Un modelo innovador de gobernanza multinivel en la atención geriátrica rural: la respuesta institucional de la Diputación de Lugo
Year: 2026
Type: article
Abstract: This study analyzes the Elderly Care Centres of the Provincial Council of Lugo as a paradigmatic case of peripheral institutional innovation in long-term care. The distinctive feature of the model (and the analytical thread of the article) is its governance: a horizontal public partnership between the Provincial Council and eighteen rural municipalities, structured through intergovernmental agreements and funded exclusively with local resources in the absence of regional co-financing. On this basis, the study examines three dimensions: the institutional architecture and its enabling legal instruments; the implementation of the Integrated Person-Centred Care paradigm through “permeable institutionalization” that preserves community ties and biographical continuity; and the role of the centers as instruments of sustainable rural development, with quantifiable multiplier effects: a fiscal return of 60–66 % and twenty-five jobs per center, with 80 % of hires being local. Based on a documentary analysis of ten agreements, economic management data, and participant observation at four centers, the results establish a critical viability threshold of 30-40 beds and identify as a central structural tension an annual operating deficit of 3.6 million euros borne by local governments, offering a model with the potential for transferability to territories facing similar sociodemographic challenges.
Author: Rivera Capón, Pablo
Language: Spanish
Subfield: Geriatrics and Gerontology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7209416500