Ageing-in-place refers to the ability of older adults to live independently in their homes, in their community, postponing relocation to long-term accommodation for as long as possible.
Ageing-in-place is not only preferred by many older adults, but the concept is furthered through Malta’s active-ageing policy objectives by promoting independence and well-being; and providing cost-effective person-centric care solutions.
Comprehensive community services are central to the success of ageing-in-place because they play a crucial role in supporting healthy ageing by addressing the physical, social and emotional needs of older adults.
Healthy ageing is a multi-dimensional process that involves maintaining physical, mental and social well-being as individuals grow older. According to the World Health Organisation, healthy ageing is defined as “the process of developing and maintaining the functional ability that enables well-being in older age”. This concept moves beyond being simply absent of disease. It encompasses the ability to live a fulfilling life, engage in meaningful activities and maintain autonomy.
Key factors influencing healthy ageing include access to quality healthcare, strong social support networks, safe living environments and opportunities for inter-generational social engagement.
As Malta’s population ages, the government itself, and an array of private entities, have turned to the construction of long-term care residences as the primary solution to providing care for older persons in Malta.
The proliferation of long-term care homes is not the only answer to addressing the long-term care predicament in Malta. This is a single-minded approach that creates a demand for beds that is artificial and economically unsustainable. The current business model relies entirely on the government ‘buying’ beds; and this model is flawed for several reasons:
1. The proliferation of long-term care residences induces demand
The expansion of long-term care facilities has been shown to induce demand, meaning that the more beds available, the more the system encourages people to occupy them. This phenomenon is referred to as supply-induced demand. Instead of addressing the true needs of Malta’s ageing population, the proliferation of these facilities is already creating an abnormal dependency on institutional care, which is massively costly and inefficient. Yet it competes directly with the implementation of more viable community-based delivery.
Many older persons are able to age in place with adequate community-based services. Yet, the over-abundance of long-term care facilities funnels individuals into institutional settings, even when such care is not necessary. This over-reliance on institutionalisation drains public resources that could be better allocated towards preventative and home-based services that allow older persons to maintain meaningful autonomy.
2. The current business model is unsustainable
The current business model for long-term care facilities in Malta largely depends on government funding to cover the costs of residents’ care. The government, in turn, is constantly pressured to continuously fund the construction of new public long-term care facilities to meet perceived demand. This reliance on government purchases of long-term care beds is unsustainable, for several reasons:
• Escalating costs: As demand is artificially induced, the cost of maintaining long-term care infrastructure will continue to escalate exponentially. With rising healthcare costs, an ageing Maltese population and inflation, the government will find it increasingly difficult to keep up with the financial burden. The continuous expansion of these facilities compounds this problem by creating more infrastructure to maintain, leading to a never-ending cycle of demand and cost inflation.
• Limited government budgets: The financial strain on the public purse due to healthcare and long-term care costs is already considerable. Investing in institutional care diverts resources from alternative models of care that might be more cost-effective and person-centered, such as home care programmes or community-based services. Ultimately, this puts a strain on other public services, leading to potential cuts in areas such as education, housing and other preventive health measures.
• Profit-driven motives: In many cases, private companies sell bed spaces to the government, operating a for-profit model that, for reasons that are obvious to the intelligent observer, prioritises profit margins over the quality-of-care. This profit-driven approach might incentivise subpar living conditions; understaffing; and inadequate patient care, which puts vulnerable residents at risk. This is particularly troubling when facilities subsidised by the government through taxpayer money, fuel private profit-making, while the quality of care diminishes.
3. Institutionalisation reduces the quality of life
Institutional settings, by their very nature, can be isolating, leading to feelings of loneliness and depression among residents. Moreover, the rigid structure and routines of long-term care facilities often strip individuals of their autonomy, leaving them to adapt to institutional protocols rather than living according to their personal preferences.
Alternative models such as ageing-in-place, where individuals receive care in their own homes, provide a more personalised, humane and dignified approach to caring for older persons. They allow individuals to remain connected to their families and communities, maintain a sense of independence and benefit from tailored care solutions that reflect their unique needs. By over-investing in long-term care facilities, Malta is missing out on investing in these more compassionate and sustainable alternatives.
4. A need to shift to community-based and home care solutions
Rather than pouring resources into an unsustainable and often ineffective system of institutional care, the government should redirect its focus towards the further development of robust community-based care models.
Home care programmes and technological solutions for monitoring and assisting ageing individuals are evolving rapidly and can provide viable alternatives to institutionalisation. In fact, home care is shown to result in better health outcomes and higher satisfaction rates among older persons.
Developing a continuum of care that prioritises prevention, early intervention and home-based services would significantly reduce the need for long-term institutionalisation. It would allow for ageing populations to stay at home longer, maintain social connections and receive care when needed without the high costs and the trauma of relocating into an institutionalised setting.
‘Intergenerational fairness’ is highly significant when viewed through the lens of older persons’ social engagement in the community. As older generations remain actively involved, their contributions help bridge the gap between age groups, fostering mutual understanding and support.
Intergenerational fairness promotes equity, ensuring that older persons not only receive adequate care and respect but also have opportunities to contribute meaningfully to societal decisions that shape the future. This framework enhances social cohesion by valuing the wisdom and experience of older persons, reinforcing their vital role in building a more inclusive and sustainable community. This is what meaningful ageing-in-place is all about.
Instead of expanding the number of institutional care beds, the government should continue developing community-based, home care and preventative health solutions, which provide higher quality and personal care at lower cost. By doing so, Malta can meet the needs of an ageing population in a way that is both humane and economically sustainable.
Brian St John holds master degrees in EU policy, bioethics, and ageing and dementia. He is also a council member of the Maltese Association of Gerontology and Geriatrics (MAGG).