The Maltese population is living longer and is in better health. Life expectancy has been on the increase. According to the National Statistics Office (NSO), life expectancy is calculated to be 79 years for men and 83 for women. Since 2001, it has climbed three years for men and 2.13 years for women.

Population growth also appears to be on the rise, with an increase of 1.1 per cent over a period of four years (the estimated population in 2008 stood at 411,579, and in 2011 it stood at 416,110). By year 2025, the Maltese population is projected to reach 429,000, with levels dwindling thereafter to just over 350,000 by 2060.

Demographic projections reveal a continuously ageing population, and the NSO foresees an increase of around 72 per cent (circa 111,700) by 2060, with a concurrent drop of approximately 35 per cent in the number of children and youths under 20 (a decrease from 90,705 to around 59,300).

Malta’s population, as with the rest of the EU and most parts of the world with the exception of the poorest countries, is ageing fast.

The European Statistical Office projects that by 2060 there will be only two people of working age (15 to 64) in the EU for every person aged over 65, compared to a ratio of four to one today. This will be most strongly felt during the period 2015 to 2035, when the baby boomers start to retire.

Population ageing presents various challenges. It calls first and foremost for a deep rethink on how we construe our various, related policies. It also mandates that we fully understand their implications, how they interact and complement each other or otherwise clash. And, ultimately, how they impact our welfare systems, and equally importantly, public finances.

In view of the higher incidence of frailty and disability (in particular among the very old, aged 80 and over), which is the fastest-growing segment of the population in the decades to come, it is envisaged that this would have a strong upward impact on public spending on long-term care.

The 2012 Ageing Report produced by the European Commission projects public spending on long-term care to double, increasing from 1.8 per cent of GDP in 2010, to 3.4 per cent of GDP in 2060 in the EU as a whole. The report presents various scenarios in order to derive long-term projections, one of which estimates an even further increase of 1.7 percentage points of GDP over 2010 to 2060 in the EU as a whole.

When it comes to ageing, our policies are geared towards hospitalisation/ institutionalisation. These communicate the wrong signals

But the projected increases vary markedly across EU member states. For instance, the projected increases in terms of percentage points of GDP over 2010 to 2060 is less than one percentage point of GDP in Bulgaria, Estonia, Spain, Italy, Cyprus, Latvia and the UK. By contrast, an increase of three percentage points of GDP or more is projected for Belgium, Denmark, Lithuania, Malta and the Netherlands.

Indeed, long-term projections are not forecasts, and the level of uncertainty is greater when undertaking projections over a long-term period. Nonetheless, such projections remain useful, firstly because they reflect various approaches to the provision and financing of long-term care across EU member states, and secondly, they highlight the need to take due account of our policy actions and the sustainability of future increases in government expenditure.

The need to give due regard to our domestic policy responses and a thorough rethink on their effectiveness or lack of it and the sustainability of public finances becomes highly evident on viewing the following graph produced by The 2012 Ageing Report, and reproduced herewith.

The graph in Table 1 plots average public spending on healthcare per capita (as a percentage of GDP per capita) against the age of individuals across EU member states. Spending generally increases as the individual ages increase, and it becomes more costly for men than for women.

Public spending becomes even more costly for the Maltese in particular! Malta’s average expenditure on healthcare per capita tends towards the high side, notably when men reach the age of circa 65, and women reach the age of about 68. Moreover, a relatively drastic rise in public expenditure is revealed as age approximates 75 both in the case of men and women.

What does this, essentially, imply? Perhaps, an ageing Maltese population with a less healthy status, or a better one, that tends to become sicker on ageing when compared with the other EU member states?

Or is it a sheer reflection of ineffective and defunct policies adopted in the past and which today are shouting in dire need for modernisation and sustainability? I tend to believe more in the latter.

An in-depth review of expenditure over the past years on care for the elderly and disabled, reveals an increase from €48.2 million in 2010 to €52.3 million in 2011 (see Table 2).

Notwithstanding the significant increase in expenditure, that is, of €4.1 million, one can note that the figures relate, more or less, to the same services, apart from the registered decrease in the provision of meals on wheels.

In the meantime, the number of applications for admission to St Vincent de Paul residence that were acknowledged by end of 2011 amounted to 764, and the number of people awaiting admission was 847 of whom 243 were men and 604 were women.

As to Karin Grech Hospital (ex Zammit Clapp Hospital), a steady increase in the number of admissions can be seen from Table 3.

It is interesting to note the fact that such an increase has been accompanied with a concurrent increase in the mean length of stay over the years. The majority of referrals to this hospital come from Mater Dei Hospital.

According to the recent NSO publication, Social Protection: Malta and the EU 2012, expenditure on social protection benefits for 2011 was estimated to stand at €1,240.7 million. This reflects an increase of €16.4 million, or 1.3 per cent, when compared to 2010.

Other increases have been categorised under Sickness/ Healthcare, with an increase of €4.1 million (NSO publication Social Protection: Malta and theEU 2012).

Indeed, the marked increases in expenditure on social protection in general and the scenario we face today concerning the ageing population can relay a pessimistic view, as ageing may unfortunately be perceived as a burden on society instead of an achievement.

The general implication, however, remains that when it comes to ageing, our policies are geared towards hospitalisation/institutionalisation. These are policies that communicate the wrong signals for they assume hospitalisation/institutionalisation at the first instance that is, as soon as the first signs of sickness or disability appear.

No doubt, the apparent need for the provision of more long-term care beds is an issue we must face and tackle. But such needs should not be based on our current policies and practices which present nothing but a major lacuna when it comes to the provision of community care support.

Long-term projections and subsequent strategic direction should be based on policies that reflect a much more balanced approach – one that seeks in the most creative and effective way, the means that enable people to remain active within their own community settings as they age, while being able to further contribute towards society as they grow older.

The key to addressing effectively and efficiently the challenge for prolonging as much as possible the length of time that elderly people stay within the community can be met by shifting the onus for requesting and responding to community services from the user to a community-based interdisciplinary team. The scope of such teams should be to identify proactively and in a holistic manner the social needs of our ageing population.

It is through the set up of such community-based interdisciplinary teams that highly valid information can be secured, thus denoting prioritisation of services commensurate with such needs. In this respect, I believe we lack first-hand holistic information that would enable a holistic approach when it comes to tackling the matter.

Furthermore, prolonging effectively and efficiently the length of time that elderly people stay within the community necessitates that we rope in the informal home carer, and due attention be given to their formal engagement.

Empowering home carers with the necessary tools, and not least, preserving their well being, are issues that in my view also need tackling seriously. It also involves empowering local communities, NGOs and encouraging the private sector to provide local welfare through the development of effective partnerships.

In essence, strategic direction and effective actions towards active ageing harness social inclusion. And if social inclusion is the opposite of social exclusion, it follows that people who are socially included have easy and reliable access to social networks, services, decent housing, support, adequate information and are able to exercise their basic rights.

Social exclusion is a complex and multi-dimensional concept. It relates to being unable to enjoy levels of participation that most of society takes for granted.

Promoting social inclusion means helping to reduce poverty, and its reduction happens to feature high on this Government’s agenda. Indeed, it needs tackling from the very grass roots – a matter that is being seriously addressed by Minister for the Family and Social Solidarity Marie-Louise Coleiro Preca.

Over the past weeks Ms Coleiro Preca has been busily engaging herself with various members of the community, obtaining first-hand information from members of the public, including leaders of NGOs and various other experts. To date, six public meetings in this respect have been held.

The minister’s dynamism and her down-to-earth approach, together with the help of Parliamentary Secretary for the Rights of People with Disability and Active Ageing Franco Mercieca, will surely see to the enactment of sustainable social policies that stand at the heart of Malta’s social and economic fabric.

Anthony Agius Decelis, MP, is the Government’s consultant for the elderly.