Legislation relating to the provision of home care services
According to the Maltese Civil Code (Book first of persons, art. 2), a married person who is in need of help with daily living can rely on maintenance from his/her spouse provided that they still live together. Maintenance is defined in article 19, paragraph 1 as including food, clothing, health and habitation. Children are bound to maintain their parents or other ascendants who are indigent. However, neither of the spouses can claim maintenance from their children if such maintenance could be provided by the other spouse (art. 5.3). No one is legally obliged to care for unmarried people or widows with no children. The State would be responsible for their care.
The main legislation that governs home care in Malta is the Social Security Act (Cap. 318). This law deals with the provision of benefits, assistances and pensions to the poor, sick, elderly and the unemployed. A Carer's Pension is payable to “all unmarried or widowed persons who are taking care, on their own of a parent who is bed-ridden or confined to a wheel-chair”. A legal notice entitled State Financed Services Rate Regulations (L.N. 259 of 2004) determines the amount that an elderly person residing in state financed homes shall contribute to Government for his/her care and upkeep. Care is classified as Level 1 care, where residential care with only minimal basic care is provided and Level 2 care where the residential service provided includes such level of care that goes beyond minimal basic care as certified by the Interdisciplinary Assessment Team within the Elderly and Community Services Department.
Organisation and financing of home care services
As Malta is small (316 km2 with a population of 400,000), all policies are promulgated and passed by the national government. There are consequently no formal regional or district tiers of health care.
Nevertheless, there are 68 local councils. They do not have any policy making power but many have an elected person who is responsible for monitoring the provision and quality of services for the elderly. Although it is the responsibility of the national government to provide day-care centres, it is often on the initiative of local councils which in many cases also provide and furnish the actual building.
The health care system is publicly financed through general taxation and is free at the point of delivery although users may have to make out-of-pocket payments. Private healthcare is fairly common (Ministry of Health, 2002).
In 1987, the Government set up a Department for the Care of the Elderly which is responsible for taking care of the special needs of the elderly. The aim, in providing these services, is to enable elderly people and those with special needs to remain living within the community for as long as possible. Community services for the elderly and for people with special needs are heavily subsidised by the State. People receiving such services pay a nominal fee based on their income (Ministry of Health, 2002).
Requests for the homecare help service must be accompanied by a medical report. This is sent to the Department for the Elderly and Community Services, which then arranges for a social worker to visit the applicant in their home in order to assess their needs. The number of hours granted is dependant on each person’s needs.
Kinds of home care services available
There is a wide range of home care services for the elderly in Malta.
There are 13 day centres mainly for people who are over 60 years of age. Priority is given to elderly people living alone, those who are not involved in social activities and those who could be at risk spending long hours on their own. The centres, which are open 5 days a week, offer physical education, social and creative activities and sometimes educational talks on relevant issues e.g. health, home safety and welfare services. Intergenerational activities are encouraged and outdoor activities are organised twice monthly. People attending day centres are required to pay a nominal fee (ranging from Lm 1 to Lm 2.5 a month depending on how many times they attend the centre) with an additional 50 cent charge being made for couples.
The handyman service offers a range of about 70 different repair jobs e.g. linked to plumbing, carpentry, transportation of objects, electrical work etc. The service is free of charge to senior citizens holding the Pink Form and Special ID Card (which are granted on a means tested basis and entitle holders to free medication and certain other benefits). People who do not have such cards have to pay for the service. This usually amounts to Lm 1- Lm 2 depending on the job required. In all cases, the person receiving the service must pay for any necessary materials.
The homecare help service provides non nursing care, personal assistance and help with light domestic work to older people i.e. over 60. The services are adapted to each person’s individual needs. People over the age of 85 are given priority. Other criteria include having special needs and the ability to live a relatively independent life in one’s own home if given assistance, being terminally ill or living alone with no formal or informal family support network. There is a nominal fee of Lm 1 per week for a single person and Lm 1.50 in the case of more than one person benefiting from the service. The preparation of meals incurs an additional charge of 50 cents for a single person and 75 cents for more than one person.
The incontinence service is available to people over 60 years of age or younger people with special needs. Incontinence pads/diapers are heavily subsidised in order to permit people with this problem to continue living in the community. Nevertheless, there is a charge which ranges from 7 cents to 11 cents each.
Meals-on-wheels are provided 7 days a week by the Maltese Cross Corps (a non-governmental organisation) and the Catholic Action Movement in collaboration with the Department for the Elderly and Community Services. People over 60 years of age and people with disability, who are unable to prepare their own meals, can benefit from this service. Each meal costs 95 cents (approx. EUR 2.2). When delivering the meals, the specially trained staff ask whether the elderly person needs anything and keep an eye on the person’s home environment. They are expected to report anything unusual to the organisers of the service.
The social work unit provides psychological counselling, guidance and assistance to certain categories of elderly people including those with dementia and those living alone with a high level of dependency. The unit “deals with social casework, provides advocacy for clients, facilitates self-help management and develops action plans, performs crisis intervention work, provides assessments for residential homes, home care help service and assessments of Carer’s Pension for the Department of Social Security, and liaises with the geriatric, general and rehabilitation hospitals, the Health Department, police, Local Councils and other community organizations.” A medical report is necessary to benefit from this service. Once approved, either the social worker visits the person in their own home or the person has a meeting with the social worker at the offices of the Department.
The telecare service is designed to enable subscribers to call for help when needed. This gives older people, those with special needs and also their friends and relatives a feeling of security and encourages subscribers to carry on living in their own homes. The service is available to elderly couples/people living alone aged 80 and over, people over 70 suffering from a chronic illness, people of any age living alone who are afflicted by a life threatening illness and people who are afflicted by a life threatening illness whose carers would benefits from the service. In case of emergency, the elderly person just needs to press a button on the unit itself or on a pendant worn round the neck and a call is made to the Control Centre which has full medical details as well as the contact details of the person, the doctor and two relatives, friends or neighbours who have a key. The service costs Lm 1 per month for single people and Lm 1.16 for two people living together
The Malta Hospice Movement offers a comprehensive range of services to terminally ill people, most of whom are elderly. This includes home care, day therapy, spiritual support, night and day nursing in the home, respite care, assistance with bathing and hairdressing.
Respite care is mainly provided at Zammit Clapp Hospital, a specialised geriatrics assessment and rehabilitation hospital and at St. Vincent de Paul Residence, a residential complex. Both these units are state-run and free. However, places are limited and an application has to be submitted beforehand. Respite can also be organised in residential homes run on a profit making basis, as well as in church-run residential homes.
Voluntary associations offering services for the elderly in the community include Caritas Malta, the Catholic Action Movement, the Legion of Mary, the Social Action Movement and the St Vincent de Paule Society. In 1982, Caritas set up the “good neighbour scheme”. Every elderly person is visited, assessed and invited to participate in this free service. If interested, the volunteers motivate neighbours who then keep a friendly and regular watch on the elderly person. Some provide direct help and some alert the necessary authorities in order to organise help.
A number of grants are available to the elderly for home adaptations or improvements.
The Independent Living Advice Centre is an organisation run by volunteers which promotes the use of technical aids to enable frail and elderly people with disabilities to manage daily activities and retain their independence.
- Department of Information (2004). Legal Notice 259 of 2004: State Financed Services Rate Regulations. http://www.doi.gov.mt/EN/legalnotices/2004/05/LN259.pdf
- Information provided by Charles Scerri and Stephen Abela
- Malta Hospice Movement website: http://www.hospicemalta.org (accessed in November 2005)
- Ministry of Health (2002), Public Health Report: Malta 2002 , Department of Health Information: http://www.sahha.gov.mt/showdoc.aspx?id=41&filesource=4&file=publichealthreport2002.pdf
- Ministry of Health website (Department of the Elderly and Community Services): http://www.gov.mt/frame.asp?l=2&url=http://www.sahha.gov.mt (accessed in November 2005)
- Ministry of Justice (2004). Laws of Malta: Social Security Act. Cap 318. Accessed on 7th June 2006 from http://docs.justice.gov.mt/lom/legislation/english/leg/vol_7/chapt318.pdf
- Troisi, J. (2004), National Background Report for Malta , EUROFAMCARE. http://www.uke.uni-hamburg.de/extern/eurofamcare/documents/nabare_malta_rc1_a4.pdf
- Zammit Clapp Hospital (2004). Annual Report 2004. http://www.sahha.gov.mt/showdoc.aspx?id=2&filesource=4&file=zchannualreport_2004.pdf
Last Updated: mercredi 15 juillet 2009