The Department of the Care of Elderly and Special Needs is entrusted with the following portfolio:

1996 saw the completion of phase one of the Mtarfa Home project for the elderly. In June 1996 residents were transferred to the new building and discussions regarding commencement of works on phase two of the same project were immediately initiated.

The other major residential care project that was embarked upon during 1996 was that of Cospicua Home for the elderly. Discussions were finalised and excavation works were subsequently embarked upon.

The refurbishment programme regarding the existing State Community Homes continued during 1996. This time the main focus was on the Floriana and Gzira Homes. The dining room furniture at Floriana Home was replaced by new chairs and table while the kitchen was given a thorough facelift. The environment of Gzira Home was also considerably brightened up with new curtains and all wooden apertures were replaced by aluminium windows.

As part of the plan to upgrade the services offered in the Homes for the elderly, staff working in these setting was encouraged and granted permission to attend in-service training programmes which were specifically organised for such personnel.

All homes maintained a full occupancy level. The total number of persons residing in these homes as at the end of 1996 was 208 females and 79 males. These were housed as detailed below:-
 

The Welfare Committee has provided funds to effect refurbishment in the homes, to buy food packs and toiletries and it also organised outings for the elderly residents. It also provided presents on Mother's day, Father's Day, at Easter and Christmas.
 
DAY CENTRES 

The number of Day Centres for the Elderly in Malta has grown to four, situated at Qormi, Dingli, Hamrun and Zejtun. Premises for a fifth Day Centre were rented at Zurrieq, while other towns are being considered to open new Day Centres, especially in collaboration with the Local Councils of these towns.

357 persons are registered in the four above mentioned Day Centres. These persons are offered free transport, and can use all the facilities available in the Centres. Tea, coffee and snacks are served daily, whilst the elderly are kept occupied with a full daily programme. Indoor activities include discussions, bingo, craftwork, games, prayers and keep fit exercises. Fund raising activities are regularly held and the elderly are also taken out on outings to enjoy themselves.

It is the policy of this Department to keep the elderly within their home community and these Day Centres are fulfilling part of this scope. It is also intended to offer the use of these Day Centres to disabled persons.

The Incontinence Service continued to be managed by the Department for the Elderly and Special Needs. This service provides free disposable nappies for disabled persons (Scheme A) whilst it also provides the same to the elderly at a reduced price (Scheme B). Applicants collect the nappies from the authorised distributor who performs this service under contract to this Department.

During 1996, the number of Scheme A users had dropped by 59 whilst the number of Scheme B users had increased by 250. This shows a considerable increase of the use of nappies by the elderly and confirms the upward trend of the number of elderly persons making use of this Department's services.

During 1996 the number of persons using disposable nappies were:-
 

One thousand, two hundred sixty-eight (1268) applications were received during 1996. Four hundred and fifty (450) applications were sent in by Pink Card Holders (persons who are entitled to medical services free of change) or persons with a disability in possession of the Special Identity Card.

Persons who are not in possession of the Pink Card are entitled to this service on a subsidised basis. Five hundred and twenty eight (528) tasks were carried out bringing a revenue of Lm 617.50.

Nine hundred and eighteen (918) tasks were completed. Two hundred seventy-five (275) applications were cancelled either because they had been commissioned privately or did not fall within the range of tasks carried out by the Handyman Service. Six (6) tasks are still pending. Maintenance and Refurbishing of Dingli and Qormi Day Centres were carried out by personnel employed at the Handyman Service.

The Electoral Office issued 3950 identity cards for the elderly (kartanzjan) to sixty-year old persons and 2324 to persons who are 75 years of age. Up to December 1996, 465 cards were re-issued to persons whose card had been destroyed.

The Info-Anzjan Project was launched in 1996. This is a project which contains a directory of all senior citizens in Malta and Gozo, involving specific information to assist all senior citizens. Thirty-four (34) Local Councils were introduced to this project and were given on-site training to familiarise themselves with the computerised system prepared by MSU. Lectures were also organised as an introduction to the project.
 
THE INTERNATIONAL INSTITUTE ON AGEING

The Institute provides multi-disciplinary education and training in various areas in the field of ageing. Moreover its training programmes are further reinforced by the Institute's other activities, e.g., data collection, documentation, information exchange, technical cooperation as well as research and publications.

Training Programmes

During 1996, the Institute organised six short-term training courses in Malta and one in Macedonia; it also sponsored a number of students for the 9-month post-graduate course in Gerontology and Geriatrics conducted by the University of Malta.

The details of the courses held and of the candidates trained are as follows:
 

Research

During 1996, the Institute continued with its collaboration with the World Health Organisation on the research project on Age Associated Dementias which covers six countries: Canada, USA, Nigeria, Chile, Spain and Malta. It is expected that findings will be available in 1997 and that they will provide useful information regarding older persons in Malta.

Conferences and Seminars

During 1996, the Institute continued with its other regular activities including:

• the publication of its quarterly journal BOLD as well as other publications among which the Proceedings of the Expert Group Meeting held in 1995 on "Meeting the Challenges of Ageing Populations in the Developing World"; and

• the collaboration with its international Collaborating Network as also with its new network TWINAGE aimed at facilitating the implementation of the recommendations of the Expert Group Meeting on the Challenges of Ageing Populations

The Hospital continued its operation for its 5th year with 60 beds for in-patient treatment and its Day Hospital / Out-patient facility. Plans for expansion of these facilities have been put on hold as no capital expenditure provision was allocated.

Under the Hospital's contract of autonomous operation, the Board of Management met regularly every month following the established pattern of previous years. A record number of patients were admitted during 1996 which reached a total of 1072 of which 706 were females and 366 males. This compares favourably with previous admission of 994 in 1995 and 909 in 1994. These figures represent a growth of 7.8% and 9.4% respectively. It enabled all the hospital staff to reach a record average monthly occupancy of 95% during '96 (reaching a peak of 98% in December). This is a significant jump from the previous years which were 92% for '95 and 90% for '94. The increase in admissions was achieved through this higher bed occupancy since the mean length of stay remained the same i.e. at 18 days.

This increased activity has pushed the staff to their maximum performance since no increases in nursing staff was registered over the previous year's figures. Other disciplines such as Physiotherapy have had a high level of staff turnover during the year which increased the individual's performance at times to unacceptable levels, which are not sustainable, without affecting negatively the quality of service provided. It is felt that these figures represent the peak performance achievable without increase in number of beds and staff.

The quality of care was certainly kept at the high levels the public has come to expect from the Zammit Clapp Hospital. The Hospital policy of Human Resource development, through continuous updating, ensures high standards of care are maintained. Another vital contribution to this high performance was the allocation of sufficient funds during 1996 as requested by management. Increases in expenditure has been kept to increases in cost of living. The Hospital management is now studying the effects of 5 years of high performance on the infrastructure of the Hospital. This study will seek to prevent reduction in the quality of service by investing in new, upgraded and modern equipment.
 
THE TELECARE SERVICE

This service is a community service provided by the Department for the Elderly and Special Needs so that according to the policy elderly persons and persons with special needs can live as independent a life as possible both in their own home and in the community.

The service (24 hours daily, throughout the whole week), provides the client with a special apparatus called Lifeline/Premier which acts both as an emergency service and as a normal telephone. The client is also given a pendant which can be activated from a distance (25 metres). When in the case of an emergency, such as a fall, the alarm call enters the Control Room at the Telecare Centre, the appropriate action is immediately taken according to laid down procedures by the Telecare Operators, (the latter are 14 in all, divided into 4 shifts). The action taken can range from contact with relatives, doctors, health centres, ambulance service, police, or others, according to the needs of the clients.

The Telecare Service which commenced in March 1991, was initiated by the Secretariat of the Elderly in collaboration with the Telemalta Corporation, which is responsible for the purchasing of the Lifeline/Premier sets, and other equipment (PNC2, Intel, U.P.'s, P.C.), installation, repairs and maintenance of this equipment at the Telecare Centre.

Statistics

Applications

The number of applications have risen to approximately 10 per day.

Installations

The total number of installations up to end of December 1996 were 5315 as shown in the immediately following table:
 

Incentives

Pink Form Concessions

The Secretariat, in collaboration with the Telemalta Corporation arranged for Telecare clients and potential clients, who are elderly, over 60 years of age, living alone and are holders of the pink card to be exempt from paying the Telecare rental. This concession was extended to those elderly persons who have a disabled person living with them (80 cases at the time). This involved great pressure over and above the normal work load of the Telecare staff. Each and every client was informed of this concession by a personalised letter. All the letters were processed and the necessary modifications were made both in clients' personal files and in the database program.

Further follow ups continued as to keep track and control of those clients whose pink form expired. This exercise was done in August 1996. From 1200 clients with pink form concession, 400 had expired pink forms. Each client was informed to renew their pink form - 40 did not have it renewed. A procedure was established in case of non renewal of the pink form.

Transfer of Telecare Centre

During 1996 a great number of meetings was held to co-ordinate and implement the necessary works to shift the Telecare centre.

Various works were carried out at the new centre. Major works have been completed and furnished with the modern furnishings - the Control Room; a separate room for the apparatus and another one for the generator; a rest room and other offices were modified according to the needs.

The plan is to effect the transfer of the Telecare Centre sometime in 1997.

New Apparatus

Telemalta, and the Board of Directors approved a call for tender to purchase new and modern apparatus for the Telecare Centres' Control Room (monitors etc.).

If the new apparatus that is chosen (windows environment) is like the model of the PNC3, then there is a scope to discuss the possibility of "Care Management Package" in service delivery. Issues like Service Provider Accountability can be addressed through this system.

For Telecare, the new apparatus means the change of the present equipment which already is past half its capacity.

Training/Participation in other activities

In March 1996, the O i/c was invited by the Telemalta Corporation to deliver a speech about the Telecare Service at an International Seminar, Cost 219. Cost 219 is a European research project in the telecommunications and teleinformatics field for the elderly and persons with disability. The experience and exchange of ideas and information in this area were invaluable.

During 1996, the O i/c attended the launch of Telemalta's Customer Care Charter, another seminar organised by the Telemalta Corporation "The impact on Society of modern Telecommunications and Information Technology" and a work trip where she visited various Control Centres all over the UK. The hosts of this visit were Tunstall International, the UK. company which supplies the Telecare apparatus.
 
MEALS ON WHEELS

The 'Meals on Wheels' Service, run by the Maltese Cross Corps and subsidised by the Department for the Elderly and Special needs, continued progressing during the year 1996. In fact 40,910 Meals were distributed all over Malta. This amount exceeds that distributed in 1995 by more than 3,000 meals. Through the Meals on Wheels service the Maltese Cross Corps also delivered meals to the elderly who frequent the Day Centres at Hamrun, Qormi and Dingli. More use as a respite service was noticed in the Summer months when carers take a holiday when they are assured that the elderly they care for will be given daily meals.
 
ST. VINCENT DE PAULE & RUZAR BRIFFA COMPLEX

At the beginning of 1996 the number of patients was 1,033 (342 males and 691 females) while the number of patients at the end of the year was 1,055 (343 males and 712 females). There was an increase of 21 beds on the female side due to the commissioning of a new ward in the last half of the year.

During the year there were 350 admissions (129 males and 221 females). There were 279 deaths (110 males and 169 females). The average age (number of the years) of the newly admitted patients was 80 years for the males and 81.3 years for the females.

Wards

During the past year extensive work was carried out on the existing Admission and Assessment ward. The patients were transferred to a temporary Admission Ward situated under the Doctors' Quarters. At the beginning of the year works on the Admission and Assessment Ward was taken in hand and was completed in the second half of last year. The masonry works, which consisted of building an extension ward to house twelve (12) beds and a one bedded-room complete with toilet and shower for isolation cases were completed.

The interior part of this ward was brought down and built again according to the requirements needed for such a ward. This ward now houses sixteen (16) beds.

One must note that all masonry works, electrical and plumbing services were carried out by St. Vincent de Paule maintenance staff.

The storey above the new Admission and Assessment Ward was re-constructed and converted into a new ward housing twenty-one beds.

This ward now known as Ward 22 in St. Joseph Wing and housing female patients was commissioned in October 1996. 

Pharmacy

It was envisaged to move the pharmacy to the ex-Sisters' Quarters, in the ground floor which is below the Doctors' Quarters. Works started towards the end of 1996 and are now at an advanced stage.

Provision Stores

These stores have not had a facelift since they came in use over seven years ago. 

The major work involved, apart from plastering and painting is:-

• the construction of an adjacent air-conditioned room to store fruit and other perishable items; and
• the tiling (floors and walls) of all the rooms

All the work is being done by St. Vincent de Paule maintenance personnel.

Occupational Therapy Department

The delivery of services by the Occupational Therapy Department at SVPR, although of considerable impact on the population of the residence as a whole, still remains regrettably limited by a number of long standing problems namely:-

Last year saw the setting up of a Committee named "Friends of St. Vincent de Paule Residence". The Committee is composed mainly of persons who have relatives at this residence.

The aims and objectives of this committee are to help the residents of St. Vincent de Paule in their various problems both personal and collective, to create awareness with the relatives regarding their responsibility to visit regularly their elderly once these are admitted into this residence, to encourage the interest of the general public in St. Vincent de Paule Residence by various means, and to organise social, cultural and other activities.
 

ADULT TRAINING CENTRES

During 1996, this Department continued to monitor the performance and to administer the four Adult Training Centres which are situated at St. Venera, Fleur-de-Lys, B'Kara, Hal Far and Mtarfa. The number of persons attending these centres was:-
 

At the St. Venera ATC for the Blind, various services were continued for the blind persons attending, including assisting them to attend hospital appointments, assisting them for purchases or to go to the Bank, reading of newspaper articles or filling in of Income Tax or other forms.

All the above mentioned Training Centres provide a warm meal daily, and take the persons attending on coach outings regularly to places of historical and cultural interest. Transport and meals are provided free.

Trainee self development programmes are being held where the trainees have to take part in various activities which bring them to a better understanding of the community and other social contacts.
 

SOCIAL WORK UNIT

Intake Unit

The Intake Unit was formally created within the Department for the Elderly and Special Needs, on the 20th September, 1996. In this initial stage the proper planning and functioning of the Intake Unit are still being processed in order that manageable solutions are implemented, monitored and periodically assessed.

The Intake Unit is an assessment unit. Social casework is dealt with within the unit. The intake officer has to distinguish whether Social Casework needed is of a short-term nature or needing longer-term intensive intervention from a social worker. This distinction is usually made on the nature, presentation and complexity of casework.

Casework needing short-term intervention will be dealt with, within a fortnight of its presentation, usually by the Intake officer. Casework needing longer duration and frequent intervention will be assigned to a social worker attached to the Intake Unit, or referred to other social workers, according to their field of specialisation, or to other social work units outside the Department for the Elderly and Special Needs.

During 1996, social workers were involved in 294 social work interventions. Out of these interventions 149 needed a short-term intervention. 145 needed longer-term intervention due to their complex nature.

The targeted plan of action for 1997 is to establish the proper management and functioning of the Intake Unit within the Department for the Elderly.

Initially the Intake officer and another full time social worker will manage the unit plan. Together they can co-ordinate interventions needed. Hopefully, during 1997, the third social worker will be assigned to the unit to make it fully functioning.
 

Unit for Liaison with Non Governmental Organisations

The principal aims of this Unit are:

During 1996 this unit held 68 meetings with various voluntary organisations. The total amount of funds asked for by Non Governmental Organisations in their "project documents" were Lm 915,128. Naturally, a very careful selection of these project documents was made, and 19 projects from various Non Governmental Organisations were approved, whilst 6 other projects were rejected.

The total expenditure of this unit, including salaries of staff reached Lm 14,957.
 
HOME CARE HELP

The aim of this service is to ensure that beneficiaries, with minimum help, can retain independence, and as long as is feasibly possibly, continue to live in their own home/environment.

It is a personalised service which is aimed at enabling them to have a good quality of life. It is also aimed to trigger off self-help and enhance any family and community support already existing.

Service is granted on the basis of social need or medical limitations of a serious nature. It can be granted on a flexible basis, both from the point of view of time as well as from the point of view of type of work; this is done so that the beneficiary can continue to live as independent a life as is possible.

Criteria and Priority

Priority is given to those persons who live completely alone, who are over 80 years of age, and those who for some reason or another are dependant on others. Another element taken into consideration is the fact that priority is given to those who suffer from "Dementia", "Alzheimer's" or "Parkinsons" which render beneficiaries unable to cope alone, but who with a bit of help can manage better.

Service is also given to those who are suffering from psychological disturbances or who are presently facing the problem of bereavement. This Unit would not like beneficiaries to let go of life, feel isolated and lost. When relatives opt to look after their loved ones themselves, this unit provides respite service, as the case may be. Service is also extended to those who have just been discharged from hospital and are in a position, with minimal support, to remain in their own homes. The scope / aim is to maintain their independence and dignity.

What does the service entail?

The service is one of a generic nature; it is meant to provide moral and practical support so as to maintain one's level of independence as well as self-help. From the practical point of view the service includes shopping (including various errands), collection of pills and other medicines from health centres or clinics and preparing a warm meal. Casual Social Assistants may also be asked to accompany beneficiaries for a walk or going out so as to arouse a certain level of motivation. Another aspect of this practical point is that of light domestic work which includes: washing of rooms which are used by beneficiaries (namely kitchen, bedroom and bathroom as the three points of hygene and the hallway).

Background history of service

This service was first introduced in the beginning of 1988 in pilot areas. This service expanded so much that by 1989 it was being utilised by beneficiaries from all over the island and most of Gozo. Now the service is widespread on both islands. Up to the end of 1996 the following number of beneficiaries were making use of the service:

Follow-up of service

In 1996 (as in previous years), the service underwent a follow-up exercise, wherein in service was monitored and cases which had not previously been granted service were again being reviewed. 

Any available hours were being re-allocated to those who were more vulnerable and dependent.

The policy is being revised so as to provide an efficient and cost effective service.