The Department for Elderly and Special Needs, which forms part of the Social and Family Affairs Division, is entrusted with the following portfolio:
a) providing domiciliary services to enable the elderly to remain living in familiar surroundings.
b) setting up of day centres in various localities to enable the elderly to continue leading an active life in their own community.
c) providing rehabilitation services and the best possible conditions for health improvements in geriatric institutions.
d) providing institutional residence to elderly persons who are unable to benefit from any of the foregoing services.
e) gerontology studies and educational facilities (training courses, participation in national and international conferences)
f) helping persons with special needs to live a normal life by providing them with the most modern and sophisticated facilities.
TELECARE SERVICE
This is one of the community services provided by the Department for Elderly and Special Needs. This was the first emergency telephone alarm system of its kind for elderly people who live alone. The purpose of Telecare is to help the elderly to live safely and independently in the community for as long as possible. The clients, that is, the elderly have direct contact with Telecare operators.
Telecare employees were trained by an English engineer brought especially by Compserv agents. Apart from the operators, there is also a Manager (a Social Worker); an Executive Officer, four Casual Welfare Officers and a Grade B member of staff. The operators help clients make contact with their relatives, with doctors, health centres, with the ambulance service or with the police. In case of emergency, such as, for example, when an elderly person falls, the operator takes the necessary steps and acts according to laid down procedures. The other employees process and assess applications, complete contracts and visit clients' homes and, apart from daily duties, liaise with other departments. Up to 31st December 1995, Telecare Statistics were as follows:
Telecare Working Sets installed: 4,199
Agreements Pending At Telecare Centre: 5
Applications Pending At Telecare Centre: 61
Agreements Pending at TeleMalta: 62
SOCIAL WORK UNIT
There are six social workers at the Department for Elderly and Special Needs. They are personally involved in social work amongst elderly persons and persons with special needs who are beneficiaries of either Telecare or Home Care/Help Service Scheme. Lately, five social workers successfully completed a course organised by the Institute of Social Welfare at the University of Malta. The aim of the course was to train the social workers to perform their duties in a more professional manner.
The Parliamentary Secretary for Elderly and Special Needs, and Social Workers meet regularly in order to monitor and evaluate the services provided for thousands of beneficiaries. In the meantime the consultant of the Social Welfare Planning Unit at the Ministry for Social Development, and the Social Workers Unit are working on the improvement of the Telecare Service.
During 1995 the Social Workers were entrusted with the following activities:-
a) Two "Pre-Retirement" Courses for persons reaching retirement age. These courses were held at the Telemalta Corporation and at Farsons
b) Lectures focusing on old-age to members of Voluntary organisations.
c) Two hundred nineteen (219) assessments of prospective applicants for admission to Homes for the Elderly.
d) Several lectures on social aspects to nurses and other professionals.
e) Ninety (90) assessments of applications for Carer's Pension.
f) Counselling to elderly persons who were undergoing social problems. There were 103 cases in all.
g) Collaboration with Cana Movement towards the setting-up of the first "Carers Support Group" whose aim is to support carers of dependent persons. Group meetings are held every month.
HOME CARE/HELP SERVICE
The Home Care Help Service was originally introduced in 1988. It provides care and assistance to persons over the age of sixty (60) and persons with special needs, in order that these persons will remain living in their own homes and community for as long as possible.
The home care help service is a personalised service aimed at improving the general quality of life of beneficiaries. It is allocated according to the needs of beneficiaries and designed to supplement and complement self-help efforts and the assistance and support that relatives are used or supposed to give to elderly parents or to persons with special needs.
Priority in allocating this service is given to applicants nearing or over the age of 80 especially those persons who live alone and/or need personal care and support and domestic help.
Priority in allocating the home care help service is also given to the most dependent applicants or to persons undergoing medical, social or psychological problems affecting their independence and participation in community life.
Before being allocated the service an assessment is carried out by a social worker or assistant social worker which centres on the applicant's social, psychological and medical needs. Allocation of hours of service is decided according to needs presented in the social report and a casual social assistant is engaged to help beneficiaries on a regular basis.
The work of casual social assistants mainly consists of shopping and errands, bed making, laundry, washing of floors of rooms frequently used once a week. Casual Social Assistants also help elderly people and persons with special needs to take care of their own basic needs. Another main task casual social assistants have to carry out is to build a healthy relationship to motivate beneficiaries to help themselves and live a full life considering their limitations and physical disabilities. A healthy relationship also serves to enable casual social assistants to notice any changes in social and health circumstances to enable beneficiaries go through changes in their lives or be helped in the facilitation to seek medical or other help needed. Where necessary casual social assistants may prepare meals or motivate beneficiaries to prepare meals themselves. Casual social assistants may also give respite to carers caring for dependent relatives. Service allocated can also be for a temporary period to help beneficiaries during convalescence periods.
The number of Home Care Help beneficiaries in 1995 was
as follows:
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COMMUNITY BASED HOSTELS
During 1995, in line with its policy to extend and upgrade residential care facilities for the elderly, the Department focused on two major projects namely:
(a) the setting up of a Home for the Elderly at Cospicua and;
(b) the conversion of Mtarfa Hospital into a Home, financed by the Welfare Committee.
The plans for the erection of a Home in Cospicua, designed to take in sixty residents, were finalised and the relative building permit was issued during 1995. Work on the Mtarfa Home involving the demolition of an existing building and the erection of a new block to meet modern standards in the provision of communal residential facilities for the elderly, progressed satisfactorily during 1995.
Besides these major projects, the Department continued with its regular maintenance programmes in existing homes. The first phase of an extensive refurbishment exercise involving the upgrading of common areas and kitchen facilities at Floriana Home was undertaken. The communal areas have been repainted in line with the policy adopted by the Homes Section to shift away from traditional colour schemes to brighter and warmer shades.
Throughout the year all Homes maintained practically a
full occupancy level. The total number of persons residing in such Homes
as at the end of December 1995 was 198 females and 79 males.
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| Floriana |
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| Msida |
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| Gzira |
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| Mosta |
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| Mtarfa |
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| Zejtun |
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At the same time, requests for admission continued to flow in. As at the end of December 1995 there were 416 persons awaiting entry to these Homes. The rate of turnover in these Homes is however relatively low.
In conclusion, the Department acknowledges the fact that the upgrading of these Homes needs to involve also the training and retraining of staff so as to provide better service. Therefore, discussions to this effect were held with the Department of Health and the Employment Training Corporation regarding training of staff in food handling techniques and caring practices, respectively.
RESEARCH AND PLANNING SECTION
Despite the lack of professionally trained staff to carry out extensive on-going research in the field of gerontology, the following major activities were carried out during 1995:
- lecturing in pre-retirement courses and participation in various radio discussion programmes with a view to promoting awareness about the implications of ageing;
- participation in the 3rd European Congress of Gerontology, an event which promotes exchange of ideas and research findings. Moreover, such activities facilitate the establishment of further contact with persons and research institutions involved in the field of ageing;
- participation and presentation of the local scene vis-à-vis demand for residential care in Malta in the DIPCOP International Conference;
- an analysis of the Casual Social Assistants' hourly rate of pay and submission of recommendations regarding review of employment conditions.
THE INTERNATIONAL INSTITUTE ON AGEING - UNITED NATIONS, MALTA
The year 1995 boasts the highest ever record of activities organised at the Institute at a national and international level. Moreover, the Institute participated in international conferences in Malta and abroad.
A. Courses organised abroad
The following courses organised on a national and regional basis were held for the first time.
- Short-Term National Training Course in Social Gerontology, Cape Town, South Africa.
- National Course in Gerontology for the Staff of the China National Committee on Ageing,China.
- Short-Term Training Course in Social Gerontology/Geriatrics, Rio de Janeiro, Brazil
- Regional Training Course on Demographic Aspects of Population Ageing, Manila, Philippines.
B. Courses organised in Malta
Five short courses and a nine-month course were organised in Malta in 1995.
- Short-Term Course in Social Gerontology
- Short-Term Course in Demographic Aspects of Population Ageing.
- Short-Term Course in Income Security for the Elderly in Developing Countries.
- Long-Term Diploma/Master's Degree Course in Gerontology and Geriatrics.
- Short-Term Training Course in Gerontology for a group of Chinese participants from China National Committee.
- Short Term Course in Geriatrics.
Details on all Programmes organised during 1995 are found
in the following table:
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OTHER ACTIVITIES
Several Maltese and foreign participants (listed hereunder) attended the International Meeting of Experts' called the Meeting the Challenges of Ageing Population in the Developing World, 23-26 October 1995.
Prof John Dixon - Department of Social Sciences Lingnan College, Hongkong.
Prof. Nana Apt - University of Ghana, Ghana
Dr. Kastini Sen - Mansfield College Oxford, United Kingdom
Dr. Sylvia Vatuk - University of Illinois Chicago, United States of America
Dr. Alex Kalache - London School of Hygiene and Tropical Medicine - United Kingdom
Dr. Christopher Beer - Help Age International, United Kingdom
Dr. Kevin Kinsella - Ageing Studies Branch
International Programs Center, U.S. Bureau of the Census, United States of America.
Dr. Richarch Osborn - Technical Evaluation Division, Reproductive Health Branch, United Nations Fund for Population Activities (UNFPA), United States of America.
Dr. Alexandre Sidorenko - United Nations Programmes on Ageing, Division for Social Policy and Development, and the Department for Policy Coordination and Sustainable Development, United States of America.
Dr. Censu Tabone - Malta
Dr. George Hyzler - INIA/MALTA
Dr. Julian Mamo - INIA/MALTA
Dr. James Calleja - INIA/MALTA
Dr. Joseph Troisi - INIA/MALTA
The Institute was greatly involved in two international Conferences, namely, Developing Inter-Professional Practice in the Care of Older Persons (4th November 1995) in collaboration with Zammit Clapp Hospital, and the Conference on the University of the Third Age (November 1995). Both conferences were held in Malta, the latter being organised at St. Vincent de Paule Residence and at the Old University, Valletta.
Experts from the World Confederation for Physical Therapy (WCPT), the World Federation of Occupational Therapists (UFOT) and INIA devised a training programme for therapists (physiotherapists and occupational therapists) working with elderly persons. In 1993, INIA and WCPT had already organised a course for physiotherapists which turned out to be quite successful. Occupational therapists will now be able to join the course. Furthermore an evaluation was carried out to include new aspects in the forthcoming course which is scheduled for 1997.
ZAMMIT CLAPP HOSPITAL
Zammit Clapp Hospital was inaugurated four years ago to tow the line with the government's policy vis-à-vis the elderly, that is, rehabilitating or providing respite care for elderly persons in order to be able to return to their normal daily life at home, or in a caring institution. Patients are referred to Zammit Clapp by a medical doctor. They may be admitted from St. Luke's Hospital or from their home. Services are free of charge.
The hospital is run by an autonomous board which is composed of a chairman and six members. A general manager is in charge of the daily management of the hospital, and each and every employee is expected to do his best in executing duties and to ensure that the service does not only retain, but will be of the highest quality. By so doing the hospital's resources are used effectively. The manner in which services are delivered at ZCH is bestowed utmost importance, so much so, that its services rank amongst the best provided by the Health Sector.
During 1995, nine hundred ninety-four (994) patients availed themselves of services at Zammit Clapp Hospital, 4% increase against 1994. (Please refer to Appendix II). The patients' average age was 79. The average number of days spent at hospital decreased to 18%. Five hundred and eleven patients (511) were admitted to hospital from their homes. (Please refer to appendix II - Admission to Zammit Clapp Hospital by Home Area). 78.2% returned back to Community life against the 76% in 1994. Moreover, the mean bed occupancy was 92% in 1995 against 90% the previous year. These statistics speak for themselves. The aim for which the hospital was established is gradually being attained.
Appendix IV indicates the number of patients availing themselves of services provided by the Day Hospital at Zammit Clapp. Here again, there is a fall in the number of patients. This is attributed to two factors - patients are benefitting of better services at hospital, and a shortage of physiotherapists at the Day Hospital.
In 1995, ZCH organised its first international conference, DIPCOP (Developing Interdisciplinary Practice in the Care of Older Persons). Though the conference's result are still being reviewed its outcome is quite successful. The conference brought to the fore important aspects:
- the interdisciplinary methods adopted by the hospital are amongst the best (which explains why patients benefit of the best services)
- employees at ZCH and at the centres for the Elderly strengthened their relationships.
Moreover, Zammit Clapp Hospital extended its pharmaceutical services to the recently inaugurated St. Philip's Hospital. The range of services given by the Hospital is thus widened. On the other hand, pharmacists employed at ZCH will gain more experience in their profession.
The hospital's agenda proceeded with the signing of the first Collective Agreement with the UHM. This agreement covers a good number of employees. The security system was updated and now it falls under the Transport Department. Information technology was also introduced in order that the administrative and information system be updated.
At present, the hospital caters for 60 persons. A 2% increase (57.3 beds per day in a month - an average of 95.5% of beds per day) was registered in 1995. An extension is therefore envisaged for 1996 to meet the ever increasing demands for hospitalisation. Both the services provided by the hospital and caring of patients will be further upgraded.
So far Zammit Clapp Hospital has fulfilled its mandate to the best of its abilities. It will continue to do so in the coming years.
THE HANDYMAN SERVICE
The Handyman Service was established on 2nd August, 1993. Its aim is to perform minor repair services or odd jobs, free of charge in the residences of elderly persons who are in possession of the Pink Card, and disabled persons in possession of the Special Identity Card.
As from 1st December 1994, elderly persons who reach the National Pension age but who are not in possession of the Pink Card, were also entitled to this service on a subsidized basis. A price scheme was introduced (the cost of material used in the repair is borne by the client) whilst the range of tasks carried out by the handymen was extended.
Between 1st January 1995 and 31st December 1995, there were 973 applications. Five hundred sixty-two (562) applications were received from Pink Card Holders and four hundred eleven (411) from non-Pink Card Holders. One thousand, two hundred ninety three (1293) tasks were completed. Four hundred and two (402) tasks were cancelled either because they had been commissioned privately or did not fall within the range of tasks carried out by the Handyman Service. Fourteen (14) tasks are still pending.
Up to January 1995 a group of Handyman Service Personnel went to Gozo once a week.
There were 10 applications in all. Five (5) applications were against payment whereas 3 were received from persons in possession of the Pink Card. The remaining 2 applications were cancelled for similar reasons mentioned above. The Ministry for Gozo assumed full responsibility of the Gozo Handyman Service as from February 1995.
DAY CENTRES
The Day Centres Project was launched a year ago. At present, there are two Day Centres, one at Zejtun, another at Hamrun. Up to 31st January 1995, three hundred eighteen (318) persons were registered at the two day centres: Hamrun (218) and Zejtun (100). The number of persons attending these centres regularly is 50 (Hamrun) and 60 (Zejtun), respectively.
Initially, services at the Zejtun Day Centre were only available to Zejtun Residents. In March 1995, elderly persons residing at Tarxien, Paola, Zabbar, Kirkop, Luqa and Marsaxlokk were given the opportunity to start attending this centre. A similar invitation was extended to residents from the neighbourhoods of Hamrun, that is, St. Venera, Marsa, Pieta' and Gwardamangia. Twice a week (Tuesday and Thursday) both centres are explicitly open to residents from these localities.
Transport services are provided by two tail-lift coaches operated by the Corradino Rehabilitation Centre, Paola. In October 1995 private transport was hired to transport persons attending the Zejtun and Hamrun Day Centres. In all, thirty-four members make use of transport facilities (24 at Zejtun, 10 at Hamrun). In the evening, two vans from SVPR transport elderly persons from the Zejtun Day Centre to their homes. Moreover, another van was hired to provide two-way transport for elderly living in the whereabouts of the Hamrun Day Centre. The same van is used to fetch the meals from a restaurant in Bugibba.
The Zejtun Home for the Elderly and the Maltese Cross Corps are the respective caterers of the Zejtun and Hamrun Day Centres. Approximately twenty-seven (27) meals are prepared at the Zejtun Day Centre and nine (9) at Hamrun. Each meal costs 80c, and is paid for by the elderly themselves.
Throughout the year, several activities are organised at the Day Centres. A Barbeque, for instance, was organised at the Zejtun Day Centre to raise funds for the said centre.
All the staff employed at the centre attended a training course that was intended to help the employees cope with the elderly.
Requests for attendance to the Day Centres are incessant.
Efforts are being made to extend further the Day Centres Project in order
to meet the increasing demands of prospective beneficiaries.
ST.VINCENT DE PAULE RESIDENCE
Last year was another year of activity at St. Vincent de Paule Residence and Ruzar Briffa Complex, where various works, particularly the refurbishment of three (3) wards were completed, while other works are still in progress. It is our aim to refurbish all wards in this Complex.
During the past year 364 elderly patients (125 males and
239 females) were admitted, while the number of deaths was 300 (112 males
and 188 females). Relevant tables can be seen at appendix V and VI.
WARDS
Three (3) wards at Ruzar Briffa Complex were refurbished last year. The ex-Ward 4 at this complex housing six (6) flatlets was modernised and an extension to this section was constructed, and was developed into a fully modernised three (3) bedded ward for respite cases only. This proved to be a great success as all the three beds were fully occupied since this ward was commissioned. The stay in this ward is for the duration of six weeks only.
The other part of Ruzar Briffa Complex housing 75 residents, was separated into two (2) modernised wards. These two wards which accommodate 30 and 45 residents are the show place of this Complex.
Towards the end of last year major refurbishing works on the Admission Ward were taken in hand and are now in an advanced stage.
The masonry works, which consisted of building an extension ward to house twelve (12) extra beds and a one (1) bedded room complete with toilet and shower to be used for isolation cases were completed and new electrical and water services have been installed. The interior part of this ward was brought down and is being built up again to accommodate four (4) beds.
It is hoped that this ward will be commissioned by mid-1996. It will house sixteen (16) beds.
It is to be noted that all the masonry works electrical and plumbing services are being carried out by our maintenance staff.
KITCHEN
The upgrading of the Kitchen was completed in April, 1995. It has been equipped with all the appliances needed to prepare around 3,000 meals a day.
During 1995 refresher courses on Food Hygiene and on Food Preparation and Production were conducted by the Institute of Tourism Studies for all the employees working at the kitchen of this Complex.
These courses which were a great help to the cooks and other kitchen hands were held at the main kitchen.
TRANSPORT
The request for transport is always on the increase, due to the opening of the two Day Centres - one at Zejtun and the other one at Hamrun.
Most of the transport is engaged in transporting elderlies to these two Centres which is practically a daily routine.
Besides, two other vehicles are fully employed with the Physiotherapy and the Occupational Therapy Departments carrying elderly out-patients to these departments.
Last year a much needed ambulance with tail-lifter was purchased by the Secretariat to cope with the ever increasing workload.
OCCUPATIONAL THERAPY
A number of achievements have been attained in 1995 which were a source of satisfaction and impetus for the staff of Occupational Therapy Department. A drastic and much needed refurbishment of the unit was undertaken during the summer period. It entailed strenuous exertion from all staff members who had to reschedule sessions in order to ensure continuous delivery of service even though facilities were quite limited.
The Craft Fair was held in October. As usual it was very well supported by the Secretariat which afforded maximal coverage and exposure of this event on all the major media helping to sensitise the public on this department's contribution.
The domiciliary service initiated on a small scale in 1994 has been developed on a more substantial basis justifying beyond any doubt, the importance of community support of clients undergoing acute rehabilitation in a home setting. A new subunit of this department was set up at the Ruzar Briffa Complex. Every effort has been made to furnish it with basic equipment and adequate staffing to enable it to provide O.T. services for a major section of this residence.
Two new junior occupational therapists have been enlisted to the professional complement of staff whilst one staff member has departed to undertake further studies abroad.
A number of nagging problems that seem to perennially tax this unit cannot be overtaken. We will briefly mention the less than optimal level of staffing, both of professional staff as well as of supportive technical aides and the lack of continuity allied to limited multidisciplinary coordination of treatment at ward level.
A special consideration to transport services cannot be avoided at this point. Although every attempt has been made to secure the expected baseline services necessary to support paramedical departments, including the requisition of a new set of coaches, this was not sufficient to overcome the usual chronic cancelling of numerous treatment sessions much to the frustration of staff and clients.
PHYSIOTHERAPY
During the year this department's activities were quite dynamic and although quite a few chronic problems have not yet been solved (e.g. shortage of nursing staff affecting the general mobility of the patients); the whole atmosphere at SVPR has been in general quite positive.
The department's activities this year included:-
1. Extensive coverage of In-patients and Out-patients.
2. A change in the working hours. The department's staff work from Mondays to Fridays from 7.30am - 3.30pm. This has had a very positive effect on the service in general.
3. Two senior members of staff obtained a B.Sc. in Geriatrics and Gerontology.
4. Staff members took an active part in:
- Ward Level Meeting
- Continual Education Seminars
- The first multidisciplinary International Conference in Geriatrics.
5. A pilot scheme of domiciliary physiotherapy was started in the community and in Residential Homes. This showed the need and benefits of having Community Physiotherapy Services.
6. Provided Physiotherapy Services at Zammit Clapp Hospital.
7. Staff was involved in practical teaching and in supervising Diploma and B.Sc. Physiotherapy students from the Institute of Gerontology.
8. A two-day Seminar was held interdepartmentally for the P.T.D. staff to evaluate and improve the function of this department.
The need for Trained Physiotherapy Assistants to help the physiotherapists has been felt and documented for a number of years but as yet this personnel is not yet available.
ADULT TRAINING CENTRES
During 1995, the Department for Elderly and Special Needs continued with its programme of servicing and improving the Adult Training Centres. Refurbishment varied from the provision of benches, dustbins and street lamps, building a watchman's hut to converting a Centre's ground for varied sports and adding a new garden ramp. Educational and cultural trips abroad and a varied programme of entertainment as well as training in skills varying from care work to animal husbandry were also organised for trainees.
The number of trainees in each Centre was as follows:
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| Ghajnsielem |
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| Fleur-de-Lys |
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| Hal-Far |
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| Mtarfa |
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| Sta.Venera (Blind) |
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A very significant development was the signing in July, 1995 of the Classification, Regrading and Assimilation Agreement of the Social Work Class (Social Work Support Service):
The agreement provides for a reorganisation of the grades, so that there would be new categories of employees, such as Head of Centre, Assistant Head, Senior Care Worker, Care Worker and Assistant Care Worker. Another new development was the purchase of a tail-lift coach for the transport of the disabled to Mtarfa ATC.
During 1995, a full programme of educational activities was carried out in the Centres, compatible with the disabled persons' capabilities. They were trained in personal hygiene and in trades compatible with their disabilities. The principal aim of this training is to render these persons useful in life thus enhancing their abilities and inducing them to live as independent a life as possible.
MEALS ON WHEELS
Meals-on-Wheels continued to progress steadily throughout 1995. About 130,520 meals were distributed in forty-five towns and villages. This service is run by the Maltese Cross Corps.
When elderly people apply to the Maltese cross Corps to receive Meals-on-Wheels, the Corps make a point of explaining to them that, if they are well enough to cook for themselves, it would do them more good and keep them active longer, were they to continue cooking their own meals.
Various local Councils are showing interest in this Service.
INCONTINENCE SERVICE
In April, 1995, the Incontinence Service formerly run by the National Commission for the disabled was handed over to the Department for Elderly and Special Needs. At the same time a new scheme whereby incontinence pads are provided to elderly people and others with a disability at a reduced price, was launched.
Persons who were formerly in receipt of this service will continue to receive incontinence pads free of charge. However, in order to extend this facility to others in the waiting list, it was decided to provide incontinence pads to elderly people and others with a disability at cost price. This means that the new beneficiaries will be able to purchase incontinence pads at half the price of the item as purchased from the open market. The number of beneficiaries receiving incontinence pads free of charge is 681. Clients who benefit of this service at a subsidized rate amount to 679. In all there are 1360 beneficiaries.
Breakdown of number of applicants per month during 1995:
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