motorised chair and wheelchair near at hand. And have helpers coming and going every day. But the mental stimulation she needs will be 100 times better. When bringing her home for just 4 hours we see a difference.

On cost we can just about manage on the 1600 Euros per month we are paying the residency. We have one lady who lives not far away. She has experience of caring and currently looks after her mother. She can do 20 hours a week for 400 Euros a month. That’s 5 days, 4 hours each morning Monday to Friday. (Clearly this will be black economy but when the state stops such people working any other way, I couldn’t give a pooh). If we can get 2 more like her, and that’s seems very likely given the unemployment and poverty around here, and the number of enquiries we have had, we will be in good shape. And that leaves 400 Euros for further and unanticipated cover. I don’t like paying below minimum wage but sadly our economy is already stretched to the limits. Thank god my economy is in the UK. And of course the lady is well pleased to get 400 Euros.

If one is thinking of going to a residency before mental and mobility states demand it a word of warning. A residency of this type mixes all types and the result is not pleasant. As I said earlier I think if you see a residency as a comfortable form of retirement then think 4000 Euros a month.

Beyond that, if you haven’t got 4000 Euros a month (remember while you will mentally deteriorate in such a place they are good at extending your life span. Bit like prisoners. So you may need to be paying that for a very long time) I’d fight like hell to remain in your home for maximum time. 

Sorry not inspiring news but didn’t want anyone thinking that 1600 Euros per month would be sufficient for some comfortable time in the final stages of life. 

Remember these are my views based on one situation. But I would say beware reports from family of inmates. People in my own Spanish family paint a wonderful story of MIL being cared for in the residency. Guess it makes them feel better.


----------



## Lynn R (Feb 21, 2014)

nigele2 said:


> If one is thinking of going to a residency before mental and mobility states demand it a word of warning. A residency of this type mixes all types and the result is not pleasant. As I said earlier I think if you see a residency as a comfortable form of retirement then think 4000 Euros a month.


Good luck with caring for your mother-in-law at home, I hope it works out well for all of you.

Not that I would relish the prospect, but there is a facility fairly close to me which seems to offer a pretty good quality of life (although undoubtedly unsuitable for someone with needs as severe as your relative, or an Alzheimer's sufferer) and their quoted fees are between €1.9 and €2.6k per month for a single room. Certainly not cheap (but a good standard is never going to be that) but some way short of €4k.

Someone we know whose wife had to move into a care home last year after her condition had deteriorated to the extent that he could no longer cope at home (she had had Alzheimers for several years) said that the care home (a different one to the one in the link, it has a good reputation locally) was actually working out cheaper than having a team of carers coming in, but probably they were paying more than €5 per hour. Her pensions cover the cost of the care home fees. You will certainly have to budget for extra costs if the people you employ are ever going to have any holidays or time off sick.

About CASA KLEIN â€” Casa Klein - Senior Hotel


----------



## Pesky Wesky (May 10, 2009)

Well, guess where I went this morning? To an old people's home - but with a difference.
This is a cohousing project. This is an explanation of cohousing


> Cohousing communities are intentional communities, created and run by their residents. Each household has a self-contained, private home as well as shared community space. Residents come together to manage their community, share activities, and regularly eat together


.
https://cohousing.org.uk/about/about-cohousing/
In Spanish you might find references to cohousing or* vivienda colaborativa*

As usual with these kind of things, this is a concept just beginning in Spain and is well established in northern Europe.
I went to Trabensol in the Comunidad de Madrid. They grouped together, found some land, bought it and built on it - a process that took 13 years, but what they have now is a wonderful purpose built residential and social area with 55 apartments and 80 people living. They now pay 1,300€ per month per couple (900€ approx for a single) for lunch cooked on the premises, heating, water, telephone,etc. They live in apartments of 50 squared meters with lots of common garden space, a dining room, meeting rooms galore, gym, painting room, small indoor dip pool, library etc. They run as a cooperative with people buying the use of the apartment and installations for life.
Trabensol – Centro Social de Convivencia para Mayores


Map of cohousing projects in Spain. Also shows intergenerational projects
eCOHOUSING Mapa cohousing vivienda colaborativa en España |

I agree with Nigel that in my experience with friends here and family in Bilbao, it is still the family who, with the help of a battalion of carers contracted privately, look after elderly people. In fact in Bilbao two of my husbands friends actually work in this area after retraining from working on ferries. It's a boom employment zone, but very poorly paid as family budgets just don't stretch for much more.


As this is a highly topical subject we are hearing more and more about these initiatives in Spain and some legislation has just been passed in Asturias regarding cohousing. I think it was to do with grants being given, but I'm not sure.


The whole idea of these places is to make a community where people can *live* their old age and not be a place where you go to die as nigel2 commented in his post. Hopefully I will end up in a place like this rather than the less attractive old people's home.


----------



## nigele2 (Dec 25, 2009)

Lynn R said:


> Good luck with caring for your mother-in-law at home, I hope it works out well for all of you.


Thanks for that thought Lynn. I'm quietly confident. Lots of planning done, experts consulted, equipment arrived, ramps in place.



Lynn R said:


> Not that I would relish the prospect, but there is a facility fairly close to me which seems to offer a pretty good quality of life (although undoubtedly unsuitable for someone with needs as severe as your relative, or an Alzheimer's sufferer) and their quoted fees are between €1.9 and €2.6k per month for a single room.


I think you put your finger on the problem there. There are old people's residencies and care/nursing homes. From that link they mention nothing about care relating to mobility or mental health. The people all look fully fit and with it. There even appear to be a lack of wheel chair access facilities (I expect there are routes but no go areas). There is emphasis on swimming, dancing and scandinavian cuisine. It would be great if we all lived healthily and able to enjoy such pastimes, and then went to bed one night and didn't wake up. Sadly the medical profession and drug companies seem determined to keep us alive, despite a total lack of quality of life, for as long as possible. So my 4000 Es budget is for what follows that luxury stage of old age.

And expats are going to face more issues as I mentioned above unless they have local family. 

Sorry Lynn not my intention to add depression to your Sunday. I hope you are relaxed, full of vitality, and enjoying Sunday cuisine


----------



## Lynn R (Feb 21, 2014)

nigele2 said:


> Thanks for that thought Lynn. I'm quietly confident. Lots of planning done, experts consulted, equipment arrived, ramps in place.
> 
> 
> 
> ...


I'm not pushing their services and have no connection whatsoever with them, but if you look at their website in more detail, actually you will see pictures of residents who use wheelchairs and quite a few mentions about assistance for wheelchair users and those with mobility problems. E.g. "we are a wheelchair friendly senior hotel", "a large outdoor swimming pool with a lift for wheelchair users" and a picture of a group of residents including 3 wheelchair users on an outing, just on one page About Casa Klein.

I absolutely agree with you about the awful prospect of being kept alive at any cost without regard to quality of life. I devoutly hope that I never become one of the (thankfully small) percentage of older people who need full time residential care, I am quite sure I would find communal living and total/near total dependency of any kind very hard to take, no matter how kind the staff or how nice the facilities.

However, because of the difference in costs it does seem to me to be easier for those who would have to self fund their care if they returned to the UK (because the level of their income/assets precludes them from receiving any help) to pay for that care in Spain instead. My sister works in a care complex in the UK (with facilities ranging from sheltered accommodation in self contained apartments to a specialist dementia unit) and their fees for the residential care home start at a thousand pounds a week, much more for specialist nursing care (and she's an Alzheimer's sufferer so it would cost even more than a thousand a week there). It is apparently good of its kind, having received an Outstanding rating from the CQC at their last inspection, but that's double what our acquaintance pays for his wife's care here. And if they would be paying for care at home instead, likewise it is much more expensive. I became aware of the Carers UK forum when looking for information to help an elderly relative in the UK, and reading some of the accounts of the struggles people have to get care provided, shortcomings in the care provided in residential homes and the realities of life with just very brief visits from carers 4 times each day (and sometimes even those visits are missed) is heartbreaking. I was recently informed of an ex colleague who is the same age as me (62) and wheelchair bound due to a form of muscular dystrophy although mentally unaffected. He is having to live in a care home where all the other residents are frail elderly and many of them dementia sufferers, because there is just nowhere else available. How dreadful.


----------



## Lynn R (Feb 21, 2014)

Pesky Wesky said:


> As usual with these kind of things, this is a concept just beginning in Spain and is well established in northern Europe.
> I went to Trabensol in the Comunidad de Madrid. They grouped together, found some land, bought it and built on it - a process that took 13 years, but what they have now is a wonderful purpose built residential and social area with 55 apartments and 80 people living. They now pay 1,300€ per month per couple (900€ approx for a single) for lunch cooked on the premises, heating, water, telephone,etc. They live in apartments of 50 squared meters with lots of common garden space, a dining room, meeting rooms galore, gym, painting room, small indoor dip pool, library etc. They run as a cooperative with people buying the use of the apartment and installations for life.
> Trabensol – Centro Social de Convivencia para Mayores


That sounds wonderful, and very reasonably priced.


----------



## Isobella (Oct 16, 2014)

Pesky Wesky said:


> Well, guess where I went this morning? To an old people's home - but with a difference.
> This is a cohousing project. This is an explanation of cohousing.
> https://cohousing.org.uk/about/about-cohousing/
> In Spanish you might find references to cohousing or* vivienda colaborativa*
> ...


Great idea but doesn't sound really suitable for those with dementia etc. also I think the price would exclude a lot of people if on basic pension.


----------



## Isobella (Oct 16, 2014)

nigele2 said:


> Thanks for that thought Lynn. I'm quietly confident. Lots of planning done, experts consulted, equipment arrived, ramps in place.
> 
> 
> 
> ...


Yes it is depressing. Two of my cousins have had Husbands with Alzheimer's and I don't think living in a different cultural environment would suit them. It does state choose your own meals and where you want them but many are so confused they can't remember when they have eaten! or they need to be fed. All care homes sound good on their websites.


----------



## baldilocks (Mar 7, 2010)

The problem is there is a lack of demand amongst the Spaniards which might otherwise increase competition, improving quality and driving down prices. Most Spaniards keep their elderly at home, often having a ground-floor layout that would, if necessary, permit a ground-floor bedroom with bathroom facilities adjacent. 

We have my m-i-l (88 y.o) living with us and we have a chairlift connecting the ground floor and first floor (where her bedroom and bathroom are located in addition to the TV room) so by using a walker or "furniture walking" she is able to stay at home and be within the family. She has a hairdresser come every 10 days or so to give her a shampoo and set which, with the occasional perm, helps to keep her spirits up.

If and when she becomes less able to get to the bathroom then we will be able to get assistance from the Residencia if needed. A number of elderly people in the village have such help for 'personal needs,' being taken out walking, meals-on-wheels, etc. All of these local services, together with the nurse who comes from the health centre to deal with medical matters, obviate the need for nursing homes.


----------



## Ifn (Jan 29, 2017)

nigele2 said:


> My MIL recently went into a residency. Cost 1600/month shared, 2000/month single.
> 
> She recently had a stroke to go with some other serious issues (heart/lungs/diabetes) and now dementia entering the equation. With lack of mobility and no movement of her left-hand side we couldn’t manage the situation at home. At the residency they are well equipped to feed her and clean her.
> 
> ...


Sadly, that’s the state of most nursing homes in the USA too. My endgame is to try and have homecare as long as possible


----------



## nigele2 (Dec 25, 2009)

Ifn said:


> Sadly, that’s the state of most nursing homes in the USA too. My endgame is to try and have homecare as long as possible


Ifn sounds the right strategy for anyone who isn’t rich. As my gran used to say “they’ll take me out of this house in a box, and not till I’m ready” 

Just a further update with the "Great Escape" as it is now known (Can't get that music out of my head) :

Well my MIL is now home, the support (4 helpers in place), all the equipment we need at the moment, and a routine that works as of now, is all in place.

My wife has tried to remove herself from the general processes so she is reserve but that is not as easy as it sounds. But the team so far is working great.

Costs are about 2200 Euros a month although that includes Rosa who spends 20 hours a week on direct stimulation. She’ll talk about anything, play games, watch TV, read - but then discusses it. Keeps asking questions. She’s a ball of energy :flame: and she must be getting it right as MIL responds throughout each 4 hour session. And of course, for 4 hours we are free. Our ball of energy costs 460 Euros a month.

One cost that is higher than my wife expected are prescriptions and general medicines. 

On a positive note my wife may be able to retire early, and we may get a little help, if she is a recognised main carer. But this could take a year to be assessed.

What about MIL?  She has improved beyond belief. A much higher percentage of meaningful conversations. Generally, much more with it. The greyness and desperation a thing of the past. Her smile is back. Really enjoying her food (might be biased as I cook it). Today she goes to have her hair done then we’ll take something in a bar (We have to thicken all her liquids but the thickener is now stored in the bar. Good old bar owner Oscar. They treat her like a VIP). 

When we left the residency, the director tried to persuade us that this was a bad move. However, when we mentioned the multiple failings: Someone else’s clothes, night cloths in the day, dirty clothes, shoes with tongues inside compressing MILs feet, MIL left sitting on shoes in her wheel chair, the shared food utensils spreading disease, the lack of promised stimulation, etc. - he blamed the huge staff turnover. 

As he can’t change that, as he won’t invest in people, at least we left happy we’d made the right decision. 

All our thoughts have now been confirmed by our helpers. They have worked, between them, at several of these types of residency. As one said, “they say they check all residents (200) every 2 hours through the night. Yet some nights there is one person doing the checking. Even simple things like replacing oxygen masks residents remove takes time”. And sadly, this lack of resource is not an isolated case. 

I wish you all a healthy life and then one night you go to bed and sleep for eternity.

ps: Just pointed out to me that none of our team speak English.


----------



## baldilocks (Mar 7, 2010)

Nigele2: The residencia is in Puerto? If so i guess part of the problem is too many residents. Here in our village (pop 5,000) the care is excellent and they even have some peripatetic carers who go out to take those who are still at home, out for walks.


----------



## Ifn (Jan 29, 2017)

Pesky Wesky said:


> Well, guess where I went this morning? To an old people's home - but with a difference.
> This is a cohousing project. This is an explanation of cohousing.
> https://cohousing.org.uk/about/about-cohousing/
> In Spanish you might find references to cohousing or* vivienda colaborativa*
> ...



Love this idea....maybe in the future....as long as they have an art room. My brother recently moved to a senior housing community in Florida. There were no art groups so he started one in a community room.


----------



## Isobella (Oct 16, 2014)

Ifn said:


> Love this idea....maybe in the future....as long as they have an art room. My brother recently moved to a senior housing community in Florida. There were no art groups so he started one in a community room.


I have a relative who lives in a retirement community in Florida. It's wonderful. Have seen others too with tennis courts, golf, one with a community boat on the river. Medical services etc. I also know a couple living in a retirement community in the Midlands. Lots going off, according to her Facebook:roll eyes: But wouldn't be where I want to be with their Tina Turner tributes shows and other events. Must be like living in a community centre. 

However they should not be confused with care homes where some are almost bedridden, unable to feed themselves or incontinent. Been in a few here where most are suffering from some form of dementia. They do have entertainment such as sing alongs, drawing, baking etc. They are not prisoners as they have frequent trips to coast, events etc. No way are the facilities as good as retirement complexes but their needs are different. People in care homes could not live independently.


----------



## nigele2 (Dec 25, 2009)

baldilocks said:


> Nigele2: The residencia is in Puerto? If so i guess part of the problem is too many residents. Here in our village (pop 5,000) the care is excellent and they even have some peripatetic carers who go out to take those who are still at home, out for walks.


I can't see Baldilocks how the number of potential residents is an issue. Indeed the more potential residents, within range by easy transport for the families, should make them more profitable. And profitable they are. And our local residency serves Valdelagrana which had a population of less than 5000 in 2015.

I know you're a fighter who takes problems head on and finds solutions, but taking people for walks is not the issue. The bigger issues are: 


being ready to rush to a hospital, and spend hours there just to keep your loved one fed (residencies do not cover this).
the waste products and hygiene in general.
protecting your loved one from self-harm.
replacing the washing machine more often (poor thing never stops ).

As with us it works fine if you have the economy, the time (not only for the elderly, but for the rest of the family), the determination, and are willing to make the sacrifice.

But sorry to say a few promised village services just won't cut it. What we've seen is promised services, as the promises of the residency, are often just vapour.


----------



## baldilocks (Mar 7, 2010)

nigele2 said:


> I can't see Baldilocks how the number of potential residents is an issue. Indeed the more potential residents, within range by easy transport for the families, should make them more profitable. And profitable they are. And our local residency serves Valdelagrana which had a population of less than 5000 in 2015.
> 
> I know you're a fighter who takes problems head on and finds solutions, but taking people for walks is not the issue. The bigger issues are:
> 
> ...


Too many residents = too great a demand.


----------



## nigele2 (Dec 25, 2009)

baldilocks said:


> Too many residents = too great a demand.


But your missing the point. The residency is not full as illustrated by the availability, the sales pressure not to extract my MIL, and then the veiled threats - anything to keep a client. And we looked at another residency, and there are others.

And there's no shortage of workers. But if you keep them on minimal wage, without a contract, and treat them like slave labour what would you expect? A high turnover! Which is exactly what the director offered as a reason for negligence of care.

The truth is that these places are very profitable and there is little incentive to improve the level of service. Many residents are not able to complain. Many families don't want to know (and who can blame them with such a financial burden). Take Antonio. He, as he puts it, has been waiting to die for 11 years. He has family visit once a fortnight. He has little mobility but is quite sound of mind - well for a person institutionalised for 11 years.

But maybe more importantly for expats there are additional pitfalls to consider. If you end up isolated and/or not fluent in Spanish you could be looking at a very bleak future. And if all things are equal you still need a good income to even stay in this level of residency. And remember the numbers we have discussed do not include anything but basics. What happens when that wheelchair needs maintenance, or you need a new hearing aid, or ………….. 

Let's hope most of us pass away while still looking forward to tomorrow.


----------



## Pesky Wesky (May 10, 2009)

nigele2 said:


> Ifn sounds the right strategy for anyone who isn’t rich. As my gran used to say “they’ll take me out of this house in a box, and not till I’m ready”
> 
> Just a further update with the "Great Escape" as it is now known (Can't get that music out of my head) :
> 
> ...


Sounds great Nigel, and its like having kids in the sense that if they are happy, you're a lot happier too, isn't that true?
I'm certainly learning a lot about my future from family life now. If you can stay at home with the right care in place, it's usually a positive experience and more positive than being in some type of home. However, you need a fireball as you say - ours are called Louise in the UK and Delia (South American of course) in Spain.Great people - honest, reliable and maybe above all, caring


----------



## Lynn R (Feb 21, 2014)

I was interested to read this - I didn't know that the Government had started paying Social Security contributions for people who provide care for family members at home (and I hadn't known that such carers could claim a benefit, either).

https://elpais.com/sociedad/2019/05/07/actualidad/1557244746_828528.html


----------

