A performance audit on the 'Care for the Elderly in Gozo' has elicited 'mixed results' in the provision of community and residential care services.

Auditor General Charles Deguara presented the performance audit to the Speaker of the House of Representatives - Anglu Farrugia.

This audit sought to determine the extent to which current practices related to residential and community care for the elderly implemented by the Ministry for Gozo (MGOZ) contributed to optimal services based on value-for-money principles, namely, quality, efficiency and reasonable prices. During 2021, the provision of these services necessitated an expenditure that exceeded €5.9 million, the National Audit Office (NAO) said.

But this performance audit "elicited mixed results" in the provision of community and residential care services for the elderly in Gozo, the NAO said. "On one hand, there is no doubt that, in general, the public money expended by the Ministry for Gozo (MGOZ) contributed positively to the welfare of elderly persons living within the community or in residential care homes. On the other hand, the opportunity existed to improve the quality and to varying degrees the cost efficiency of services."

On Home-Help, the NAO said that this service has facilitated and continues to encourage elderly and disabled persons to live in the community. The total cost of around €9.00 per hour which is incurred jointly by Government and clients, is considered reasonable when benchmarked against NAO established criteria. On the other hand, MGOZ was not able to provide around 20% of Home Help hours (42,869 hours in 2021). This situation materialised even though MGOZ had secured an adequate supply of home help hours through a contract with a service provider and through the direct employment of social assistants."

Meals-on-wheels

Regarding the meals-on-wheels service, the NAO found that the price of this meal delivery service reflected value-for-money both from a client and government's point of view, since their collective contribution of around €5.55 for a three-course meal is similar to a modest take-away meal. "Despite the increase in take-up of this service during the COVID-19 period, surveys commissioned by the contractor showed that, percentagewise, the level of client satisfaction has declined in December 2021 when compared to the April 2019 results."

Villa San Lawrenz

The NAO found that the rates charged by Villa San Lawrenz to MGOZ position themselves among the higher end of daily fees charged in Malta for similar services. "Despite the costs involved, MGOZ is constrained to reserve a limited number of beds at this residence to cater for emergencies."

Downtown Hotel

"The relocation of 80 elderly patients from Gozo General Hospital to Downtown Hotel was brought about to cater for Covid-19 pandemic related circumstances. While acknowledging the urgent need to resolve arising issues during emergencies, this transfer was not fully supported by documentation and robust audit trails. The rent element concerning the Downtown Hotel contributed to higher total costs when benchmarked against other residential homes in Malta and Gozo."

Dar San Guzepp

Following an expenditure of over €1 million over a span of eight years, MGOZ remains in a position where it cannot establish a definite date when this project is to be finalised to enable the accommodation of elderly residents at this property, the NAO said. "This project has been besieged by project management and administrative issues, including the revaluation of tender bids."

Casa Amalia

The 23-bedded Casa Amalia, which provides dementia-related services charges MGOZ a daily rate of €106.50 per bed, the NAO said. "To various degrees, these services are similar in nature to those provided by Dar Padova, another facility which provides dementia care which is managed by Active Ageing and Community Care Department (AACC). The opportunity exists for better communication and coordination between MGOZ and AACC to guide and enable residents and potential clients to maximise on the facilities offered at these Homes."

The NAO said that the MGOZ monitoring function of all the contracts in place was generally reactive to customer complaints, "as the Ministry does not operate a structured approach to monitor contract implementation comprehensively and regularly. These limitations detract from the principles of transparency and accountability. To this end, MGOZ has committed itself to review and enhance its monitoring role concerning agreements with third parties providing services to elderly persons."

This review showed that MGOZ has set up the foundations for expanding its services to an increasingly ageing population in terms of broadening the scope of community and residential services for the elderly as well as improving on the quality of their delivery, the NAO said. "Nonetheless, this report elicited a number of issues relating to monitoring, contractual obligations and value for money. In this regard, the NAO proposed a number of strategic and service specific recommendations."

The full report can be read here