Compensation for forgone state services may be matter of social justice – Ombudsman

Ombudsman Joseph Said Pullicino has raised the issue of whether citizens should be compensated for opting out of healthcare services they are entitled to, in an observation he delivered on a complaint concerning MMDNA services contracted by the Elderly and Community Care Department.

Elderly persons eligible for institutional care in state-owned residences like St Vincent de Paule Home, but who fail to make use of this facility, are not entitled to any compensation under the social security legislation.

This led the Ombudsman to comment that although the situation is legally in order, it could in effect amount to injustice, and asked whether legislation should be amended in order to allow some form of compensation to persons who opt out of care services to which they would otherwise be entitled.

The Ombudsman's observations came on a complaint by an elderly lady about damage allegedly caused to her property by nurses from the Malta Memorial District Nursing Association (MMDNA), who are contracted by the state to deliver community care to elderly persons living in their homes.  

The lady also claimed that the nursing care given to her bedridden husband was inadequate and asked the Ombudsman to intervene with the department so that she would receive compensation for expenses she incurred for physiotherapy and occupational therapy sessions, since this treatment did not form part of the rehabilitation service provided by the department. 

While it is not the Ombudsman's role to determine the quality for healthcare service for elderly persons and in chronic cases, he recognised it was his duty to see whether public policy was creating greater demand for places in state-owned homes for the elderly, and long waiting lists as well as the sharp rise in what are termed as social cases in hospitals such as Mater Dei Hospital.

Said Pullicino said releasing elderly patients to a rehabilitation hospital before going back home "in a rigorous and non-discriminatory manner of well-defined policies" would permit the release of several beds in Mater Dei and homes for the elderly in favour of more deserving cases.

"In the absence of clear policies and protocols, demand for hospital beds and for institutional care for the elderly and for persons suffering from chronic illness is bound to rise. In this regard the announcement of a set of transparent guidelines that the hospital authorities would be bound to follow should contribute towards better all-round administration of hospital space and resources and improved public health service provision," Said Pullicino said.

The Ombudsman added that despite the growing awareness of the importance of community care in the homes of elderly patients, these services do not seem to be provided in a holistic and personalized manner according to patients' particular needs.

Even the care from interdisciplinary teams of doctors and healthcare professionals such as speech therapists, physiotherapists, occupational therapists and social workers, was not being applied in a sufficiently comprehensive manner on patients to be monitored on a regular basis and according to their particular needs.

"Community primary care services delivered to elderly persons in their homes must be up to expectations and fully responsive to their needs," Said Pullicino said, referring to elderly patients and those with chronic illnesses who do not require acute general care.

As patient referral to private hospitals for certain operations gains further ground and helps to cut down on waiting time, the Ombudsman referred to the proposal to organise teams of medical doctors on call on a 24x7 basis to respond to the needs of elderly patients placed under their care and with direct access to information regarding their medical history.

"These arrangements, if implemented wisely, would mean a saving to the national coffers and at the same time reduce the need of institutional care to these patients," Said Pullicino said.