Elderly people are dying while waiting for carers

Malta’s shortage of live-in carers is creating dire situations, with some elderly people dying while waiting for help.

The gap between demand and supply has become critical, Bernard Micallef Cann, a nurse and founder of the private homecare service 3C, has warned.

The process for third-country nationals to obtain the necessary permits to work as carers in Malta is too slow and bureaucratic, often taking between five and 10 months.

“Malta needs about 3,000 carers a year, but many applications are refused, sometimes at the final stages,” he explained.

“It’s heartbreaking when people die during the wait. Others are forced into elderly homes when they don’t need to be there, or they suffer injuries – for example, from falls – because there is no one to help them comply with their treatment.”

Bernard Micallef Cann is the founder of private homecare service 3C.

And the demand is set to increase. One in three people in Malta will be aged 65 or older by 2050, according to United Nations Population Unit estimates. Currently, one in every five Maltese citizens is over the age of 65.

Making the profession more attractive

Micallef Cann, who has worked in intensive care units in Malta and London before moving into management, identified two main solutions: increasing carers’ salaries to make the profession more attractive, and fast-tracking applications for those with healthcare qualifications over other jobs such as drivers and waiters – jobs that can be filled by locals.

He pointed out that third-country nationals are willing to live with their patients, something Maltese workers will not do.

Currently, live-in carers in Malta earn about €1,100 gross per month, plus food and lodging. The government subsidises €8,500 a year towards their salaries for private clients. By contrast, the cost of placing an elderly person in a care home can cost the government around €27,000 annually.

Micallef Cann believes that raising subsidies for live-in carers could allow families to offer those carers better pay, helping Malta compete with countries like the UK, where salaries can be €2,800 a month.

It is because of this that carers sometimes leave without notice – with many just failing to turn up for work after having found a better opportunity in a different country.

It is also the reason why qualified carers – from countries including the Philippines, Pakistan, Nepal and India – come to Malta to work as waiters and drivers – lured by agencies that offer the best salary package.

“My dream would be that every third-country national in Malta is first vetted to see if they can work in healthcare – we have doctors working as Bolt drivers and nurses working as waitresses. The agency which pays most wins. We need to make the carer role more attractive – because we need them and only third-country nationals are willing to do it.”

Overwhelming demand

The demand for care is overwhelming. 3C Malta receives 15 to 30 new requests for live-in carers each month, but most are refused due to a lack of available staff. Delays also affect carers already in Malta who find themselves in legal limbo while appealing work permit decisions.

“They have the certificates to work as carers, but we can’t employ them until the appeal is decided,” he said, calling for the speeding up of these appeals.

Another problem is that patients and their families often wait for a crisis to happen to request a carer.

Micallef Cann noted that 90 per cent of 3C’s clients are referred after a crisis – often a fall or sudden deterioration in health.

“People wait until it’s too late to ask for a carer,” he said.

One other issue that emerged is that when a patient dies, family members at times do not terminate the carer’s employment properly. Some decide to backdate the termination resulting in the carer becoming illegal, triggering the appeal process that blocks them from moving on to another patient.

He also pointed out that informal care by family members, once common in Malta, has declined, although it remains stronger in Gozo.

3C provides a holistic approach to community-centred care, working with doctors, nurses, dietitians, psychotherapists, dentists and carers to support elderly people, those with disabilities and patients needing acute care. In the case of elderly patients, the most common reasons for care are dementia, Parkinson’s disease  and compliance with treatment for conditions such as diabetes.

The company also works closely with Hospice Malta, with Micallef Cann emphasising the importance of palliative care at home: “I believe people should die at home, surrounded by family, with the right support. Most elderly people feel they are a burden – on their families and on doctors and healthcare workers – but with proper palliative care, they can pass away comfortably in their own home.”