A Perfect Storm? Exploring Governance Responses to the COVID-19 Crisis in the Spanish Elderly Care Sector

COVID-19 has been referred to as the "second transboundary mega-crisis to hit contemporary societies in this century". This transboundary threat has hit vulnerable societal groups the hardest; among these, nursing home residents have been the most affected population. On average, between 30 and 60 percent of overall COVID-19 related deaths in European countries during the spring of 2020 occurred in nursing homes. As of January 2021, 47.5% of the fatal cases officially reported in Spain had occurred among nursing home residents, which accounted for 31,460 deaths. Despite the COVID-19 crisis has revealed a failed governance model in the elderly care sector, few academic studies have examined the weaknesses of existing governance arrangements in detail. Hence, our primary research question investigates the factors influencing the performance of Spanish nursing home services amid the COVID-19 crisis. To answer this question, we examine the impact of four main sets of governance variables: ownership type (public, private nonprofit, and private for-profit facilities), transparency/information provision mechanisms, quality services, and the performance of central and regional governments. We also control by core characteristics of nursing homes, residents, and family members. Since this outbreak has mainly affected the elderly living in these facilities, we examine the perceptions that service beneficiaries have on the response given by nursing home facilities. In particular, we surveyed family members of nursing home residents (1009 respondents) in Spain.