Minimum standards for care of the elderly

It seems to be a trend of the current administration to hold unannounced spot-checks on government-run institutions to verify allegations of abuse, neglect or maladministration.

The first example was a surprise inspection of the prison facilities by the Home Affairs and National Security Ministry in April last year, which revealed a host of administrative failures that led directly to the resignation of the prisons director.

Over the past month, the parliamentary secretary for social welfare, Justyne Caruana, has similarly visited a number of government and private institutions for the care of the elderly, and was reportedly shocked at what she saw in some cases. Among the problems that appalled Caruana (though to be fair, not in all institutions: she had words of praise for individual homes such as the one at Mtarfa) were the overall poor standards of food and hygiene, while there were also reports of physical abuse and of theft of personal items.

One official responsible for the Msida centre has since been replaced.

Clearly, the government intends to deliver on its electoral promise of a more hands-on approach to allegations of mismanagement in various sectors. This is in itself commendable, though it remains to be seen whether such random spot-checks by individual ministers will indeed result in the root-and-branch reform so many institutions seem to need.

The problem with this approach is that – even if the government’s intentions are beyond reproof – it inevitably creates a sense of arbitrariness in the question of which problems are identified and tackled, and which are left to fester ignored. Politics plays a part in the prioritisation of such sectors. After numerous scandals, such as the Josette Bickle case of 2011, there was political pressure on the incoming government to revise its prison administration methods. Care for the elderly was similarly a political issue before the last election, as least insofar as the largest such facility, St Vincent de Paul, was concerned.

It is unsurprising, then, that the government would focus on these two areas to make a public display of dedication and commitment. One must however question why no such commitment has so far been shown to other critical social welfare areas, such as facilities for the disabled: nearly all of which are run along charitable lines by a financially beleaguered Church, and in most cases depend exclusively on the public’s generosity for their survival.

Moreover, while spot-checks are useful in identifying and addressing individual problems – truancy among staff in the case of prison, and sanitation and hygiene issues where retirement homes are concerned – there are other systemic and policy problems associated with such institutions which cannot be solved by random initiatives of individual ministers.

Some of these situations are less problematic than others. For instance, there is only one prison facility on the island: it is centrally administered by the government, with the private sector contractually engaged only for the provision of food, cleaning services, etc.

The situation regarding homes for the elderly is however more complex. The government runs a number of such homes along the same basic ‘private-public partnership’ model outlined above. But there are also a number of fully private homes, as well as government homes whose internal administration has also been farmed out to the private sector.

This inevitably creates issues concerning divergences in standards between the different administrative models. By far the most pressing problem concerns the fact that private and public facilities appear not to be answerable to the same standards. Until last July, private retirement homes could not be officially monitored at all, and were not accountable to any central monitoring authority. Now that this situation has been rectified, there remains to date no legally established national minimum standards for care for the elderly. In the absence of such a basic policy tool, it remains unclear how the monitoring authority can actually use its newly acquired powers over the private sector to enforce standards which do not, at present, exist.

What is certain, however, is that the problem will exacerbate itself in future. Statistically, in Malta there are 102,026 (roughly one quarter of the population) in the 60+ category according to the latest census. The real challenge, however, concerns the 75+ bracket, which is expected to triple in number over the next 20 years.

As gerontologist Marvin Formosa recently told this newspaper, by 2050 the elderly will outnumber those under 60 by five to one. And with people living considerably longer today than 50 years ago, the challenge of both meeting minimal standards of care, and creating opportunities for active ageing, is only going to become more acute.

The Social Policy Ministry has now launched a public dialogue exercise with a view to launching a set of minimal national standards for this sector. This is welcome news: in fact it is surprising that Malta has operated without any such minimum standards for so long.

But given the demographic trends for the foreseeable future, and the implications on other aspects of public policy – not least, pensions – having a ‘national minimum standard for elderly care’ is the very minimum we should be striving for.