With more than 50 per cent of patients in hospitals aged over 65, the healthcare staff working in this speciality are a necessary force in taking care of older adults. Whether working in the hospital or in a long-term care facility, nurses must have extensive knowledge about the special care needed in rehabilitating and maintaining the mental and physical health of the elderly.
But what is the care that should be provided to the elderly by nurses? Are we addressing the nation’s needs? This is not an easy question to answer in the light of the aging population which all of Europe is facing
As the number of elderly people in our country is increasing, it becomes more obvious that services for elderly people in hospitals and institutions offering rehabilitation services have become more in demand, causing pressures on those working within the health care area. In Malta we have seen the various extensions or to use a simpler form, an increase in bed state across the country. The health division policy has been more geared to add to the services within hospital and institutions but we have not developed any new service in the primary health setting, which encourages elderly people to remain in the community.
The investments seen in the last few years took the form of increasing the number of beds in the main institution for the elderly, St Vincent de Paul residence, and an increase in the bed capacity of the main rehabilitation hospital, Zammit Clapp, and it is envisaged in the future to build a new hospital to replace the latter with an increase in bed state. An increase was also provided in Mt Carmel hospital by opening two new wards for the elderly, with a plan to open two more wards.
We are also aware of the heavy investment by the government in partnership with the private sector in building several institutions across the Maltese islands with the most recent one being the Mellieha home, which will take 110 beds for the elderly, but Malta still has a big issue and a big problem since the number of beds in any government institution seems never to be adequate to needs. Just to highlight how big the problem is where caring of the elderly is concerned; one has only to consider the waiting list for every institution for the elderly.
It clearly shows that something is not going in the right direction and one should question if the investment being done both in finances and human resources is providing us as a nation with the results we would all like to see.
Let us face some facts to put the whole picture in the proper perspective. We are in the era of the post baby boom, where now the birth rate has decreased significantly compared to the last 60 years. So we are paying a price for our success.
European countries have invested heavily in community and primary health care facilities. The initial investment in primary care would seem high compared to today’s cost but would actually in the long term save money, limit human resources and would be the proper direction to address the needs of the elderly population. I believe the main aim in any rehabilitation should be to elevate the general condition of our client sufficiently as to allow him/her to return to his/her home environment. Thousands of elderly people should be targeted with support to keep them out of hospital as part of a drive to improve care in the community and nurses and physiotherapists have a lot to contribute in this aspect. In the UK experts estimate that by reducing admissions by just a third they could save the public sector £175m.
Health Secretary Patricia Hewitt said: “We know, because older people tell us, that they want to live independently for as long as possible. Too many older people are being admitted to hospital, often as an emergency, when this could be avoided if the right community services were in place at the right time.”
We have stagnated in the polyclinic era which was adopted in the 1970s. Most European countries have developed innovations, such as the family health nurse whose sole purpose is to address the needs and various aspects of the elderly so as to prevent illness and offer the proper support facilities to allow them to remain in the community.
Therefore it was a great relief to MUMN to see that the commitment of the present government as viewed by the new health minister is in line with the thought of this union regarding the development of services within the primary health care settings. The strategy being favoured by John Dalli (the Health Minister) to use the primary health care settings so as to relieve the pressures on Mater Dei hospital was forwarded through the WHO document on the family health nurse to the previous health minister by my union. The health division services are considered to be a chain and every loop is important and even though massive investment has been done on one particular loop the chain will still break. Therefore a holistic approach is imperative where investment has to be done not in one particular institution but in all sectors within the health division which provides a service to our patients.
The change in policies of the present government to invest in primary health care is in line with the care provided in other European countries. Such investment should not be the development of the polyclinics only but a more focused patient approach where the needs of the patient are addressed in his home settings. With this new approach, the government and MUMN are on the same vision and empowering the nurses in such settings would enable achievement of this vision.
Therefore MUMN is launching an appeal to the newly elected government that a consultative approach be adopted for the next five years. Before any extensions within the health care service are brought in, a proper manpower plan has to be proposed since removing nurses and midwives from the health care settings is suicidal. Resources within the government hospitals are so depleted that MUMN cannot accept extension of new services with the existing human resources. The challenges within the health care services are continuously evolving and will definitely increase in the future since the expectations and the life expectancy of our population are always growing. Once the issue of human resources is addressed seriously the health care services will definitely improve and that is what as a nation we rightly deserve.
Paul Pace is president of the Malta Union of Midwives and Nurses