The state's care home for the elderly never used the tracking devices it had purchased after their safety was questioned, according to the internal inquiry into how a resident went missing from the home on June 28.

There also appeared to be some disagreement among staff at the St Vincent de Paul residence over who would be held responsible for the devices and place them on the patient.

The detail is contained in the report seen by Times of Malta of an internal investigation into the disappearance of Carmelo Fino.

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

The inquiry’s first recommendation is that the home should adopt a tracking device which is “dignified, safe and medically and legally acceptable”.

CEO Josianne Cutajar told the judge that the home functions on the concept of “dignity and self-determination” but she was not happy with the idea that elderly members can walk in and out of St Vincent de Paul as they wish.

“Last year the government introduced the ‘telecare on the move’ system and since the government accepted the system, SVP had to adopt it,” the report read.

‘Telecare on the move’ is a tracking device launched by the Ministry for Active Aging in 2021, to help people with dementia continue to live in their homes and in the community.

How does the system work?

The device is attached to a lanyard and placed around the person’s neck. It connects to a 24-hour call centre and to the relatives of the wearer. It can also detect if the person has fallen and has a battery life of three to 10 days.

The device has one button, with SOS engraved on it. It comes with a GPS chip and relatives or carers relatives can check the wearer’s location.

It also includes a ‘geo-fencing’ feature, creating a perimeter for a person with dementia: if the wearer goes beyond the limits set, the device will send an alert to notify the relatives and carers.

Why wasn't it implemented?

According to Cutajar, the pendants were purchased and all the documentation was in place regarding operating procedures, responsibility for them, and when they should be worn.

However, there was “opposition” within the home as someone would have to be responsible for the devices and put them on the patients, the report said.

The device was also challenged on the basis of safety: the person could easily remove it and risk harm to themselves. 

It was decided that patients who could leave the home would be given the device and a list of such patients was compiled by doctors.

However, despite Fino having dementia, he was not on that list.

The report said more assessments were to be carried out and management is looking for a device that was “safe and acceptable.”

Tagging and tracking are not foreign concepts to homes for the elderly in Malta.

The privately run Dar l-Annunziata in Tarxien gives each resident a wearable device that relays geographical information directly to clinical staff.

What are the concerns about tracking devices?

According to the head of the Department of Gerontology and Dementia Studies, there needs to be a “serious discussion” on all aspects of electronic tagging before a decision is taken.

“Unfortunately, this is not a clear-cut decision, as it involves considerable ethical concerns,” Dr Christian Borg Xuereb said.

He said there were different types of devices that could either track the person’s whereabouts or “geo-fence” a person inside an “invisible perimeter.”

“Electronic tracking devices (ETD) are some of the least restrictive ways to maintain safety and manage wandering in persons with dementia, however, this should be done in conjunction with a person-centred care management plan,” he said.

“For example, investing in green areas would permit the person to wonder within a multisensorial garden. Therefore, the environment and the way we construct the residential areas play a critical role in enhancing the lived experience and managing challenging behaviours, in contrast to a hospital-like environment.”

He said one of the main concerns of using ETDs is consent.

“Will the elderly be informed and educated about these technologies and given enough time to think about consent? Will significant others be included in the decision-making process?

“And, how will competency and capacity to consent be assessed?” he asked.

Another issue is privacy.

“How will the dignity and autonomy of the older person be preserved and respected? What about privacy? This is one of my biggest concerns. Being tracked means data is being gathered, how will this data be managed and stored?

“And who has access to it?” he added.

Borg Xuereb said such ethical issues need to be discussed in depth by an ethical board.

“We need to reflect on who stands to benefit from electronic tracking devices, the person with dementia, the caregivers or the system?”