The move from a private home to a residential care facility can be one of the most difficult moments in an older person's life. Leaving behind independence, routines and familiar surroundings often brings with it a sense of loss, even trauma. For George Fenech, chief Executive officer of Malta's Older Person Standards Authority (OPSA), this is at the heart of why the organisation exists: to ensure that care homes do not simply provide beds and meals, but deliver dignity, safety and quality of life to residents.
In an interview with The Malta Independent on Sunday, Fenech explained that OPSA's work is not just about paperwork and licences. It is about making sure that older people - who are increasingly living longer, healthier and more active lives - are respected as complex individuals, not reduced to stereotypes of frailty.
"Older persons are no different to younger generations," he said. "They remain physically active, maintain rich social lives and are very particular about their appearance." But he admits that challenges remain. Chief among them is social isolation. Even in well-run care homes, older residents may struggle to adapt to communal living, having to give up a flexible lifestyle for routines imposed by necessity.
"Personally, I am very worried about social isolation among older persons," Fenech said. "This problem spans settings: in the community as well as residential care homes." It is this human concern that drives OPSA's work as a regulator. Established in November 2023 under Chapter 640 of Maltese law, OPSA is Malta's regulatory body for geriatric services, with a focus on residential care homes. Its role is to safeguard the rights of older persons and to ensure their well-being is fully realised.
Malta was one of the first countries in the world to create such an authority, a move that earned praise from the World Health Organisation during an official visit in June. The authority also holds a seat at the European Partnership for Supervisory Organisations in Health Services and Social Care (EPSO), giving Malta a respected voice in shaping European policy.
Fenech brings a wealth of clinical experience to the role, having worked as an operating theatres scrub nurse, clinical procurements chairperson, and in nursing management. Today he leads an authority tasked with one of the most sensitive responsibilities in Maltese society: protecting the elderly. At the core of OPSA's mission are regulatory standards that cover everything from fundamental rights to the day-to-day care of residents. These standards are legally binding, but, as Fenech stresses, they are not static. "Our standards remain a living document," he said, explaining that they are constantly updated to reflect new international guidelines. In 2024, OPSA signed a memorandum of understanding with the University of Malta to ensure that fresh academic insights in geriatric research can be translated directly into practice.
The authority operates with a twofold approach: licencing and inspection. The Licencing Office ensures that care homes meet all requirements before they are allowed to welcome residents. Once licenced, homes are subject to yearly reviews covering staffing, facilities and environmental standards. Alongside this, OPSA's Inspectorate Office investigates complaints made by residents or their families.
The scope of this work is significant: in 2024 alone, the authority carried out 872 in-person licencing audits, monitoring visits and investigations, including on weekends. When allegations of abuse or neglect are reported, OPSA opens an immediate investigation. Non-compliant providers are first issued with recommendations for remedial action, followed by in-person follow-ups. If they still fail to comply, OPSA has the power to impose monetary fines, though Fenech noted that most service providers cooperate before it comes to that. Abuse allegations are also passed directly to the police and relevant authorities. "We ensure that all allegations and incidents of abuse, including neglect, are acted on immediately," Fenech said, stressing that OPSA's duty is not just regulatory but protective.
To make sure standards are properly implemented, OPSA also invests in its own staff. Last July, personnel from Licencing, Well-being and Outreach, and the Inspectorate teams underwent refresher training in evidence and documentation. In parallel, OPSA is working to formalise closer collaboration with other government bodies to deal with abuse cases more efficiently. Some critics argue that residential care homes have become too business-driven, putting profits before the well-being of residents. Fenech does not deny that the sector attracts heavy investment, but he insists OPSA's role is to ensure that care always comes first.
"This is the OPSA's raison d'être: to be the intermediary between profit and the well-being of older persons," he said. He pointed to the Authority's licencing record as proof. In 2024, OPSA issued 94 licences - but only after imposing 326 remedial actions and 1,056 conditions. No home, regardless of investment, was allowed to operate until it fully complied with the standards. "A lot of capital is being invested into these ventures," Fenech said, "but the OPSA is constantly making sure that the service provided to older persons is up to standard."
The question of staffing is central to quality of care. OPSA's standards require each resident to receive a minimum of 2.38 hours of daily individualised care from a nurse or carer, plus 0.38 hours of care from a qualified nurse. While there is no global consensus on staff-to-resident ratios, Malta's requirements are ahead of many international benchmarks. Importantly, they were established through public consultation and agreement among local stakeholders in 2021. Fenech emphasised that the authority enforces these requirements through unannounced inspections. "It is crucial to note that the staff-to-resident ratio is dictated by OPSA in accordance with its standards that are codified in law," he explained, underlining that enforcement is a daily reality, not just a principle.
The issue of working conditions and burnout among care workers, however, lies outside OPSA's remit. Fenech was candid on this point: "While I sympathise with the nurses and care workers, working conditions do not lie within the OPSA's remit. Our priority is the well-being of older persons." Even so, OPSA does ensure that carers and nurses are properly qualified and that they maintain their skills through continuous professional development. This applies equally to Maltese staff and the many third-country nationals working in the sector. Competence, Fenech stressed, is non-negotiable.
For Fenech, safeguarding dignity goes beyond audits and licences. The emotional and social dimensions of ageing require as much attention as the regulatory side. The trauma of leaving home, the difficulty of adapting to routines, and above all the risk of social isolation are the real challenges many older persons face when entering residential care. To address this, OPSA's Well-Being and Outreach team visits care homes regularly, working to resolve complaints amicably and to promote social participation. These visits, Fenech said, are vital in creating environments where older residents feel seen, heard and valued.
He pointed to an upcoming initiative as an example of OPSA's human-centred approach. Later this month, the authority will host an exhibition, Talenti b'Għożża, showcasing artisanal work created by older residents in care homes. "Apart from celebrating the skills of these persons, developed over the years, it also serves to tangibly show that they remain active, sharp and valuable contributors to society," Fenech explained. For all its audits, inspections, and legal frameworks, OPSA's ultimate responsibility is to the human beings living in Malta's residential homes. Fenech's concern for their dignity, independence and quality of life comes through strongly. "Older persons remain complex individuals," he said. "While they may have different and daily needs to younger generations, they deserve to be treated with the respect and dignity they deserve."
As Malta's population ages, OPSA's role will only become more important. Its work is not just about ensuring that care homes meet minimum standards, but about creating an environment where older persons can continue to live full, engaged lives - even in the later stages of life.