1In rural areas, the desire of elderly people to remain in their homes and be cared for by their family members turns out to be unfeasible in many cases.
2The relationship between ageing and the environment is evident: the smaller the municipality, the larger the proportion of elderly population that it contains. Thus, for example, people aged over 80 years represent over 10% of the population in villages with fewer than 1,000 inhabitants, while the total values for Spain do not reach 6%.
3Without relatives living nearby, with a deficit of female population and with a large part of the population being elderly, the care needs in the rural environment will need to be resolved through the incorporation of new actors.
4The incorporation of men into caregiving is a need imposed by demographic imbalances that, nevertheless, is desirable because it represents an opportunity to transform a historical gender gap that excluded men from these activities that are so necessary for sustaining life.
5Given the difficulties posed for males who are direct family members and take on the task of caring in rural areas, this activity should be accompanied by training and support programmes.
The Potential Caregivers Ratio (PCR) enables measurement of the relationship that exists between the population that can potentially provide care (number of people aged between 45 and 69 years) and the people that probably are going to need some type of care (people aged over 70 years). In rural municipalities with fewer than 5,000 inhabitants there are barely two people who could potentially care for each dependent person. In smaller villages, the presence of women is so scarce that there can be no guarantee of care if people continue to expect female informal caregivers.
Elderly people prefer to remain in their homes when they grow older and they value very positively the autonomy that this decision represents for their lives, even if it means their living alone. Other options such as old people’s homes or the traditional alternative of living with one of their children are viewed by elderly people with greater misgivings. In rural areas, the desire to continue living in the family home has an especially important significance, as it helps to maintain the symbolic value for inhabitants of maintaining a common, shared identity; a feeling of belonging that is important from both the individual viewpoint, for the wellbeing of the elderly person, and from the social and collective viewpoint, since permanence in rural environments is contributing to the survival of these areas.
Moreover, when care needs start to appear and dependency ensues to a greater or lesser degree, elderly people point to their direct family members as the caregivers that they consider as ideal. In fact, in Spain the family continues to maintain its status as the unquestioned ideal caregiver, a role that it exercises by virtue of the sense of reciprocity and affection that is expected to be received from children, and that bears no relation with the capabilities nor the training that those children have for caregiving (Moreno-Colom et al., 2016). These preferences in terms of the way of being cared for are met, since families continue taking on the care of their elderly relatives as a family responsibility.
However, in rural areas, this combined desire of elderly people to remain in their homes and be cared for by family members turns out to be unfeasible in many cases, since it is practically impossible to trust in the care of elderly people being provided by their direct family members.
On the one hand, these are areas with higher levels of ageing, therefore they have a greater population in potential need of support in order to undertake daily activities. On the other, they are areas that have experienced the constant emigration of younger generations, especially of women, who emigrated from the second half of the last century in a higher proportion than men, causing the depopulation of these areas and leading to a deficit of women. Therefore, the situation is frequently found that elderly people have no family members living in their municipality. Consequently, the family care model, which is female and informal, becomes unsustainable.
2. Ageing in rural areas: peculiar and more dependent
In Spain, rural areas present a high degree of ageing – a high percentage of people aged over 65 years – and over-ageing – a high percentage of people aged over 80 years – as a consequence of the continued emigration from their villages from the second half of the 20th century. The exodus from the countryside to the city has gradually reduced the size of small villages, especially of their younger populations which, attracted by the possibilities of economic and personal development offered by the cities, chose to abandon their municipalities of origin.
In demographic terms, the first consequence of this continued process of emigration by younger people is population ageing, which is much higher in rural areas than in Spain as a whole. Thus, in municipalities that have fewer than 5,000 inhabitants, nearly 25% of the population is older than 65 years, a percentage that rises to nearly 40% in the smallest municipalities, much higher than the 19% that they represent across the whole of the country. If we focus on over-ageing, the reality of rural areas alerts us to foreseeable caregiving needs that affect very striking percentages of the population. People aged over 80 years now represent over 10% of people in villages with fewer than 1,000 inhabitants, while the total values for Spain do not reach 6%. The relationship between ageing and environment is, therefore, evident: the smaller the municipality, the larger the proportion of elderly population that it contains, as can be seen in graph 2.
The consequences of this ageing should not be underestimated, especially since it is occurring in zones that are poorly served by social services. Although it is true that population ageing is the result of important social successes, such as the increase in life expectancy and the improvement in quality of life at advanced ages, it is also important to recognise the evident need for care required by elderly people and guarantee sufficient resources to respond to these needs.
The second demographic effect that emigration from the countryside to the cities has produced is the masculinisation of rural environments. These areas present a larger proportion of men than women due to the fact that the rural exodus occurs among women to a greater extent than among men. Women leave their villages in favour of the cities because in the latter, for decades, they have found educational opportunities, as well as an alternative employment offering to the usual invisibility of domestic work exercised traditionally in rural areas. This tendency, which continues today, causes a strong imbalance in the population structure of rural areas, there being a greater presence of men than of women, as shown in graph 3.
We must remember that until the second half of the 20th century, the Spanish economy was mainly agricultural, a production system that relegated women to domestic and care work, without offering them other employment alternatives. The growth of the cities represented the development of the services sector, in which women found a powerful new market niche, which explains their mass migration to the cities. This emigration differentiated by sexes has occurred in many countries, but it is especially pronounced in Spain, due to the delay with which processes of urbanization and industrialisation took place (Camarero and Sampedro, 2016).
The combination of these two demographic processes (population ageing and masculinisation) explains why the question of care and attention for elderly people is so complex in rural areas. If we take into account the fact that Spain has traditionally had a care model based on the family and in particular on women, the demographics of rural environments reflect very clearly the unsustainability of this care model. Without families nearby, without women and with a large part of the rural population being elderly, care needs must be resolved via the incorporation into caregiving of new actors.
3. How to receive care, how to give care: preferences and realities
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.
4. Notes for the future
Rural areas are facing important difficulties in attending to elderly people, which is leading to new actors being incorporated into these tasks: the role of neighbourhood networks is important within the informal sphere and the arrival of the migrant population is enabling the hiring of professional male and female caregivers. Focusing on the family sphere, which constitutes the objective of this article, it is pertinent to call attention to the necessary incorporation of men into care in rural areas, since in many cases they are the only family members available given the absence of daughters in their municipalities.
The figure of the male caregiver in rural areas has been little explored in Spain, since the traditional protagonism of women in the field of care explains why knowing the needs of the latter has been given priority. However, considering the current demographic imbalance existing in rural areas, both between generations and between sexes, it seems evident that the incorporation of men is an emerging need, imposed by demographics, and that it requires research studies that specifically focus on these environments.
In recent years attention has started to be paid to the incorporation of men into caregiving roles from two positions: one, the majority position, as caregivers of their wives when, at very advanced ages, the latter enter into processes of dependency. These are men who become incorporated into an activity, that of caregiving, for which they have not been trained and they do so at very advanced ages (Abellán et al., 2017). The difficulty that this represents is obvious; both from the viewpoint of physical and psychological care alike. The other position is related with the concept of the “new primogeniture”, in reference to partnerless children who remain living with their parents and, years later, when their parents age, become their caregivers. In both cases the incorporation of the male into caregiving is a reality resulting from the demographic situation, but desirable because of the opportunity that it represents to transform a historical gender gap that excluded males from caregiving activities, which are so necessary for the sustaining of life among all, male and female alike.
The incorporation into caregiving of men, sons and husbands, in rural areas, constitutes an interesting change in tendency that must be explored and supported by public institutions. Firstly, it may become a resilience strategy that contributes to making it viable to age in rural areas, an urgent need in light of the depopulation of these areas. At the same time, it may help to normalise caregiving as an intra-family act of solidarity, which affects women and men alike at certain times in life. We are therefore living through a time of transition where the ageing of rural areas may constitute an opportunity to respond to the challenge of caregiving and dependency from an egalitarian viewpoint, understanding that men and women alike must participate in this activity.
This assuming of caregiving by men who are direct family members, in rural areas, should be accompanied by training and support programmes, as we are dealing with a population group (males of advanced age) whose members have not been educated to provide care and who present, therefore, specific difficulties with performing this activity. However, at the same time, it cannot be assumed to be an alternative to the development of professionalised social services by the public institutions. The fact that these changes are occurring in the informal sphere should not be used as an excuse to postpone public investment in formal caregiving services.
Rural areas suffer from a persistent undersupply of public services, which functions as a factor in the expulsion of their populations. Guaranteeing attention and care for elderly people requires this traditional public undersupply to be overcome.
The development of home care by social and healthcare services constitutes an essential mechanism for facilitating that people who so desire can continue living in their own homes and may constitute a fundamental tool for caring for elderly people in rural areas.
The so-called Home Help Service enables elderly people who want to continue to live in their homes to have the guarantee that they will also receive attention when the need for support and care arises. However, and despite the fact that it was designed as a priority service in the Law on Dependency, its development has been affected by the successive cutbacks and reforms that the implementation of this Law has suffered, therefore a reappraisal of it is urgently needed. These services constitute or should constitute the main guarantee that people will receive attention when dependency develops, independently of where they have decided to live.
Abellán García, A., A. Ayala García and R. Puyol Rodríguez (2017): «Un perfil de las personas mayores en España, 2017. Indicadores estadísticos básicos», Informes de Envejecimiento en Red, 15.
Camarero, L. (coord.) (2009): The rural population in Spain. From disequilibrium to social sustainability, Barcelona: Obra Social ”la Caixa”.
Camarero, L., and R. Sampedro (2016): «Exploring female over-migration in rural Spain – Employment, care giving and mobility», en K. Wiest (ed.): Women and migration in rural Europe: labour markets, representations and policies, Basingstoke (Hampshire) y Nueva York: Palgrave-Macmillan.
Durán, M.A. (2006): «Dependientes y cuidadores: el desafío de los próximos años», Revista del Ministerio de Trabajo e Inmigración, 60.
Martínez Buján, R. (2014): «Los modelos territoriales de organización social del cuidado a personas mayores en hogares», Revista Española de Investigaciones Sociológicas, 145.
Moreno-Colom, S., C. Recio Cáceres, V. Borràs Català and T. Torns Martín (2016): «Significados e imaginarios de los cuidados de larga duración en España. Una aproximación cualitativa desde los discursos de las cuidadoras», Papeles del CEIC, 145.
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