Chartering the cross-roads of care : a phenomenological study on the experiences of older persons who sought long-term care but were redirected to community-based services

Abstract

This dissertation explored the lived experiences of older persons in Malta who applied for long-term care but were instead referred to community-based services. Utilising an Interpretative Phenomenological Analysis (IPA) approach, the study examined how older persons interpret and respond to this redirection, and how it affects their autonomy, emotional wellbeing, and care preferences. Semi-structured interviews were conducted with seven participants, and themes were identified relating to system navigation challenges, emotional strain, housing inaccessibility, and the perceived burden on informal caregivers. Findings indicated that despite policy efforts promoting ageing in place, community services remain inconsistently delivered, under publicised, and lacking emotional engagement. Formal assessments were often experienced as impersonal and physically demanding. Emotional and relational support emerged as equally vital as functional assistance. Comparisons with international care models revealed gaps in Malta’s system, particularly in supporting persons with complex health conditions and reducing reliance on family caregiving. The study recommends enhanced person-centred community services, greater public awareness, improved communication in assessments, and structured support for informal carers. These insights inform future policy development aimed at aligning practice more closely with the principles of active ageing and sustainable long-term care.