How digital platforms are
reinventing the care sector
Developments and high penetration rates of communication and information technologies have been fuelling the expansion of digital platforms specialised in home care. Use of algorithms and business models in Spain
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In different countries, web platforms and mobile applications are now enabling carers to find work at the same time as they are helping families find a carer. What traditionally used to take days can take just hours thanks to a mobile application.
Digital Future Society Think Tank’s recent report Home Care and Digital Platforms in Spain identifies at least eight businesses using web and mobile application platform technology to match carers with dependent and elderly people needing care in Spain. The companies were founded as start-ups between 2015 and 2018 and have since scaled to offer services in cities across Spain. One of the platforms also offers services in rural areas.
As the article Home Care and Digital Platforms describes, the home care and domestic work sectors in Spain are characterised for having an overwhelmingly female workforce, for being highly precarious and socially invisible and undervalued. In Spain, a large proportion of carers and domestic workers are foreign, and many receive cash in hand and work without a contract or social protection. At the same time, the ageing population and high incidence of chronic disease in old age, together with the shortage of public services, make for home care to be a lucrative, growing industry in Spain.
Two business models
Recently, mostly in the last five years, new intermediaries have entered the sector both in Spain and abroad. Developments in digital technologies and high penetration rates of communication and information technologies have been fuelling the expansion of digital platforms.
The platforms in Spain specialising in home care have two distinct models: the digital placement agencies and the on-demand models. The digital placement agencies operate similarly to the traditional placement agencies. Under this model, the families are the employers, with the carers employed under the Special Social Security System for Domestic Workers. The platforms specialise in mid to long-term care and charge an initial fee for selecting the carer and doing the contractual paperwork on behalf of the family. The platforms also charge a monthly fee to cover administrative costs which include managing payslips, finding a substitute for summer holidays, and providing general ongoing support services.
Cuideo, founded in Barcelona in 2016, is one of the biggest of this type of platform in Spain. The platform offers long-term, regular, and pre-programmed by-the-hour services and live-in care (including weekend only live-in care). Services are available in more than 24 cities across Spain. The platform has over 3,000 active carers and employs 50 staff. Carers help with a range of day-to-day activities, including shopping, personal hygiene, administering medication, cooking and cleaning, and accompanying the client on doctors’ visits. The needs of the client can vary widely depending on the degree of dependency. Some, for example, only require a light level of assistance with cleaning, shopping or running errands a few hours a week. In contrast, others with multiple chronic pathologies need round the clock assistance.
The other model used by on-demand platforms is similar to that used by on-demand platforms in other sectors. These platforms specialise in one-off short-term services. Typical client needs would include someone needing a carer to accompany their elderly parent home from the hospital, someone whose regular carer cannot come at the last minute, someone whose child is sick or on school holiday while they have to work, or someone wanting to take a respite and go out for dinner with friends. The workers set their hourly rate, with the platform taking a commission and setting a minimum hourly rate.
Familiados is an example of this on-demand model. Founded in Pamplona (Spain) in 2016, it is registered as a limited company and, through its mobile app, offers on-demand, one-off and regular by-the-hour care services. The company has around 2,000 carers and ten staff. For long-term care needs, Familiados suggests customers use the app to find a worker for a few hours and then, if they are happy with them, employ them directly. The app allows for clients to chat with and videocall carers suggested by the platform’s algorithms. Customers can cancel up to two hours before the service is due to take place.
The platforms’ key selling points
Founders of both models coincide in describing the advantages of digitalising the sector, especially regarding increased agility, ease of use and peace of mind. As for the user needs they are addressing, the founders have tapped into some very specific “pain points”. Historically, finding a carer can be a stressful process and often the end-user (dependent person) is different to the service purchaser. In other words, the service purchaser is in the so-called sandwich generation: the parents of children in the case of childcare and daughters and sons in the case of elderly care. As one of the interviewees said, children give a nine-month notice, but “dependency” in old age often comes unannounced.
The platforms remark as one of their key selling points to clients the agility of their services (users can find a carer within an hour on the on-demand app and within a day or two through the digital placement agencies). They offer more agile services from the comfort of one’s home compared to the time and effort involved in going through traditional agencies and informal channels, such as looking up phone numbers in ads on a hospital notice board. They emphasised the tension generated by the delay in finding someone suitable against the need of having to find someone urgently, someone trustworthy.
Another important selling point is related to trust and professionalism. Due to the nature of the job, care for young and elderly relatives is fraught with fear around the risks of seeking services from strangers online or off the street. In this sense, most platform websites and marketing materials references how they work with the best professionals, their rigorous selection process, and the low proportion of applicants that make it through successfully.
Clients are systematically encouraged to review the carer. However, although carers might be able to provide feedback, they are generally not asked to review the client by default.
Furthermore, potential carers must invest a considerable amount of time online, filling out templates and uploading documentation such as certificates and proof they can legally work in Spain. They also need to provide contact details for references. In some cases, they also have to record themselves on video or build an online profile with a picture. Some platforms require carers complete online personality and psychological tests, and all digital placement agencies mentioned they interview (mostly virtually) those who have completed all the previous steps.
Use of algorithms
All platforms we spoke to in our research use algorithms in the process of matching clients with a suitable carer and some platforms work with dozens of variables. However, all of the digital placement agencies interviewed emphasised the importance of having a person check the matching done by the algorithms. This marks a clear difference with the modus operandi of platforms in the delivery and transport sectors. For on-demand platforms in the care sector, however, the process is fully algorithmic like that of Glovo or Uber.
One of the on-demand platforms also mentioned how algorithms reward those who are most active on the platform by sending them more job offers.
Some platforms select the worker themselves, or they might highlight three candidates. In the case of the on-demand platforms, the algorithm generates one suggested candidate and three alternatives, and the system facilitates the profiles and photos for the clients to make the final call.
Looking ahead: the role of technology and digital platforms in home care
Across the board, the platforms interviewed for the Digital Future Society report were at different stages of further developing the technology used, beyond recruitment, in the day-to-day follow up of services. This includes, for instance, the development of apps with the daily activities for the carer to do with the client and for the carers to communicate with relatives. Looking forward, as discussed in the Home Care and Digital Platforms in Spain report, it is yet to be seen what role digital platforms and technology can play in promoting decent work in this highly precarious sector. Even in the cases where a contract formalises the working relationship, this does not, by definition, go hand-in-hand with decent working conditions. Ensuring home carers are valued socially and enjoy full rights and decent working conditions, requires the participation of all social actors involved, including workers themselves.
Data related to Cuideo and Familiados platforms are from 2020.