The government deserves to be commended for publishing a proposed set of national minimum standards for care homes for older people.

The proposals can be considered a milestone in a country where the quality of institutional care for the elderly has so far been practically unregulated. Horror stories have emerged about the way people in homes are sometimes treated, causing them daily suffering and indignity. The NGO Fondazzjoni Xjuħija Attiva Malta must be credited for highlighting some of these cases and lobbying for standards to be laid down.

They appear to be fairly comprehensive, covering a multitude of factors that affect residents’ well-being. They range from respecting their food preferences and giving them access to social activities, to making sure they receive tailored healthcare and adequate end-of-life pain relief. They emphasise the need for “person-centred” care, dignity, privacy, self-fulfilment, autonomy and both physical and mental welfare.

“The mission of the home,” the proposals say, “must go beyond the traditional concept of ‘elderly care’ and shall enable residents to realise their full potential for physical, social and mental well-being. The home shall provide an environment where residents are enabled to engage in productive activities and a healthy, independent and secure lifestyle.” These are lofty goals indeed.

Now for the hard part: their application. In other words, bridging the yawning gap that exists between today’s often abysmal practices (while recognising the undoubted existence of good ones) and the fine ideals being aspired to. No matter what form of monitoring and however rigorous the inspections planned, there can be no illusions: it’s going to be an uphill climb to ensure that residents’ interests will in reality always be placed before those of staff or homes’ owners.

Some residences will require a revolution in culture to come in line with the standards. The private ones may need to strike a better balance between their profit motive and their role in the provision of a vital social service.

The cracks are already showing. St Vincent de Paul Residence has been exempted from the standards on grounds that it provides hospital and medical services. The foundation, rightly, has challenged this decision, insisting the place is primarily a residential home.

Ten years will be allowed to pass before the standards come into force. This is understandable in regard to structural changes that some homes will need to make to come in line. However, surely the grace period could be shortened in relation to aspects of care such as the quality of daily life and health and personal care.

A major obstacle to applying the standards will be the quality of staff. Will homes be ready to weed out personnel whose attitude is not the caring and compassionate one demanded by the standards? Who shall replace them if there is already a shortage?

There will also be ethical questions to settle: “Residents’ health and personal care shall be based on their specific individual needs and wishes within reason,” the standards read. To what extent will the residents be allowed to define their own needs and who decides what is “within reason”? To what degree will patients’ “autonomy” be respected when their “individual needs” clash with care home policies, staff comfort or doctor’s orders?

These are some of the difficult questions that may need to be tackled in the next stage of evolution in geriatric care in Malta as the field moves increasingly towards elevating the psychological and spiritual well-being of elderly patients above their purely medical needs.