Structural characteristics of the LTC system, impact of the pandemic, measures adopted and new reforms
This country profile brings together information on the experience of the long-term care sector (focussing on people who use and provide care) during the COVID-19 pandemic in Malta from a living international report on COVID-19 Long-Term Care. It also provides links to research projects on COVID-19 and long-term care, to key reports, and lists key experts on the impacts of COVID-19 on the long-term care sector in Malta.
Experts on COVID-19 and long-term care in Malta that have contributed to this report:
Living report: COVID-19 and the Long-Term Care system in Malta
PART 1 – Long-Term Care System characteristics and preparedness
- 1.01. Population size and ageing contextThere was a 0.3% increase in Malta’s population from 2019 to 2020; the estimated population of residents of Malta and Gozo standing at 516,100 at the end of 2020. People aged 65 and over amounted to 18.9% of the population, and 2,223 females and 984 males were aged 90 years and over. There was a 10.7% increase in the resident deaths in 2020 from 2019 largely, owing directly or indirectly to the COVID-19 pandemic. In 2020, 4,084 resident deaths were registered, of these, 66% were people aged 75 or over, deaths among this group increased by 12.5% of deaths compared to 2019 (source: https://nso.gov.mt/en/News_Releases/Documents/2021/07/News2021_122.pdf). Malta forming part of Southern Europe together with Croatia, Greece, Italy, Portugal, Serbia, Slovenia and Spain are the oldest region in the world where 21% of the population is aged 65 years and over (source: https://www.prb.org/resources/countries-with-the-oldest-populations-in-the-world/).
- 1.02. Brief description of the Long-Term Care system
The Maltese long-term care system is not even, in that service delivery for the older person requiring care, is spread across 3 Ministries, (a) Ministry for Health in Malta, (b) Ministry for Senior Citizens and Active Ageing in Malta, and (c) Ministry for Gozo, (source: https://www.gov.mt/en/Government/Government%20of%20Malta/Ministries%20and%20Entities/Pages/default.aspx). In the case of Public Private Partnership (PPP) agreements for private and church-run insitutions, 3 separate admission/assessement/care criteria and contractual obligations are therefore employed in lieu of the differing Ministries. The Ministry for Health is responsible for offering services to circa 314 older persons through the PPP scheme; the Ministry for Senior Citizens and Active Ageing offers a service to approximately 3148 older persons through state run and private and church-run care homes employing the PPP agreement; and the Ministry of Gozo provides a service to around 53 older persons, through the PPP scheme, within a church-run care home, (source: https://ltccovid.org/wp-content/uploads/2020/06/LTC-covid-situation-in-Malta-6-June-2020.pdf).
No information is available on the websites for the Ministry of Health and the Ministry of Gozo in respect of the eligibility criteria, assessment, successive admission of older persons to the long-term care sector, as well as to contractual obligations for the service user and service provider, with no reference to service delivery within care homes, (source: https://www.gov.mt/en/Government/Government%20of%20Malta/Ministries%20and%20Entities/Pages/Ministries%202020/health.aspx), (source: https://www.gov.mt/en/Government/Government%20of%20Malta/Ministries%20and%20Entities/Pages/Ministries%20Nov%202020/Gozo.aspx).
The Ministry for Senior Citizens and Active Ageing, through the Active Ageing and Community Care (AACC), is responsible for the state run homes and other care homes employing the PPP scheme, (source: https://activeageing.gov.mt/active-ageing-and-community-care/?lang=en). Service delivery within the long-term care sector at AACC, is mainly centred around the levels of care the older person would be in need of as of the time of assessment, as follows, (a) Level 1 care, where long-term care services with only minimal basic care is provided and (b) Level2 care, where the level of care required for the older person and as indicated by the Interdisciplinary Assessment Team goes beyond the minimal basic care, (source: https://activeageing.gov.mt/wp-content/uploads/2021/05/LN-151-2018.pdf).
Older persons, (a) over the age of 60 years, (b) live with dementia, (c) require long-term care, and (d) can no longer live within their own home environment are eligible to apply for the state run (and PPP) long-term care services, (source: https://activeageing.gov.mt/residential-care/?lang=en).
Once an application for long-term care is compiled by the older person and/or next of kin/guardian, the Multidisciplinary Team, analyses aspects of the older person’s (a) Medical Report that would have been filled by the General Practioner, (b) social and wel-being, (c) cognitive difficulties, (d) mobility and dependency levels and (e) support network, (source: https://activeageing.gov.mt/residential-care/?lang=en). Through this assessment, the Team decides on the level of care required, considering also the priority and urgency of the case in respect of the admission to long-term care, (source: https://activeageing.gov.mt/residential-care/?lang=en).
Saint Vincent de Paul (SVP) long term-care facility is on other state facility falling within the remit of the Ministry for Senior Citizens and Active Ageing, but autonmous from the AACC mentioned earlier, (source: https://activeageing.gov.mt/st-vincent-de-paul-long-term-care-facility/?lang=en). With a population of circa 1500 older persons, SVP offers high dependency chronic care services for the older person, through the Level 2 care tier referred to previously, (source: https://activeageing.gov.mt/wp-content/uploads/2021/05/LN-151-2018.pdf), (source: https://ltccovid.org/wp-content/uploads/2020/06/LTC-covid-situation-in-Malta-6-June-2020.pdf).
The Maltese long-term care system also offers private self-funded care by the older person herself/himself through a number of private run organisations, (source: https://www.caremalta.com/our-homes/), (source: https://simblijacarehome.com/why-simblija/), (source: https://casa-antonia.com.mt/), (source: https://goldencare.com.mt/). These care homes advertise service provision to ‘patients’ falling within the medium to high dependency category, as well as older persons requiring respite care, or to older persons needing help to perform normal activities of daily living because of cognitive difficulties or loss of muscular strength or control).
A number of small church-run institutions for older priests and religious (around 9, source: https://ltccovid.org/wp-content/uploads/2020/06/LTC-covid-situation-in-Malta-6-June-2020.pdf ) are scattered across both islands of Malta and Gozo. No information on the Archidiocese of Malta or the Diocese of Gozo websites is available in respect of assessment and admission criteria or to the level of care offered to the older priests and religious.
- 1.05. Quality and regulation in Long-term care
The Social Care Standards Authority (SCSA) was set up in 2018 through Act No. XV of 2018. The SCSA is a regulatory body responsible for (a) the issuing of licences and warrants for service providers within the long term care sector, (b) the setting up of regulatory standards in respect of the various areas of social care, assistance and services provided by public and private entities, and (c) inspecting the long term care sector services, ensuring that practices are safe and up to the required regulatory standards for the persons using these services.
PART 2 – Impacts of the COVID-19 pandemic on people who use and provide Long Term Care
PART 3 -Measures adopted to minimise the impact of the COVID-19 pandemic on people who use and provide Long-Term Care
- 3.07.03. Care homes: visiting and unpaid carer policies
In July 2021, despite all older persons who had wished to avail themselves of the vaccine having been able to do so, older persons were still not allowed outside the care homes. Older persons have been confined in their respective care homes, at times also confined in their own rooms only, since March 2020.
With respect to visiting in care homes, (1) visits are currently allowed for 25 minutes 3x per week where 2 members of the same household are allowed time with the older person, (2) for older persons living with dementia, they will be allowed 15-minute visits every day with 2 members of the same household (3) for both instances, visits take place either behind Perspex or at a safe 2m distance within the care home’s common area as visitors are not allowed in the older person’s room.
Moreover, the Minister responsible for the older persons has indicated that vaccinated individuals will be given priority to visit their loved ones, when the care homes open ‘properly’ in the coming months.
PART 4 – Reforms to strengthen Long-Term Care systems and to improve preparedness for future pandemics and other emergencies
- 4.02. Reforms to the Long-term care financing system
The country reinforced homecare by introducing a cash benefit for people employing a fulltime carer (source: Publications catalogue – Employment, Social Affairs & Inclusion – European Commission (europa.eu).
- 4.05. Reforms to address Long-Term Care workforce recruitment, training, pay and conditions
An EU report (2021) noted that jobs in the LTC sector are being made more attractive through new training opportunities at tertiary level, with the launch of certified training programmes for potential carers.
Printable version of this country profile:
To cite this report:
Fenech M.A. LTCcovid country profile – Malta. In: Comas-Herrera A., Marczak J., Byrd W., Lorenz-Dant K., (editors) International living report on COVID-19 and Long-Term Care users and providers: context, impacts, measures and lessons learnt. LTCcovid, Care Policy and Evaluation Centre, London School of Economics and Political Science. Available at: https://ltccovid.org/country-questions/
Ongoing research projects on COVID-19 and Long-Term Care in Malta:
Most recent LTCcovid report:
Acknowledgement and disclaimer
This report has been initially developed by the team working on the Social Care COVID Recovery and Resilience project and questions will be added to and validated by LTCCovid contributors who are experts on Long-Term Care in their respective countries. This study is funded by the National Institute for Health Research (NIHR) Policy Research Programme (NIHR202333). The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.