Institute for Contemporary Research Africa role & programmes in assisting old age homes in the province

Meeting report

Programmes and role of ICRA

Dr Louw Pieterse, Chief Executive Officer (CEO), Institute for Contemporary Research Africa (ICRA), presented the programmes and role of ICRA in assisting the nursing homes struggling to operate in the province.

He said that before transferring any funds, other than grants in terms of the annual Division of Revenue Act (DORA) or to a constitutional institution to an entity within or outside government, a written assurance must be obtained from the entity by the accounting officer (AO) that it implemented effective, efficient and transparent financial management and internal control systems. If such written confirmation is not or cannot be given, the AO must render the transfer of the funds subject to conditions and remedial measures requiring the entity to establish and implement effective, efficient and transparent financial management and internal control systems.

Capacity building at caring facilities requires a research-based approach and a practical, implementable process. Factors to be considered included governance matters, oversight, facility management, financial management, the entities' income, and constraints.

Dr Pieterse said that after and during establishing and implementing effective, efficient, and transparent financial management and internal control systems, the application of funding was maximised, and the facility could be sustainable or needed to prepare for closing within 12 to 18 months.

(See attached presentation for details)

Discussion

Ms N Bakubaku-Vos (ANC) referred to ICRA’s collaboration with the Department of Social Development (DSD), and asked it to elaborate on how many non-profit organisations (NPOs) were assisted with yearly capacity-building support.

She noted the challenges experienced regarding the funding of NPOs due to non-compliance. Slide four of ICRA’s presentation highlighted these challenges in the provinces. For example, in some instances, NPOs would provide insufficient information in reports, thus not fulfilling the Department’s expectations.

She requested ICRA to elaborate on measures to assist the Department, and the NPOs outlined in slide 14, to improve the service delivery of the funded and non-funded NPOs in the provinces. She also asked what the most common challenges experienced in the social development sphere were, and what tools could address the challenges.

What was required from the government to improve financial management in the funded NPOs? What were the current practices to monitor financial compliance and to prevent financial mismanagement?

She said the Committee had conducted an oversight visit to Khayelitsha. The Members visited an old age home which accommodated elderly persons of a certain age and for a certain period. However, in practice, there was non-compliance with the requirements in certain aspects:

• Some elderly residents were younger than the required age, and some elderly residents were accommodated for extended periods. 
• The new board members opposed the accommodation of elderly residents receiving an ICRA subsidy.
• It received funding from the Department, but it was not registered. 

Mr G Brinkhuis (Al Jama-Ah) referred to the NPO and non-profit company (NPC) status of old age homes, and highlighted the case of an old age home registered with and receiving a subsidy from the Department. He asked about the consequences if the old age home changed its status from an NPO to an NPC without informing the Department.

Mr C Fry (DA) referred to the slide on the governance universe, and asked if monitoring and evaluation were conducted simultaneously or separately. He expressed his appreciation for the ICRA’s work with NPOs, especially old age homes and assisted care facilities.

Ms W Philander (DA) noted concerns about the condition and location of some of the old age homes. In some cases, the conditions had worsened. The presentation provided the requirements, monitoring and evaluation, and external conditions to ensure suitable old age homes. 

She said the Committee had also conducted an oversight visit to an old age home in Paarl East. The management was in order, but the conditions needed to be more conducive to the residents’ well-being. The former JJ le Roux Clinic in Paarl had been presented as an alternative option, but the Members had raised concerns that this was used as a storage facility. 

She asked whether such cases were a priority for inspection and intervention.

Ms Bakubaku-Vos highlighted the challenges at an old age home in Murraysburg -- specifically, the lengthy tenure of the board members. She asked whether the Department and ICRA had intervened and resolved the matter.

Ms R Windvogel (ANC) asked ICRA to elaborate on the evictions mentioned in the presentation. She was concerned about the eviction of the elderly from old age homes. 

She referred to an issue of racism experienced at the old age home in Murraysburg. She asked whether the government had a monitoring and intervention system to monitor racism in old age homes.

DSD and ICRA’s responses

Dr Pieterse responded that ICRA had a monitoring system within the boundaries of the Department. ICRA was an independent NPC, and has assisted local DSD offices in meeting their objectives since 2015 by assessing the old age homes and new applications. ICRA had been involved in and provided management assistance to five old-age homes.

There had always been a good relationship between ICRA and the Department. ICRA informs the Department if there are any incidents at the old age homes. Thus, when someone contacted the DSD, it was already aware of the situation.

However, Departmental funding had been unavailable in the last two years, and ICRA’s involvement was limited. Nevertheless, it had continued its engagement with and assistance of old age homes and staff with which it had a relationship. In some cases, ICRA provided free assistance to old-age home managers who were unable to afford payment for services rendered. For example, Groenewald Accounting Services provided accounting and auditing services at a substantially reduced fee.

ICRA utilised its resources to their maximum capacity, but its management and board structures needed to be adequately equipped. Often the staff had the passion, but needed more experience. ICRA provided aid as and when requested.

On the NPO and NPC status, the NPO Act provides that an NPO may register an NPC. However, there must be members to function as an NPO. An NPC may operate with or without members. It was essential to understand the role of an NPO and an NPC.

He referred to the governance framework and ICRA’s toolset for monitoring and evaluation. He said that if the NPOs, including the board members, applied the governance framework, they had to monitor and evaluate the financial compliance and progress. Failure to do so would be contrary to the Companies Act. In such cases, ICRA would guide the Department on closing such NPOs.

On the issue of evictions, he reiterated the example of the old age home in Murraysburg. He stated that subsidised funding and services could be provided only where there was compliance. He provided the example of an elderly resident who had refused to comply despite several attempts to resolve the matter amicably. ICRA had been compelled to consider legal interventions.

ICRA was an asset to the Department and Committee, as it provided an independent viewpoint and assessment of cases. There was no financial benefit to ICRA, except the money charged for its services. ICRA was also seeking additional funding from bigger funders.

Ms Sharna Fernandez, Member of the Executive Council (MEC): Social Development, thanked ICRA for its insightful presentation, which was often lacking in the public domain. She said there was a DSD section supporting older persons and the broader DSD which monitored approximately 300 old age homes in the province.

She highlighted the post-Covid challenges, such as the increased operational costs of facilities. The DSD had received only a 4.05% budget increase.

The Department managed the norms and standards in a facility. However, it could not interfere with a facility's day-to-day and board management. Challenges often arose in such instances.

When a board is taken over, it may be due to political instability. The Department was required to address such challenges by assessing the areas it was responsible for. For example, if residents complain that they were poorly fed or the facility was not well-maintained, the Department would dispatch a team to deal with the matter.

In cases where there were internal disputes, an independent organisation (with no governmental affiliation) such as ICRA would be utilised. The DSD would utilise this as a permanent toolkit if long-term funding was available. ICRA’s toolkit would be beneficial especially to facilities without adequate funds.

The DSD offices were compelled to intervene only in accordance with the monitoring and evaluation norms and standards.

On the question of conditions and locations, there had been a degradation of facilities. For example, there were some areas which had become gang-infested areas. Unfortunately, the DSD could not relocate facilities. There was a process of engagement with the DSD. It was engaging with the National Department of Public Works and provincial infrastructure on suitable locations and buildings. She also referred to the complexities mentioned in the ICRA’s presentation.

Managing an old age home requires a specific responsibility, such as ethical leadership, integrity, and trust between the board, residents and employees. Many cases reported to DSD indicated a breakdown of these requirements. Often employer versus employee relationships was the cause and required resolution.

Questions from the public

Mr Haroon Abdul, a public representative from Avondrust care centre, referred to the ICRA’s confirmation that an NPO may change its status to an NPC. He disagreed that an NPO may become an NPC. Only an NPC may change its status to an NPO.

He provided the challenging case of an NPC -- formally an NPO -- which was unable to obtain funding. Such NPCs were compelled to utilise the subsided funds it had previously received as an NPO from the DSD. He asked what monitoring and evaluation measures are in place for such illegal activities.

Dr Pieterse responded that the ICRA had previously collaborated with Avendrust. He said that the NPO continued to belong to the Worcester Welfare Association, which had ceased to exist. Further, only one board member (who has since passed away) had provided authority and approval for the transfer to an NPC. There was no constitution in place. Only the facility buildings existed. Upon assisting the NPO in becoming an NPC, the ICRA advised it to register the buildings accordingly. It was available to assist the NPC as required.

The Chairperson thanked ICRA for the offer of assistance. He recalled that the Committee had conducted an oversight visit to Avondsrust and referred to the report of the visit. He suggested that a follow-up should be conducted. He would request that the Department should lead the discussion between the board, the union and community members.

Mr Charles Jordan, Chief Director: Children, Families and Early Childhood Development (ECD), DSD Western Cape, said the older persons' programme managed by the DSD was experiencing a crisis. R16 million had been cut from the budget in the financial year. This greatly impacted the Department’s capacity to continue funding many organisations. Several older persons' service centres were closing due to the lack of funding, and a lack of compliance and operational requirements. Approximately 16 had been closed in the current financial year.

He said the Committee should engage on the matter, as oversight was required.

Regarding monitoring, the DSD operated according to the norms and standards set out in the Older Persons Act. This required that DSD was not mandated to appoint a board and staff. The NPO Act provided that a board must be appointed. The old age facility’s constitution provided how the board was established. Usually, community members were co-opted and elected. As the DSD provided partial financial subsidies, there was a fundamental misconception in this regard.

The Department did engage with the board and management when there were issues. The DSD's monitoring and evaluation (M&E) officials and social workers regularly conducted monitoring visits and engaged with both staff and residents. He shared his own experience of assisting old age homes since 2005.

If an old age home was non-compliant with the Act, the DSD would not close the facility. Instead, it applied a developmental approach and would provide remedial assistance for two years. It would rather arrange for another organisation to manage and mentor the facility to avoid closure. Two old-age homes closed in 2022 due to their decision to close.

He cited the challenges of lack of funding due to reduced DSD budget allocations. It had advocated for increased budgets to Treasury for the last three years, but this was unsuccessful. Funding was provided only to registered facilities. He asked for clarity on the name of the Khayelitsha facility in question.

Ms Bakubaku-Vos clarified that the old age home was based in Gugulethu, not Khayelitsha. It was registered, but was non-compliant due to mismanagement of funding.

Mr Jordan responded that the DSD would monitor the facility closely, as it was funded by the DSD.

Referring to Murraysburg, he said that a major concern was the racial composition of the board, as was usually the case. Most of the board members were white, as per the voting by the electors. The DSD did not participate in the election process but would intervene if there were transformation issues by engaging with the board.

Ms Bakubaku-Vos requested that the DSD discuss the matter with the Minister.

The Chairperson added that the Committee would conduct an oversight visit to the facility from 26 to 30 June.

Mr Jordan said that one of the challenges of old age homes was that they had been built 50 years ago in predominately white areas during the apartheid era.

Maintenance was a serious concern, as the DSD did not have the funds to support upgrades of buildings, or where they were private buildings.

Ms Deborah Fontein, Social Work Policy Manager: Older Persons Programme, confirmed that the DSD may not fund private buildings.

Mr Jordan said the JJ le Roux issue was not about relocating, but expanding the facility. Public Works facilitated the property, and it was initially identified for DSD office space. Public Works should therefore be approached to confirm whether it would still be utilised for this purpose or whether it may be leased as an old age home.

On the issue of NPCs, he confirmed that the DSD funds NPCs, NPOs and Trusts. The latest NPC legislation required an NPC to also have an NGO.

Ms Patiswa Momoza, Programme Manager: Disability Programme, DSD, said that this was correct, as it was no longer voluntary but compulsory to register as an NPO.

Mr Jordan said there had been several investigations on Avendsrust. The DSD had received the forensic report and had engaged the board. He was concerned by the board’s negative approach to the Department. The DSD was considering escalating the matter to legal services.

The Chairperson reiterated that the Committee had drafted a report on its oversight visit. He requested that the DSD provide a separate briefing to the Committee on the Avondrust matter. On the Rusthof old age home matter, he said the DSD managed the facility. He added that the JJ le Roux facility was utilised as a DSD storage facility. The Committee would also consider a separate visit to the facilities.

Ms Windvogel said that her query on racism in rural areas required a more detailed response from the Department and the Minister.

Mr Brinkhuis referred to a forensic report, and asked how long the DSD had had the report and whether a copy may be shared with the Committee.

Mr Jordan responded that the report had been received in February. The investigation had been lengthy and conducted by the forensic unit in the Office of the Premier. A copy would be shared by the DSD.

Dr Robert Macdonald, HOD, DSD, responded on the issue of racism. He said the Department dealt with it when it was reported and intervened, depending on the situation.

The DSD was mandated to ensure that there was no abuse of the elderly, and took the matter seriously. It also ensured financial compliance for facilities registered with the Department. If there were incidents beyond the DSD’s powers, the matters would be referred to the SA Human Rights Commission or for court intervention.

Committee matters

The Committee considered the draft minutes of 28 February and 17 March. The minutes were unanimously approved and adopted.

The meeting was adjourned.