Performance Audit: Care for the Elderly in Gozo

The Auditor General, Mr. Charles Deguara, presented the performance audit highlighted in caption to the Honourable Speaker of the House of Representatives Dr Anglu Farrugia. This audit sought to determine the extent to which current practices related to residential and community care for the elderly implemented by the Ministry for Gozo (MGOZ) contributed to optimal services based on value-for-money principles, namely, quality, efficiency and reasonable prices. During 2021, the provision of these services necessitated an expenditure that exceeded €5.9 million.

This performance audit elicited mixed results in the provision of community and residential care services for the elderly in Gozo. On one hand, there is no doubt that, in general, the public money expended by the Ministry for Gozo (MGOZ) contributed positively to the welfare of elderly persons living within the community or in residential care homes. On the other hand, the opportunity existed to improve the quality and to varying degrees the cost efficiency of services.

Home-Help: This service has facilitated and continue to encourage elderly and disabled persons to live in the community. The total cost of around €9.00 per hour which is incurred jointly by Government and clients, is considered reasonable when benchmarked against NAO established criteria. On the other hand, MGOZ was not able to provide around 20 per cent of Home Help hours (42,869 hours in 2021). This situation materialised even though, MGOZ had secured an adequate supply of home help hours through a contract with a service provider and through the direct employment of social assistants.

Meals-on-wheels: The price of this meal delivery service reflected value-for-money both from a client and Government’s point of view, since their collective contribution of around €5.55 for a three-course meal is similar to a modest take-away meal. Despite, the increase in take-up of this service during the COVID-19 period, surveys commissioned by the contractor showed that, percentagewise, the level of client satisfaction has declined in December 2021 when compared to the April 2019 results.

Villa San Lawrenz: The rates charged by Villa San Lawrenz to MGOZ position themselves among the higher end of daily fees charged in Malta for similar services. Despite the costs involved, MGOZ is constrained to reserve a limited number of beds at this Residence to cater for emergencies.

Downtown Hotel: The relocation of 80 elderly patients from Gozo General Hospital to Downtown Hotel was brought about to cater for COVID-19 pandemic related circumstances. While acknowledging the urgent need to resolve arising issues during emergencies, this transfer was not fully supported by documentation and robust audit trails. The rent element concerning the Downtown Hotel contributed to higher total costs when benchmarked against other residential homes in Malta and Gozo.

Dar San Guzepp: Following an expenditure of over €1 million over a span of eight years, MGOZ remains in a position where it cannot establish a definite date when this project is to be finalised and to enable the accommodation of elderly residents at this property. This project has been besieged by project management and administrative issues, including the revaluation of tender bids.

Casa Amalia: The 23-bedded Casa Amalia, which provides dementia-related services charges MGOZ a daily rate of €106.50 per bed. To various degrees, these services are similar in nature to those provided by Dar Padova, another facility which provides dementia care which is managed by Active Ageing and Community Care Department (AACC). The opportunity exists for better communication and coordination between MGOZ and AACC to guide and enable residents and potential clients to maximise on the facilities offered at these Homes.

MGOZ monitoring function of all the contracts in place was generally reactive to customer complaints as the Ministry does not operate a structured approach to monitor contract implementation comprehensively and regularly. These limitations detract from the principles of transparency and accountability. To this end, MGOZ has committed itself to review and enhance its monitoring role concerning agreements with third parties providing services to elderly persons.

This review showed that MGOZ has set up the foundations for expanding its services to an increasingly ageing population in terms of broadening the scope of community and residential services for the elderly as well as improving on the quality of their delivery. Nonetheless, this report elicited a number of issues relating to monitoring, contractual obligations and value for money. In this regard, the NAO proposed a number of strategic and service specific recommendations.