Spain Long Term Care Market Overview, 2031

Key Insights

• Spain is the third most aged country in the world, only behind Japan and France. In 2025, one in five people in Spain was aged 65 and over, equivalent to nearly 10 million people or 20.4% of the population. More than 1.2 million people were aged 80 and over, and those aged 90 and over exceeded 650,000. The aging index stands at 148% for every 100 people under 16, there are 148 people aged 65 and over.
• Spain's long-term care system is anchored by the Sistema para la Autonomía y Atención a la Dependencia (SAAD), established under the 2006 Dependency Law. At the end of 2025, 1.784 million people had their dependency situation recognised. The number of people attended increased by 158,618 during the year.
• Public investment in dependency care reached €13.734 billion in 2025, a record high. Of this, the central government contributed 27.4% (€3.758 billion) and the autonomous communities financed 72.6% (€9.976 billion). However, Spain invests only 0.8% of GDP in long-term care less than half the EU average of 1.7%.
• Spain's residential care sector comprises 5,530 public and private nursing homes with a total capacity of 407,780 beds at the end of 2025. Almost 340,000 people live in residential care centres. However, the sector faces a deficit of more than 50,000 places to meet current demand for people with severe and great dependency.
• The long-term care workforce in Spain employs more than 600,000 people, of whom 83% are women. Despite this significant workforce, Spain faces a shortage of care workers. Estimates suggest that more than 260,000 additional professionals will be needed before 2030. Approximately 168,000 nursing care assistants are currently working in Spain.

Market Outlook

• According to the research report, "Spain Long Term Care Market Overview, 2031," published by Bonafide Research, the Spain Long Term Care Market was valued at more than USD 23.95 Billion in 2025. This market is supported by accelerated demographic aging, rising prevalence of chronic conditions, and ongoing policy reforms aimed at strengthening the dependency care system.
• Spain's demographic trajectory is a primary driver of long-term care demand. The population aged 65 and over, currently at 20.4% of the total, is projected to reach a maximum of 30.5% around 2055. By 2045, the older population could exceed 15.9 million, equivalent to 29.2% of the total population. The feminisation of ageing remains a constant phenomenon: among those aged 65 and over, women outnumber men by 29.5%.
• The demand for residential care places is expected to significantly outpace supply. At the beginning of 2025, Spain had 412,109 residential places for older people, an increase of 17,044 from the previous year (+4.3%). However, Spain needs more than 50,000 additional places to meet current demand for people with severe and great dependency. The residential care sector has grown by 23,075 places in the four years following the pandemic (2021 to 2025).
• The shift toward home and community-based care continues to reshape Spain's LTC delivery system. Of the 2,204,784 total benefits of the Dependency System, 56% (1,240,337) are deployed in homes and community settings. Residential care accounts for 13% of benefits. The total number of benefits increased by 25% between 2020 and 2025. The Home Care Service (SAD) had 168,666 beneficiaries in Andalusia alone as of July 2025.
• The reform of the Dependency and Disability Laws, approved by the Council of Ministers in July 2025 and currently in parliamentary proceedings, represents a significant policy development. The reform aims to eliminate incompatibilities in dependency benefits, expand home care services, recognise telecare as a subjective right, and eliminate the two-year suspensive period for economic benefits for family care.

Market Dynamics

Driver: Accelerated Demographic Ageing and Rising Dependency Spain is experiencing one of the most rapid demographic transitions in Europe. The country is the third most aged in the world, only behind Japan and France. In 2025, one in five people in Spain was aged 65 and over, equivalent to nearly 10 million people or 20.4% of the population. Those aged 80 and over reached 6.1%, and those aged 90 and over exceeded 650,000. The ageing index stands at 148%. Life expectancy at birth in Spain is among the highest in the world, reaching 83.77 years in 2023, with 86.34 years for women and 81.11 for men. Life expectancy at 65 years is also high: 21.68 additional years on average. However, healthy life expectancy at 65 years remains around 9.7 years. This means Spaniards live on average many years with chronic conditions or disabilities. The proportion of older people is projected to reach 30.5% by 2055. By 2045, the older population could exceed 15.9 million, equivalent to 29.2% of the total population. At the end of 2025, 1.784 million people had their dependency situation recognised. The feminisation of ageing is a constant phenomenon: among those aged 65 and over, women outnumber men by 29.5%.

Challenge: Chronic Underinvestment and Workforce Shortages Spain's long-term care market faces a persistent challenge of chronic underinvestment compared to European peers. Public expenditure on long-term care in Spain is only 0.8% of GDP, less than half the EU average of 1.7%. The OECD average for long-term care spending is 1.8% of GDP, substantially higher than Spain's 0.9-1%. This underinvestment has direct consequences: there are more than 280,000 people waiting for assessment, and waiting times have increased from 334 days in 2024 to 342 days in 2025. The workforce shortage is equally critical. While more than 600,000 people work in the long-term care system, of whom 83% are women, estimates suggest that more than 260,000 additional professionals will be needed before 2030. Low wages and precarious working conditions make it difficult to fill vacancies. Only 168,000 nursing care assistants are currently working in Spain. The average annual expenditure per beneficiary was €8,417 in 2025, with significant regional variation from €14,384 in the Basque Country to €7,159 in Aragon. Without significant investment in workforce recruitment, training, compensation, and career development, Spain's long-term care system will face increasing difficulty in meeting growing demand.

Trend: Shift Toward Home and Community-Based Care A fundamental shift in long-term care delivery is occurring in Spain, with services increasingly being delivered in home and community settings rather than institutional facilities. Of the 2,204,784 total benefits of the Dependency System, 56% (1,240,337) are deployed in homes and community settings. Home care services (SAD) are the primary community-based service, with 168,666 beneficiaries in Andalusia alone as of July 2025. Residential care accounts for 13% of benefits, reflecting the preference for home-based care. The total number of benefits increased by 25% between 2020 and 2025, demonstrating the growing reach of the system. The reform of the Dependency Law is accelerating this trend by expanding home care assistance to tasks such as going to the doctor or shopping, and recognising telecare as a subjective right. Telecare is being positioned as a key tool to enable people to remain in their homes for longer, with the government emphasising its capacity to help people stay in their homes. The reform also includes the recognition of personal assistance as a service and the expansion of home care services, reinforcing the shift toward community-based care. This trend is driven by multiple factors, including beneficiary preference for ageing in place, government policies promoting home care, and the potential for cost savings compared to institutional care.

Policies

• The Dependency Law (Ley de Promoción de la Autonomía Personal y Atención a las Personas en Situación de Dependencia, LAPAD), established in 2006, is the cornerstone of Spain's long-term care system. The law defines three dependency grades and establishes the Sistema para la Autonomía y Atención a la Dependencia (SAAD) as the institutional framework for organising resources. In 2025, the number of people attended reached 1.784 million.
• The Council of Ministers approved the reform of the Dependency and Disability Laws in July 2025, with the legislative process currently in the Congress of Deputies. The reform eliminates the incompatibility regime in dependency benefits introduced in 2012, expands home care assistance, recognises telecare as a subjective right, and eliminates the two-year suspensive period for economic benefits for family care.
• Public investment in dependency care reached a record €13.734 billion in 2025, of which the central government contributed 27.4% (€3.758 billion) and the autonomous communities financed 72.6% (€9.976 billion). The central government increased its expenditure by €185 million due to the increase in the number of people attended.
• The National Recovery and Resilience Plan (PNRR) has allocated €1.5 billion for autonomous governments to undertake transformation works in residential centres and their adaptation to the new model, impacting 90,000 places.
• The government has committed to reaching 50% financing of the dependency system from the central government, up from the current 27.4%. The Ministry of Social Rights has set as a priority objective the development of the System for Autonomy and Attention to Dependency.
• The reform establishes that the recognition of dependency will automatically grant a 33% disability certificate, prohibiting discrimination based on disability in insurance and guaranteeing universal accessibility as a right. The reform also regulates personal assistance as a service, recognises telecare as a universal right, and expands home care assistance.

Segment Analysis

Spain Long-Term Care Market By Service Type • Home Healthcare: Home healthcare represents the largest and fastest-growing service segment in Spain's long-term care market. Of the 2,204,784 total benefits of the Dependency System, 56% (1,240,337) are deployed in homes and community settings. The Home Care Service (SAD) had 168,666 beneficiaries in Andalusia alone as of July 2025. Home healthcare includes personal care, nursing care, and support services delivered in the patient's home. The segment is supported by the reform of the Dependency Law, which expands home care assistance to tasks such as going to the doctor or shopping, and recognises telecare as a subjective right. The number of people at home needing assistance with autonomy is projected to rise significantly, creating sustained demand for home healthcare services.
• Nursing Care / Skilled Nursing Facilities: The nursing facility sector in Spain comprises 5,530 public and private nursing homes with a total capacity of 407,780 beds at the end of 2025. Almost 340,000 people live in residential care centres. Residential care accounts for 13% of the total benefits of the Dependency System. The sector faces significant capacity constraints, with a deficit of more than 50,000 places to meet current demand for people with severe and great dependency. The residential care sector has grown by 23,075 places in the four years following the pandemic (2021 to 2025). However, 4% of existing places are not occupied. The average annual expenditure per beneficiary was €8,417 in 2025.
• Assisted Living Facilities: Assisted living represents a growing segment in Spain's long-term care market. The sector includes assisted living facilities, day care centres, and supported housing for older adults. Residential care homes in Spain include both public and private facilities, with the private sector playing a significant role. The number of assisted living facilities is expanding, with new centres opening across the country. Day care centres provide social engagement and support for older adults, supporting the preference for home-based care. The reform of the Dependency Law includes supports in shared housing and the loan or temporary transfer of support products that improve autonomy, such as electric wheelchairs, walkers, articulated beds, and voice assistants. Day centres are being considered as proximity services and will be opened to provide support outside their facilities.
• Hospice and Palliative Care: Hospice and palliative care services in Spain are delivered across multiple settings, including homes, nursing homes, hospitals, and specialised palliative care units. The growing prevalence of chronic conditions and the ageing population are driving demand for end-of-life care services. Palliative care is integrated into the broader continuum of long-term care services. The growing number of people aged 80 and over (6.1% of the population) and 90 and over (more than 650,000) creates sustained demand for palliative care services. The segment is supported by the development of palliative care units in hospitals and nursing homes.
• Other Services: This segment includes day care centres, telecare services, and respite care. Day care centres provide social engagement and support for older adults, supporting the preference for home-based care. Telecare is being positioned as a key tool to enable people to remain in their homes for longer. The reform of the Dependency Law recognises telecare as a subjective right. Respite care services provide temporary relief for family caregivers. The need for these services is growing as families seek alternatives to full-time institutional care while maintaining caregiving responsibilities. The total number of benefits of the Dependency System increased by 25% between 2020 and 2025.

Spain Long-Term Care Market By Payer Type • Public: Public sources are the dominant payer for long-term care services in Spain. Public investment in dependency care reached a record €13.734 billion in 2025. Of this, the central government contributed 27.4% (€3.758 billion) and the autonomous communities financed 72.6% (€9.976 billion). The central government increased its expenditure by €185 million due to the increase in the number of people attended. The government has committed to reaching 50% financing of the dependency system from the central government. However, public investment as a percentage of GDP is only 0.8%, less than half the EU average of 1.7%. Public payers represent both the largest and fastest-growing payer segment.
• Private: Private sources account for a significant portion of long-term care spending in Spain. The private sector plays a significant role in residential care, with 5,530 public and private nursing homes operating in Spain. Private expenditure on long-term care includes out-of-pocket payments for services not covered by public funding, as well as private health insurance. The private residential care market is growing, with major operators expanding their networks. Private equity investment in the sector is increasing, with significant transactions such as the recapitalisation of Vitalia, Spain's second largest senior care provider. The private segment is growing as the public system faces capacity constraints.
• Out-of-Pocket: Out-of-pocket payments represent a substantial component of long-term care spending in Spain. Families bear a significant financial burden. The direct cost of benefits and services in 2025 was €11,847.9 million, of which €9,521 million was assumed by the public administration and the rest by users in the form of regulated co-payment. Private economic contribution amounts to €3,138 per household, a burden currently borne by 728,851 families. These amounts can increase depending on the degree of dependency, reaching €2,064 for Grade I, €3,324 for Grade II, and €4,620 for Grade III, with significant differences between territories. Out-of-pocket payments represent a significant financial burden on Spanish families.

Spain Long-Term Care Market By Gender • Female residents account for the largest share of Spain's long-term care spending, driven by higher life expectancy and higher rates of disability in advanced age. Life expectancy at birth for women is 86.34 years compared to 81.11 years for men. The feminisation of ageing is a constant phenomenon: among those aged 65 and over, women outnumber men by 29.5%. Women represent the majority of centenarians, with more than 80% of the almost 16,000 centenarians being women. The long-term care workforce is also predominantly female 83% of the more than 600,000 people working in the system are women. Women are more likely to live alone in old age, increasing their reliance on formal paid care services.
• Male residents account for a smaller but growing share of Spain's long-term care spending. The need for long-term care affects persons of all ages and is generally measured by limitations in an individual's ability to perform daily personal care activities. Men are more likely to need long-term care at younger ages due to disabilities and chronic conditions. As male life expectancy increases, the representation of men in the older adult cohort is slowly growing. The gender gap is gradually narrowing as male life expectancy increases.

Spain Long-Term Care Market Economics

• The cost of long-term care services varies significantly by service type, geographic location, and payer source. Public investment in dependency care reached a record €13.734 billion in 2025. The direct cost of benefits and services was €11,847.9 million, of which €9,521 million was assumed by the public administration and the rest by users in the form of regulated co-payment. Private economic contribution amounts to €3,138 per household, borne by 728,851 families.
• The average annual expenditure per beneficiary was €8,417 in 2025. Public expenditure per dependent person exceeded €6,015 in 2025. However, there is significant regional variation: the Basque Country spends €14,384 per beneficiary annually, while Aragon spends €7,159. The central government contributed €2,306 per beneficiary in the form of minimum protection, while the autonomous communities contributed €6,111.
• Staffing costs represent the largest operating expense for all long-term care providers. The sector employs more than 600,000 people, of whom 83% are women. However, low wages and precarious working conditions make recruitment and retention challenging. Estimates suggest that more than 260,000 additional professionals will be needed before 2030. Only 168,000 nursing care assistants are currently working in Spain.
• The economic value of home- and community-based services relative to institutional care is a key policy consideration. Home care is generally less expensive than institutional care on a per-patient basis, and the shift toward home care is expected to continue. Of the 2,204,784 total benefits, 56% are deployed in homes and community settings. Unpaid care work has a significant economic value, estimated at 3.6-4.7% of GDP.


Considered in this report
• Historic Year: 2020
• Base year: 2025
• Estimated year: 2026
• Forecast year: 2031

Aspects covered in this report
• Long-term care Market with its value and forecast along with its segments
• Various drivers and challenges
• On-going trends and developments
• Top profiled companies
• Strategic recommendation

By Service Type
• Home Healthcare
• Nursing Care / Skilled Nursing Facilities: 
• Assisted Living Facilities
• Hospice & Palliative Care:
• Other Services

By Payer Type
• Public
• Private
• Out-of-Pocket

By Gender
• Male
• Female