Inspections reveal elderly get inadequate care in private homes

The absence of minimum requirements for the care of the elderly has led to inadequate standards for old people in private-public homes and outsourced ‘buying of beds’, a damning report by the National Audit Office reveals.

Malta spends €56.9 million in state-financed beds for the elderly, up from €43 million back in 2011 and faces a waiting list of 2,100 people seeking long-term care because of the absence of community alternatives.

But despite outsourcing care of the elderly to private homes, Malta’s elderly residents in four private homes received less care time and nursing hours than contractually laid down.   

Perhaps the most damning finding is that despite the millions in taxpayers’ cash paid to finance beds for long-term and high dependency patients in private homes, is that minimum nursing and caring times had fallen well short of contractual obligations.

On average, the elderly in homes in Zejtun, Mellieha, Roseville Home and Casa Leone had to be given, individually, a minimum of 132 minutes caring time on a daily basis, and 24 minutes nursing time daily.

The reality is that chronic understaffing and a lack of rigorous enforcement, sometimes even absence of contractual obligations, are resulting in grievous shortfalls.

The Mellieha home was found to have given over 80 hours less caring time during three inspections in 2013 and 2014; the Zejtun home fell short by 178-202 hours; Roseville home fell short by some 40 hours; and Casa Leone fell short by 35 hours on average.

The shortfall in caring and nursing time meant that some high dependence patients were not even receiving the necessary care they deserved, despite clear contractual obligations. “It can be argued that the provision of minimum care services entails that, at the very least, all residents are considered as semi-dependent,” the NAO said.

Malta is grappling with an ageing population that between 1985 and 2013 has seen the number of persons aged 75 years and over rise by 141 per cent from 12,221 to 29,444.

To counter the demand for residential care for the elderly, the State increased contractual arrangements with the private and the Church sectors to increase beds by 10%.

But the private elderly care company of construction magnate and PN donor Nazzareno Vassallo turns out that it owns the absolute majority of government-financed beds in private homes.

The company, Care Malta, operates 76% of the 1,118 government-financed long-term-care beds in homes for the elderly as of 2013, with a whopping 78% of all of Care Malta’s beds being financed by the state. 

The NAO warned that Care Malta’s market dominance could not only stifle competition, but enhance owner Nazzareno Vassallo’s relationship and negotiating power with the state’s Department for the Elderly (DfE). 

The NAO analysed bed procurements for three homes for the elderly operated by Care Malta – the Zejtun Home, the Madonna tal-Mellieha Home, and the Roseville Home in Attard. 

Zejtun

In 2002, Care Malta was awarded a 25-year contract on a direct order, with a Cabinet memo highlighting that the company was the sole tenderer for the running of the home, and that “hardly any people complained about their running of the home”, and how it was an established leader in the care industry.

The Social Policy Ministry, then under Lawrence Gonzi’s stewardship, insisted that the tendering process would have taken too long to provide those 80 beds in Malta’s “most needy region”, hence the direct order.

The NAO argued that a call for tenders would have created competition between Care Malta and another bidder, resulting in more favourable financial conditions than the direct order.

Mellieha

In 2007, Care Malta was also awarded a public-private partnership to construct the Madonna tal-Mellieha Home following a successful tender bid for a home catering for 130 residents. Just four weeks after the contract was signed, the home’s committee started discussing a 24-bed extension, prompting the auditors to question why such an extension, that eventually cost €450,307 in refurbishment works, was not foreseen. 

The DfE agreed to give Care Malta the 21-year extension contract on a direct order and the first residents were admitted into the new extension in January 2011. 

However, the Contracts Department only gave their seal of approval to the extension in June 2012, implying that Care Malta was allowed to carry out its works prior to mandatory approval and therefore against the terms of the public procurement regulations. 

Indeed, the NAO quoted the Contracts Department remarking that it was being requested to act on a “fait accompli”. 

The contract was signed on 1 March, 2013, over two years later than the contract initiation date as indicated in the agreement, flagged by the NAO as a poor business practice. 

Roseville Home

Following an expression of interest issued by the Foundation for Medical Services (FMS) in 2009, the DfE decided to procure 80 beds from Care Malta to be placed in a new residence for the elderly at the Roseville villa in Attard. 

15 operators declared their interest, five of whom offered beds from a ready-available stock, and the other ten offering medium- to long-term projects as well as the provision of community care services. 

These ten were immediately ruled out, as the DfE was faced with the pressures of instant bed demand. Out of the remaining five, the DfE claimed that only Care Malta had the immediate facilities at Roseville at its disposal to offer long-term services for the elderly. Care Malta was therefore awarded a one-year contract on a direct order. 

However, the NAO pointed out that the DfE and the FMS had not carried out a comprehensive evaluation report of all 15 requests to justify their eventual selection of Roseville. 

In its approval, the Contracts Department laid out three conditions enabling the DfE to proceed with a direct order – the procured services must be absolutely necessary, considered value for money, and that funds are available for such procurement. However, the NAO argued that the DfE’s urgency could have been avoided through better planning, as the department was aware of the demand trends and projections. 

Also, the Contracts Department did not check whether the conditions for approval were met, instead placing the onus on the DfE. 

“The absence of formal and comprehensive evaluation reports justifying the utilisation of direct negotiation procedure clauses, as well as the ensuing procurement of 80 LTC beds at Roseville, is deemed to have digressed transparency, good business practices and internal control mechanisms,” the NAO damningly stated.