Reaching a ripe old age with dignity is a blessing. One can enjoy the fruits of one’s love and work over the years, see how his vision has turned out and hopefully enjoy the serenity of his remaining years. It can also be demanding, very much so. As the later years roll by, our faculties decline, our dependency on the assistance of others grows.
Late life can also be cruel. Disease is not exempt. To run into the cancer ogre at 73 is better luck than those afflicted by it at a much younger age. It is, nevertheless, still tough, increasing the dependency burden on others. Economically, too, old age can be very challenging. We all have a pension under the social security provisions. It is far from being enough, even for the few who, like me, as a former minister, have one higher than the average.
It is a period in our lifetime when things converge as well as diverge. In our modern times, it is a period different than it used to be some years ago. Not so long in the past, it was customary for grown-up offspring to look after their ageing parents in their days of need. Now it is the other way round. With so many married women out working, they depend extensively on their parents to look after the children. Even the introduction of free childcare centres will not reduce that practice by much.
When grandparents can no longer carry out their child-minding tasks, working mothers tend to have little time to spare, if any at all, to look after them.
That is where homes for the elderly come in. In the old days, it was the Catholic Church that provided care in homes run by it. Later, the government entered the scene in a big way, with the building and running of St Vincent de Paule, off Luqa.
In the context of the socio-economic changes lightly touched upon, that was not enough. That allowed private entrepreneurs to identify an economic niche in the market. Private retirement homes have been opening fairly rapidly, with Vassallo enterprises leading the way, both with private initiatives and in private-public-partnership with the government.
There are currently no fewer than 37 private homes in operation. More are needed. Social cases left in Mater Dei and Mount Carmel hospitals are not the only indication of that. Malta’s population is ageing. That trend, combined with more married women taking up employment and therefore having less time to care for elderly parents in need of assistance, makes the necessity for more care for the elderly increasingly urgent.
There is much space for more public-private partnerships and the government is committed to exploit this; the sooner the better. Such exploitation must go along with careful regulation of retirement homes for the elderly.
This was highlighted in an audit of residential old people’s homes, conducted by the Office of the Commissioner for Mental Health and Older Persons and published by Times of Malta (March 12).
Old age is a period in our lifetime when things converge as well as diverge
A specialist three-person team, including legal, social work and medical experts, carried out the audit by visiting all 37 homes for the elderly across the country. The outcome was not disastrous. Yet it came across shortcomings significant enough to raise concern and defines the need for better monitoring and regulation of such homes.
Among other things, the audit noted that patients’ safety in old people’s homes is at risk from widespread inappropriate practices for dispensing and documenting medication. Nearly half of old people’s homes have unsatisfactory documentation for medication and one in five do not dispense medication appropriately.
For example, treatment charts were not signed when the actual medication was dispensed; inappropriate dispensing and documentation of treatment, said the audit report, may lead to errors, jeopardising patients’ safety.
To my mind, this stresses a point I have observed from my experience with the care given to our parents in retirement homes. The care was good. Nurses and carers were dedicated. But it was quite obvious that carers had to be better trained, and more so that there was a requirement for more nurses.
Retirement homes that provide a nursing service do have directly employed nurses, but they also have to add to them nurses who are off duty from the State hospitals. Not exactly the best arrangement in terms of the rest hard-working State nurses require.
The specialist team noted other shortcomings, including ones falling under the physical safety category. For instance, handrails in corridors and bathrooms were present in less than half of all residences. One home did not even have a single fire extinguisher on site. Only just half of homes had adequate anti-slip steps and floor services.
Dinner in some homes is served far too early, probably due to staffing problems related to part-timers. The audit team recommended that dinner should be served after 6pm and that pre-bedtime snacks should be offered in homes that serve early dinners, particularly to diabetics (I know that some homes do this).
The audit report also touches on behavioural aspects. It notes that many homes organise activities inside and outside their premises on a regular basis, but participation was extremely low. This can be partially addressed through the appointment of an activity co-ordinator in each home.
Cleary, there is much to be done. The government has appointed, as the previous one had done, a parliamentary secretary to cover the senior citizens sector.
He has drawn up a strategy for the elderly but will be leaving in the coming reshuffle. Whoever replaces him will have to tackle the running of existing and the need of new retirement homes with much vigour.