Staff shortages hinder community services for the elderly

Anzjani Malta

While the community services provided to the elderly through the Active Ageing and Community Care brought “overwhelming” benefits, a lack of human resources – including a social worker exodus – have hindered the implementation of some services, Auditor General Charles Deguara found.

The National Audit Office carried out a performance audit of the AACC, and its final report was presented to Parliament today. In its audit, carried out in 2018, the office focused on four key services – Social Work, Domiciliary Nursing and Caring, Meals on Wheels, and Home Help – out of the 18 provided by the AACC, but these four services alone took up the lion’s share of the budget. During 2018, the provision of these services entailed an expenditure of €10.56 million, out of a total budget of €15.33 million.

The office did highlight that during 2019, AACC sought to address a number of shortcomings flagged during the audit, and that the community services were clearly financially advantageous when compared to residential care homes.

But in 2018, the AACC’s Social Work Unit haemorrhaged staff: it started out the year with 11 social workers, but ended it with four full-time social workers and another working part-time. The lack of human resources was exacerbated by the practice of assigning caseloads according to districts, and the NAO also determined that staff would benefit from specialist gerontological training.

Lack of human resources also affected the Home Help service, through which older people and others with special needs are helped with the housework, to help them live as independently as possible, against a modest weekly payment. But the contractor tasked with managing the service failed to employ enough people to meet demand, and consequently, applicants had to wait an average of four months for the service to start, while a total of 5,684 hours of service could not be provided in 2018.

The Contractor’s inability to engage more helpers in line with the Home Help contractual obligations resulted in over 5,684 hours of undelivered service by end 2018 as well as a ripple effect on the efficiency and overall quality of service delivery. Client complaints about this service included timeliness-related issues, a shorter visit than the stipulated period, the unwarranted behaviour of some helpers and unhygienic practices.  AACC is currently in the process of launching a re-engineered service where clients can engage their own helpers.

Throughout the course of this audit, AACC embarked on a range of short-term and medium-term initiatives to improve community services.  These included the strengthening of administrative capacity, process re engineering and service re-conceptualisation.  It remains imperative that AACC maintains effective mechanisms in place to ensure that care services adhere to good governance principles.  The NAO, in due course, will follow up these initiatives and recommendations proposed to ascertain that they are effectively delivering the intended results.

On a more positive note, the NAO found that the Domiciliary Nursing and Caring service – the most costly of the services provided, costing over €7 million in 2018 – was effective, but it had reservations about the annual automatic renewal of the contract, stating that this went against good governance principles.

Client satisfaction was overwhelmingly positive – over 90% of clients ranked the overall performance of nurses and carers as “very positive.” The relatively few complaints that were registered were mainly related to timeliness, the adequacy of the length of visit, and language barrier issues involving foreign workers.

As for the Meals on Wheels service, through which people aged 60 and over as well as eligible persons with disabilities can have a meal delivered to them daily, the NAO found it to be reasonably costed at €4.20 per meal, of which €2 is subsidised by the government. 169,561 meals were delivered through the service in 2018, with the contract capped at 232,237 meals.

But client dissatisfaction was rife, with telephone surveys carried out by the AACC showing that only 23.2% of clients were satisfied with the service, whereas 68.2% flagged various issues. Delivery times were inconsistent, and the NAO found that the contractor overseeing the service was only using half the number of vehicles stipulated in the contract. Over a third of those surveyed also said that they had received the wrong meal.