Shortly after retirement, Tessie* developed one of the most debilitating illnesses – a rare condition that progressively damages part of the nervous system. She would lose the use of all her limbs but her brain would remain completely functional. There is no cure.

She used to be a headmistress, a really good one, so much so that she was entrusted with the responsibility of managing government schools in the more deprived districts. Her many successful pupils remember her with admiration.

Her devoted husband, Ninu, did everything possible to look after her and her two, married, working sons were as supportive as their free time permitted. However, without adequate community support services that would enable her to continue living in her own home, the dreaded day eventually came when Ninu could no longer cope.

With Tessie’s consent, and as soon as they were advised a place was available, the family reluctantly arranged for her to be admitted into a residential home. A private home was well beyond their means but, with help from party political fixers, they were not kept waiting too long.

There was, of course, no invitation for a trial visit. Moreover, the family was never given any information on the home’s facilities and services, so they did not know whether the care Tessie required would actually be provided. They had no option but to take what was offered and were told they should be thankful that she had been admitted at all.

Before entering the home, Tessie was not assessed by qualified staff to determine how dependent she was, what her needs were, what diet she required and what her current and prospective nursing care and medical treatments should be. As a result, her family was never given written assurance that all her needs would be adequately met.

Such an assessment, of each resident, should form the basis of his/her written plan of care and should be revised regularly and/or after an acute phase. Naturally, the staff should have the experience and the skills to administer the care required by each resident.

So, with no assessment, no care plan and no knowledge of the skills and experience of the residential home’s staff, Tessie’s family was at a loss. They were deeply concerned that she would not be well looked after.

This was an institution; it certainly wasn’t a ‘home’

The staff did not give the impression of having the skills and experience to care for her then, let alone as her condition deteriorated. Certainly, the care workers they met were kindly, if somewhat loud. On the other hand, it was clear the remuneration they receive is well below that required to instil the commitment and devotion to their work that all elderly people deserve so much.

Furthermore, it was not the practice of the home, or of others, to commit to legally-binding contracts with residents, detailing the facilities and the services provided as well as the fees payable or percentage of pension deductible.

For Tessie’s sake, they chose not to question the management.

They had no other options.

The day she was admitted was heart-rending. Tessie and her family desperately wished she could remain in their home. Tessie, although loath to depart, put on a brave face. Yet, upon entering the residence, tears welled in her eyes and Ninu could not repress his sobs.

The strong smell of disinfectant, boiled cabbage and soiled nappies, the brash behaviour of the staff, the shabby tasteless furnishings: this was an institution; it certainly wasn’t a ‘home’.

They were led down dark corridors with gaudy imitation works of art. They passed the dining room – more akin to a boarding school refectory – where the pungent smell of overcooked soup assailed their nostrils: then the chapel, a lounge with chip wood furnishings and a TV set the size of a matchbox, passed a stark outside area dotted with a few wooden benches.

Tessie was not asked if she would be willing to share a room with a stranger for the rest of her life. To her dismay, she discovered she was placed in a pokey room with 90-year-old Ċettina who was afflicted with loud asthmatic breathing difficulties.

Through the one small window, they could look out onto the bare yard surrounded by a wall so high that there was only a sliver of blue sky in sight.

Tessie and Ninu were thankful that they had not brought more of her personal belongings, considering the limited space available for storage, which the cupboards and drawers provided.

At the time Tessie arrived, Ċettina was having her nappy changed and only then did the staff bother to draw the cubicle curtains around her. Tessie, always concerned to preserve her modesty and dignity, was shattered by the absence of privacy.

Having finished with Ċettina, the care staff covered the old hole-ridden mattress on Tessie’s bed with a plastic under-sheet and made it up with well washed floral linen.

Although Tessie was still continent and able to go to the toilet with adequate mobility assistance, she was unceremoniously bundled into two nappies: the second for ‘safekeeping’, the care staff said.

Tessie was crestfallen: Ninu left with a massively heavy heart: she wept for the rest of the day.

(Episode 1. To be continued.)

At Fondazzjoni Xjuħija Attiva Malta (FXAM), we maintain that if the national minimum standards for care homes for older persons as we drafted them are statutorily implemented and legally enforced by an independent regulator, such situations like that of Tessie, described above, would no longer be permissible.

The dignity of residents in homes for elderly persons would become achievable.

*All accounts are based on experiences of various care homes. For personal protection reasons, the characters are fictitious.)

Anne McKenna is a member of Fondazzjoni Xjuħija Attiva Malta.