More than €400,000 is being spent by the government every day in taking care of the elderly, with services ranging from providing homes to offering services that keep the older members of our society within the community, Jo Etienne Abela, minister for Active Ageing said.
In total, government allocates €145m every year for such services, the minister said in an interview with The Malta Independent on Sunday, which also dealt with nurse shortages, the wellbeing of people at the end of their life and also euthanasia.
Abela said that the annual budget for St Vincent De Paul (SVDP) home for the elderly is €98m and the active ageing agency within the Ministry has an additional budget of around €47m to take care of government care homes, as well as to cover the costs of beds in private homes which are sometimes “rented” out by the government.
This figure also includes the number of incentives and services which government provides for active ageing within the community. These services include free transport, home help and live-in carers.
These schemes are aimed at providing the elderly with the care they need at home, Abela said. “The elderly who feel that they cannot live alone but want to stay in the community can opt to have a live-in carer, subsidised by government at €7,000 per year. This will be increased to cover the minimum wage in two years’ time and in total the scheme currently costs €3.5m.”
St Vincent De Paul
Shifting focus on the elderly care home and hospital, The Malta Independent asked Abela on the shortage of nurses and whether the issue has disrupted any services provided by the hospital.
Abela explained that SVDP is not any other care home but it is also a hospital. This is important in defining the elderly patients who are admitted at SVDP.
The elderly are split into three categories – Category 1 patients are those who are highly dependent on constant care, have reduced mobility and in most cases are bed-bound; Category 2 patients are still dependent on carers but not as much; while Category 3 patients are able to live independently but for some reason or another cannot remain in the community.
SVDP mostly takes care of Category 1 patients and Category 2 individuals. In total at any time a maximum of 1,500 patients can be taken care of at SVDP and there are no waiting lists for the hospital, Abela said.
“Sometimes admissions can take a while because of the various directives from MUMN but other than that there is no waiting list,” he said.
Addressing the issue of shortage of nurses, Abela said that “the nursing shortage is an endemic issue for all developed countries. It is not a perception but rather an issue faced by other countries such as the UK, France, Denmark and Germany. That is why there is a big drive for third party nationals to form part of our respective health services”.
“Unfortunately nurses who are third country nationals sometimes use Malta as a springboard to the UK. We have a common factor, which is the language, and that is why we want these third country nationals to integrate into Maltese society in order for them to remain in Malta. But we cannot force anyone to stay here.”
On a more local perspective, Abela said that addressing the nurse shortage starts with total collaboration between the Ministry of Active Ageing, the Health Ministry, the nurses unions and the University of Malta.
“A proper strategy is required by the stakeholders mentioned in order to make the profession more attractive. I honestly think that the nurses’ wages are not that bad but at the end this is an individual choice but nonetheless there are still things which could be done.”
Abela believes that the future of geriatric care lies in specialisation. “We need to combine geriatric care with other areas such as orthopedics, physiotherapy, general surgery, gynaecology, and so on. Through this we would be caring for the patient by providing a more interesting and engaging specialised care.”
The way forward
Recently at SVDP an elderly man went missing from the care home. This sparked a heated discussion on security matters in relation with people who require constant care.
Describing the man’s absence as a shock, Abela said that an independent inquiry into the matter is under way to establish what exactly happened and possibly lead to changes to avoid it happening again.
“The moment that the tragedy happened I immediately started an inquiry headed by an ex magistrate to get to the bottom of the situation. We have to see if it was due to an error of the system or any other issue.”
Abela said that this could be a result of two scenarios happening at the same time which allowed the individual to leave the premises of SVDP. But he would not go into further detail, saying that he would be waiting for the verdict of the inquiry stating that “wherever there are deficiencies, we have to fix them”.
Currently there also is a 360 degree audit of SVDP, Abela said. This task is being undertaken in order to assess all assets of the facility and improve them from a safety perspective.
“We want to take Saint Vincent De Paul into the future and this audit will make it possible. This is not just an easy fix and through this exercise we will be planning the next 10 years for the hospital.”
Ageing population, palliative care and euthanasia
Government must also give due consideration to the fact that the population of Malta is becoming increasingly older. One fifth of the population is over 65 years of age, and a better quality of life means that people today are living longer.
“Speaking about the elderly as if they are a burden is not right,” he said. “At the end of the day they spent a big part of their lives working and paying their taxes and national insurance. In their old age, the elderly still contribute 15% to 20% of the country’s economic turnover and this is not a negligible amount.”
Abela said that there needs to be a change of perception in the way society looks at elderly people as “they have paid their dues to society”.
With regards to changing the way care is given to the elderly, Abela said that as a country, every effort should be made to keep elderly people in the community and not simply put them in a residential home.
The use of palliative care among the elderly is also an essential part of their care.
“We are offering services of psychotherapy, psychology, pain treatment and even general treatments for nausea and symptoms felt by people at the end of their natural life. We are constantly training our nurses in this care and providing specialised equipment needed.”
Before the election, the Labour Party had presented a list of 100 proposals, one of which was to start a discussion on “voluntary euthanasia for people with a terminal illness”.
Abela said that this topic has not as yet been brought up for discussion within the PL’s parliamentary group.
“Euthanasia is a word which maybe scares people but that is why we need to discuss it in a proper and mature manner. My opinion is that we should discuss it and not shy away from the topic in general.”