Elder Abuse: hearings

Meeting report

WELFARE AND POPULATION DEVELOPMENT PORTFOLIO COMMITTEE
6 June 2000
ELDER ABUSE: HEARINGS

Submissions Handed Out:
Medical Research Council
National House of Traditional Leaders
South African Council for the Aged (Eastern Cape)
The Association for the Aged (TAFTA)
Pietermaritzburg and District Council for the Care of the Aged (PADCA)
Focus on Elder Abuse

SUMMARY
Public hearings were held to address the issue of elder abuse. The hearings were in response to an episode of "Carte Blanche" which illustrated the extent of the problem in South Africa.

Organizations present pressured the committee to take swift action to address the plight of the elderly. The committee was urged to implement policies and programs to:
· improve the conditions of pension pay-points by making them safe and more accessible to the elderly in rural areas. Recommendations were put forward that pensions be granted at financial institutions rather than in open areas where the elderly were susceptible to attack.
· develop mechanisms and strategies to develop and promote sensitive and informed community participation. It was advised that interventions should be intersectoral, including government, NGO, and private sector participation.
· provide supplementary financial support to the current pension amount.
· establish a national 24 hour abuse line so the elderly can report abuse.

Various organizations were also critical of continuing systemic abuse, such as insufficient funding for homes for the aged, the exclusion of older persons from the "one-off" grant for low cost housing, and the exclusion of retired persons from some medical aids.

The committee is expected to table a report outlining recommendations on the plight of the elderly in Parliament after the hearings have concluded. The report will then go to the Department of Welfare.

MINUTES
The committee heard from various organizations regarding the state of the elderly. The hearings were in response to an episode of "Carte Blanche" which illustrated the extent of elder abuse in South Africa. Mr Saloojee (Chairperson) stated the hearings were an essential part of the process in attempting to find proper solutions to the problem. He admitted that the government had not committed sufficient time or effort to resolving the issue.

Medical Research Council
Dr Priscilla Reddy, Director of National Health Promotion Research and Development Office, briefed the committee on the results of research that they had conducted regarding abuse of the elderly in South Africa.

Dr Reddy attributed abuse of the elderly, in part, to policies and programmes that neglected to realize the importance of older persons in society. The elderly are often burdened by having to provide emotional, social, and financial care to family members who suffer from HIV/AIDS without any supplemental support. She dismissed the claim that ageing was a concern solely for developed nations citing that from 1990 to 2010, the proportion of older persons in Sub-Saharan Africa was expected to double from 15 million to 29 million.

Dr Reddy identified three levels of elder abuse. The first , macro-level, occurs at a societal level, such as having limited access to water and sanitation. The second, mezzo-level, refers to the behaviour, attitudes, and policies at a community level, such as the misuse or theft of old age pensions. Micro-level abuse is abuse that occurs within the family structure.

In studies conducted by the Medical Research Council, it was found that participants described experiences of macro-level abuse. Many were in a poor financial position due to primary dependence on the welfare pension, and were solely responsible for fulfilling the basic needs of their grandchildren.

Abuse at the mezzo level was articulated by participants who expressed fear about their own safety and security, often as a result of threats and aggressive attitudes from younger generations. Micro-level abuse was found in older persons who felt isolated, alienated, and neglected by their families. This resulted in a loss of control and mental anguish.

Dr Reddy recommended that further studies were needed to better understand the extent of elder abuse, and to establish interventions that would solve the problem. It was advised that interventions should be intersectoral in nature, including government, NGO's, and the private sector. Mechanisms and strategies also need to be developed to promote sensitive and informed community participation.

Discussion
Concern was raised that clinics in rural areas do not have the necessary medications for conditions facing the elderly, and as a result, they are forced to travel for long periods of time to the nearest hospitals. Ms Ghandi (ANC) asked what could be done to correct the situation?

Dr Reddy responded that the Medical Research Council was primarily concerned with research in the health and medicinal field, and not with the distribution of medications. She recognized that the challenge over the next five years will be in improving health management, but stated clearly that it was the role of the welfare committee in connection with the Department of Health to develop and implement strategies to that end.

Ms Chalmers (ANC) asked what security measures were in place to ensure the elderly received their pensions, and did the management of social security differ from province to province?

Dr Reddy responded that little research had been done in that area, but that they were aware that elderly people were often physically beaten for their pensions, or would have their pensions taken by loan sharks to whom members of their families owed money. Dr Reddy attributed these problems to the primary health care system being overburdened.

Ms Tsheole (ANC) asked what supplementary assistance could be given to the elderly who often look after their grandchildren?

Dr Reddy said research had shown that the elderly often provided a role similar to that of a psychologist in their communities, as well as acting as a type of "pre-primary health care service" to grandchildren. Dr Reddy stated that the role of the elderly must be both recognized and celebrated. It was recommended that an intersectoral intervention between government, NGO's, and the private sector be established to provide support-care for these individuals.

Mrs Southgate (ACDP) asked what percentage of the population were elderly, and how many of those had access to medical assistance?

Dr Reddy was unable to respond with specific statistics, but stated that South African Demographic Health Services would be able to provide that information with respect to the percentage of elderly with specific types of chronic diseases. Dr Reddy further recommended that interventions had to be developed to treat middle aged adults suffering from chronic diseases as well.

National House of Traditional Leaders
Mr Kgosi Suping, Committee Chairperson of the National House of Traditional Leaders briefed the committee. He stated the traditional caring mechanism of the extended family taking care of the aged had been neglected. The aged were now seen as a source of income to their families, and often lived in unhygienic and squalid conditions without decent food.

Mr Suping suggested the answer to eradicating this abuse was returning to the traditional norms and principles whereby children would be "morally compelled" to look after their elderly parents.

In some areas, traditional courts and family forums were conducted to account for neglect of the elderly. The practice had proved effective in that it exposed the individual concerned, and often meant that that individual would no longer be entitled to their parents property after the parent had died.

They condemned institutionalized care, arguing it was not part of African culture to send the elderly away to be cared for. They dismissed claims that homes provide better comfort and treatment, stating the practice was founded on commercial consideration rather than passion.

Mr Suping called for proper legislation and programmes to protect the aged similar to those that were given to children. He also criticized the conditions of the pay-point stations which were susceptible to unfavourable weather conditions, and attacks from thieves. It was recommended that pensions be made available at financial institutions, and that the amount of the pension be increased.

Discussion
Ms Southgate (ACDP) asked whether the elderly were well cared for in traditional communities?

Mr Suping responded that many of the elderly were now being taken to homes for the aged. This was a new trend for traditional communities, as the elderly had always been cared for by members in the community. As a result of rural children moving to urban areas, there had been a significant increase in the number of elderly people being institutionalized. This was seen as a threat to the traditional community, who felt it was the role of society to "cherish and aid" their elders.

Ms Tsheole (ANC) asked what mechanisms they had developed to combat elder abuse?

Mr Suping replied that they fully realized it is not viable to expect educated children to remain in the rural areas. In traditional communities, however, it becomes the responsibility of the entire clan to care of it's elderly, and not solely the immediate family. As such, the clan is obliged to look after elderly parents, when their children move to urban areas.

Ms Tsheole (ANC) asked why they saw institutionalized care as abuse? Mr Suping replied that placing older persons in an environment that is unknown to them, and where their culture is not understood was abuse.

Professor Mbadi (UDM) asked whether there were proposals to incorporate pay points into traditional institutions?

Mr Suping stated that no proposals had been made, but that they would be very much welcomed.

Ms Cupido (DP) raised the issue that banks would not allow elderly persons to open accounts when pensions were their only form of income. She also stated that due to the high unemployment rate, many adults were relying on their parents pensions for food. Based on these problems, it was asked whether traditional communities had economic development programs in place?

Mr Suping replied that there was a need for the government to introduce employment programs in their communities for both youth and adults.

South African Council for the Aged
Mr Hewit Simon briefed the committee (see submission).

Discussion
Ms Chalmers (ANC) asked if the elderly knew it was illegal for loan sharks to take their ID booklets?

Mr Simon responded that it was difficult to prosecute loan sharks since no legislation was in place that enforced a ceiling on interest rates. As a result, loan sharks remained able to charge interest rates in excess of 50%. It was suggested that provinces needed to create low-interest credit programs specifically for the elderly so that they could have access to money in order to support their extended families.

Ms Ramotsamai (ANC) stated it was clear that the elderly were an important part of the social fabric of society, and that they provided a tremendous resource to the community. She agreed with Mr Simon that the government must provide funding for the active role that the elderly play.

The Chair did not allow further questions due to time constraints.

The Association for the Aged (TAFTA)
Mr Henry Spencer, Executive Director of TAFTA addressed the committee on the major causes of abuse facing institutionalized care.

One of the major causes given for elder abuse was insufficient funding to institutions. It was stated that the subsidy for a category 3 frail aged home had not increased since 1993, whilst the subsidy for category 2 aged homes, in Kwazulu-Natal, had ended in 1998. This meant that in 1993, the subsidies available to a home represented 97% of their total wages and salaries, whereas they currently amount to less than 33%. As such, homes for the aged are unable to compete in terms of salaries and wage structures offered by state and private hospitals.

Mr Spencer attributed the insufficient funding to the large number of retrenchments which had occurred, the breakdown in the working relationship between employers and employees, and the closure of over 400 homes since 1996.

Systematic abuse was another cause of abuse stated. Systematic abuse includes laws, policies, and practices that negatively effect the elderly. Reference was made to certain local authorities who had been attempting to levy rates charges on welfare organizations. Attention was given to Life-rights units. Life-rights units had been initiated to supplement the shortfall engendered by caring for social pensioners, but it's ordinances were not equally applied to institutions within the same region. Other forms of systemic abuse noted were the conditions at pension pay-out points, the exclusion of older persons from the "one-off" grant for low cost housing, and the exclusion of retired people from some forms of medical aid.

In his recommendations to the committee, Mr Spencer included the following:
· abolishing private rooms and returning to a "ward" type situation. The wards would be comprised of 30 to 40 beds.
· the use of surveillance equipment to monitor the actions of staff.
· the use of outsourced staff in nursing homes.
· proper education and training of all staff
· the establishment of a 24 hour toll-free abuse hotline.
· the creation of an ombudsmen programme both nationally and provincially.

The Chair asked that no questions be asked for the remainder of the presentations due to time constraints.

Pitermaritzburg and District Council Care for the Aged (PADCA)
Ms Margaret van Zyl, Executive Director of PADCA briefed the committee on examples of systemic abuse in the Pietermaritzburg area in the following areas:

Health System
Many seniors are falling through the gaps left in the process of rationalizing hospitals is Pietermaritzburg. Seniors were faced with problems In accessing repeat medication, and often spent long hours at hospitals without receiving any attention.

Social Security System
Seniors are continually harassed at pension pay out points by loan sharks, and by members of the life assurance industry selling funeral policies. Often money is being deducted from pensions by the pay out company for a funeral policy premium without the individual knowing. Furthermore, allegations have been made that funeral policy payments are made to whomever the company chooses, instead of the owner of the policy nominating a beneficiary.

Complaints are often received that departmental officials are rude, and unhelpful, and that policies are often canceled without written notification.

Department of Justice
Seniors have experienced long delays with the Legal Aid system when they have attempted to bring charges of neglect and abuse against family members.

Transport System
Taxi drivers and conductors are often extremely impatient and disrespectful to the elderly. Training in customer care dealing with the elderly is required.

Department of Education
Greater attention to teaching youth about aging and dealing with the elderly is needed to restore respect. Traditional systems of extended families and familial support structures are not always working today, and there is much abuse of older persons by their adult children and grandchildren.

Focus on Elder Abuse
Ms Marilyn Lilly, Acting Director for Focus on Elder Abuse, briefed the committee on the ways in which the elderly were continuously abused in society. These abuses were related to the public's insensitivity to the specific needs of the elderly, the poor conditions and negative attitudes that they faced when collecting their pensions, and financial abuse by both family members and professionals.

Ms Lilly criticized the government for their inaction and "blindness" in addressing the need to propose and implement legislation.

The Chair thanked the organizations for their presentations. The presentations will be utilized to write a report outlining the committee's recommendations on elder abuse, and will be tabled in Parliament.

The meeting was adjourned.