There is historical evidence for the preoccupation of the religious and civil authorities during medieval times for care towards the old infirm. In 1433 Santo Spirito was known to cater for about 8 resident paupers (infirmorum et pauperum / abitanti poviri). The hospital accounts for 1494-1548 include the expenses covering the board, lodging, clothing, care in illness, and burial of the resident paupers. After 1550, hospital still supported paupers but no board apparently given. In addition during 1592-3, The Universita` provided financial assistance to the needy living in central regions of Malta. The lists of recipients of this assistance include the aged and infirm decrepit old women. The Sacra Infermeria in 1776 dispensed bread and soup to the poor and infirm of the capital city. Elderly men in need were provided with about 50 perpetual beds in the hospital, while these were also awarded financial assistance [1].

The care of the elderly has thus always centered on the provision of Residential Care in the form of hostels or hospitals provided by the state, philantrophic activities, the Church, and today by business enterprise. In addition there has been the availability of Community support schemes to assure financial resources via alms and financial schemes such as the government pension scheme of relatively recent years, and the availability of community services aimed at helping the elderly live in the community. Until the twentieth century, the old people hospices were often initiated by philantrophic individuals who eventually passed the management of these homes to the control of the Church authorities. The state also provided services.

Saura Hospital at Rabat was founded 1667 by Dr. Nicholas Saura who left all his personal and his daughter’s wealth for the building of the edifice. Further funds were given by Rev. M. Azzopardi in 1762, while further donations and bequests given by other individuals. Regulations for running the hospice laid down by Bishop M.G. Molina in 1680. After 1762, preference for admission to this hospice was given to old priests from Zebbug and those giving service in the Cathedral and St. Paul’s Church. By 1798, there were 80 beds reserved for members of both sexes. The running of the hospice was entrusted to the care of the Sisters of Charity. By 1975, the hospice was only offering refuge for 36 individuals. The Sisters of Charity still run Saura Hospital at Rabat caring for about 62 residents [2]. St. Joseph Hospital at Zebbug was another philantrophic hospice founded in 1778 through a bequest of the butcher Gio.Battista Debono from Zebbug. The decree authorizing the establishment was issued by Bishop Labini on 7^th November 1787 and the hospital was declared open catering for 15 female patients on 19^th March 1788. It was placed under the direction of the nuns of the Tertiary Order of St. Francis [3]. St. Anne’s Hospital at Senglea was similarly founded by a testament bequest of Nikola and Madalena Dingli in 1794. The hospice was set up after the death of Madalena in 1814 and opened in 1817. The administration of the hospice was left to the Bishop. Priority for admission was given to the relatives of the Dingli family and to the people from Senglea or Siggiewi. Only six admissions were accepted at any one time. The management in 1880 was put under the Tertiary Franciscan Sisters, who ran the place until 1984. After the Second World War the hospice was found to be inadequate for modern needs and in 1953 a new hospice on the same site was planned. The old building was brought down in 1980, and subsequently rebuilt. The new St. Anne’s Hospice accommodating 33 individuals was re-opened in 1987 [4].

The philantrophic institutions all fell under the control of the Church authorities. A number of religious orders of nuns remain responsible for old people homes. The Society of the Little Sisters of the Poor opened their first old people homes at Pieta in 1878. Two years later in 1880, they moved to the country house of the Bailiff de Blacas at Hamrun which was named St. Paul’s Home. This afforded hospice care for about 200 persons, though now it accommodates about 92 residents of mixed sexes. In c.1975, the Society opened a branch at Naxxar in premises formerly owned by Jesuit fathers and named this the Holy Family Home. Staff restrictions caused the Society to abandon the running of this home which is now being run by the Church Authorities. The Naxxar Home houses about 53 individuals of mixed sexes. The Order of the Franciscan Sisters still run St. Joseph Home at Zebbug caring for about 14 residents of mixed sexes. They also were responsible until 1984 for St. Anne Hospice in Senglea. The nuns of this Order are still responsible for the homes for elderly females at Mosta - Pax et Bonum, opened in 1961, accommodating about 20 females - and at Msida - Betanja, opened in 1973 accommodating about 12 females. The Dominican Sisters are responsible for the management of St. Peter’s Home in Lija accommodating about 15 females; St. Dominic’s Home in Victoria (Gozo) accommodating about 20 females; and St. Catherine’s Home at Attard accommodating about 60 elderly individuals of both sexes. Other Religious-run homes for the elderly include the Domus Mariae at Marsaxlokk (about 8 females); Casa Leone XIII at St Julians (about 74 elderly mixed sexes); the Apap Institute at St. Venera (about 40 females); Madre Margerita Home at Qormi (about 18 females); and Prozjunkola at Mgarr (about 6 females). Homes for the elderly religious include Dar tal-Kleru at B’kara (about 40 priests); Villa Marija Assunzjata at Balzan; Tal-Virtu` Home at Rabat; and Kunvent San Guzepp also at Rabat, the latter three reserved for nuns [5].

The state also provided accommodation for the care of the elderly and infirm. The Floriana Ospizio was the first state institution aimed at accommodating the elderly. The hospice was set up in 1729 in Floriana by Order of St. John in the old polverista or gunpowder store. This accommodation however proved unsatisfactory, and in 1732 a new building in vicinity was founded by GrandMaster de Vilhena. The new hospice housed about 380 inmates per year. [1798 inmates ~280/yr]. The administration of the hospice was left to a Commission of 10 members. The staff included a surgeon to attend to the medical needs of the inmates. In 1785, GrandMaster de Rohan issued a set of regulations for the management of the hospice which remained in force until 1816. During that year the management was transferred to the Committee of Charitable Institutions set up by the Governor Sir Thomas Maitland [6].

The Floriana Ospizio was found to be inadequate in 1848, and proposals to build a new building were initiated with architectural plans being completed in 1862 by T.H. Wyatt and Hon. F.V. Inglott. These plans were seen and commented favorably on by Florence Nightingale, Dr. J. Sutherland and Captain D. Galton. The site chosen for the new hospice was situated in the southern part of Malta on lands called "ta l’Imghieret" covering an area of about 27¹/₂ acres. The nearest populated centers were Paola and Tarxien about 1500 yards to the east, Luqa 900 yards to the south, Qormi 1200 yards to the north and Hamrun 1500 yards to the northeast. The building of the new edifice was put off until 1886, so that the new hospice was only finished in 1892. The building consisted of several detached wards, one or two storeys high with administration blocks, quarters for staff, and the necessary annexes. It was initially intended to house 930 individuals. In 1910, when a proposal to change the edifice into a general hospital was being contemplated, several other wards were added [7].

In 1912, the hospital was described as quadrilateral in shape and was enclosed all round by a stone wall except for an iron railing in front. St. Batholomew’s Hospital for lepers, built in 1911 and housing 120 patients, was situated in the vicinity. The wards and their offices were placed in two sets, male and female divisions, each consisting of four two-storied rectangular buildings, on the pavilion system, disposed symmetrically with the male division on the left and the female division on the right of the administrative block and Medical Officers’ quarters which faced the main entrance. The arrangement was such that three buildings formed three sides of a quadrangle, of which the remaining side was not built over. The fourth building was structurally distinct and stood in a parallel line to the block forming the outer side of each quadrangle. The inner blocks of the quadrangle, together with the administration building in front and the chapel at the back, enclosed another large rectangular area. At the back of the grounds in detached blocks were the kitchen pantries, store rooms, steam laundry, disinfector and other offices. The stables were on the extreme left (male side), while the mortuary was built against the front boundary wall on the same side. All the buildings had an abundance of free air space. Each storey was divided into two wards, aerially disconnected. On each side, a ground floor was used entirely used as a refectory. On each side, there was approximately the same number of "common", "infirmary", bed-ridden" and "incurables" wards. At the end of each ward, disconnected by means of lobbies, were the water closets, baths and lavatories [8].

With time, other persons besides the elderly started to be admitted. These included cases of malignancy, paralysis, mental deficiency, medical conditions including Tinea, trachoma, medical and surgical convalescence, brucellosis, and tuberculosis. Some social conditions also merited admission to St. Vincent de Paule’s Residence. These included children who had been abandoned (prior to 1937) and orphaned children (prior to 1939), reformed prostitutes, and women prisoners (prior to 1895). In 1937, the hospital accommodated 950 beds - 550 for men and 400 for women. The hospital was generally overcrowded with an average daily population of 995. The building was evacuated during the Second World War after it suffered extensive damage through enemy action. It was reopened after repairs were completed in 1944. In the post-War period it continued to serve other purposes besides the care for elderly, including the provision of isolation wards. In 1957, the hospital catered for 986 inmates including four wards devoted to chronic sick cases. The hospital also dealt with indigent and infirm, and mentally defective children. Four further wards were devoted to the treatment of tuberculosis. A new block consisting of three floors accommodating a further 150 inmates was being reconstructed. The medical staff included a resident Medical Superintendent, two resident medical officers, and four other medical officers responsible for the management of tuberculosis patients. The nursing duties were in charge of members of the religious order Sisters of Charity, one sister to two wards of 50-60 beds each assisted by eight hospital attendants [9].

Modernization of the hospice started in 1957 and continued throughout the 1970s, 1980s and 1990s in line with the increasing demands of care of the elderly. A Rehabilitation wing, named Ruzar Briffa Wing, was opened in 1988 [10]. In 1991 Zammit Clapp Hospital at Sliema was reopened as a Geriatric Rehabilitation Hospital after structural alterations made to the old abandoned establishment. The aims of this latter institution is to provide a holistic approach towards the care of the elderly with the aim of rehabilitation of the elderly sick to the community. Business enterprise homes made an appearance in the late 1990s with the opening of Casa Arkati at Mosta, housing about 90 residents; Villa Messina at Rabat, the Xemxija Rest Complex; and Suncreek Apart Hotel at Sliema. A new enterprise at Sa Maison is projected for the near future, while Capua Palace Hospital extended its hospital services with a residence/hostel for the elderly in 1998 [11].

The elderly in the sister island of Gozo were similarly served by a hospice. In the earlier part of the nineteenth century the elderly and infirm patients in Gozo were housed in the Hospital of St. John, but in 1838 these inmates were transferred to the Malta Ospizio at Floriana to make room for female patients in the general hospital in Gozo. A new Ospizio in Gozo for the disabled poor aged over sixty years was established in 1849 in the basement of the Hospital of St. John. This Ospizio had a bed capacity of 172, half assigned for males and half for females. The total bed complement in 1957 was 147. This hospice was transferred together with the general hospital to Craig Hospital in 1975 [12].

1. S. Fiorini, 1989: op. cit.; P. Cassar: St Vincent de Paule’s Residence for the Elderly. The medico-social record. Secretariat for the Care of the Elderly, Malta, 1994, +31p.

2. P. Cassar, 1964: op. cit., p.381-382; A. Bonnici, 1975: op. cit., p.136-137

3. P. Cassar, 1964: op. cit., p.382-383

4. A. Bonnici: Dar Sant’ Anna ghall-Anzjani fl-Isla. Senglea Parish, Malta, 1987, +40p.

5. P. Cassar, 1964: op. cit., p.383; A. Bonnici, 1975: op. cit., p.137; Fiera Anzjan Attiv ’95. Secretariat for the Care of the Elderly, Malta, 1995, p.22

6. Annual Report…. For the year 1937, 1938: op. cit., p.64; P. Cassar, 1964: op. cit., p.375-378

7. Annual Report….for the year 1937, 1938: op. cit., p.64-68; P. Cassar, 1994: op. cit.; F. Nightingale: Notes on Hospitals. Longman, London, 3^rd edition, 1863, p.104-106. The copy of the latter book kept in the National Library of Malta belonged to the Comptroller of Charitable Institutions F.V. Inglott. This copy had been annotated by its owner who writes that "The Block plans, and details of internal arrangement were all given by me. Wyatt reduced the whole to "architectural proportions", and no more was done by him. Documentary proofs are in my possession, bearing the Governor’s signature". Vide note pg. 105. Inglott further believed that "A hospital in Malta should be perfectly isolated, and as truly oriented as possible, or placed with its sides facing due North, South, east and west. The correct orientation of a huge field is a most important circumstance, and should never be left unnoticed. " vide note facing title page. Inglott seemed to be in agreement about many of Nightingale’s recommendations.

8. Reports …….. during the Financial year 1911-12, 1912: op. cit., p.K32-33

9. Reports ….. during the Financial year 1911-12, 1912: op. cit., p.K32-33; J.O.F. Davies, 1957: op. cit., p.3; L. Farrer-Brown et al, 1957: op. cit., p.21-22

10. Annual Report….for the year 1937, 1938: op. cit., p.64-68; P. Cassar, 1994: op. cit.

11. L-Isptar Zammit Clapp ….: op. cit.; Fiera Anzjan Attiv ’95: op. cit., p.21

12. P. Cassar, 1964: op. cit., p.90-92; L. Farrer-Brown et al, 1957: op. cit., p.27