Dementia and Alzheimer's care in Spain: services and next steps

Terms used

• Centro de salud — The centro de salud is your local public health centre, where your family doctor and social worker work.
• Grado de dependencia — The grado de dependencia is the official level of care need recognised by the regional administration after an assessment visit.
• Servicios sociales de base — The servicios sociales de base are the municipal social services office that guides you to local help.
• AFA — An AFA is a local family association for people affected by Alzheimer's, offering advice, day centres and workshops.
• Poder preventivo — A poder preventivo is a notarial power of attorney signed in advance that continues if the person loses capacity.
• Autocuratela — Autocuratela is a notarial deed where a person names in advance who should support them.
• Guarda de hecho — Guarda de hecho is informal support by a relative who is already helping, accepted without court for most acts.
• Curatela — Curatela is court-ordered support, tailored to the person, used only as a last resort.

Key rules

• Legal planning: Sign a preventive power of attorney while the person still has capacity to understand and decide.
• No automatic court: If nothing was signed, a relative already helping can handle most acts without a judge.
• Dependency: Public services usually come through the dependency recognition, applied for at your regional administration.
• Regional differences: Waiting times, services and funding vary by region and locality.

Start with the family doctor, and plan the legal side early

The public route begins at your centro de salud, and the legal paperwork is easiest while the person can still understand and decide. Do both in parallel: medical steps and a visit to a notary. The checklist below lists the steps in order.

How diagnosis works

Book an appointment with the family doctor (médico de atención primaria). The doctor does a first memory screening and blood tests, and may order imaging. Then comes a referral to neurology, geriatrics or a hospital memory unit for a full diagnosis. This route is for people covered by the public health system. Waiting times vary widely by region.

What to do after diagnosis

Contact the social worker (trabajadora social) at the centro de salud and your municipal servicios sociales de base. Then:

1. Apply to your regional administration for recognition of dependency (grado de dependencia).
2. Expect an assessment visit.
3. Receive an individual care programme (PIA), which assigns services or benefits. These can include home help, a day centre, a residence place or a carer allowance.
4. Apply separately for the disability certificate (discapacidad). It gives tax and other benefits.

Services you may find

• Day centres (centros de día), often specialised in Alzheimer's.
• Home help (SAD).
• Short respite stays for the carer.
• Residences with dementia units.
• Memory and occupational therapy workshops.
• Training and psychological support for carers.

Some services are public, some are concertados (publicly funded but privately run), and some are fully private. Public access normally goes through the dependency system and social services. What exists near you, and how it is funded, differs widely by area.

Family associations

A family association (AFA) is often the most practical help. Local AFAs give advice on benefits and the care system, and many run day centres and workshops. They belong to regional federations and to the national confederation, CEAFA. Contact the nearest one soon after diagnosis. There are also national foundations, such as Fundación Pasqual Maragall and the Fundación Reina Sofía Alzheimer Centre in Madrid.

Legal planning: do it while the person can decide

Spain no longer declares adults legally incapacitated or places them under guardianship. It uses supports that follow the person's own wishes. This applies to adults with dementia in Spain, including foreigners whose assets or residence are here.

See a notary as soon as possible after diagnosis, usually in the early stage. The notary can advise and prepare:

• A preventive power of attorney (poder preventivo). It keeps working if the person loses capacity. It can record their wishes on care, property and who supports them.
• A self-guardianship deed (autocuratela), naming who they want to support them.

The notary or a lawyer will confirm whether the person has enough capacity to sign. If you wait until capacity is lost, the family is pushed into a court procedure.

If nothing was signed

You do not automatically need court. A relative who is already helping (guarda de hecho) can act for most things without a judge. A court's approval is needed only for certain significant acts. Judicial support (curatela, or a defensor judicial for specific conflicts) is a last resort. It is tailored to the person and reviewed at most every three years, or up to six in exceptional cases.

Timeline and deadlines

• Start legal planning and sign a preventive power of attorney with a notary: as soon as possible after diagnosis, while the person can still understand and decide

• If no deed was signed, rely on the relative already helping (guarda de hecho) for most acts: when capacity has been lost without any planning

• Ask the court for judicial support (curatela) only as a last resort: when other supports are not enough

• Review the court support measures: at most every 3 years, or up to 6 years in exceptional cases

Documents you need

• Preventive power of attorney (poder preventivo): a notarial deed signed by the person while they still understand and decide, which keeps working if they lose capacity. A notary grants it.

• Self-guardianship deed (autocuratela): a notarial deed where the person names who they want to support them. A notary grants it, and it is optional.

• Disability certificate (discapacidad): issued by the regional administration, it gives tax and other benefits. Apply for it after diagnosis; it is optional.

• Dependency recognition (grado de dependencia): the regional administration issues it after an assessment visit. It is needed for public services and benefits.

Checklist

• Book an appointment with the family doctor at your centro de salud for a first memory screening and blood tests.

• Contact the social worker (trabajadora social) at the centro de salud and your municipal social services after diagnosis.

• Apply for the disability certificate (discapacidad) to get tax and other benefits.

• Contact the nearest family association (AFA) for guidance, day centres and workshops.

• See a notary soon after diagnosis to arrange a preventive power of attorney while the person can still decide.

Frequently asked questions

Do we need a court procedure if my parent already has dementia and signed nothing?

Not always: a relative who is already helping (a guarda de hecho) can act without a court for most everyday acts. Court-approved authorisation is needed only for certain significant acts. Formal court support measures are a last resort, tailored to the person and reviewed periodically.

How often are court support measures reviewed?

Court support measures are reviewed at least every three years, or up to every six years in exceptional cases. They are tailored to the person and used only when needed. A notary can advise you on grants that avoid this route.

Where can a family association help with the care system?

A local family association (AFA) can guide you through the process and advise on benefits. Many run day centres and workshops, often under agreements with regional or municipal authorities.