Loneliness driving Malta’s care home demand, Healthmark conference told
Study shows that failing health is not the only reason why older people apply for admission to long-term care facilities
With around 93% of older people in Malta still living in their own homes, the NAO concluded that information management and inter-entity coordination must be strengthened.
“The loneliness is killing me… I can’t stay alone anymore,” an 84-year-old widow told her interviewer during a study conducted by the University of Malta’s Department of Gerontology and Dementia Studies.
The woman was one of seven older people interviewed who had applied for admission to a long-term care facility but, on assessment, were redirected to community-based services.
What did she need? Human presence and companionship.
The finding, presented by Katherine Bonett, Maria Aurora Fenech and Roberta Sultana at the ‘A Caring Nation’ conference hosted by Healthmark and the International Institute on Ageing (UN ‒ Malta) on April 16, shows that behind a meaningful share of Malta’s long-term care applications lie other factors beyond failing health.
The five drivers identified by this study were fear of falling, chronic pain, loneliness, feeling like a burden to family and inaccessible housing.
Speaking at the same conference, EY Malta partner and economist Chris Meilak set out the demographic arithmetic plainly: one-in-three Maltese will be aged 65 or over by 2060, up from one-in-five today.
Malta will need more than 11,000 care home beds by then, against roughly 5,300 today. And public long-term care spending, at 0.9% of GDP currently, will need to rise to roughly 2.3% of GDP by 2070 just to keep pace.
Meanwhile, a performance audit by Malta’s National Audit Office (NAO), presented by Simon Vassallo alongside colleagues Lorna Fenech Azzopardi, George Calleja Gera and Sara Jayne Mizzi, examined home-based medical and clinical services for older persons between 2019 and 2024.
The NAO found that six government entities between them deliver 29 distinct home-based services, ranging from primary healthcare and active ageing and community care provision to mental health, oncology and hospital outreach. The range is wide; the coordination is not.
For an older person managing several conditions at once, the auditors warned, a decentralised system risks becoming a maze. The NAO recommended exploring a “one-stop-shop” concept and, more bluntly, that future strategies attach measurable targets and time frames to their commitments.
The data gaps were starker still. Of the 29 services in scope, detailed and usable usage trends and projections were available for just one. Most entities could not produce expenditure figures specific to home-based services for the over-60s. And human-resource data, where it existed, pointed to a 19.4% staffing shortage on home-based services in 2024.
With around 93% of older people in Malta still living in their own homes, the NAO’s conclusion was unambiguous: information management and inter-entity coordination have to be strengthened so that home-based care can be planned, costed and developed as a distinct part of the national health system.
Manwel Debono of the University of Malta’s Centre for Labour Studies presented findings from a body of research on foreign care workers, many of them Filipino women, who have become indispensable to ageing care in Malta.
He opened with the story of Maria, a 40-year-old Filipina live-in carer who arrived in Malta after difficult years working in the Middle East. Her life, Debono said, captures the resilience and the vulnerability of the migrant carers Malta now relies on: long hours, blurred boundaries between work and personal life, language barriers, and limited family reunification.
Some of his interviewees described holding two contracts of employment: an official one filed with the authorities, stipulating medical care, and a separate one with the family that quietly extended their duties to housework.
One worker, after eight years in Malta, said no official had ever knocked on her employer’s door to check that her conditions were being respected.
A separate study Debono is currently conducting, involving 400 Maltese and migrant care workers, found migrants reporting significantly higher work demands, lower managerial and peer support, lower role clarity, and higher rates of harassment and bullying than their Maltese colleagues.
Debono’s assessment of Malta’s growing dependence on migrant care labour was bluntly “hardly sustainable”, both practically and ethically. His recommendations were equally direct: unionisation, family reunification, and dedicated psychosocial services for the people on whom the care system increasingly depends.
If there is a single line that captures the spirit of the conference, it came from Patrick Barbara, a consultant psychiatrist with Malta’s mental health services: “Dementia care,” he told the room, “is the stress test of whether a nation truly cares.”
A caring nation, he added, is judged not by its intentions but by how it cares when the work becomes difficult, prolonged and uncertain.
Barbara set out three tensions that define daily life on a dementia ward: autonomy versus safety, care versus control and dignity versus liability. A system designed to eliminate every risk, he warned, drifts inevitably towards control. When staff are left to carry the resulting moral strain on their own, the system has already failed.
Francesca Monseigneur, a recent University of Malta social policy graduate, made a case for embedding dance movement therapy in Malta’s dementia care, drawing on the UK’s experience to argue for creative, non-pharmacological approaches the country has yet to scale.
From Ágnes Bene of the University of Debrecen came a working example of what an active ageing infrastructure can look like: Hungary’s ‘Move Debrecen!’ and ‘Move Nyíregyháza!’ programmes have grown from 12 weekly activities in 2013 to 71 weekly activities across 36 locations today, free at the point of use, intergenerational by design and explicitly aimed at combating isolation.
A diverse panel highlighted the human side of care across generations. John Grech, speaking from his experience in residential care, emphasised the importance of person-centred approaches that truly respect individual dignity.
Doris Zammit advocated for greater inclusion, stressing that older persons should have meaningful opportunities to remain active and connected within their communities, fostering intergenerational solidarity.
Nicola Montesin underscored the vital role of informal caregivers, urging that families be recognised as essential partners in care, especially in the context of dementia.
Tyron Silos drew attention to the “sandwich generation”, calling for greater visibility, support and training for carers balancing multiple responsibilities.
Finally, Nirvana Tabone reminded healthcare professionals to look beyond clinical conditions and see the whole person, reinforcing a compassionate, holistic approach to care.
Setting the global frame at the start of the day, Amal Abou Rafeh, chief of the UN Programme on Ageing, reminded the conference that the population aged 80 and over is now growing faster than the 60-plus group worldwide, and that the geography of the world’s oldest societies is shifting from Europe towards east and southeast Asia. The ageing narrative, she said, is one the world can no longer afford to push to the margins.
Meilak’s closing slide put the choice in the simplest possible terms. Four futures, he suggested, are open to Malta: a community-care future built on local relationships and mutual trust; a state-enforcement future of mandated duties and centralised oversight; a tech-enablement future where ageing is treated as something to be optimised; and a system-collapse future in which years of underinvestment finally catch up with demand.
His question to the room, and, by extension, to the country: which future do we want to grow old in? What feels acceptable, until it’s us?
