Following the rest of Europe, Malta is aiming to provide care for elderly people in their own homes and communities. Yet Mepa has launched a policy to promote large-scale institutions instead of fostering small community residences and home care, which medical authorities endorse.
Have professional studies been undertaken to justify this approach? Instead of seeking medical consultation, the Mepa document only indicates developers as the source of proposals.
Why does the document refer to government land planning objectives but ignores healthcare objectives? Studies in Sweden and New Zealand have shown that in spite of growing ageing populations, a better service is provided by increasing facilities in the community, without adding to institutional beds. The increased demand in Malta is partially a result of the lack of home care on offer.
New nursing homes are increasingly designed as spaces for residents to live a fulfilling life rather than institutions primarily planned for cost-efficient and safe service. Homelike alternatives to traditional large-scale nursing facilities have been shown to improve residents’ quality of care and satisfaction by enhancing the physical environment, improving quality of life and offering the added boon of reducing providers’ operational costs. Studies indicate that: “The visual character and physical massing of the building should be reminiscent of a house. The building should avoid the institutional look of a healthcare facility. A residential-looking building appears friendly, familiar and inviting, stimulating a positive response from family, friends and staff.
“The building should seek to be the opposite of the sterile stereotype we often associate with nursing homes”. (California Health Foundation – New Models for Nursing Homes, April 2012)
Institutions become ghettos for the aged instead of enabling the residents to remain involved in their communities.
Studies indicate that older people suffer from increased alienation at heights of over three floors. In studies, elderly inhabitants report that tall buildings cause them stress, therefore lower buildings would suit elderly people better due to the higher percentage of rooms at ground level with greater accessibility to outdoor areas and non-reliance on stairs and lifts.
In a study of elderly people living in either high-rise or garden apartments, Devlin (1980) found that those in garden apartments were significantly more satisfied with their housing than were high-rise residents, mentioning proximity to nature as a main source of their satisfaction.
Multi-storey buildings are heavily dependent on lifts and need more staff to assist wheelchair-bound residents to dining rooms, lounges and gardens on different floors. This decrease of patients’ independence renders them prisoners on their floors, when staff lack the time to transfer them.
“No secure unit should be considered acceptable unless it has direct, unrestricted access to a (secure) outdoor space.” (Calkins and Mardsen, 2003). Additional floors pose an increased risk during an evacuation of disabled or bedridden elderly persons: lifts are inaccessible in case of fire.
This policy clearly puts the interests of developers before the needs of the elderly
“As the demand for care of dementia patients increases, small-scale residences that subdivide the population into small clusters of eight to 15 residents are desirable. Easy access to a safe outdoor garden is necessary, as it can reduce the anxiety level of residents, who have an incessant need to wander…” (Design for Assisted Living; Guidelines for Housing for the Physically and Mentally Frail – V Regnier, FAIA, 2002).
The policy document claims that Mepa will assess buildings in relation to their context, the effect on the skyline, the design and the microclimate, however these are often ignored at permitting stage. Much of the traditional architecture of Malta’s urban cores has been replaced by featureless buildings that tend to disrespect scale or character of the surroundings.
When hotels were allowed extra floors, Urban Conservation Areas were excluded from the policy: why has Mepa caved in to developers’ demands to include UCAs and Schedule Grade 2 buildings as changes to the retirement homes policy?
Over-development of scheduled monuments (Mtarfa Isolation Hospital comes to mind), would destroy the beauty of such sites and would violate the Heritage Act. While tall buildings are acceptable in certain development zone areas, they will ruin the traditional skyline and overshadow neighbouring buildings, often scheduled buildings themselves, in low-rise localities.
Such developments would also deprive neighbours of their solar rights, which runs counter to current policies promoting solar energy and alternative energy sources.
Furthermore, allowing nursing homes to build into gardens beyond the 30 metre limit will not only destroy the much-needed gardens, to keep residents healthy and active, but will further encourage the destruction of green urban lungs.
Increasing the size of institutions in Urban Conservation Areas will concentrate more traffic in village cores, contravening Sustainable Planning PED policy, adding a negative impact to human health, especially among the vulnerable elderly, and contributing to the erosion of stonework in old buildings.
There is no need to encourage higher floors to avoid building in Outside Development Zones, as empty properties are available in Malta’s towns and villages and can be redeveloped as low-rise residential units, far preferable to large-scale institutionalisation.
Flimkien għal Ambjent Aħjar cannot identify any positive benefits to the well-being of elderly residents by the addition of two floors on retirement homes. This policy clearly puts the interests of developers before the needs of the elderly and those adjacent residents of retirement homes, and counteracts the protection of Malta’s heritage.
As Gordon Caruana Dingli, president of the Medical Association of Malta wrote, Malta’s national health policy “should be determined by patient and social needs, and not by business priorities”.
Astrid Vella is a spokeswoman for Flimkien għal Ambjent Aħjar.