Competencies to adapt nursing homes to face the coronavirus crisis, hire staff or equip them during the pandemic has been at all times in the hands of the autonomous communities. This is reflected in several orders published in the BOE since March, which explain that the responsibility of the central government – fundamentally, of the Ministry of Health – has been that of the coordination and control of the action of the autonomies.
In recent weeks, the central executive and some autonomous governments – Madrid with particular harshness – have accused each other of being the maximum responsible for the deaths in nursing homes that occurred during the pandemic. The declaration of the state of alarm and the centralization of some powers in the Government have led some regional administrations to blame the Minister of Health, Salvador Illa, or the second vice president, Pablo Iglesias, of these deaths.
But the truth is that the competition on nursing homes it was never withdrawn to communities. The orders given by both Health and the Second Vice Presidency are limited to establishing guidelines for the reinforcement and reorganization of the residences whose compliance was required of the communities, which were also empowered in mid-March to intervene or medicalize the centers if necessary. The Government, in addition, approved a fund of 300 million euros, a part of which was intended to improve care in the residences, whose distribution to the communities was coordinated by Churches. But the command remained autonomous.
With data from June 11, the total number of deaths in nursing homes due to coronavirus or compatible symptoms amounted to 19,481 people. The Community of Madrid and Catalonia, the most affected by the coronavirus, are also the ones with the highest number of deaths in residences: 5,975 and 4,082, respectively, representing 68% and 74% of their total deaths. Also in Aragon, Asturias, Cantabria, Castilla-La Mancha, Castilla y León, Extremadura, Navarra and La Rioja more than 50% of the deaths recorded have been in nursing homes.
On March 17, three days after the declaration of the state of alarm, the Government approves a decree of urgent measures in which the budget of the second Vice-presidency of Pablo Iglesias is increased in a total of 300 million euros. This fund, according to the same order, would be distributed among the communities “to finance the basic benefits of the social services of the autonomous communities, provincial councils, or local corporations, whose sole purpose is to face extraordinary situations derived from the Covid -19 “.
Among the benefits that the Government considered necessary to reinforce (and for which it gave the money to the communities) were “home proximity services”, the transfer “to the home environment of rehabilitation services, occupational therapy, hygiene, and the like “, the reinforcement of “the templates of social service centers and residential centers in the event that it is necessary to make substitutions for prevention, contagion or for the provision of new services or overload of the workforce “or the” acquisition of means of prevention (PPE) “.
However, the final decision on where the money granted by the State through the second Vice-presidency was spent corresponded to the communities at all times.
Two days after this royal decree was signed, on March 19, Iglesias appears together with Illa in Moncloa and announces that he has called the communities the next day to “address the distribution of this fund of 300 million euros to strengthen attention Social”. The second vice president mentions three problems that will be addressed with this money, and among them makes an express reference to nursing homes.
“Nursing homes, as you know, are one of the most vulnerable places in this health emergency. Their staff is overflowed, and in many cases they have not had the necessary personal protective equipment,” said Iglesias, who assured that “for the Government is an absolute priority to respond to the situation that is arising in the centers for the elderly and this 300 million euro fund will be used for this purpose. ”
“There is an urgent need to medicalize these centers, reinforcing the staff with more resourceful personnel and health elements,” as well as acquiring “individual protection equipment for the professionals of these centers,” Iglesias said. But At no time did he say that it would be himself or the Government who assumed that competence: He simply pointed out that the fund of 300 million to the communities should be used to make these acquisitions.
Two days later, on March 21, the BOE publishes an order from the Ministry of Health in which communities are urged to strengthen services in nursing homes, including cleaning or preventive measures. This order establishes the obligation to classify (and, in the case of patients, isolate) residents based on their epidemiological situation in order to stop the chain of infections.
The document approved by Health also empowers “the health authority of the autonomous community” to “modify the provision of services of medical, nursing or other health personnel associated with residences” to adapt it to needs. Both from public centers, and if necessary, from private ones. And, if it were not clear enough, the order states that “it is the responsibility of the competent health authorities of each autonomous community to issue the resolutions, provisions and interpretive instructions that are necessary in the specific sphere of their action.”
A couple of days later, the central government again reinforced the powers of the autonomous communities over residences through a new ministerial order for Health, is at the proposal of the Second Vice Presidency of Churches. Through it, the closure or cutting of personnel in nursing homes was prohibited and it was empowered “to the competent authority of the autonomous community” to “intervene in residential centers” according to “the epidemic and healthcare situation of each residential center or specific territory”.
The order itself detailed that the communities could order “the discharge, the withdrawal, relocation and transfer of the residents to other residential centers, regardless of their public or private nature”, as well as “the adoption of the appropriate measures for the implementation march of new residential centers and the modification of the capacity or organization of the existing ones “. And, expressly, communities were allowed to medicalize nursing homes to better serve coronavirus patients.