Demographics provide us with a clear snapshot of the so-called care crisis, alerting us to the paradox that, at the same time that the elderly population is growing and therefore the needs for attention required by this group are also growing, the number of people potentially available to provide care for them is falling. Thus the question is: who looks after elderly people? In Spain the answer to this question has traditionally been unequivocal: the family, and specifically women, in a care model that has been defined as informal and family-based. In this model, caregiving is exercised by people close to the person given care, and does not carry any remuneration. And so it continues to be in the majority, as the profile of the caregiver in Spain is clear: mainly female and of an advanced age, whether wives or daughters (Durán, 2006). Over 80% of caregivers in the country are direct family members, according to the Survey on Disability, Autonomy and Situations of Dependency conducted by the National Institute of Statistics (INE). They are relatives of the person given care and in the majority of cases they are women caregivers (Martínez Buján, 2014).
It is women who continue to attend to and care for the elderly, despite having joined the labour market en masse, and therefore, having less availability to devote to these tasks. Predominant, then, is informal, female and family caregiving, as opposed to professionalised caregiving, exercised by people who have received specific training in this occupational field.
This model has a very high degree of acceptance among the Spanish population and, despite the difficulties, continues to be generally applied. Although it is true that a growing appreciation of domestic autonomy exists and that the number of people who prefer to continue living in their own homes as they grow old is increasing, they continue trusting in the family as the main provider of care when dependency develops.
This preference is especially widespread in rural areas: nearly 86% of people aged over 65 years who live in municipalities with fewer than 5,000 inhabitants (the most aged) state that they prefer to be cared for only by members of their family and there are very few, less than 10%, who affirm that they would like to be cared for by outside caregivers. In larger cities, with over 100,000 inhabitants, a higher degree of acceptance of professional care appears to exist, since over 30% of elderly people indicate that they would like to have the support of non-family caregivers (as sole caregivers or as a complement to support the family) (Survey on Elderly People, IMSERSO, 2010).
The problem posed by this preference for family and female caregivers is evident: the incorporation of women into the labour market limits their availability for caring. Thus, continuing to take care of elderly people becomes impossible, or it is undertaken at the cost of an important work overload for these women caregivers.
The Ratio of Potential Male and Female Caregivers (RPC) enables measurement of the relationship that exists between the potential caregiver generation (number of people aged between 45 and 69 years) and the people who a priori are in a phase when they may need care (people aged over 70 years). The data are very revealing: in municipalities with fewer than 5,000 inhabitants there are barely two people who could potentially care for each dependent person. This is a very low ratio that, first of all, indicates a break with the demographic balance between generations and is making it impossible to ensure caregiving through informal mechanisms. Meanwhile, and from the gender viewpoint, the presence of potential women caregivers is so low in rural areas that new actors are needed. There is barely one potential woman caregiver for each person aged over 70, a clearly insufficient level of availability. In the year 1950 in Spain there were 2.5 women for every elderly person.

The population situation in rural areas, therefore, reflects the breakdown of the balance between generations and by sexes, a situation that inevitably demands changes in the way in which care for elderly people who live in rural areas is organised.