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Malta

2013: National policies covering the care and support of people with dementia and their carers

Background information

Where people with dementia receive care and support

The following table provides estimates of the number of people with dementia living at home, in various types of residential care and in hospitals or psychiatric institutions.

Place of residence

 

YES or NO

Estimated number/

Additional information

At home (alone)

Yes

Low

At home (with relatives or close friends)

Yes

High

At home (with other people with dementia)

Yes

Very low

In general/non-specialised residential homes

Yes

High

In specialised residential homes for people with dementia

No

None exist

In general/non-specialised nursing homes

 Yes

High

In specialised nursing homes for people with dementia

 No

None exist

In hospitals, special wards or medical units

 Yes

Very low (very few units are available

In psychiatric establishments

 Yes

Very low

No precise data is available concerning the percentage of residents with dementia living in general/non-specialised residential homes or general/non-specialised nursing homes. However, the number of individuals with dementia in each is considered to be significantly high.

The ratio of staff to residents in general/non-specialised residential homes and in general/non-specialised nursing homes is usually adequate for elderly residents who do not have dementia. Although there are no specialised residential homes or specialised nursing homes for people with dementia, there are units housing individuals with dementia. In these units, the ratio of staff to residents is less than 1:3, which is considered inadequate.

The organisation of care and support for people with dementia

The overall organisation of care and support

Most of the care for people with dementia is provided in the community by family members (Innes, Abela and Scerri, 2011).

As Malta is so small (316 km2), all policies are promulgated and passed by the national government. There are consequently no formal regional or district tiers of healthcare. Nevertheless, there are 68 local councils. They do not have any policy-making power but many have an elected person who is responsible for monitoring the provision and quality of services for the elderly.

In Malta the Civil Code clearly places the responsibility of caring for a spouse or parent with family members.  According to the Maltese Civil Code (Book first of persons, art. 2), a married person who is in need of help with daily living can rely on maintenance from his/her spouse provided that they still live together. Maintenance is defined in article 19, paragraph 1 as including food, clothing, health and habitation. Children are bound to maintain their parents or other ascendants that are indigent. However, neither of the spouses can claim maintenance from their children if such maintenance could be provided by the other spouse (art. 5.3). No one is legally obliged to care for unmarried people or widows/widowers with no children. The State would be responsible for their care.

There is little interaction between state, private and voluntary providers but Forum Malta in Europe works to strengthen the interface between government and NGOs.

In 1987, the Government set up the Department of Elderly and Community Services (within the Parliamentary Secretariat for the Elderly and Community Care) which is responsible for taking care of the special needs of the elderly. The aim, in providing these services, is to enable elderly people and those with special needs to remain living within the community for as long as possible. Community services for the elderly and for people with special needs are heavily subsidised by the State. People receiving such services pay a nominal fee based on their income (Ministry of Health, 2002). Following the change in government in March of 2013, the Parliamentary Secretariat for the Elderly and Community Care was renamed as Parliamentary Secretariat for Rights of Persons with Disability and Active Ageing under the remit of the Ministry for the Family and Social Solidarity.   

Services are not targeted specifically for people with dementia and they are slow to respond especially in times of crisis. Entry to a long-stay government home may take months to arrange due to long waiting lists.

As mentioned above, social support, when provided, is organised through the Department of Elderly and Community Services. Social Workers are responsible for conducting assessments for people in state hospitals or in the community. Requests for the homecare help service must be accompanied by a medical report. This is sent to the Department for the Elderly and Community Services, which then arranges for a social worker to visit the applicant in their home in order to assess their needs. The number of hours granted is dependent on each person’s needs.

Healthcare and services are funded through general taxation. The healthcare system is publicly financed through general taxation and is free at the point of delivery although users may have to make out-of-pocket payments (for example to purchase medicine that is not reimbursed under the National Health System). Private healthcare is fairly common (Ministry of Health, 2002). National (social) insurance serves to fund pensions.

There is no problem with accessibility to services and support, even for people living in rural areas, although many services need to be up-graded.  Services for individuals with dementia in the community such as day care, respite care and community psychiatric nurses are scarce. There are associations for people with conditions that mean they are at a higher risk of developing dementia e.g. Huntington’s disease or Down’s syndrome. There are no special provisions for people with dementia and carers from minority ethnic groups.

How specific aspects of care and support are addressed

Although the Malta Dementia Strategy has not yet been published, sections addressing the provision of care and support are included. These should cover both residential (central and private) and home care settings. The main objectives of the strategy in this particular area include:

  1. Provide training opportunities for professionals and other staff within healthcare services to help in the management and care of people with dementia.
  2. Set up a liaison service that specialises in the treatment of dementia in acute general hospital. The multidisciplinary team may be based in the general hospital or visit the hospital on a regular basis.
  3. Ensure that all patients with dementia have a care plan developed during their hospital stay after consultation with specialists in this field. Individual care plans will address activities of daily living that maximise independent activity, enhance function, adapt and develop skills and minimise the need for support.
  4. Offer rehabilitation services to people with mild-to-moderate dementia following a stay in acute hospital if there is a need for it. This service will seek to equip the patient to return to the community. Assessment of the needs of carers will also be undertaken. People with severe dementia may need more specialised services to meet their physical, psychological and mental health needs.
  5. Develop dementia specialist units within the community to assess and care for people with dementia.
  6. Enhance the dementia rehabilitation programme.
  7. Strengthen human resource capacity of memory classes.
  8. Extend the operating hours of the Dementia Activity Centre thereby increasing flexibility for patients and carers.
  9. Provide training to staff working in community day centres in order to be able to deal with behavioural and physical needs of people with dementia as well as creating an activity programme suitable for these patients.
  10. Make appropriate transport services available to take patients to and from activity centres.
  11. Develop a Dementia Liaison Interdisciplinary team which will serve as a point of referral and support for people with dementia and their families/carers in order for the family to gain easy access to services, according to their needs.
  12. Provide additional support for the Dementia Helpline, as this serves as an important source of information and support to people with dementia and their carers.
  13. Provide home support programmes: this includes both specialised home help for individuals with dementia and respite services in the community. This will require the training of a team of certified care-workers and the appointing of a dementia home-help coordinator. Different forms of respite care will become available to accommodate patients’ needs.
  14. Increase the number of beds dedicated to institutional community respite for people with dementia, thereby increasing availability.
  15. Assist in the setting up of a voluntary service for the elderly in the community with the aim of providing companionship to individuals with dementia as well as the elderly in general, as well as providing some respite to carers.
  16. Assist in the creation of a network to help individuals with dementia and their carers in having peer support. This may be achieved by boosting non-government organisations working in this field.
  17. Provide financial assistance to purchase/rent new assistive technologies e.g. safety alarms, fall alerts, wandering alarms, as well as to provide continued support in other assistive technologies, e.g. telecare

Most of the care is provided in the community by family caregivers. Other support is offered by the government in the form of:

  1. Memory Clinic:The Memory Clinic is a specialised out-patient clinic for individuals aged 60 years and above, who have symptoms such as increasing forgetfulness and/or confusion that may possibly indicate the onset of dementia. The clinic is run by a team of professionals who carry out a thorough assessment of the patient’s condition, functional status and living situation.  If dementia is confirmed, then further information about the condition, advice about treatment options and support services will be provided. 
  2. General Geriatrics Clinic:Many patients with a diagnosis of dementia also attend the general geriatric out-patient clinics at the Rehabilitation Hospital Karin Grech, since cognitive impairment commonly exists concurrently with other co-morbid illnesses in older people. 
  3. Dementia Rehabilitation Programme:A Dementia Rehabilitation Programme is currently being offered after the patient is assessed at the Memory Clinic. Here further assessments are carried out by the occupational therapists and speech language pathologists. Functional ability, cognitive assessments, domestic, language and swallowing assessments are carried out according to need.
  4. Memory Classes:Memory Classes are organised at Rehabilitation Hospital Karin Grech. The classes take the form of 10 parallel sessions, one for the person with dementia and a separate information session for caregivers and relatives.

Training

Which social and healthcare professionals provide care and support

The following social and healthcare professionals are involved in the provision of care and support to people with dementia in residential care or living at home.

Social or healthcare professional

Involved in the provision of care and support to people with dementia in residential care or at home

Nursing staff

Yes

Auxiliary staff

Yes

Allied health professionals

Yes

Specialists (e.g. psychiatrists, gerontologists, neurologists)*

Yes (usually gerontologists)

General practitioners*

No

* Only if they are linked to the provision and organisation of care and support (i.e. not with regard to their role to provide medical treatment).

The type of training that social and healthcare professionals receive

Social and healthcare professionals in the residential care and home care setting receive the following training:

Nurses need to have a BSc degree in Nursing Studies issued by the University of Malta to practice the profession. Dementia training is covered in topics related to Geriatrics and Neurology. However, such training is limited and inadequate (Scerri and Scerri, 2013).

No formal training is provided to auxiliary staff and learning occurs mostly through work experience. Occasional talks on dementia management and care are organised by the Malta Dementia Society. These are open to all, including non-professionals. Informal talks are also organised by residential care/home care settings but no data is available on number of attendees and job description.

Social sector professionals as well as allied health professionals (e.g. language therapists, physiotherapists, dieticians, podiatrists) receive very limited training, if any, in dementia.

How the training of social and healthcare professionals is addressed

The Malta Dementia Strategy is still in its draft form and is not yet published. However, it is envisaged that it will contain a section relating to the development of the workforce in the various aspects of dementia management and care. This will include undergraduate and postgraduate training (through collaboration with the University of Malta), training of health and social care staff (also in collaboration with the Malta Dementia Society), specialisation in the context of developing a multidisciplinary team (by increasing collaboration between different categories of healthcare professionals), training of caregivers (in collaboration with the Malta Dementia Society and government-supported dementia care homes), and increase in specialised training to boost the number of medical specialists in the field of dementia.

Meanwhile, most training is provided as undergraduate programmes in the various healthcare disciplines at the University of Malta. However, coverage of dementia in programmes at undergraduate level is low, variable and most of the time fragmented. Furthermore, most training focuses on the medical model leaving out the social context of the condition. In the recent years, there has been increased interest in expanding the level of dementia training at undergraduate and postgraduate levels. Indeed, one of the objectives of the Malta Dementia Strategy is to develop, in collaboration with the University of Malta, undergraduate level study units on the medical, social, psychological and economic aspects of dementia for all health and social care students. An interdisciplinary team approach will be fostered and emphasised using appropriate teaching methodologies, starting at this level. The strategy also highlights the need for continuous professional development to update skills.

Support for informal carers

The support of carers is addressed in national policies in the following ways.

Respite

Respite Care is provided for a limited period of time through government-supported residential/nursing homes. Respite is also provided by the dementia activity centre during working days/hours. The national dementia plan aims to increase respite also in view of the fact that the numbers of people with dementia in Malta is expected to rise considerably in the coming years. Furthermore, due to the current decrease in the birth rate, family care and support is expected to decrease significantly.

Training

Most of the training for carers is provided by the Malta Dementia Society through the organisation of talks and seminars. The aim of the strategy is also to increase dementia training to caregivers in collaboration with the Malta Dementia Society.

Consultation/involvement in care decisions

With regard to consultation/involvement in care decisions, involvement in dementia care decisions is currently at the discretion of the specialist. The national plan aims to increase the involvement of people with dementia and caregivers/family members in decision-taking.

Counselling/support

Most of the Counselling/support for caregivers is currently provided by the Malta Dementia Support Group which organises activities for people with dementia and their caregivers.

Case management (insofar as this relates to care)

The national plan will put an emphasis on developing a care pathway specific to each and every person with dementia according to their needs. The inclusion of home care support programmes should also help in this regard.

 

Services relating to carer support are currently very limited and most carers are of the opinion that they are left to fend for themselves following a dementia diagnosis. The launch of the Dementia Helpline was a step in the right direction, as for the first time carers coming from the community could be advised on the best practices. However, the much needed services for individuals with dementia have yet to materialise. Psychological, palliative and end-of-life support is absent. The dementia activity centre is well attended but lacks a transport infrastructure and will certainly not cope with future demand. Monitoring of residential units housing individuals with dementia needs to be improved to reflect current best practices. Assistive technology to support caregivers at home (as clearly indicated in the national plan) should also be introduced as soon as possible.

National Alzheimer Association

The Malta Dementia Society provides the following services and support.

Helpline

x

Information activities (newsletters, publications)

x

Website

x

Awareness campaigns

x

Legal advice

 

Care coordination/Case management

 

Home help (cleaning, cooking, shopping)

 

Home care (personal hygiene, medication)

 

Incontinence help

 

Assistive technologies / ICT solutions

 

Tele Alarm

 

Adaptations to the home

 

Meals on wheels

 

Counselling

 

Support groups for people with dementia

 

Alzheimer cafes

x

Respite care at home (Sitting service etc)

 

Holidays for carers

 

Training for carers

x

Support groups for carers

x

Day care

 

Residential/Nursing home care

 

Palliative care

 

Some of the above services, which are not provided by the Malta Dementia Society, are provided for free (or against a nominal fee) by the Maltese government. These include home help, home care, incontinence help, a telecare system, meals on wheels, day care and residential/nursing home care. As of November 2013, the telecare system was improved to include a wider range of services aimed at increasing independent living.

References

Innes, A., Abela, S. & Scerri, C. (2011). The organisation of dementia care by families in Malta: The experiences of family caregivers.Dementia, 10, 2, 165-184

National Statistics Office. (2012). Census of population and housing: Preliminary report. National Statistics Office Malta.Accessed online on 5 September 2013 at: http://www.nso.gov.mt/site/page.aspx

Scerri, A. and Scerri, C. (2012). Dementia in Malta: new prevalence estimates and projected trends.Malta Medical Journal,24(3),21-24

Scerri, A. and Scerri, C. (2013). Nursing students’ knowledge and attitudes towards dementia – a questionnaire survey.Nurse Education Today 33,962-968.

Acknowledgements

Charles Scerri, Department of Pathology, University of Malta

 

 
 

Last Updated: Tuesday 25 February 2014

 

 
  • Acknowledgements

    The above information was published in the 2013 Dementia in Europe Yearbook as part of Alzheimer Europe's 2013 Work Plan which received funding from the European Union in the framework of the Health Programme.
  • European Union
 
 

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