Can dignified home care for the elderly become a feasible reality?

We are an ageing population just like the rest of the world. People over the age of 85 years of age are the fastest-growing segment and half of them need some help with activities of daily living. Beyond age 65, people have more than a 70% chance of needing some sort of long-term care. Care for the elderly has been in the spotlight since it is fast becoming a crucial sector to maintain a sound social structure.

Although home facilities or family help for the elderly have been their only choice, home care is now becoming a preferred option with 95% of seniors aged 75 years or older wanting to remain living in their own home. If properly managed it may be very beneficial to the family and with the right system in place the person being cared for usually shows signs of increased motivation to carry out activities of daily living as they now no longer feel alone or a burden on others.

This option is very cost effective if the assistance needed is a few hours daily for shopping, cooking, companionship, overnight stays or a few days a week as respite for the family. However once the situation turns into a 24-hour scenario there is a big gap between pensions and the cost of hiring a care worker even at minimum wage, since the maximum pension stands at €12,772 per annum and the cost of care calculated at minimum wage would be around €33,000 per annum, not including insurances, NI, VAT etc. If calculated as a real cost and not at minimum wage it would be closer to €60,000 per year.

So many families are forced out of the option of proper care for their elderly and opt to hire a live-in housekeeper, usually from the Philippines, and without choice have to abuse their time! Why? Because like any worker, although they live in your home they are paid the minimum wage for an eight-hour shift, the rest of the time they should be free to go or do as they wish unless they work and get paid overtime, but since the whole scope is 24-hour care, they are inadvertently asked to stay at home all the time without proper compensation or time for rest, while the foreign worker feels obliged not to complain since they are afraid of ending up on the street. Many foreign workers go even further and don’t report vital incidents which are crucial for the wellbeing of the client, so as not to ruffle any feathers, leading to the total lack of safety and continuation of care.

Unfortunately we also very often hear of the abuse that foreign care workers dish out to their clients, especially if they are hired privately and have no one who can train them and keep them in check.  Elderly persons who have been left alone unattended, unwashed and inadequately hydrated are just a few of these stories we hear on a weekly basis. More problems also arise since these workers are being so overused and overworked that they end up experiencing burnout again, to the detriment of proper care.

Thanks to the FXAM (Fondazzjoni Xjuhija Malta) and our current President, the government has started the process of setting up the much needed standards for homes for the elderly in the country and will start giving the elderly some much needed improvement. This will be followed by standards of in-home care which will go far to curbing abuse by the care worker or towards the care worker.

Until the government manages to figure out how to help the elderly who can remain at home with some assistance and bridge the gap between pensions and the cost of care beyond the current €300 a year, the problem of hospital crowding and long waiting lists for public homes for the elderly will continue to mushroom. Furthermore it is really sad to see so many dedicated, caring Maltese people who are willing to work and devote their time to really helping others, out of work due to the ever increasing influx of cheap foreign labour who due to their circumstances at home accept wages far below what is legal or even humane.

The inclusion of a responsible party overlooking and helping in the management of care, where either the care worker, the family or the elderly themselves have an outlet to share any grievances that may arise, goes a long way to eliminating abuse and promoting the proper care the elderly deserve in such a difficult part of life.