In some cases, this care work complements public services. According to a survey carried out by the City Council of 600 dependent people (as yet unpublished), it can be seen that those who state that they feel well cared for receive an average of 17 hours of care every working day. Taking into account that the SAD provides its users with an average of only one hour of service per working day, the role of non‐professional caregivers is vital for achieving these levels of satisfaction, something that also reveals a situation of deep inequality. The City Council contributes to the support of these people with its Respir and Respir Plus programmes, where up to 1000 families receive financial aid in order to temporarily place their dependent relatives in elderly care homes, and Barcelona Cuida, a new facility as part of a support strategy for non‐professional caregivers (Ajuntament de Barcelona 2017, 2019a).
Innovative Practices: Milestones Towards a New Approach to Care
In general terms, what is described above is the traditional model for caring for elderly people in their own homes. However, in recent years, Barcelona City Council has carried out innovative practices in this field, which illustrate a way of caring for people that is more consistent with the current situation. The common denominator of these practices is the idea of proximity. It is based on the hypothesis that in order to coordinate social care programmes and services in a more suitable way, it is necessary to take territorial scale into account. Spatial proximity would be essential in economic and ecological terms, from the perspective of democratic governance, management and service quality, and at a social‐community level.
It may be that the idea of proximity has arisen more from the perspective of urban planning than from social policies, linked to a redefinition of public space and mobility in order to make cities more habitable. In the case of Barcelona, in recent years the proposed redefining of the city based on new ways of grouping the traditional blocks of buildings has emerged and started to be implemented. These are known as ‘mobility superblocks’ (Ajuntament de Barcelona 2016; Mueller et al. 2020; Rueda‐Palenzuela 2019): territorial areas that are smaller than neighbourhoods. This strategy aims to traffic‐calm streets, reduce noise and atmospheric pollution (mainly associated with motorized traffic), improve road safety, increase the number of green areas and public squares, and adapt urban furniture. These interventions are meant to achieve physical environments (sets of city blocks and/or green areas) that prioritize pedestrians, facilitate local residents interactions, and involve greater enjoyment of public space. This proposal from Ecosystemic Urbanism has popularized the concept of ‘superblocks’, mainly relating them to mobility and the ecological transformation of cities. However, the same concept has been very stimulating in the field of social policies. There is a description below of two lines of action that aim to create or adapt services, and which consider the target population's local environment to be of the utmost importance.
Home Care Service from a Proximity Perspective
Barcelona City Council has promoted a new concept of SAD in order to provide it with a proximity perspective. Originally, before its exponential growth, the SAD had a local perspective yet. This was helped by the fact that it was a smaller service, included in social services and run by municipal workers. But the SAD that has predominated in recent years, and described above, has lost contact with the neighbourhoods and areas where dependent people live and does not consider territorial distribution, while some areas of the city have a far greater density of users than others (Figure 1.1).
Therefore, the implementation of a proximity SAD has been planned in order to improve the quality of the service, working conditions (in material and symbolic terms), and its overall sustainability (economic and ecological). This redesigning is based on the idea of creating teams of professionals (10–15 people) who care for a group of dependent people (between 50 and 75) that live in a particular local area. This area has been defined as a ‘social superblock’, replicating and adapting the concept of ‘mobility superblocks’. Their size allows them to be perceived as the reference urban habitat for service users, and allows for the efficient coordination of the journeys made by the teams. The idea is to locate a small logistics base in each social superblock, from which the team is able to plan its care work, as personalized and flexible as necessary, and share the monitoring of the service users. The challenge is to achieve an SAD that is as sustainable as possible and which generates recognition among the general public and in the area of social and healthcare services, so that professionalized care work can become an attractive job.
Figure 1.1 Density of SAD's users and locations in the District of Ciutat Vella.
Source: Department of Research and Knowledge, Area of Social Rights, Barcelona City Council.
The most recent projection divides Barcelona into 316 SAD teams, which would provide care services to dependent persons living in their corresponding superblocks (BCNEcologia 2019). This delimitation (Figure 1.2) has been carried out using administrative, urban planning, management, and demographic‐density criteria. However, this is one of many proposed territorial management units for a future local SAD covering the whole city. This would vary according to any changes that may occur, starting with the number of service users, the hours of service, and their spatial distribution.
Since 2017, Barcelona City Council has implemented eight proximity SAD pilot projects in superblocks located in four neighbourhoods of the city (Figure 1.3), caring for over 500 dependent persons and involving over 90 professional workers. Their identification is the result of the initial steps taken towards producing a map of the city's social superblocks. The project has been inspired by the model employed by the social company Buurtzorg, in the Netherlands, a pioneering organization in the implementation of a holistic, community‐based home care model with the teamwork of professionals who work with a high degree of self‐management.
Figure 1.2 Provisional map of SAD superblocks, Barcelona 2019.
Source: Barcelona Urban Ecology Agency (BCNEcologia).
Figure 1.3 Density of SAD's users and location of the proximity SAD pilot projects in superblocks.
Source: Department of Research and Knowledge, Area of Social Rights, Barcelona City Council.
With an awareness of the different contexts, in Barcelona the model has been employed in the following way: each superblock has an SAD team that cares for the people who live there. They always receive care from a professional in the team: normally between two and three professionals visit a person's home per month, depending on the number of hours of service provided to each service user. Teamwork ensures the continuity of the service and personalized care, which is severely undermined in the traditional model, due to the need for substitutes to take on the role when the regular professional is unable to go. Teamwork and the proximity of people's homes make it possible to adapt the service to full working days or over 30 hours a week, as well