It happens more often than we'd like to admit. An elderly resident in our care needs to be taken to hospital. We make the call to the next of kin. Sometimes we get no answer. Other times, the answer is clear: "I can't make it today."

And so we go. One of our carers sets aside their day to accompany that person. Not because it's in their contract. But because no one else is coming.

This is not a one-off situation. It's becoming a pattern. And while we're used to offering physical care, we are less equipped to fill the growing emotional gaps left behind when family members gradually, and often unintentionally, disappear from the picture.

We don't speak about this enough - this quiet form of neglect. It's not malicious. There are no bruises. There's just absence. And silence.

The truth is that elder neglect doesn't always look like abuse. Sometimes, it looks like no one showing up. It looks like residents facing hospital corridors alone. It looks like decisions being made without the voices of those who know and love them best. It looks like care workers becoming companions by default, not by design.

This isn't about blame. Families today face enormous pressures - from jobs, travel, young children, strained dynamics, or unresolved history. We know it's not always easy to be present. But that doesn't make presence any less vital.

In our homes, we see the difference it makes. Residents who receive regular visits tend to eat better, communicate more, and remain more connected to who they are. Those who don't - gradually fold into themselves. It's not just sad. It's a quiet erosion of dignity.

We believe it's time to talk about this - honestly, openly, and with care.

Because this issue doesn't only weigh on the emotional wellbeing of our residents. It also strains the system - socially, financially, and ethically. Carers cannot be in two places at once. And yet we are increasingly asked to send them away from care homes to act as family stand-ins.

Which brings us to the proposal we are considering. If a family member formally opts out of accompanying a resident during external appointments - which remains a legal responsibility - a carer will step in but this cannot continue.

At present, when a family member is unable to accompany a resident to a medical appointment, a carer is often assigned to step in. However, we believe this practice needs to change. Moving forward, we are proposing a system in which family members take primary responsibility for attending such appointments, with carers stepping in only in exceptional circumstances - specifically when a resident has no relatives or close friends available to accompany them. It is after all the legal responsibility of the next of kin to continue to be present in the lives of the elderly person.

We hope that by talking about this openly, we can prompt reflection - and change. Families matter. Even a short visit, a phone call, a hand on the shoulder during a hospital check-up - these moments ripple out far beyond what we see.

This World Elder Abuse Awareness Day, let's widen our understanding of neglect. Let's talk about absence. Let's talk about what it means to be truly present.

Because care begins with connection. And no one should face their most vulnerable moments alone.

Julia Aquilina is Policy Executive, The Malta Chamber of Commerce, Enterprise and Industry