Health and labour impacts of proximity-based home care reorganisation in Barcelona

Issue/Problem

Home Care Services (HCS) are essential for ageing populations and vulnerable groups. In Spain, HCS are provided by local administrations and Barcelona City Council has been reorganising its HCS to improve the quality of service and workers’ labour conditions. The new model brings together teams of home care professionals assisting a group of service users living within a defined city area. This reorganisation offers lessons for settings with publicly provided home care or those seeking to promote proximity-based, team-oriented models to improve labour conditions.

Description of the Problem

With the objective of examining changes in travel time, employment conditions, ergonomic and psychosocial risks, and health outcomes among HCS workers in Barcelona, a mixed-methods evaluation was conducted between 2022 and 2025. It comprised a quasi-experimental pre–post survey with intervention and comparison groups (total n = 1,288) and longitudinal qualitative methods (n = 27).

Results

The reorganisation reduced travel time between homes and increased contracted hours and permanent posts. However, fatigue rose, psychological job demands increased and ergonomic risks remained high. Peer relations intensified and bonding improved, though isolated harassment cases appeared.

Lessons

By shifting from isolated care work to proximity-based teamwork, this reorganisation intended to improve jobs but revealed adverse health effects. After the pilot phase, digital disconnection measures were taken. Current recommendations should prioritise action on ergonomic risks, rest and work pace.

Key messages

• Proximity-based services raised actual working hours, and thus fatigue, by reducing commutes and expanding contracted hours.

• The new model reduces workers’ isolation and strengthens peer support but requires safeguards against harassment.