The St Vincent de Paul hospital for the elderly will be getting a 300+ bed intermediate care unit while introducing more specialisations over the next years as part of plans to redefine geriatric care, residence CEO Jorgen Souness said.
The plan aims to ease pressure on the national healthcare system and, most important of all, to strengthen the geriatric care.
Souness spoke to The Malta Independent on Sunday on how SVP is ensuring holistic care for the country's geriatric population, those aged 60 and over, with the hospital set to expand both its capacity and the quality of the care it provides.
Malta's geriatric hospital: a decade of transformation
Souness said that SVP has undergone a remarkable transformation over the past decade.
From a simple long-term elderly care facility, the institution now functions as a fully-licensed geriatric hospital, offering a wide range of specialised geriatric services for approximately 1,500 residents and others as outpatients.
"If you look at St Vincent de Paul in the last years, it has undergone major changes, major upgrades," Souness said.
"Prior to obtaining its current hospital licence, the facility operated solely as a long-term care institution. At present, it accommodates approximately 1,500 patients, offering both long-term care and specialised services aimed at more effectively addressing patients' diverse healthcare needs," Souness said.
Under its hospital licence, SVP has established specialised units to address the complex needs of geriatric patients. This includes the recent launch of a palliative care unit, which offers tailored support for elderly individuals, and complements existing services provided at the acute hospital. Additionally, a psycho-geriatric unit is scheduled to become operational in the coming weeks.
"We are specifically a geriatric hospital growing weekly," Souness said.
Beyond in-patient care, Souness said that SVP runs an outpatient day clinic for individuals aged 60 and over.
The hospital also focuses on creating spaces for social interaction, opening initiatives such as a therapeutic farm, a bocci pitch, cat café and an expanded theatre for community activities.
SVP has already implemented inter-generational programmes aimed at fostering meaningful interaction between its geriatric residents and the younger generation, through ongoing collaboration with schools, youth organisations such as the Scouts, and other community-based groups. These initiatives, which are designed to promote social engagement, reduce isolation, and enhance residents' emotional well-being, particularly benefitting those without regular family visits. In the coming years, SVP is committed to further strengthening and expanding these programmes as a core strategic objective.
Staffing shortages and community care
Despite these advancements, SVP continues to face challenges that are prevalent across the healthcare sector. One of the most pressing issues is the shortage of staff, a concern that has been recognised not only at national level but also globally, including by the World Health Organisation. This widespread shortage of healthcare professionals presents an ongoing and significant operational challenge, Souness stated.
Another significant challenge lies in the strategic shift from traditional in-patient care to a more community-based model of service delivery. In this regard, the Active Aging Community Care (AACC) initiative is undertaking measures to expand its domiciliary support services, with the aim of assisting elderly individuals within their own homes and thereby reducing the frequency of hospital admissions.
While staff shortages remain a recognised barrier to this transition, Souness emphasised that these challenges may be mitigated through targeted training initiatives and the provision of appropriate incentives for primary caregivers. He further underlined that SVP distinguishes itself from conventional community-based facilities by offering acute geriatric care services that necessitate continuous, 24-hour medical and nursing supervision.
"This is not long-term care within a community setting. The patients admitted to SVP require acute geriatric intervention, supported by round-the-clock multidisciplinary teams to manage complex clinical needs. This extends far beyond the provision of basic daily living activities such as eating, drinking, and personal care," Souness explained.
He further noted that the hospital functions through multidisciplinary teams and delivers specialised medical care, thereby ensuring a higher standard of clinical oversight and clinical treatment than that ordinarily provided in conventional community care facilities.
Responding to Malta's ageing population
In response to the increasing demand for geriatric care, SVP has expanded its recruitment efforts by creating new positions for practice nurses, palliative care consultants, and psychiatrists with a special interest in geriatrics, alongside an ophthalmologist with expertise in geriatric eye care.
"By integrating these specialised roles within the facility, SVP can help alleviate the pressure on the acute hospital and, in turn, enhance the overall quality of care being delivered," Souness stated.
Admissions to SVP follow strict criteria, Souness said, with decisions made by geriatricians after a thorough needs assessment, rather than by patients or relatives.
He said that if a patient's needs can be met in the community, they are directed to community homes.
Only those requiring elevated, specialised care are admitted, reiterating that it is not the patient or the relatives who decide, it is the geriatricians that do the needs assessment.
Expansion and intermediate care
Souness said that SVP is expanding both specialised services and its physical capacity.
He said that the psycho-geriatric unit is expected to open within two months, while a renal unit pilot project with five machines will begin shortly, eventually scaling up to a fully-fledged haemodialysis unit with 18 beds by the third quarter of 2026.
Souness said that long-term care capacity is also set to grow to meet rising demand.
"1,500 beds for the time being is enough, but in the near future, yes, we will expand," Souness said.
A major new initiative is the introduction of intermediate care, designed as a step-up and step-down service between the community and acute hospital, Souness said.
He continued that patients who require geriatric expertise but not the full resources of Mater Dei can now be admitted to SVP's 40-bed pilot intermediate care unit. This is to be expanded to more than 300 beds in the next few years.
Since its launch in April 2024, approximately 300 patients have been admitted, reducing pressure on Mater Dei and offering targeted rehabilitation and treatment for the short-term, Souness said.
He further explained that the average length of stay in this unit is approximately 14 days, although extended care is provided for patients requiring additional medical support.
For those patients who are unable to return home due to inadequate familial support, Souness noted that SVP offers alternative arrangements to ensure that all residents receive the necessary continuous, 24-hour care.
"Despite significant efforts to enhance community support services, when a patient requires round-the-clock medical care and is unable to return home, alternative care options are available and can be considered," Souness stated.
Lessons from the Carmelo Fino case
Souness was asked if SVP has learnt any lessons after the case of the death of 83-year-old Carmelo Fino, when he disappeared from inside the St Vincent de Paul residence in 2022.
Souness was asked if security has increased since, or if protocols and oversight had been strengthened to avoid similar tragedies.
Souness stated that the death of Fino at SVP, which was before his tenure at SVP, prompted a comprehensive review of existing protocols and security measures.
"Protocols were already established prior to the incident; however, when faced with such an unfortunate event, it is imperative to implement additional safeguards to prevent recurrence. This does not imply that there were no policies or stringent measures in place at the time. Rather, the incident occurred at a specific moment and location, which highlighted vulnerabilities. Consequently, all protocols, standard operating procedures (SOPs), and security measures were significantly enhanced thereafter," he explained.
The changes implemented included the strengthening of SOPs, expanded CCTV coverage, operational modifications, updated hospital preparedness plans, and the exploration of health monitoring technologies such as geo-fencing devices. These measures aim to avert similar incidents in the future while maintaining the hospital's operational integrity.
During his tenure as CEO over the past two years, Souness also indicated that SVP is exploring the integration of artificial intelligence and digitalisation technologies to support healthcare workers, intended to augment rather than replace them thereby enabling staff to focus more effectively on delivering high-quality patient care.
"By exploring alternative approaches and learning from past mistakes, SVP collaborated with relevant entities to ensure that such incidents are not repeated," he said.
When pressed on specific changes made following the protocols implicated in the incident, which resulted in six SVP staff members being charged with involuntary homicide and neglect in connection with Fino's disappearance and death, Souness reiterated: "Protocols were indeed in place. Since that event three years ago, St Vincent de Paul has expanded, with evolving needs requiring updated protocols. These changes were informed by a root cause analysis of the case. We identified potential protocol failures and instituted robust backup systems, including enhanced CCTV coverage and operational adjustments. Given that the matter remains under judicial review, I must refrain from providing further details at this time," he stated.
Souness further noted that SVP operates within the frameworks established by government authorities and benefits from public funding to support expansion, digitalisation, and staff training initiatives. The hospital is actively pursuing Gold Standard accreditation for palliative care to further elevate the quality of services provided.
He also highlighted that collaborative training programmes involving multiple healthcare entities promote the consistent application of standards and the sharing of best practices across the sector.