In the sun-filled living room at Santa Engracia nursing home, nonagenarian Candida Castillo says she was moved out of her nephew's home because six people could not fit in a three-bedroom apartment.
"It's comfortable here and they give us care and peace," she says. "But am I happy here? I'd rather be with my own."
Ms. Castillo is among an increasing number of Spaniards confronting a new trend that runs counter to longstanding cultural tradition. Previous generations expected to spend their golden years in the care of loved ones. But today, with more women working outside the home and a growing population of senior citizens to take care of, families are turning to nursing homes for help.
"The traditional model of extended families living together, this deeply rooted style of life in the Mediterranean, is no longer sustainable," says Dr. Antonio Abellan, a demographer and sociologist based in Madrid. "Society is changing radically, and governments are not prepared to deal with it."
Europe's population is aging continentwide, but the surge in the number of elders is particularly dramatic in the Mediterranean region, which is experiencing the lowest birthrate in Europe alongside the greatest longevity.
Spanish women live 82.7 years on average, among the longest life spans in the world. According to the United Nations, Spain will be the oldest country in Europe in the next 50 years, when more than 37 percent of its population will be 65 years or older. Globally, UN figures show, Spain ranks second behind Japan, in terms of oldest population.
In Spain, the thought of placing grandparents in a residence was almost unthinkable a couple of years ago.
"Nursing homes didn't exist when 80-year-olds today were younger," says Tino Villanueva, the director of Santa Engracia, a state-funded facility. "Residences were only for those with no money, with no family - or for crazy people."
In a recent survey carried out by the government's Superior Council for Scientific Research under the direction of Mr. Abellan, nearly 80 percent of seniors said they would prefer to stay in their own homes instead of a residence for seniors, even if they suffered from an illness that needed constant vigilance.
"These numbers are much higher than in the rest of Europe," Abellan says.
"In Germany, the elderly have known since they were young that they'd end up in a nursing home," he says. "In Spain, they feel they should be taken care of by their own daughters, because they took care of their parents."
The demographic shift has sparked rising demand for senior services throughout the Mediterranean.
According to the Spanish government's Institute of Migrations and Social Services, more than 100,000 senior citizens in Madrid were on waiting lists for beds in nursing homes in 2000. Nationwide, there is only enough space for 1 in every 8 seniors dependent on nursing care.
Some unauthorized residences for seniors have recently taken up the slack. And allegations that unlicensed senior homes have mistreated residents have surfaced in the Spanish press recently.
In the past five years new immigrants - mostly from Morocco, Ecuador, and Sub-Saharan Africa - have also filled the demand for caretakers. Along the streets of the cities, immigrant women are often seen walking hand in hand with an elderly patient.
Experts say a more formal network is needed.
"The Spanish government hasn't yet focused on this problem," says Maria Rodriguez, president of the Confederation of Consumers and Users.
Her organization is one of 13 not-for-profit groups that are organizing next month's World NGO Forum on Aging, to be convened in Madrid, and working to develop a global public policy on seniors.
Many governments are examining the economic and social implications of aging populations. The costs of elderly care - from pensions, to pharmaceuticals, to assisted care - are surging as the working-age population shrinks. Spain's spending on pensions is expected to double between 2000 and 2050, for example.
The UN has calculated that Spain will need 12 million immigrants in the next 50 years to maintain the size of its working-age population.
By mid-century, in developed nations, people over the age of 65 will outnumber those under the age of 15, for the first time in human history, according to the UN.