The Ombudsman has suggested that study should be carried out into whether people who opt out of state services they are eligible for, should be given some compensation for using private services.
In a report issued today, the Ombudsman noted that where an elderly person eligible for institutional care in a state-owned residence for elderly patients fails to make use of this facility and makes no call on public funds, this person is not entitled to any compensation under the social security legislation.
"Although the situation is legally in order, it could in effect amount to injustice," the Ombudsman said.
He therefore raised the issue whether legislation should be amended in order to allow some form of compensation to persons who opt out of care services to which they would otherwise be entitled.
The report was issued after the Ombudsman, Joseph Said Pullicino, investigated the case of an elderly who complained about damage caused to her property by nurses from the Malta Memorial District Nursing Association (MMDNA) involved on behalf of the Elderly and Community Care Department in the delivery of community care services to elderly persons living in their homes.
The lady also claimed that the nursing care given to her infirm and bedridden husband was inadequate and asked the Ombudsman to intervene with the department so that she would receive compensation for expenses that she incurred for physiotherapy and occupational therapy sessions for her husband since this treatment did not form part of the rehabilitation service provided by the department.
Complainant maintained that she deserved financial compensation as well in recognition of the fact that rather than resort to institutional care for elderly persons at the government-owned St Vincent de Paule Residence, she chose to keep her husband at home and look after him herself.
Upon looking at the first accusation, the Ombudsman found that MMDNA nurses who look after complainant's husband have to work in very cramped conditions inside his room – and, in the circumstances, it is extremely difficult, if not downright impossible, not to accidentally knock against the furniture and other chattels that clutter this room.
Despite these mitigating circumstances the Ombudsman disagreed with the stand by the department to disclaim any responsibility for damage that might have been caused to complainant's property on the grounds that the nursing service being delivered to her husband is provided by the MMDNA that is a voluntary organization and does not form part of the department's setup.T he Ombudsman insisted that it is the department that is ultimately answerable for every aspect of the network of care services provided by the Association on its behalf.
At the same time the Ombudsman made it clear that this does not mean that the department should unquestioningly accept any claim for damage that may be presented by patients who make use of the service given by the MMDNA. In any similar situation there should be clear evidence that the damage was caused through carelessness or lack of skill and that it could have been avoided if there had been greater attention.
On the other hand the Ombudsman noted that the MMDNA management gave a plausible explanation for the conduct of its nursing staff in the performance of their duties at complainant's house. He also noted that the department accepted the MMDNA's dismissal of complainant's charge that its employees were negligent and caused damage to her property and made it clear that in his view there was no maladministration at all by the department's officials when they turned down her request for damage to her property.
COMPENSATION
The second aspect of the complaint concerned the extent to which complainant could claim financial compensation from the authorities to make up for payments that she made for physiotherapy and occupational therapy sessions for her husband that were excluded from the community care services provided to him by the Elderly and Community Care Department.
From the Department of Social Security the Ombudsman learnt that in an instance such as the one under scrutiny where an elderly person eligible for institutional care in a state-owned residence for elderly patients fails to make use of this facility and makes no call on public funds, this person is not entitled to any compensation under the social security legislation. This led the Ombudsman to comment that although the situation is legally in order, it could in effect amount to injustice. He therefore raised the issue whether legislation should be amended in order to allow some form of compensation to persons who opt out of care services to which they would otherwise be entitled.
The Ombudsman also took this opportunity to put forward a series of observations on primary care services in the community.
From the outset he admitted that it is not his function to determine the quality and the nature of the services that the health authorities should provide to elderly persons.
At the same time he recognized that it is his duty to establish the extent to which the government's policy in this field could possibly be contributing towards a heavy build up in the demand for places in state-owned institutions for residential care for elderly persons and towards long waiting lists as well as the sharp rise in what are termed as social cases in hospitals such as Mater Dei Hospital. As a result of this situation, several patients who ought to be cared for elsewhere, occupy beds in state-run acute general hospitals at the expense of, possibly, other more deserving cases.
The Ombudsman felt that this situation could be considered as tantamount to maladministration that he is entitled to investigate.
The Ombudsman recalled that in the past patients referred to Zammit Clapp Hospital for rehabilitation undertook to go back home once their rehabilitation was over. Although unaware if this procedure is being adopted in Karen Grech Hospital, the Ombudsman stated that he understood that several patients in this hospital could go back home after they complete their rehabilitation as long as effective community care services would be delivered to them in their home.
The Ombudsman, while appreciating that this is a difficult social problem, expressed his conviction that the application in a rigorous and non-discriminatory manner of well-defined policies in this field would permit the release of several beds in acute general hospitals and institutions for the care of elderly patients in favour of more deserving cases.
The Ombudsman observed that in the absence of clear policies and protocols, demand for hospital beds and for institutional care for the elderly and for persons suffering from chronic illness is bound to rise. In this regard the announcement of a set of transparent guidelines that the hospital authorities would be bound to follow should contribute towards better all-round administration of hospital space and resources and improved public health service provision.
In the light of his analysis of the current situation in this field the Ombudsman put forward the following observations:
- Despite an awareness of the importance of community care services delivered in the homes of elderly patients and persons with chronic illnesses and the advances registered in this field in recent years, these services do not seem to be provided in a holistic and personalized manner according to patients' particular needs;
- Although most elderly patients as well as persons with chronic illnesses that do not require acute general care and even their immediate families are known to prefer that as much as possible these patients remain in their own familiar domestic environment, this wish needs to be backed by an assurance that community primary care services delivered to elderly persons in their homes are up to expectations and fully responsive to their needs;
- Demographic trends as well as changing lifestyles together with substantial investment in recent years to promote improved standards of institutional care to elderly persons serve as a constant source of encouragement to family members of these persons to do their utmost to place their relatives in residences for the elderly; and as a result lists of elderly persons waiting to be taken in residential care facilities have become unacceptably long. In turn this situation has led to usage of Karen Grech Hospital as a half way house to accommodate elderly patients who do not require acute general treatment while awaiting their turn to be admitted to a residential care facility;
- Although community care services at the primary level should, where possible, incorporate an element of assistance by relatives of elderly persons and carers as well as the service of doctors and healthcare professionals such as speech therapists, physiotherapists, occupational therapists, social workers, etc., the Ombudsman referred to indications that this approach by interdisciplinary teams in the healthcare professions is not applied in a sufficiently comprehensive manner in the sense that patients are not monitored on a regular basis and according to their particular needs;
- There is also evidence that owing to the lack of professional and specialized resources it is not possible to provide primary healthcare services in the community in a holistic and personalized manner and the Ombudsman recommended that this matter be given urgent attention by the national health authorities;
- As patient referral to private hospitals for certain operations gains further ground and helps to cut down on waiting time, the Ombudsman referred to the proposal to organize teams of medical doctors on call on a 24x7 basis to respond to the needs of elderly patients placed under their care and with direct access to information regarding their medical history – these arrangements, if implemented wisely, would mean a saving to the national coffers and at the same time reduce the need of institutional care to these patients.