Performance Audit: Community care for older persons

The Auditor General, Mr. Charles Deguara, today presented the performance audit report in caption to the Speaker of the House of Representatives, Dr Anglu Farrugia. The Report focused on the Social Work, Domiciliary Nursing and Caring, Meals on Wheels and Home Help services out of the 18 provided by Active Ageing and Community Care (AACC) as at 2018. The Report acknowledged the overwhelming benefits of such services. Nonetheless, the increasing demand and customer expectations were not always balanced with the appropriate level of resources at both AACC and the contractors delivering these services. Moreover, contract implementation, on occasions, deviated from the relative provisions.

During 2018, the decline in the number of social workers by around 50 per cent negatively impacted work processes at AACC. At the time, social workers spent significantly more time performing case-related administration and follow-up rather than being directly involved with clients. Furthermore, the Social Work Unit did not maintain comprehensive case information to the detriment of more effective case management and monitoring.

In total, AACC expenditure in 2018 on the Domiciliary Nursing and Caring service amounted to over €7 million. The contractual rates of this agreement increased substantially following the change in service providers in 2015. This contract remains effective despite the terms of the approval by the Department of Contracts, which stipulated that the negotiated procedure was to be followed up by a competitive call for tenders. Client satisfaction was overwhelmingly positive. The few complaints registered by AACC related to the timeliness, the time available for patients, language barriers in cases where services were delivered by foreigners, and the interpersonal skills of a few members of staff.

At a total cost of €4.20 per meal (€2 of which is Government subsidized), the Meals on Wheels Service was considered reasonable for all stakeholders. However, client frustration resulted due to inconvenient delivery times and wrong meal delivery. As an interim measure, in November 2019, AACC signed an addendum to the contract with the service provider to facilitate meal delivery. This initiative is estimated to cost around €95,000 annually.

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 behavior 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 reengineering 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.

To open NAO video related to the Report: Performance Audit – Community Care for older persons follow link.