We envisage a Maltese society that empowers older people to remain actively engaged in their community, to maintain the highest level of independence possible and to continue to contribute to society.
Unfortunately at present we are nowhere in sight of this goal.
Paradoxically, we Maltese pride ourselves on being a caring family-oriented nation, and yet many of us turn a blind eye to the unwarranted neglect and degradation suffered by a number of our senior citizens.
There exists an urgent need to challenge local stereotypes about ageing and acknowledge the huge contribution that people in later life can make to their communities.
With so many issues to tackle, we asked ourselves at FXAM – which one should we focus on first? We then discovered a distressing lacuna in our statutory regulations.
Our country has Standards for restaurants, hotels, guesthouses, kindergartens, even for host families for foreign students – but no Standards for care homes for our own elderly! How could it be possible that as an EU Member State with a relatively opulent life style in the year 2014, Malta still has no Standards for care homes for our older people?
We acknowledge the fact that there are Homes that do provide quality care and services for their residents, but there are also bound to be ones that cut corners. The absence of National Standards and Legislation to enforce such Standards has allowed for the growth of relatively unregulated public and private services for vulnerable seniors with highly variable levels of care.
As a Foundation, we find this situation unacceptable. Thus the formulation of Standards for Care Homes for Older Persons together with their effective Regulatory Framework and implementation became our first priority.
Just think – one day sooner or later you too will be old: after working hard and providing maximum support to your family, how would you prefer to spend the twilight of your life? Like Ms. M or like Mr. B.?
Ms. M is an 80 year old who lives alone and is independent in all the activities of daily living. She goes shopping every day, attends Mass, cooks and manages her household chores. She also helps her daughter who lives nearby and works full time, by cooking her meals during the week. One day Ms. M, unfortunately, suffers a severe stroke. She is taken to hospital where the treatment she receives causes her condition to improve but she is no longer able to look after herself at home. Given the paucity of community support services, her family have no option but to arrange for her to move into a residential home. This was discussed with her in detail and she participated in the meetings with the management of the home. She and her family were given a Residents’ Guide providing them with the following information about the Home:
{C}· A full description of all services provided (including health, nutrition, social, cultural, spiritual, educational) detailing charges where applicable;
{C}· An accurate description of individual rooms and communal space provided;
{C}· Relevant qualifications and experience of the licensee, all managers and direct care staff; staff;
{C}· The maximum number of residential places provided and any special needs or interests catered for;
{C}· A copy of the most recent inspection report;
{C}· A copy of the complaints procedure;
{C}· An up-to-date summary of residents’ views on their home.
Before moving into the Home, Mrs. M and her family were also provided with a Contract detailing terms and conditions together with the level of care she required – this was based on a physician’s assessment evaluated according to the Barthel 100 Dependency Tool. Mrs. M had her own room with en suite bathroom so her precious privacy was not jeopardized. Her dietary requirements were adequately met and all meals served were appetising and nutritious. She was given physio and speech therapy on a regular basis. She was encouraged to be as independent as possible and to participate in the programme of social activities organised by the Home. She settled in well and, indeed, her friends and family were happy to visit her in this comfortable and homely environment.
Mr. B
Had a comparable life style and also a similar stroke. His hospital treatment was relatively successful but he too had to be moved to a Home. Unfortunately he was not involved in any discussions that may have taken place between his family and the Home. Neither he, nor his family were given a Residents’ Guide to the Home, nor a Contract detailing the level and nature of the care the Home would provide for him. He shared a room with 4 others and had little if any privacy. He could not go to the toilet on his own as it was too far away from his bed so he was donned with a nappy. Within a matter of a few days developed pressure sores. The food presentation was unattractive; he ate less and less and became increasingly depressed. The physiotherapy sessions were regularly postponed. He also inevitably became forcefully incontinent. As the weeks passed, he became less and less independent. His family felt sad and guilty about his circumstances. It hurt them so much to observe their once so active father in such a helpless state, increasingly dependent on others, his pride and dignity whittled away.
How can two such divergent scenarios continue to exist?
We (FXAM) thus lobbied vociferously for the introduction of the much-needed Standards. It was our new President – then Minister for the Family and Social Solidarity, her Excellency Marie Louise Coleiro Preca and her Parliamentary Secretary, Mr Franco Mercieca, who honoured us with an invitation to participate in drafting the National Minimum Standards for Care Homes for Older People (NMS) in collaboration with the Directorate for Health Care Standards in the Ministry for Health.
The overarching aim of these Standards is to ensure Care Homes meet the needs and secure the welfare and social inclusion of those who live in them. They will be applicable to all operations for which registration and annual licensing as a “care home for older people” are required.
The Standards acknowledge the unique and complex needs of each individual residing in a care home. They stipulate the minimum requirements for a facility to operate as a care home as well as the required knowledge, skills and competencies needed by management and staff to ensure care homes deliver individually tailored, comprehensive and quality services. Moreover, although the Standards are qualitative, they are also measurable. Each Standard has an achievable Outcome that can be objectively ascertained. These outcomes provide an instrument for the independent regulator to assess the degree to which the Standards are being met.
Once effectively implemented, these Standards will be just one small step taken by FXAM towards achieving our goal – that of ensuring that Maltese citizens not only live longer, but also live well.
Moreover, we will continue to urge younger generations to interact with older people: to enable them to enjoy a better life by providing needed services and support, and by maximizing opportunities for them to remain active participants in all aspects of social life.
We want to make it possible for all Maltese citizens to age as you and we would like to.
FXAM Founding Members
Dr. David Mamo, Dr. (Perit) Joseph Spiteri, Antoinette Powell, Maria Taliana, Dr. Stephen Mangion, Lora Cascun, Simon Fiorini Lowell, Nadienne Zammit Fiott, Anne McKenna.
FXAM –Fondazzjioni Xjuħija Attiva Malta / the Foundation for Active Ageing Malta