Consultants at St Vincent de Paul Residence have placed 90 residents on constant watch in a bid to avoid a repetition of the disappearance of a resident in June, according to the nurses’ union.

The Malta Union of Nurses and Midwives (MUNM) said the orders were issued following the introduction of a mandatory assessment of all residents as one of the emergency measures introduced after Carmelo Fino walked out unnoticed on June 28.

More care workers were employed to sit with these residents who were at risk just like Fino was.

Meanwhile, the minister for active ageing, Jo Etienne Abela, said tagging of elderly residents was “definitely the way forward” after Fino's fatal disappearance.

“When we speak about an elderly residence, especially St Vincent de Paul, this is a very large home, and no matter how many CCTV cameras you put in, no matter how large the security detail is, the healthcare system is one where if all little incidents line up, they can cause a tragedy,” the minister told Times of Malta.

The more safety nets introduced into the system, the better the outcome for the institutions, he stressed.

Raft of measures

A raft of measures have been introduced since Fino walked out of the residence without anyone noticing. Most notably, the number of security officers guarding entrances and exits at the home has been tripled from 20 to almost 60.

Shortly after Fino's disappearance, the elderly residents were ordered not to leave their wards, go for a walk or attend Mass unless accompanied by a nurse, carer or relative.

Since then, just 75 have been given the free pass to go anywhere they wanted.

Fino, an 83-year-old dementia sufferer, exited the facility in the middle of the night. Also known as Karmenu and Charlie, he was recorded on CCTV leaving the Luqa home at 3am on June 28.

Tests on a corpse found underneath a tree in Birżebbuġa have established that the remains were Fino’s.

In his inquiry findings, Judge Geoffrey Valenzia pinned the responsibility for Fino’s disappearance on the staff on duty that night.

Four security officers, two carers and nurse Rhys Xuereb have since been suspended on half pay upon the instructions of the Public Service Commission. Another carer, who was employed by a contractor and assigned to the care home, has been replaced by another employee.

In a judicial protest expected to be filed by the MUMN in court on Monday, Xuereb will be calling for the immediate revocation of his suspension.

He has already claimed, among others, that the inquiry was “flawed”, primarily because it did not include his version of events.

He was suspended after it was alleged that he “neglected [his] duties of supervising the residents entrusted to [him]”.

As he reiterated his innocence, insisting that he had not abdicated any of his duties, the nurse and his union will tell the court that the Fino tragedy would have been avoided had the elderly man been placed in a closed ward with other dementia sufferers.

Apart from being alone in the ward at the time when there should have been at least two nurses on duty, Xuereb said he administered medicines to Fino and then continued with his other nursing duties.

Fino was not on constant watch, so he did not require any further nursing care required by other residents.

The MUMN said the introduction of security measures constituted an admission of a system failure and that it was not fair that Xuereb was being used as a scapegoat to blame the shortcomings of others. It said Xuereb should be reinstated and given other nursing duties away from the care home.

In its protest, to be filed by lawyer Chris Cilia, the nurses’ union and Xuereb will hold the chief executive at the St Vincent de Paul Residence, the permanent secretary in the Active Aging Ministry and the Public Service Commission responsible for damages.

Tracking devices under consideration

The minister said he has had several meetings regarding the introduction of a tracking device, with the main priority being dementia residents.

The state care home had previously purchased tracking devices, but after their safety was questioned they were never used, according to the internal inquiry. One of the inquiry’s recommendations is that the home should adopt a tracking device.

There also appeared to be some disagreement among staff at the home over who would be held responsible for the device and for placing them on the patient.

Abela said he is aware of the legal, data protection and human issues which may arise when tagging elderly people. “I am also aware the subject is being tackled by the St Vincent de Paul directors and they will give me reports of their discussions.” But he said he would like to see a tracking device which is “conspicuous, safe and provides the necessary information needed”.

The minister said he does not want a device that can be easily removed by the resident.

He hopes that before a pilot project is introduced, more discussions will be held, and he is not excluding public consultation.

Clash of opinions

While Abela is pushing for the introduction of the devices, he admitted a clash of opinions with his consultants.

“When I meet with my consultants, the floor is divided ‒ those who want it and others who don’t,” he said. He said his main dementia consultant is against its introduction as he believes tracking someone is “demeaning”.

“I agree with that point of view, but I cannot shut off to the requirements of proper safety demands. With my experience in healthcare, we have to make sure we do everything in our power to reduce incidents.”

Abela said he hopes a “multidisciplinary approach” will be adopted when it comes to assigning which dementia patients will be tagged. “It won’t just be up to the doctor’s assessment, but the carers, nurses, physiotherapists, and all other professionals who assess the patient.”

Asked what happens if a resident or their guardian does not want the tracking device, Abela said the home should respect their decision, as long as there is a disclaimer.

He rejected statements that such measures would turn St Vincent de Paul into a prison, insisting that the institution must be responsible for its residents, but that the responsibility must also come from residents, legal guardians, and families.