By the phrase of ‘Long-term social care’, one can understand the continuous provision of medical and social services to support the needs of older people who may have an illness or health problems and who cannot independently care for themselves for long periods of time. Among the many services that are offered for older persons in order to benefit from long-term social care and where people can still live independently in their homes or else have a live-in carers or in residential home, some services are: home admission; carer at home scheme; community geriatrician services; meals on wheels; night shelters; telecare+; active aging centres; home help services; handyman services; Dementia activity centres; and domiciliary nursing/care (“Welcome Active Ageing”, n.d.)
During the years, long- term care for older persons has been concentrated on and improved. Pace, Vella and Dziegielewski’s study shows that progress in long-term care for the elderly has changed its focus, making it more community-based. This includes providing care within the household or in smaller community-based centres (Pace, Vella & Dziegielewski, 2016). As mentioned before, such community-based care consists of meals-on-wheels; home-help services; handyman services; telecare+, day-care centres and so on. However, after this progress which dates back to 1987, to this day, long-term care has become a pressure on the state and its citizens. This is because the aging population has increased, while traditional ways of taking care of the elderly such as children taking care of their elder parents; children offering to sleep with their parents at night; or giving ‘shelter’ to their elder parents by bringing their parents to live with them; has drastically decreased. Another issue that has decreased the traditional ways of taking care of the elderly is that, in the past fewer women were in employment, and therefore they were more ‘free’ to take care of their elderlies. Nowadays more elderly people are opting for residential care and those who do not want to live in residential care are too weak to live fully independent without an excessive amount of assistance from several resources (Pace, Vella & Dziegielewski, 2016).
When thinking about the provision of long-term social care, one has to also think about the challenges that long-term care can bring with it. One of the challenges is that of the scarcity of financial resources. While the aging population increases, so do the provision of social care, which means that more money has to be invested towards that part of society. According to Pace et al 2016
…In the 10 years between 2006 and 2015, the public expenditure on nursing home has increased fourfold, while the expenditure on the state’s primary residence for the elderly (SVRP) has doubled over the same period. On the other hand, allocations to community services have remained more or less static.
Another challenge is that there has been an increase in demand for community care services such as meals-on-wheels, yet the existing services cannot keep up with the high demand. Due to a limited amount of assistance available to the elderly who still live in their own households, many people are looking at private services such as care services provided by agencies on an hourly basis, as well as live-in carers. However, this also depends on, if the person using private services can afford to pay or not (Pace, Vella & Dziegielewski, 2016). Furthermore, another challenge that long-term social care is facing is that formal community care in Malta is not adequately developed in order to take over the traditional ways of taking care of the elderly, which is unpaid work done by female relatives (Vella & Pace, 2015), and which is also drastically decreasing due to higher employment rates and more opportunities for women in the workplace. Due to the elderlies’ preference to remain living in their own homes and the lack of spaces in residential homes, “the safety and quality of life of the growing number of the very old will be imperilled unless planning and investment in this sector are not accelerated.” (Vella & Pace, 2015). This leads to the diminishing of the quality of the services that are being provided for long-term social care.
In order for services to be effective, successful and of high quality, some aspects have to be taken into consideration. Such aspects include: having independence in terms of daily activities – meaning that older people can choose how they want to spend their day; being mobile rather than the person staying in the same spot looking at the same walls; being secure- meaning that the older person needs to feel safe and at ease with trusting her carer, live-in-carer or residential carers; the services that are provided need to be flexible according to the person’s needs. Another aspect which works toward good quality of service is that elder people should be treated personally and individually with dignity and a holistic approach and not seen as ‘just another number’. In order to make sure that the services that are being offered are being kept up to standard, assessments and interventions are needed to safeguard the lives of the elderly as well as those of care workers. When looking at challenges that can diminish the quality of long-term social care, one has to keep in mind, that care workers are one of the pillars of long-term social care. Therefore the carers’ rights as a person and their working conditions should also be respected.
When comparing Malta’s long-term social care to other countries, one can notice several similarities. One of the similarities between Malta’s long-term care and that of the United States is that “the family-based informal care system that originally provided all long-term care is now seriously strained.” (Smith & Feng, 2010). While other services providing long-term social care, are being limited by lack of resources and availability and still having high demands. All this boils down to the same factor – which is, those who can afford will make use of private long-term care or have a migrant live-in-carer, and those who cannot afford have to depend on the limited services that are being provided (Smith & Feng, 2010). Similarly to Malta and the United States, England is also having difficulty in meeting the needs of the elderly. These struggles have sent England to cut on their budgets which lead to fewer people getting them the help that they need. These reductions have led to shortages of nurses and carers and have put social care providers under remarkable pressure. Once more, people in England who can afford their own carer are employing carers to look after themselves or their elderlies, but those who do not afford and depend on social care provided by the state are finding themselves in difficulty (Humphries, Thorlby, Holder, Hall & Charles, 2016). This has driven England to protect the very frail older persons who have higher demands while trying to encourage others to live more independently and reducing the dependency on support from the state. The bigger problem is that this is not only affecting today’s aging population but it will also affect the coming generations, as it is unlikely that the government will eliminate the gap between the needs and the resources. This also leads other agencies and elderly who want to achieve more within the existing resources but cannot since it is very limited, leading them to struggle to meet certain basic needs (Humphries, et al. 2016).
Long-term social care is becoming deinstitutionalized and privatized throughout all of Europe. Several European countries are facing the same challenge of having aging populations while their country’s financial resources are becoming scarce. European countries have seen the restructuring of long-term social care for the elderly. The main motives for the restructuring processes were the economic and state financial crises. The Great Recession of 2008 was not of any help towards long-term care since several countries were making efforts to provide a wider selection of services and resources towards the aging population (Deusdad, Pace & Anttonen, 2016). Although many countries were affected by the 2008 economic crises, many European countries were affected differently. While places such as Spain were deeply affected, other countries such as the Nordic countries had little to no effect from this economic crises. A new form of care has been developing in several European countries. This new model combines all types of care together such as family care, semi-informal care work within the household and formal social care. One can notice a movement towards refamiliarization (Deusdad, et al. 2016). In Malta, the government has introduced an allowance for carers who are over 18 and who are taking care of a relative on a full-time basis (“Increased Carers Allowance and Carers Allowance”, n.d). Another scheme which was implemented recently was that of the ‘carer at home scheme’ where the Government would financially help the elderly who decide to employ a carer to assist them in their daily needs. (“Carer at Home Scheme”, n.d.)
One can say that Malta has not coped in the best way with the increasing need for long-term social care regarding its aging population. While providing adequate long-term social care to the elderlies of the community and keeping in mind to always provide high-quality services, policymakers have to also keep in mind other social contexts such as pensions, health-care services as well as the carers’ workload and overall health. If these pillars of long-term care are not given the necessary importance, one cannot hope for the best quality of social care and this can threaten to diminish the quality given to the elders of the community.