The government’s carer-at-home scheme, billed as a way for incapacitated elders to be cared for in their home while reducing waiting lists for government residences, has only been modestly successful, with figures showing that waiting lists have lengthened not shortened.

Currently, 223 elders are benefitting from the scheme, under which the government subsidises the salary of a home carer by up to €5,200, according to figures supplied by the Department of Active Aging and Community Care.

Yet in the three years since the scheme was launched, the waiting list for admittance to government homes or beds in private residences paid for by the government has grown from 1,400 to 1,600.

Although it is not known how many of those on the waiting list would qualify for the home-care subsidy, it is estimated that the number of potential beneficiaries is much higher. (An assessment is carried out upon applying, with eligibility tied to some sort of physical or mental dependency by the elder).

Ritianne Buttigieg, the assistant director of the Active Aging and Community Care Department, told The Sunday Times of Malta that there is no cap on the number of beneficiaries, and applications are processed efficiently within three weeks.

“We shall continue supporting senior citizens in similar initiatives so that they can keep living in the community where their needs are fully met,” she said.

We shall continue supporting senior citizens in similar initiatives so that they can keep living in the community where their needs are fully met

Inquiries among industry insiders identified a variety of stumbling blocks to greater uptake of the scheme by the elderly. These include lack of awareness of the subsidy and a chronic shortage of carers.

Chiefly, however, it’s a question of cost for elderlies on a modest pension. For even though the government subsidises more than half of a full-time carer’s average monthly salary of about €850, as well as exempting the payment of NI, the carer would still cost the elder just over €400 monthly.

That means an elder on a pension of around €700 would have to cope on the leftover pot of €300 for all other household expenses, including food.

By comparison, the same elder in a government home would have 24-hour all-round care and needs provided in return for forfeiture of the entire pension.

Mindset barriers also play a signif-icant role: many elders appear to be averse to employing a carer at home, especially a foreigner.

Foreigners account for the overwhelming majority of all home-based carers and virtually all live-in carers (see table). Of the 223 elders benefitting from the scheme, 191 employ foreign workers, mostly Filipinas.

The preponderance of foreign elderly carers is now also a common theme in all major hospitals in Malta.

In Karin Grech Hospital, a rehabilitation hospital for the elderly, and St Vincent De Paul, a long-term care facility for the elderly, the proportion of foreign carers has tipped over half (see table).

It’s a similar situation in Mater Dei, where a senior official confirmed that “foreign carers now outnumber Maltese carers” (Mater Dei has no geriatric wards, and carers are assigned to various duties throughout the hospital).

Elderly care has emerged as one of a trio of industries – the other being waitressing and online gaming – in which foreign workers now predominate. 

“Maltese people prefer other kinds of jobs,” a senior health official who wished not to be named told The Sunday Times of Malta.

Carers or care assistants are mostly assigned mundane tasks: to move, wash and feed patients; to assist them in the toilet; to keep vigil over patients who require constant observations; and other humdrum work.

“The shortage of carers, especially elderly carers, is chronic across all sectors in health,” the official said.

Only Gozo bucks the trend: just one of 83 carers throughout the Gozo General Hospital are foreign.

Do hospital carers have to speak Maltese?

Many elderly express uneasiness at having to communicate with staff in English in public hospitals. For this reason, the preponderance of foreign carers has given rise to questions over the use of Maltese language in communicating with patients, The Sunday Times of Malta has found out in an extensive inquiry. 

St Vincent De Paul said that “English is the mandatory language but we encourage them [carers] to follow basic Maltese language courses.”

Alessandra Pace, chief of staff at Steward, said with reference to Karin Grech Hospital that “while knowledge of Maltese is not obligatory it is asked that all carers have a working knowledge of the language.”

As for the Gozo General Hospital, she pointed out that there is only one foreign carer there but that “going forward preference will be given to Maltese-speaking or those who are prepared to learn Maltese”.

Mater Dei was more unequivocal. “We do obligate foreign nurses to take Maltese courses so that they can communicate with patients in Maltese,” Chief Nursing Officer Paul Buttigieg pointed out.

“But foreign carers are not obligated to take a course in Maltese.”

The essentialness of carers’ ability to speak Maltese is a moot point considering the tasks they are assigned – washing, feeding, shifting, dressing and taking frail elders to the toilet, as well as other nonclinical jobs. Even among infirm elders who may struggle to express themselves with precision in English, communication is hardly needed in the delivery of structured, repetitive tasks of basic care in a hospital setting.

However, it is a different story for home carers, where sustained communication takes place throughout the day. A shortage of Maltese carers appears to be a factor in holding down greater uptake of the scheme.

As in home care, cultural stiffness comes into play in public hospitals. Many Maltese hold on to the expectation that delivery of public services, particularly something as essential as health, ought to be in Maltese.

In fact Maltese knowledge is often a stipulation for employment in the civil service (an exception has long been made for highly-skilled foreign medical consultants who would be assisted by Maltese-speaking nurse when seeing patients). But this does not apply to carers because they are employed by private companies and assigned to public hospitals.

It is understood from conversations with various sources that most, if not all, carers of the elderly, and carers generally, at Mater Dei and St Vincent De Paul are employees of a company called Healthmark.

Healthmark did not reply to an e-mail and phone calls from this newspaper seeking figures on foreign carers employed through them, as well as comments on the shortage of carers and use of Maltese. Ms Pace of Steward would not be drawn into naming the companies that employ carers assigned to Stewart’s hospitals, saying that “as a private company” Steward “does not typically supply commercially sensitive information about contractors and suppliers”.

Comprehension of Maltese is also specified by at least two of the four entities that hold courses in elderly care in Malta. These are JobsPlus and St Vincent De Paul, both of which specify that applicants have to be “literate in Maltese and English”.

The course at St Vincent De Paul (SVDP), Care of the Elderly, is the more ambitious of the two, and something of a standard-bearer in elderly care study in Malta. 

SVDP was asked whether the stipulation for Maltese literacy still makes sense in a situation wherein the majority of carers are recruited from abroad and aren’t obligated to learn Maltese, and whether the stipulation is rigorously enforced on non-Maltese applicants who are resident in Malta.  

“The course is delivered in Maltese and hence it is compulsory that all students are able to understand and communicate in Maltese,” SVDP wrote in an unsigned e-mail, adding that “Maltese will remain the language used as this gives an opportunity to those who are not fluent in English”.

The Sunday Times of Malta has found out that the course notes are in English, the lecturer speaks “mostly” in Maltese, and that applicants whose Maltese is elementary are starting to be accepted for the course.

In fact, at least three Asian applicants who were not “literate” in Maltese were enrolled in the last intake of students. Unlike Maltese students, who were tasked with translating a paragraph between Maltese and English during the interview, these were verbally assessed for elementary comprehension of Maltese utterances in a patient setting.

Carer-at-home scheme

Live-in carers Full-time carers Part-time carers Nationality of carers
      Foreigners Maltese
177 26 20 191 32

Elderly carers employed in public hospitals

St Vincent de Paul Karin Grech Hospital Gozo General Hospital
Foreigners Maltese Foreigners Maltese Foreigners Maltese
225 177 113 93 1 27

Figures supplied by St Vincent De Paul and Steward Malta (figures for Gozo Hospital are for carers in geriatric wards only). No figures were collated for Mater Dei as it has no geriatric wards, carers are assigned throughout the hospital.

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