PUBLIC COMMENTS ON THE
DRAFT REGULATIONS FOR OLDER PERSONS
NAME OF ORGANISATION |
ISSUES |
RECOMMENDATION BY ORGANISATION |
RESPONSE BY DSD |
1. Kerk Maatskaplike Werk (KMDR) |
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2. Cor Z A Beek |
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3. SOUTH AFRICAN OLDER PERSONS FORUM |
§
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?
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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
f) Spiritual, g) cultural, h) medical, i) civic /social security
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:
·
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.
·
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
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)
·
Rendered 2 x a week only
·
(What does this mean?)
·
Contract between service provider/ organisation and
recipient / representative.( B& C categories). (Format?)
·
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
·
Bathing, dressing and grooming (By whom?) ·
Prescribed caregiving tasks” by caregiver”? |
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5. 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. |
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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 MINIMUM NORMS AND STANDARDS FOR RESIDENTIAL
FACILITIES o
REGULATIONS IN TERMS OF CHAPTER
5 OF THE ACT[U8]
o
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·
“ 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] .
·
The Minister may confirm or set aside the decision of the Director General[U21] .
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6.LATEST 1st OCT 2007
PRE-FINAL(1)VAL HEIGHWAY |
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. 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) ..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. |
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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 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 |
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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? 1. Comprehensive assessment by psychiatric services. 2. Reception Order for certification 3. Alternative Placement |
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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. |
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|
[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
[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.
[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 –
[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.
[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.