PUBLIC COMMENTS ON THE DRAFT REGULATIONS FOR OLDER PERSONS

 

NAME OF ORGANISATION

ISSUES

RECOMMENDATION BY ORGANISATION

RESPONSE BY DSD

1. Kerk Maatskaplike Werk (KMDR)

  • Distinction between CBCSS & Residential Facilities in the Act
  • Regulation on financial records clear in residential facilities but do not appear in CBCSS
  • Regulation on SLAs not included in CBCSS
  • Regulation on residents committees in residential facilities but nothing on CBCSS
  • Concern about the minimum norms & standards as being part of the regulations. Does that mean that they are regulations?
  • The relationship between minimum norms and standard and the broad norms and standards for Integrated Services Delivery Model?
  • Assessment of financial implications for implementation of these minimum norms and standards
  • Concern of the publication of protocol on management of elder abuse with the regulation. Do they have the same status?
  • The purpose of the definitions which are at the beginning of each chapter of the regulations as the Act has the definitions. Is it important?
  • CBCSS also be regulated on financial records/management, SLAs & committees

 

 

 

 

2. Cor Z A Beek

  • Paragraph (c) of the proposed sub-regulation (11)(1)  states that a residents’ committee MAY include at least one member of the local community, sub regulation (4) makes it compulsory for the manager to ask nominations by announcements via local radio stations & news papers.
  • Sub regulation 12 (6) prescribes that a member of residents committee should be a South African citizen.
  • Recommendation is made that sub regulation(4) be made applicable to only residential facilities funded by government

 

 

 

 

 

 

 

 

  • Recommendation is made that sub regulation(4) be made applicable to only residential facilities funded by government

 

 

 

3. SOUTH AFRICAN OLDER PERSONS FORUM

  • In general the current regulations do not seem practical, with specific reference to norms and standards.  For instance no nursing services are rendered in a home for the aged, but rather caring with element of health services (pages 20 and 81). 
  • Several typing and typographic errors for example:

§         SAPS (Art 7(2)(a)), page 7.

§         benefit older person (Art 8(1)), page 2 in stead of benefit of

§         Spacing of last part of sentence Art 2(b)(I)(ii), page 42.

§         Spacing Art 6(2), page 45.

§         Art 3(i) page 124: Start sentence with capital letter.

§         Art 3(2), page 124:  End sentence with full stop.

§         Art 6(i)(c), page 125 : Write name of department with capital letters.

§         Spacing of lines: Page 128.]

§         Spelling error” minted” :Point 9,page 130

·         Annexure A, Form 1, page 9:  Form is not consumer friendly, for instance “No of management/staff” – it is unclear which number is requested?; and “certified copies of management committees” – does it refer to ID-documents or what?

  • Minimum norms and standards for care for older persons can never be formulated solely by the Minister and his department without consulting and obtaining input from relevant service providers/NGO role-players.  This aspect should be included in Art (2)(vi), page 86.

 

 

  • The requirements for the residents’ committee (pages 91 to 94) Art 4(2) page 125 and Art 8(2) page 126 are not considered to be workable, as the residents in residential facilities/homes for older persons are frail.
  • No where in the regulations of Chapter 5 of the Act (pages 123 to 127) a reference is made to Annexure B as being a national elder abuse protocol.  This creates confusion. Refer thus in the applicable regulations of chapter 5 to Annexure B.  (Pages 136 to 164 refers).
  • Furthermore, the national elder abuse protocol is seen merely as a guide or suggestion.  If it is meant to be anything more than this, thorough input should be requested from civil society

 

  • Furthermore, the national elder abuse protocol is seen merely as a guide or suggestion.  If it is meant to be anything more than this, thorough input should be requested from civil society

 

  • The Elder Abuse Report is a very important tool when handling abuse cases of older person (compare it with the Form 4 where a child is removed from an abusive situation).  In the light thereof, the proposed Elder Abuse Report is found to be not user friendly and effective.  Some examples are as follows

 

  • Annexure A, Form 1 Elder Abuse Report, page 128:  Is it of any importance to complete the race of an alleged abused older person?  This is regarded as irrelevant and should be removed

 

  • Annexure A, Form 1 Elder Abuse Report, page 128:  Is it of any importance to complete the race of an alleged abused older person?  This is regarded as irrelevant and should be removed

 

  • Page 129 Elder Abuse Report:  Not enough space is provided to complete “key issues of risk assessment” and it is unclear what the latter will refer to

 

  • Page 129 Elder Abuse Report:  How can it be possible not to identify the person making the report?  The form states “if available”

 

 

 

 

4.  South African older forum Chapter 2 and Chapter 3           

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ø       National norms and standards for acceptable levels of services

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ø       The minister may confirm or set aside the decision of the Director General

 

 

 

 

 

 

 

 

 

 

Ø       A person who receives a financial award must comply with norms and standards

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ø       Compliance with accounting principles and measures by service providers in receipt of financial award

 

 

 

Ø       Minimum norms and standards for community based care and support services to older persons

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ø       Delivery of services

 

 

 

 

 

 

 

  • Statutory requirement

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  • Economic empowerment

 

 

 

 

 

 

  • Education

 

 

 

 

 

 

 

  • Counseling  services

 

 

  f)    Spiritual,

 

  g)   cultural,

 

 

 

  h)   medical,

 

 

 

 

  i) civic /social security

 

 

  • Provision of nutritionally balanced meals to needy older persons

 

 

 

 

 

 

  • Provision of skills and capacity of older persons to sustain their livelihood

 

  • Services contained in the indigent policy for vulnerable and qualifying older persons

 

 

 

 

 

 

  • Provision of Intergenerational programmes

 

  • Capacity building

 

 

  • Transport

 

 

 

 

 

  • Social and economic independence

 

 

 

 

Ø       Definitions in terms of Chapter 3 of the Act

 

 

 

 

 

 

 

 

 

 

 

 

Ø       Application and approval of registration

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ø       Training of caregivers

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ø       Register and registration of Care Givers

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ø       Home Based Care Programmes

 

 

 

 

 

 

 

 

 

 

 

Ø       Short title and comments

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ø       Course/qualifications

 

 

Ø       Definitions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ø       Functional Area

 

o        Home Based Care Programme

o        (These categories are according to need only

 

·         This draft is an improvement on earlier drafts but does not address the following issues:

  1. The norms and standards and application forms are too complicated and will discourage service providers from applying for awards.
  2. There should be guidelines for the Minister in collaboration with other Ministers or MECs to develop community based programmes (Clause 11 of the Act)
  3. There is no mention of the  provision of basic infrastructure , where none exists , from which such services can operate (Plan of Action on Ageing)
  4. The Regulations must be consistent with the Act which requires “accessible, equitable and affordable” services. They cannot provide for “basic”, “intermediate” and “tertiary” services which range from survival to luxury.
  5. There are no guidelines for the levels or standardization of financial awards. These need to be related to the cost of services if services are to be sustainable.
  6. Monitoring of community and home-based services is not covered at all in the Regulations and sketchily  in the Act but this is crucial especially for new services
  7. Urgent attention must be given to accrediting training programmes for home-based care.
  8. Why have service level agreements been left out of this version of the Regulations?

 

 

·         The Act allows the Minister prescribe national norms and standards for “the acceptable levels of services that may be provided to older persons” and changes existing laws “ to facilitate accessible, equitable and affordable services.”. Why have the Regulations changed “national” to “minimum” in Annexure B?  In addition Regulations use levels of need and levels of cost/affordability interchangeably.

 

·         The application  form only fits existing service-providers does not allow for applications by new service providers or for new services yet the majority of older persons do not currently have access to community or residential services. Presumably new service providers apply for temporary registration. This should be stated.

 

(b)·                  comply with norms and standards referred to in Regulation 2 (the specific norms which apply to a particular service and level must be spelt out)

·         allow a team, which may include management, the residents committee (in the case of a residential facility) and an official designated by the Director General in writing,  to visit and monitor a residential facility or community based care and support service at any reasonable time and provide that official with documentation and information which may be required by the team

 

 

(e)·   ensure that all financial

activities are in line with current Treasury regulations (This is too vague and may be unattainable by many existing and potential service providers)

 

·         The Act provides for The Minister in collaboration with other Ministers or MECs to develop community-based and home-based care programmes as well as support “any person” who runs such programmes. The Regulations should cover both eventualities. In the least-serviced areas there are no prospective service providers.

 

It is not clear how levels of service here fit with levels in the Community Based Care and Support Services model in which Level 1 is Prevention, Level 2 is Care and Protection and Level 3 is Residential or alternative Care (which falls under the Frail Care Guidelines)

 

Basic Services (Formal)

 

§·     Community Hall – at least 1,5 m2 per person

·         Rendered 2 x a week only

 

 

b)Membership policy in accordance with statutory requirements

·         (What does this mean?)

 

 

§·     Implementation of departmentally approved assessment instrument (B & C categories) Refer to specific regulation on this.

 

§·     Completed standardized background report. (Where is the format?)

 

·         Contract between service provider/ organisation and recipient / representative.( B& C categories). (Format?)

 

§·     Membership policy and code of conduct  to be in line with policy, principles and the South African Declaration on the Rights and Responsibilities of Older Persons. Will this be attached to the Regulations?

 

§·     Arts and craft ( All categories)Poverty relief projects

·         Financial management training

 

 

§         Adult Basic Education Training (ABET)

§         Life skills programmes( e.g. budgeting, parenting skills)

§         Computer literacy

 

 

·         Counseling on health issues

 

§         Religious activities

 

§         Cultural/traditional activities( e.g. indigenous games)

 

§         PHC services(e.g. immunization, basic podiatry services, monitoring of Health status, etc)

§         Pension pay points/access social grants

 

§         Food on foot(When members from the service centre deliver meals to other members who are ill)

§         Provision of balanced meals to older persons at a Community Based Care and Support Service centre

 

§         Life skills training (Link to economic empowerment in sub-clause a))

 

 

·         Awareness on the content of the indigent policy of local government and rebates or rates concession for qualifying older persons( e.g TV license discounts, business and Telkom discounts, subsidized transport)

 

§         Transport

 

 

 

·         Combine with volunteerism

 

·         (Note that some service centers provide transport but it is costly and not sustainable without government support)

 

·         Programmes  for the young to promote preparation and preparation and costs of retirement

 

·         Definitions

·         The following definitions Community Based Care and Support Services Model and Guidelines for Frail Care Services to Older Persons should be added:

·         Service Centre

·         Day Care

·         Day Care Centre

·         Assisted living

 

 

·         The services provided may be entrusted to or conferred on the management of that community based care and support service; and (What is the intention of this clause? To hand over to the service-recipients?  Can this be done realistically? If not, what is the point of the clause?)

 

·         it complies with the conditions set out in the  minimum norms and standards for community based care and support services determined by the Minister from time to time ,

                        (Presumably service providers planning to provide community based                                   services apply for temporary registration in clause 3))

 

 

·         The service provider of home based care must ensure that a caregiver undergoes the accredited training programme (what of existing programmes?) before such caregiver is allowed to render the service,

·         The Director General must ensure that the training programme designed for

·         caregivers is accredited by the Health and Welfare Seta, aligned with unit standard

·         based qualification registered by the South African Qualifications Authority (SAQA). (Will there be transitional arrangements before this is done? Should there be time-frames?)

 

·         Levels Of Community Based Care And Support Services

 

·         This clause does not fit here, nor speak to Norms and Standards which distinguish between location, size of membership, number of days)

 

 

·         Basic services provide the most basic needs for survival such as primary health and social care eg. Health, Nutrition, Shelter, Water, Sanitation, Power.(How will other Departments be mobilized? Who will fund?)

 

·         intermediate services in addition with the qualities referred to in (a) has additional support that are ancillary to health and social services such as podiatry, occupational therapy, physiotherapy, counseling, group support, education and training, capacity building, facilitation, respite care, culture and spiritual, transport services, transcultural,  social rehabilitation and excursions, that require additional resources; and (Does this mean you only get podiatry and OT if you can afford to pay?)

 

 

·         tertiary services are in addition to (a) and (b), more comprehensive, which includes accommodation, assisted living, home based care, holiday excursions and other services delivered in settings such as Retirement Homes and Estates, Service Centers and Private Homes, and are partially or self funded.  (And only holidays for those who can pay?)

 

·         Any person who provides a service to older persons must comply with the minimum norms and standards referred to in subsection (1). (Does this refer to National Norms and Standards in Clause 6 of the Act?)

 

 

 

·         Monitoring of Community-based services

·               N.B. Clause 15 of the Act states that Clause 22 on monitoring of residential services will apply “with the necessary changes”. This clause requires a social worker or designated person to visit and monitor, with or without a health care provider, demand access to documents and report to the Director General.

Page 24 of the Community Based Care and Support Services Model requires a multi-disciplinary team to appraise services, a social workers report, a government department report, feed back and a Service Level Agreement. This document also states that “The Act will prescribe tools for monitoring”.

How will the cost effectiveness and efficiency of these programmes be evaluated. In addition, present service providers complain that subsidies are too low and are not based on cost drivers or inflation linked.

Monitoring of  Home-based services: The Guidelines for Frail Care Services for Older Persons require the following:

 Synergy of Health and Social Development Regulations

Agreed monitoring tools and strategies to ensure compliance

Joint annual inspections by Health inspectors and social workers

National implementation of DQ98  as an assessment tool for frail Ops in the community

Finalization of the Elder Abuse Protocol

 

 

 

  • What about experience? References?
  • ‘DQ98’ means an assessment tool that is used to gather information on the disability of the potential client and to assess his / her need for a caregiver, i. e. the dependency level. The effect of any specific physical impairment is expressed as its consequent disability / dependence. (This should be attached)

 

  • Caregiver’ means any person excluding a family member who provides care to older persons. (Is this the “formal” caregiver?)

 

 

 

·         Bathing, dressing and grooming

(By whom?)

·         Prescribed caregiving tasks” by caregiver”?

 

 

 

 

 

 

5.PROVINCE OF KWAZULU NATAL

 

 

Ø       Minimum Norms and Standards

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

·         Residential Care

 

a)       Medical Waste: Storage disposal and transformation

b)       Dedicated medical doctors from GP/PSYCHIC etc by the Department of Health

c)       Recreation activities to include, music, dance, art and craft, excursions, gardening, animal and pet care, therapy

d)       Place of safety(subsidized)

e)       2065-Subsidy system must be reviewed to accommodate unoccupied beds and creative use of such subsidy for outreach programs. Also remember that basic services electronic, water staff salaries do not change if beds are not fully occupied

f)         Social workers-Employed at NGOs aged sector don’t have many junior workers in their team but instead have support staff. Therefore don’t enjoy “supervisors subsidy

g)       DOH-To provide surgical ,medical, disposable napkins, ward stocks, equipments for BP’s and diabetic control

h)       Assistive Devices-DOH to assist NGOs through its lending Depot system/Programme

i)         Active Ageing is the process of optimizing opportunities for health, participating and securing in order to enhance quality of life as people age

 

·         Community Base Care

 

a)       Spiritual Cultural civic-Reps by Older Persons on Local Ward Committees and Community Police Forum

b)       Partnership /networking with Amakosi Religious Institutions, Schools and Sports

c)       Utilization of existing facilities use state owned buildings, school posters and community halls

d)       Staff: Remuneration of living wage volunteers not easily available protection for staff training must be provided by the Department of Health(Frail Care Staff)

e)       PHC Nursing scare skills revisit norms and standards or allocation of nursing staff from local hospitals and Department of Health

f)         Public transport: not easily available within rural areas, private taxi services must be regulated/educated on services to older persons

g)       Provision of food: Subsidies must be reconsidered in order to provide balanced and nutritious foods.

 

·         Statutory Requirements-No member to serve as an Hon. Position of the same family e.g. treasurer and president(Husband and Wife)brothers

 

·          Financial Management-Annual Budgets must be approved in accordance with the services that are provided.

 

 

 

 

5. SOUTH AFRICAN HUMAN RIGHTS COMMISSION

 

 

Ø       OLDER PRESONS ACT NO 13.OF 2006

 

o        Definitions  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

o        Application of financial award

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

o        Manner of entering into Contracts with Service Providers

 

 

o        Conditions for the disbursement of financial awards and compliance with norms and standards

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

o        Compliance with accounting principles and measures by service providers in receipt of financial awards

 

 

 

o        Penalties and Remedies for failure to comply with conditions for financial award[U1] 

o        Conditions for management of assets

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

o        Application form for fincial award

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

o        REGULATIONS IN TERMS OF CHAPTER 3 OF THE ACT[U2] 

o        Definitions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

o        Governance Details

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

o        DEPARTMENT OF SOCIAL DEVELOPMENT[U3]  

OLDER PERSONS ACT, 2006 (ACT NO. 13 OF 2006)

 

o        ANNEXURE B

 

CODE OF CONDUCT[U4]  FOR COMMUNITY-BASED CAREGIVERS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

o        Definitions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

·         REGULATIONS IN TERMS OF CHAPTER 4[U6]  OF THE ACT

 

·         Definitions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

o        RESIDENTS’ COMMITTEE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

·         ANNEXURE B[U7] 

 

MINIMUM NORMS AND STANDARDS FOR RESIDENTIAL FACILITIES

 

 

 

 

 

o        REGULATIONS IN TERMS OF CHAPTER 5 OF THE ACT[U8] 

 

o        DEFINITIONS[U9] 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

o        Acknowledgements[U10] 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

o        DEFINITIONS[U11] 

 

o         

 

 

 

 

             

 

 

 

 

 

 

 

 

·         “ asset” means any[U12]   immovable or movable property owned by the service provider bought with Government funds;

 

·         basic needs” are needs which must be met in order to ensure survival[U13] ;

 

·         financial year” means the period between the 1st of April[U14]   to the 31st  March every[U15]  year

 

·         “the Act”  means the Older Persons Act, 2006 (Act No. 13 of 2006[U16] ).

 

·         Levels of Services provided to older persons are defined, monitored and evaluated        according to the national norms and standards contained in Annexure B[U17]  of these Regulations

·         A service provider who is entitled[U18]  to receive a financial award referred to in section 8(1)(a) of the Act must make an application to the Director General in a form similar to Form 1 contained in Annexure A and comply with policy on financial awards as determined by the Director General[U19] .

 

(c)·  is registered in terms of the Act[U20] ;

 

·         The Minister may confirm or set aside the decision of the Director General[U21] .

 

(c)Ø          the amount of the financial award including capital and/or operating funding[U22] ;

 

·         .  A person who receives a financial award must comply with the following conditions[U23] :

·         use[U24]  the financial award for the care and benefit of older persons, and meet

·         allow a team, which may include management, the residents committee and an official designated by the Director General in writing,  to visit and monitor a residential facility or community based care and support service[U25] 

·         report any financial irregularities and abuse of older persons[U26]  to the South African Police Services or the designated official referred to in paragraph (c); and

· Despite any other law[U27] , a service provider must, when preparing financial

statements[U28] , adhere to generally acceptable accounting principles including:

  

 

 

 

 

 

 

 

 

 

 

(a)           immediately on buying the assets, forward to the Director General the description[U29]  details and a certified copy of proof of purchase of the said asset for purposes of entry into the register;

 

·         If the facility is closed or a service is discontinued the[U30]  assets will be disposed of according to stipulated conditions or will be handed over to another facility or service with similar objectives as stipulated in the constitution of that facility or service.

 

Documents to be attached to the form

·         Business plan

·         Certified copies of management committee[U31] 

·         Constitution[U32] 

·         NPO registration certificate

 

ANNEXURE B

MINIMUM NORMS AND STANDARDS FOR COMMUNITY BASED CARE AND SUPPORT SERVICES TO OLDER PERSONS[U33] 

 

§·     EDUCATION- Pre[U34]  and Post retirement counselling

ANNEXURE B[U35] 

 

MINIMUM NORMS AND STANDARDS FOR RESIDENTIAL FACILITIES

 

  • Examination Room / Treatment room facility- Painted in light coloured[U36] , washable paint.

 

 

 

 

d) 

  • applicant” means  a person who is applying to provide a service defined  in section 1 of the Act[U37] ;

 

 

  • asset” means any  immovable or movable property owned by the service provider bought with Government[U38]  funds;

 

·         Arrangements prior to termination of community-based care and support service[U39] 

 

  • The Minister may confirm, set aside or amend the decision of the Director General[U40] .

 

(c)·  employment history details[U41] ;

 

 

Levels Of Community Based Care And Support Services

 

7[U42] . (1) Levels of community based care and support services provided will vary according to the needs and means of older persons, be assessed by the service provider on a regular basis and must comply with the Minimum Norms and Standards contained in Annexure C of these Regulations.

 

·         Penalties[U43] 

 

 

·         Short title and commencement[U44] 

 

5.1         Constitution or deed[U45] :  Please attach a copy of the above

   Please attach a list of     your Board[U46]  members

 

·         Do you hold General Members[U47]  Meetings

 

2.3o        On how many days per week do you operate[U48] ?  Tick

 

·         Please give a breakdown of persons who benefit from the services on weekly bases[U49] 

 

·         NB. This certificate in terms of section 18(7) of the Older Persons Act, 2006 is[U50]  not transferable

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The caregiver, must at all times, executes his or her duties in accordance to the instructions of superiors and the applicable job description.  The following is of particular importance to the caregiver[U51] -

 

(d)·   adhere to the human resource guidelines and requirements of the employer[U52] .

 

(d)·   continue to further and expand his/her knowledge and skills regarding the care of older persons[U53] .

 

 

o        MINIMUM STANDARDS FOR HOME BASED CARE SERVICES[U54] 

 

·         Frail Care’ means the provision of services that address the physical, social and emotional well-being of frail persons[U55] .

 

·         ‘Domestic assistance’ means the provision of domestic services to an older person living outside a facility, in order to enable the older person to maintain his or her present[U56]  level of ‘independent’ living[U57] .

 

·         Respite Care’ means a service offered specifically to a frail older person and to a caregiver and which is aimed at the provision of temporary careand relief[U58] .

 

·         ‘DQ98’ means[U59]  an assessment tool that is used to gather information on the disability of the potential client and to assess his / her need for a caregiver, i. e. the dependency level. The effect of any spesific physical impairment is expressed as its consequent disability / dependence

 

 

·         Caregiver[U60] ’ means any person excluding a family member who provides care to older persons

 

·         Care’ means[U61]  the provision of physical, psychological and material assistance to an older person where such older person is unable to provide these for himself or herself, and includes the service aimed at promoting the quality of life and general well-being of older persons

 

·         The above definitions were adapted[U62]  from the Older Persons ‘Legislation[U63] ’ Act 13, 2006

 

 

 

 

 

·         asset[U64] meansmeans any  immovable or movable property owned by the service provider bought with Government funds;

 

·         “financial year[U65]  means the period between the 1st of April to the 31st  March every year

 

·         person[U66] includes an organization

 

·         the Act”  means the Older Persons Act, 2006 (Act No. 13 of 2006[U67] ).

 

·         A Residents’ Committee consisting of a minimum of 5 members and a maximum of               12 members, must be established in every[U68]  Residential facility

 

·         is representative, on grounds such as, race, gender and disability[U69] .

 

(a)· not a South African citizen[U70] ;

 

 

(d)·   convicted of any offence of which dishonesty or violence is an element[U71] ; or

 

(b)·  for misconduct[U72] ;

 

(e)(a)           if he or she is convicted of an offence which involves dishonesty[U73] .

 

(e)(b)   if he or she is convicted of an offence which involves dishonesty[U74] .

 

·         All members must be notified in writing of every meeting of the residents committee[U75] .

 

·          

 Penalties

 

14. Any person who contravenes or fails to comply with these Regulations is guilty of an offence and liable on conviction to a fine or to imprisonment not exceeding one year or to both such fine and such imprisonment[U76] .

 

·         short title and commencement[U77] 

 

 

 

 

10[U78] . DELIVERY OF SERVICES

 

dd[U79] ) Building and facilities are accessible to the residents

 

Sluice Rooms[U80] 

 

 

 

 

 

 

 

·         Measures to promote the rights of residents in residential facilities[U81] 

 

·         Measures to promote the rights of older persons that are not[U82]  in residential facilities

  • For the purpose of sub regulation (1), the residents committee or any other person must in writing, inform the Minister of any conviction resulting from the abuse of an older person[U83] .

 

  • Any person who contravenes or fails to comply with these Regulations is guilty of an offence and liable on conviction to a fine or to imprisonment not exceeding one year or to both such fine and such imprisonment[U84] .

 

·         Short title and commencement[U85] 

 

·         Minted[U86]  by Management Committee on

 

  • This protocol is based on[U87] :

 

  • Older Persons Act of[U88]  No 13 of 2006.  In this document the term Act is frequently used

 

  • Older[U89]  persons have a right to live safely and without fear of abuse, violence or exploitation

 

  • Older Persons are protected under the Older Person’s Act no 13 of 2006.  The objects of the Act under Article[U90]  2 inter alia to:

 

  • Elder Abuse is a crime, and if committed, should[U91]  be reported. Everyone, both in residential facilities and in the community, has a responsibility to report it and take the necessary steps to protect and assist the victim.  It is an offence to conceal the crime of abuse[U92] .

 

Physical Abuse Indicators

 

·         Physical Abuse is the infliction of physical pain or injury or physical coercion.  Examples include hitting, shoving, pushing, burning, and physical and chemical restraint[U93] .

 

 ·     Incontr[U94] ??? and care demands

 

  • Abuse may be[U95]  disclosed by a concerned member of the public, a relative, a neighbour, a professional person or any other person who has reason to believe that the well-being of an older person is threatened or being compromised

 

 

  • The Older Persons Act must not be construed as limiting amend[U96] ?? replacing or otherwise altering any provisions of the Domestic Violence Act (No 116 of 1998).  Both acts must be used interchangeably

 

 

 

·          

 

 

 

 

 

 

6.LATEST 1st OCT 2007 PRE-FINAL(1)VAL HEIGHWAY HIGHLANDS HOUSE

 

 

 

 

 

The overall presentation is not of an acceptable standard.

            Sections are duplicated, e.g. minimum norms and standards for residential facilities are duplicated, pg. 22-39 appear again in Chapter 4.

The layout is fragmented and incoherent, e.g. laundry is covered in various places.

Sections are out of sequence, e.g. pg. 120 Health and Safety is not part of Specific Care.

Statements contradict each other, e.g. 107 (ss) secure and safe environment, the standard requires support rails on both sides of corridors yet on pg. 103 (hh) states handrails on at least one.

Pg. 113 management services residents committee requires monthly meetings yet pg. 93 (14.1) states quarterly meetings as a standard.

Standards do not always correlate to the area and norm under which they appear, e.g. much of pages 110-112 apply to community and not residential.

 

Bullets and squares intermix which suggests that information has been taken randomly from other documents.

 

Page 91.

(b) How would the resident know the best members of staff to elect to the committee?

(4) & (5) This could be open to abuse and prevent honest monitoring

 

Page 93

14 (1) Quarterly meetings are insufficient to manage the organization and contradicts standard on pg. 113.

 

Annexure B

10 Delivery of Services

            Maximum of 4 beds: is this realistic for a minimum standard in rural and poor areas?

            Emergency exits: cannot make it a requirement as lifts cannot be used in a fire.

            Add smoke detectors in every room

            (cc) Change Nurses to Work Station: not only nurses involved in care.

Do these regulation apply to new buildings only?

How will older homes be treated if they cannot meet the requirements?

 

Page 103

Wash hand basins with taps: delete “regulating”.

Wash hand basins and medication and drug lock-up facilities only if applicable.

 

(ff) STAFF rest room (not nurses). Lockers for all staff of each gender.

(gg) Screened off cubicle: singular

            Washable paint. Stating the colour is too prescriptive

            Storage facility for medical stock items.

            Wash hand basin with taps; “controlled” unrealistic and expensive

            Equipment for management of general and BASIC FIRST AID; medical situations needs clarification as it is not a hospital

(hh) Outside passages; does this mean covered above and both sides? How would organization in rural areas afford this?

            Width of corridor; too narrow for emergency equipment.

            Steps too high; should be 115mm. Too narrow; should be 400mm for safety as elderly people need room to place both feet on each step.

 

(ii)         Bath and shower

            ..durable washable paint; colour too prescriptive

Wash hand basin and Grab rail (not towel rail); too flimsy to hold onto.

One toilet for every 8 residents of each sex; fewer men than women. What if only 1 or 2 men on floor?

Urinals are unhygienic and this would mean fewer toilets.

 

(jj)         Hand wash facility in sluice room to prevent cross infection

Unrealistic to have separate toilets for male and female visitors.

(kk)             Kitchen area inadequate to house equipment

(mm)    Layout of laundry must allow for separate washing of different types of laundry as well as separation of infected linen

Outside contractor approval by whom?

(nn)       Dining area insufficient to allow access for wheelchairs

Heating mentioned but nothing about ventilation and cooling

            (rr) Security in terms of local conditions: not sufficiently defined.

            (ss) Support railings: contradicts earlier standard

                        No mention of maintenance of building

 

10.2 Capacity building

                        (k) Should be (a)

                                    Clarification of term “caregivers”

1.3 Should be 10.3

            This could be entered under 5 on page 117

                        Residents appropriately dressed: this could be interpreted quite widely. Whose standard would apply?

 

Sections d), e) & f), 1.5, 2.6, 2.7, 2.8 & 2.9 are for Community and Home-based Care: not residential

 

1.12 Hygienic food: disjointed. Belongs elsewhere e.g. pg.117

 

2.1     Residents Committee

       Regular monthly meetings: contradicts pg. 93 which requires quarterly meetings

 

2.2     Complaints register: what kind of complaints?

2.3      

2.3.1          Developmental Quality Assurance: is this a financial audit?

Monthly minuted operational meetings: is this a financial matter?

2.8       Nursing Adminstration: does this include the caregiving component that forms the majority of activity?

 

3             Rights and Responsibilities

Protection against abuse: mixture of residential and community .

 

5.                   Individualised Care Plan for Residential Care: delete HOME

c) Repeat of part of b). Belongs with care giving

Specific care should be under nursing care on pg.117

 

Page 119. d) Rehabilitation Services; omit Habilitation as there is no such word.

                  h) Provision of beds: need to take into account the risk for residents already in the home. There is a risk when taking in someone from the street with no medical or social history.

 

Page 120. Numbering needs attention. Add section heading for Emergency Procedures.

 

 

 

7.COMMENTS ON DRAFT POLICY –FRAIL  HIGHLANDS HOUSE VALHIGHWAY

 

 

Ø      Introduction

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ø      DEFINITIONS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ø      SCOPE

 

 

 

 

 

 

 

 

 

 

 

Ø      BENEFICIARIES

 

 

 

Ø      BASIC PRINCIPLES OF FRAIL CARE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ø      RESIDENTIAL CARE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ø       MONITORING AND EVALUATION OF FRAIL CARE SERVICES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ø       FINANCING OF FRAIL CARE SERVICES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ø       TRANSFORMATION OF FRAIL CARE SERVICES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ø       Criteria for measuring transformation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ø       CONCLUSION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  • The opening paragraph makes two statements that are potentially contradictory.

            The first is that the policy is intended for older persons who are unable to live independently.

This statement implies the provision of services to those who are not necessarily frail. Some older people are not able to live independently due to socio-economic factors, housing difficulties, transport problems, etc.

The next statement refers to older persons who need continuous care. These people need care and assistance with management of existent chronic medical conditions in addition to the prevention of illness and treatment thereof.

·         Determination of the care needs and the service providers required needs to be preceded by clear and accurate definitions. Only then can statements about place and service provision be determined

 

Frailty: 

This can be defined in several ways.

 

Suitable for community living:

1.       Can manage with limited assistance and support.

Can be left untended for periods of time without coming to harm.

 

Has enough insight into own disabilities that care plans for management of condition and activities which are potentially harmful are understood and compliance occurs.

 

Movement from bed to chair and toilet can be achieved with assistance of one carer.

 

Has appropriate support system to provide the day and night care required.

 

Suitable for residential care:

1.       Has no one to provide daily care as above.

2.   Cannot be left unattended at any time.

Has little or no insight into own disabilities.

Potential to wander, cause disruption in the community, unable to participate in own care planning.

Needs assistance from at least 2 carers to transfer and mobilise.

Needs specialised nursing care to manage medical condition.

 

            Funding:

Whether a frail person is cared for in the community or in a residential facility, funding of the carers needs to be determined according to the level of care required.

The funding from Dept of Social Services should be confined to those aspects for which the department is mandated and has expertise, namely housing and support services, e.g. feeding, transport, etc.

The persons defined as 1) and 2) above would fit this type of funding.

Those whose needs include the above but also need specialised care from professional staff should receive additional funding for the special medical care from the Dept of Health. The majority of very frail residents of residential facilities currently receiving subsidy fall into the latter category.

 

Community based care:

·         Applicable, as defined, where the above 1) applies, where the family and others can provide the major part of the care. Provides “significant others” with advice, support, limited assistance and teaching

Day care:

Has limited application. Requires co-operation from the individual and a degree of mobility to access daily transport. Can be potentially a cause of confusion and disorientation in the demented who do not respond well to changes in routine.

 

Frail person:

Limits the service provision by age. What about the frail person who is younger than 60? The older male has to be 65 before he can access a pension. Does he fulfil the requirements of frailty but not age if he is over 60 but not yet 65?

Why is the psychiatric condition excluded? Since long-term facilities in the psychiatric hospitals have been closed, are there alternative plans being made to provide care for this category of frail person who is excluded from this frail care policy?

Home-based care:

Cannot be applied to the frail if they are defined as requiring 24-hour care.

·         This service is similar to the community based care as it only occurs for a short period (45 minutes) each day

 

Residential care:

·         A definition of and discrimination between residential home and a nursing home should be determined. Residential care may or may not include a need for nursing care.

The Dept has often stated that they do not fund nursing care. Clarification is needed to determine the distinction between the care currently being funded and nursing care which has other implications. If the definition is accepted, this has the implication that the Dept will fund nursing. It also implies that the type of care level required is greater than that provided by home-based care. Thus anyone in the community requiring nursing is suitable for admission to a residential facility or nursing home.

 

Mental condition:

·         This definition now includes psychiatric conditions. Clarity is needed since psychiatric conditions are excluded above. Older people with existent chronic psychiatric conditions other than the dementia group of conditions need to be included in this document. Many already live in residential facilities and there will be others in the future who need care that is no longer provided in psychiatric hospitals.

This implies that facilities that do not receive subsidies are included. This is not apparent in the rest of the document. Perhaps this should read, “Any home, facility, day care centre, frail care unit and community based service that provides subsidised services to the frail and aged.”

 

·         This definition is problematic as it once again excludes the under-aged frail and males under 65

 

·         These are not principles of care. These are very acceptable general aims and objectives.

The principles of frail care need to be spelled out as this would assist in clarifying who is frail and where frail persons can have their needs met.

 

The principles that need to be stated include:

a.         Holistic provision of services that meet the daily needs of individuals who are unable to meet these needs unaided. These include meeting personal hygiene, nutritional, excretory, mobility, sleep, recreational, spiritual and social interaction needs.

b.                   Implement the chronic and acute health care as per a medical prescription.

c.                   Provide a safe environment in order to enhance safety and prevent accidents as far as possible. This is a particular and special need for those with moderate to severe dementia.

d.                   Intervene and refer appropriately in the event of unforeseen occurrences that affect health and/or well-being.

e.                   Provide the services of specialised professional services when appropriate e.g. chiropody, wound management, occupational therapy, physiotherapy, etc.

f.                     Provide appropriate equipment and furniture to meet the needs of the frail person, e.g. walking aids, eating utensils, pressure sore prevention aids, etc.

g.                   Adapt the diet, food preparation and feeding method to meet the medical condition of the person.

h.                   Manage the environment to ensure that changes in weather and climate do not affect the person’s comfort, i.e. fans in summer, heaters in winter, appropriate clothing, etc.

i.                     Ensure access to safe drinking water and toilet facilities according to degree of disability and available assistance.

 

Management of homes

·         Admission criteria based on non-discrimination, formal admission criteria which not only comply with the Aged Persons Amendment Act (100 of 1998) but also which are within the capabilities of the facility and that the applicant is motivated to be admitted. No one should be compelled to be admitted if able to express an opinion. Family should also be motivated as problems occur when one or both parties are not convinced of the wisdom of the admission

§         Staffing of home

The staff complement must be designed to meet the needs of the residents. The number of residents will also affect the number of staff required.

The suggested staff complement implies that residents will require professional nursing expertise.

The suggested norms are not clear and are potentially problematic.

A home admitting group 3 frail aged must have a manager (preferably with a nursing qualification) as well as clerical, social work, catering, laundry and domestic staff. The home will need access to human resources, bookkeeping and auditing expertise that can be provided by own staff or from external sources.

On current screening systems used in the Western Cape, residents are classified as group 1, 2 or 3.

Each group requires a different ratio of carer and professional staff.

Group3 residents who score between 25 and 30 need:

      Senior professional nurse:                  1 (Mon to Fri)

      Professional nurse (RN or EN):            Minimum 1 on day shift (07h00-19h00 shift)

                                                            Minimum 1 on night shift (19h00-07h00 shift)

      Care givers:                                     1:10 residents (day) (07h00-19h00 shift)

                                                            1:20 residents (night) (19h00-07h00 shift)

 

Where residents score in excess of 30, particularly when they score in excess of 40 these ratios need to decrease because the number of nursing hours increases per resident to 25 or more per week.

 

Nursing hours per resident = 18 per week = group 2 resident

30 residents need 540 hours per week

Care givers needed to meet this need =  14

 

Nursing hours per resident = 25 per week = group 3+resident (high scoring group 3)

      30 residents need 750 hours per week

      Care givers needed to meet this need =  19

 

It may be necessary to increase the number of professional staff to meet the increased nursing needs of this group of patients.

 

These figures do not include time spent on complicated dressings and other technical assistance;  nor does it take into account the amount of time spent escorting residents to see the doctor in the community clinic. This latter aspect uses an enormous number of manpower hours. Not only is the process slow and cumbersome but the differing needs of the residents often requiring a one-on-one escort system. One home can have anything up to 4 carers out of the home for most of the day escorting 4 residents to hospitals and clinics. This happens virtually every day of the week.

 

It would be potentially hazardous to leave carers without direct professional nurse supervision at night. The carers are not equipped to recognise or make appropriate decisions when a resident presents with an acute medical condition. Only the RN/En has the necessary skills and the Scope of Practice to react to emergencies common to homes for the frail aged.

Buildings and facilities of homes

 

An alternative power source in the event of electricity failure is not always feasible because of the cost to install. This should be a recommendation rather than a requirement.

Services to residents

 

g)   reinforces the need to have a professional nurse on duty at night.

k)         This is assumed to mean telephone system to enable staff to phone the local community hospital and ambulance services. Any other level of system is not practical.

l)          This service is dependant on funding and availability of paramedical professionals. Not possible at present as current funding does not provide sufficient to make this affordable. The lack in the availability of medical doctors, particularly those trained in geriatric medicine as well as the almost complete unavailability of paramedical support for old people, whether they are in a home or resident in the community, results in the current situation where there is poor rehabilitation and management of both acute and chronic health conditions in the elderly. An improved system of care from these professionals would result in fewer preventable admissions to secondary and tertiary institutions.

m)        Transport to hospital is based on local authority provision of an ambulance service.

o)         Access to legal advice cannot be the responsibility of the home unless appropriate contingency funding is provided. What should be in place is the right of residents to contact the legal assistance of their choice and ability to fund or to contact State Legal Aid.

 

9.1.1          Services to the community

 

a)         If this proposal is implemented a separate protocol needs to be developed. The mere subsidising of a bed is insufficient. The legal, medical, financial and social documentation must be in place before any short-term person can be admitted.

b)         This service needs to be clarified in terms of determining conditions warranting admission as well as funding or subsidy.

c)         This needs much more detail. Staff available to train and support home-based carers must be paid for as the staff ratio above does not allow for these extra duties and skills.

d)         The out reach programmes that are needed should be determined by the Dept. It is not  always possible for residential homes to determine what community needs have not been met. The home should then be approached to consider whether it has the capacity to provide the service. Services which are not related to care of frail aged may not be within the capacity of the staff of the home. Again the issue of funding is also pertinent.

 

9.2               Community based care services

 

It is difficult to understand how day care and home based care can provide for those requiring continuous care as they are, by definition, not continuous.

Rehabilitation is a very specialised field which should remain with the Dept of Health.

Training, provisioning and monitoring of services rendered by community carers is currently done via the Dept of Health and community hospital system.

Provisioning of assistive devices is also surely the mandate of the Dept of Health.

Shelter should be extended to include appropriate housing for aged persons able to live independently and accommodation that provides assisted living services. At present there are little or no housing options to suit the special needs of the aged. This should be on the agenda of the National Housing Ministry. In addition old people are more likely to remain able to stay in the community if they had adequate appropriate transport to get to the shops, pension pay point, medical services, etc.

 

9.2.1     Day care model

 

The provision of day care for community aged will require that fewer beds are allocated to the needs of current residents. The income of the home will then be negatively affected. Adequate funding will be required to make this option financially viable. The number of day care persons who can be accommodated will also be dependent on the availability of seating, meals and recreational activity programmes.

This is not a viable option for the very frail who requires continuous care. Assuming the person wants to go to the day centre, the process needed to get frail persons from a wide community area assisted onto a bus or other vehicle is a time and manpower consuming Herculean task. To do so in all kinds of weather puts vulnerable chronically sick old people at unnecessary risk of acute illness plus an enhanced possibility of falls and fractures.

This is only potentially viable for those who are less than group 3, ideally it is for those who meet the requirements of Level 1 Programmes.

 

Staffing:

 

The staff provision will make the day care programme extremely expensive.

Do the Dept of Social Services and Poverty Alleviation have a budget to cover these additional expenses?

How many of these facilities is it planning to provide?

Are these figures for the number of people who would make use of such an option?

Volunteers with the requisite skills, time to give and the willingness to provide this kind of service are not freely available. Consideration must also be given to the thought that mistakes made by volunteers become the responsibility of the service provider.

Carers generally do not have the skills to provide counselling, which is a highly skilled professional activity.

The staffing list does not include professional nursing staff. This would be necessary for the management of medication as well as acute emergencies.

Day care programmes listed reinforce the fact this that is not appropriate for the Level 3 frail older person.

 

9.2.2          Home based care model

 

The inclusion of this model in this document is puzzling as this service is currently funded and managed by the Dept of Health.

 

This list of officials to monitor and evaluate the services to the elderly means a major increase in the number of persons to do so. At present the number of people involved in this work is limited to the point that inspections of any kind have been a rarity in the last few years.

Only officials with professional health training can monitor the health care provision.

Since this has been deemed not part of the Dept of Health’s mandate, will the Dept of Social Services be appointing appropriate persons to do it? Until there is a relevant, appropriate and regular system of auditing and checking facilities and services, evaluation will be no more than paying lip service to the policy.

There is a need for an Ombudsman or team comprising a geriatric nurse, geriatrician, psycho geriatrician, social worker with expertise in the field of elder abuse, paramedical experts “on call” plus a legal expert to investigate serious complaints of elder abuse and mismanagement of aged care recipients.

More than synergy between the departments will be needed to achieve the above objectives.

a)                   Residential care

The main source of funding is from private funds, donations and fund raising. The subsidy portion has been decreasing, proportional to inflation, for the last 10 years. This means that subsidies only provide for approximately 1/3 of the actual per capita cost of the service.  There has been no increase in the subsidy for the last 3 years. Pensions increased this year by 5,4%. The per capita cost will increase by 7-10% this year.

Affordability for

the pensioner is only related to this income. For a State pensioner paying a percentage of his pension this does not change. The service provider has the biggest affordability factor to deal with.

 

There is no indication of funding for non-residential services

 

 

Shifting support from geographically based services; if the service provides for the neighbouring community surely this is inevitably going to be geographically based. If the local community comes from one racial group, how will extending the service to a wider geographic area affect the first group?

The financial cost is increased to the service provider the wider the scope of his service provision.

Applicants for a service do not want to travel outside their own community. The service provision will need to be provided within the community which needs the service. Care must be taken that policy that resolves one set of problems does not create a situation that institutionalises isolation of individuals from their own cultural context, religious and friendship circles. Taking people out of their own immediate community could create this situation.

The proposals mooted in this document are not practical and will not resolve the problem of meeting the needs of under serviced communities.

The communities concerned must also be given a voice to indicate what kind of services would meet their needs. Bussing frail people from one area to another is not a feasible option and will not be supported by the affected communities.

 

The ratio of 60:40 social pensioners to other pensioners. This is surely also a factor related to the community being served as well as the need of the service provider to remain viable. Where the community is predominantly poor, there will be a few applicants who are not social pensioners.

Evidence that the profile of facilities is similar to that of the surrounding community. This will become redundant if the facility does not stay within geographically based service areas.

Meeting food preferences is possible within limits. The provision of Halaal and Kosher food preferences has major cost implications and for most service providers not possible.

Targeting marketing strategies for recruiting residents; this seems to be a strange strategy when the thrust of the document is to minimise the number of people housed in residential facilities. When people are frail enough to require residential care they or their significant others make use of Social Services and other sources of information to identify the nearest service provider.

This document contains principles that are sound, fair, equitable, non-discriminatory and all encompassing. However, there are a range of issues that have been highlighted as requiring definition, clarification or rewording in order to prevent confusion and misinterpretation.

In addition it should be noted that the practical feasibility of some of the proposals may differ when applied to the diverse communities, cultures and the norms, social values and expectations of residents and families.

The FRAIL person must be central to the focus of those providing the services. To this end the kind of service must be appropriate to the best interest, care needs and total well being of the frail individual. While the services under consideration are costly to the government and the taxpayer, short-term financial short cuts may be both detrimental and, in the long term, not cost effective.

Despite the fact that this document is about the frail, cognisance must be taken of the well aged who need services that are geared to prevention of ill health and the promotion of health in order to keep them from joining the ranks of the frail. This group are critical to the welfare of the younger generation as they provide invaluable assistance in the raising of the children and caring for AIDS orphans.

It is imperative that a partnership between the Departments of Health and Social Services be forged in order for these proposals to have any chance of succeeding. While the Health Services remain only minimally accountable for the health care of the frail and aged, the provision of appropriate, affordable and accessible services for this group of marginalized people will remain an exercise in futility.

VAH/06.06.05

 

 

8.CHAPTER 5

PROTECTION FOR OLDER PERSONS

 

Ø       Measures to promote the rights of older persons that are not in residential facilities

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ø       Penalties

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ø        

 

 

 

 

 

 

(a) Every service provider must take measures to prevent abuse of older persons, including: promote awareness and educational programmes in the community and services that will facilitate understanding of ageing issues and create awareness that ageing is a natural process;

(b) Protect older persons from any form of abuse including neglect ill-treatment and financial exploitation;

(c)Elder Abuse Protocol to be made available at strategic areas such as police stations, hospitals, clinics, pay points, tribal authorities.

 

 

(d)Display contact details of department of Social Development and help lines in public       areas frequented by older persons and community members e.g. clinics, libraries, schools, day hospitals, banks, post office, pay points.

(e)Display a Charter on the Rights of older persons in public areas frequented by older persons.  

(f) Display registration certificate in the case of a service center

 

Any person who contravenes or fails to comply with these Regulations is guilty of an offence and liable on conviction to a fine or to imprisonment not exceeding one year or to both such fine and such imprisonment.( What if failure to report abuse results in death?   The penalty should be appropriate to the contravention.)

Details of alleged perpetrator:

Name:

124

Address:

Contact No.

Occupation:

Relationship:

 

 

The Following forms need to be included in these regulations in order for the relevant organisations/Departments to carry out the Action Plan effectively.

 

1.       Protection Order – to be utilised in terms of the Domestic Violence Act-Section 27-(perpetrator information and notification of appearance can be used from the regulations of this Act).

2.        Warrant Authorising social Worker /Health care provider to enter premises to complete investigation in terms of section 28(3)2 ,28(4).

3.       Warrant to remove Older Person to a Hospital / Place of Care in terms of section 25(4)(a) (attached specimen copy)

4.       Medical Report on the Status of the older person needs to be formulated and should include: -In cases of physical and/or sexual abuse what steps have been take to preserve evidence?Whether or not the matter has been reported to the police?

Mental State: - Recommendations should specify the following if appropriate- :

1. Comprehensive assessment by psychiatric services.

2. Reception Order for certification

3. Alternative Placement

 

 

9.ACTION ON ELDER ABUSE SA

·         The forms necessary for the removal of the perpetrator by SAPS. There is nothing attached? Are these developed by SAPS? Think this is a very important area of the Act and forms are vital.

 

 

 


 [U1]Penalties are provided for clause 7 & 9. Thisr epetition is not acceptable.

 [U2]The title of the chapter should be provided to remind the reader which chapter is being commented on.

 [U3]This Form sounds like an acknowledgement letter. Is it really needed? If yes, it should clearly stipulate that is an acknowledgment form.

 [U4]This should be a code of GOOD conduct

 [U5]It is difficult if not impossible to comment on this annexure. The infomraiton is not set out in a manner that makes logical sense and it is difficult to understand what the drafter si trying to achieve. This renders the annexure in legal terms vague and embarrassing.

 [U6]The full title of the chapter needs to be inserted to make the Regulations more accessible to the reader.

 [U7]This annexure is very difficult to access. It is difficult to work what the drafter is trying to stipulate. Comment hereon is not possible.

 [U8]Reference to the bame of the Chapter should be made.

 [U9]Many of the definitions are being repeated. Theses regulations need to be cross referenced.

 [U10]Acknowledgement should not form part of Regulations.

 [U11]Definitions must be in conformity with the Act.

 [U12]The word asset is too broad. It should be limited to an asset above a certain amount.

 [U13]This is too broad, vague and confusing. It is debatable which needs and the extent to which the chosen needs must be met to comply with this definition

 [U14]Of one year

 [U15]Of the following year

 [U16]“this Act” is defined in the main Act and this definition is thus not needed.

 [U17]There should be logical sequencing of Annexures, Annexure A should be mentioned fisrt.

 [U18]No service provider is entitled to receive financial awards. The service provider may make application for a financial award and be considered.

 [U19]There are 2 pieces of information contained in one sentence. The ideas should be split into 2 sub sections.

 [U20]It should be stated clearly which Acts the service provider must be registered in terms of. Must there be registration in terms of the Non Profit Organisations Act as well?

 [U21]A time perios must be stipulated. The service provider cannot be left in limbo awaiting the D-Gs’ determination. It is suggested that the D-G should consider the appeal and make a decision within 60 days.

 [U22]Line spacing

 [U23]These requirements should be in the contract

 [U24]This sentence is not grammatical. This whole section needs to be carefully edited for grammatical errors and sentence construction errors.

 [U25]Community services must always be mentioned first to reflect the developmental nature of ageing.

 [U26]Financial irregularities and abuse of older persons must not be conflated. They must be dealt with epearately.

 [U27]Regulations cannot override laws.

 [U28]Generally acceptable accounting practices and principles should be adhered to at all times.

 [U29]A & c appear to provide for double reporting. This appears to be onerous and it is questionable if this is necessary.

 [U30]Again, a reference to the facility and then the service. The reference should be the other way around to reflect the developmental nature of ageing.

 [U31]This is not clear

 [U32]This is unclear. Service organizations can be voluntary organizations, trusts or section 21 companies. This should read founding document.

 [U33]It is very difficult to comment on this section as it is not set out in an accessible aligned manner.

 [U34]Is this possible? A persons must be an older person to benefit from the provisions of the Act. This appears to be including persons who are not older persons.

 [U35]Inconsistent numbering

 [U36]Is this possible of regulation? Is this not over regulation.

 [U37]This is repetition of the previous

 [U38]State funds would be more appropriate.

 [U39]This is a different ofnt and point size. It looks untidy.

 [U40]A time period must be given. Community service providers are very often vulnerable and need to know in a reasonable time the outcome of any appeal.

 [U41]This is presuming that the person has been employed. The person may have relevant experience, community based service or experience from caring for a family member. An space should be provided for recording this informraiton.

 [U42]The numbering is out of sequence.

 [U43]This is repetition of what is in the previous chapter.

 [U44]This is repetition of what is in the previous chapter.

 [U45]This should read Founding document. It can be a constitution, trust deed or voluntary assosication.

 [U46]Only s21 companies have board members. Trusts have trustees etc. …

 [U47]This is confusing, Voluntary associatins have members meetings. This would be stipulated in the founding document.

 [U48]It would be interesting to keep a record of the days of the week which service organizations operate on.

 [U49]Spelling error!

 [U50]This should be a new sentence.

 [U51]The wording is clumsy and needs tot be reworked.

 [U52]What about voluntary care givers?

 [U53]This section sounds more like terms of employment that matters that should be placed in a Code of Good Conduct.

 [U54]The font and lay out of htes Annexure is very different from the rest of the draft regulations. It creates the impression that it was drafted by a different persons and chopped and pasted into the current document. This raises concerns about its consistency with the current document.

 [U55]Frail older person is defined in the Act. Frail care and frail person were not defined for very specific reasons during the drafting of the Act. These definitions that were rejected during the drafting process of the Act cannot be introduced in an Annexure within the Regulations.

 [U56]This is ideologically unsound as the ageing process dictates that levels of living will change over time. It is to be expected.

 [U57]The definitions are not in alphabetical order.

 [U58]This is defined in the Act. It should not be repeated.

 [U59]This is government assessment tool. It needs to be referred to more accurately.

 [U60]Defined in the Act

 [U61]Defined in the Act.

 [U62]Definitions cannot be adapted in Regulations!

 [U63]Words such as this suggest that a legally qualified person has not gone through the draft regulations prior to the request for comments.

 [U64]See previous comments on this definition

 [U65]See previous comments on this definition

 [U66]This is defined in the Act and is thus unnecessary.

 [U67]This is already defined in the Act.

 [U68]This goes beyond what is provided for in the Act. Section 20(1) provides that a residents committee need only be established if there are more than 10 residents in a residential facility

 [U69]This is a repetition of 3(a) above

 [U70]What is the purpose of discriminating against non nationals? This could be challenged in an Equality Court.

 [U71]This is more onerous that being excluded from being a member of parliament. This is too braod.

 [U72]Who will determine this and how will this be determined?

 [U73]Again this is too broad.

 [U74]Again this is too broad.

 [U75]Does this exclude persons who are illiterate from serving on the committee?

 [U76]This is repetition of previous clauses/

 [U77]This is repetition of previous clauses.

 [U78]Why does this document begin with 10? Surely it should begin with 1?

 [U79]The numbering does not make logical sense in this annexure.

 [U80]What is a sluice room?

 [U81]Again, the Regulations lack a development approach of first addressing the needs of older persons in communities and then the needs of older persons in residential facilities.

 [U82]In terms of the developmental approach this is an inapprrpriate way to refer to these older persons who live in communities.

 [U83]It is the duty of the Justice Department to inform the Department of Social Development of such convictions. It cannot be made the responsibility of community persons and residents committees.

 [U84]This is repetition of previous provisions

 [U85]This is repetition of previous comments.

 [U86]?

 [U87]The Protocol appear to have been imported from elsewhere. It does not appear to have been integrated into the Regulations. This needs to be done before it can be adequately commented on.

 [U88]The name of the Act is incorrect.

 [U89]This part of the Annexure is not laid out adequately – there is not adequate numbering system.

 [U90]This should be section. It would appear that a legal persons has not gone through this Annexure and incorporated it into the Regulations

 [U91]This should read must – South Africa has adopted mandatory reporting of elder abuse.

 [U92]It is an ofence not to report the crime.

 [U93]The indicators need to be listed.

 [U94]These tyes of errors should not appear in a document for public comment.

 [U95]It is obligatory to report abuse. This should read must. This Protocol is not in line with the Act.

 [U96]?

 [U97]This is not traditional drafting syle.

 [U98]It needs to be spelt out very clearly when it would be appropriate to refer matters to these bodies.