Briefing by Department of Welfare on Programmes for the Aged

WELFARE PORTFOLIO COMMITTEE
11 May 1998
BRIEFING BY THE DEPARTMENT OF WELFARE REGARDING PROGRAMMES FOR AGED

Documents handed out:
Briefing By The Department Of Welfare Regarding Programmes On The Aged And Legislation (Appendix 1)
Briefing By The Department Of Welfare Regarding Disability (Appendix 2)

The Committee asked the Minister some outstanding questions on the budget arising from the previous briefing.

The Minister informed the committee that the South African Law Commission would release its First Issue Paper on the Review of the Child Care Act.

The committee agreed to holding a meeting during parliamentary recess on 26 June, the International Day Against Drug Abuse and Drug Trafficking, in order to highlight issues on drug abuse and drug trafficking.

The committee was briefed on the care of the aged by Dr. C van den Heever, Director of Special Needs: Department of Welfare. As the present legislation is totally outdated, it must be repealed. The major objectives of new legislation are to create norms and standards in the care of the elderly and implement an ombuds system to monitor care of the aged. The appointment of a voluntary omsbudsperson to management committees of aged care facilities is proposed and is to be piloted in Durban and elsewhere. It is hoped to have a first legislative draft by November 1998. The Committee was invited to forward recommendations regarding this legislation to the department.

Due to time constraints a briefing on the issue of disability was postponed. The Committee was asked to forward questions on the subject so that the department could provide the necessary information at the briefing.

Appendix 1:: BRIEFING BY THE DEPARTMENT OF WELFARE REGARDING PROGRAMMES ON THE AGED, AND LEGISLATION

Presented by:
Dr C M van den Heever: Director: Special Needs

Annexure:
* Status from institutional care to community based care for older persons
* Disability - Integrated National Disability Strategy
* The Relationship between the Department of Welfare and the Office
on the Status of Disabled People in the Office of the Deputy President

Additional copies of this briefing material is available at Room 1025,120 Plein Street. Tel 021 45 1257/77

INPUTS FOR MINISTER ON AGEING: BRIEFING ON POLICIES AND
PROGRAMMES BEING IMPLEMENTED. WHAT IS STATUS OF THE
MOVEMENT AWAY FROM INSTITUTIONAL CARE TO COMMUNITY BASED
CARE FOR OLDER PERSONS:

1) INTRODUCTION
In South Africa the situation prevails where a significant percentage of the White community does not support its older persons in the family environment, but rather prefer them to be cared for in residential care facilities (homes for older persons). Homes for White older persons have been established throughout South Africa. Until recently many White older persons have moved into residential care facilities without them needing specialised frail care services at all. The Black community, on the contrary prefer to care for their older persons within the family environment for various reasons. As a result of a difference in the approach to ageing, very few homes for Black older persons, in comparison with homes for White older persons, have been established.

The over utilisation of residential care facilities by White older persons is amongst other factors, the result of not providing in the basic needs of older persons. The importance of appropriate and affordable housing, accessible health care, personal safety and socialisation have largely been under-estimated during the previous dispensation.

There are, according to NISWELL, at present 721 registered homes for older persons in South making provision for 42 366 persons (Jan 1996 - Jan 1997). The indications are that there is an increase in the number of surplus beds.

Housing schemes for older persons are privately established facilities. Some of the facilities have been established with private funds. The majority of housing facilities however have been established with financial assistance by the State. There are 375 housing schemes making provision for 24 850 older persons.

Approximately 46 212 older persons are making use of services provided by 373 registered service centres. There are however a large number of luncheon clubs providing services to a large number of Black older persons. Most of the luncheon clubs are not registered and cannot therefore be reflected in the official statistics of the Department.

Residential care is, as a result of many factors, not the most cost effective manner to care for older persons. South Africa has reached the point where residential care is unaffordable for most of older persons in need of care. The percentage of the budget for services to older persons, spent on residential care is a cause of great concern. It not only limits the availability of funds for community based services, but homes for older persons only provide in the needs of approximately 42 366 older persons. The majority of older persons do not have access to homes for older persons. The pressure on the budget to provide services for older persons will increase due to a sharp increase in the number of older persons. It is important that homes for older persons only accommodate those who are in need of twenty four hour care. Services for older persons should therefore be planned and managed in such a manner that it will promote independent living, that is affordable and accessible for those older persons in need of care.

2) PROGRESS WITH THE TRANSFORMATION OF SERVICES FOR OLDER PERSONS
2.1 Background
Good progress has been made with the transformation of care of the aged to a. more appropriate and accessible dispensation for older persons. The new funding formula for frail care, implemented during 1994, the implementation of the DQ 98 during 1998 and the implementation of criteria for community based care and support will promote de-institutionalisation of services for older people.

It is estimated that approximately 20% of the current residents in homes for older people can be accommodated in assisted living facilities (accommodation with support services). The development of appropriate community based care and support models are a prerequisite for the de-institutionalisation of services. There is a real danger that older people will be re-cycled into residential care if appropriate and affordable community based care and support models are not developed. Lack of models for community based models will inevitably encourage older persons from developing communities to demand the establishment of residential care facilities.

The progress made with the de-institutionalisation of services has already resulted in surplus capacity at certain homes for older people (approximately 10 %). It is essential that the current surplus facilities are not lost in order to be converted into assisted living units or accommodation, as the basic condition for independent functioning in the community.

Transformation of the previous dispensation for older people and the finalisation of the policy framework are based on the following critical outputs:

* Correct implementation of the funding formula for frail care.
* Models, funding criteria, norms and standards for community based care and support services.
* Implementation of the new assessment instrument for admission to homes for the aged (frail care facilities) i.e. DQ 98.
* Norms and standards for frail care in residential care facilities.
* New legislation to promote and protect the dignity and well-being of older persons
* Implementation of an ombuds system for older persons.

2.2 Development of norms and standards, criteria for funding and models for community based care and support.
Attempts to develop funding criteria, minimum norms and standards for community based care and support failed, due to lack of reliable information. As a result of the lack of information it has been decided to launch a number of pilot projects. It is envisaged that pilot projects would make a meaningful contribution to promote the development of community based care and support models, funding criteria as well as norms and standards.

The objective with the pilot projects is to develop appropriate and sustainable community based care and support models, to promote and ensure the optimal independent functioning of older persons.

Four Provinces, namely Mpumalanga, Gauteng, Northern Cape and Western Cape indicated a commitment to take part in the proposed pilot projects. The Northern Cape is selected to be involved due to the specific needs of the province.

It is important to take cognisance of the fact that the pilot projects will make a valuable contribution to the costing of the White Paper and the development of a model for project funding.

2.3 Assessment of older persons for admission to frail care facilities. (Dependency Questionnaire. DQ 98)
In order to optimise the utilisation of homes for older persons (frail care facilities) the Department of Welfare initiated the development of an instrument to determine the need for frail care.

The DQ 98 was developed by a multi disciplinary task team and was tested nation wide during 1997 by the Geriatrics Unit (Department of Medicine. University of Cape Town) The finalisation and the implementation of the DQ 98 is an important milestone in the transformation of services for older persons. The successful implementation of the instrument will have a meaningful impact on the reprioritisation of the Welfare budget.

The DQ 98 is a "first" of its kind in the world. It not only assesses the dependency of older persons, but also take into account the accessibility of basic services such as water, etc and the capacity of support systems. The DQ 98 can also be utilised to determine the needs of persons with special needs in the community.

2.4 Norms and standards for frail care in residential care facilities.
A draft set of criteria for frail care has been developed in collaboration with the
Department of Health, Prof D Wicht (Department of Medicine, University of the Free
State), multi disciplinary team from the Medical School of the University of the Free
State and Prof Majet (Emeritus professor, University of Natal).

The criteria will be workshopped with a number of practitioners in the field of ageing. The criteria will make a meaningful contribution to contain the cost of frail care and will also provide a user friendly framework for inspections.

2.5 New legislation to protect and promote the dignity and well-being of older persons
The Aged Persons Act, 1967 (Act 81 of 1967) was previously administered by the Department of Welfare. However, the administration of the whole of this Act, excluding sections 5,6 and 16, has been assigned to the Provinces by Proclamation R7 in Government Gazette 16992 of 23 February 1996. The assignment of the Act implies that the Provinces individually can draft a new Act or amend the current Act. The Department of Welfare however has the power to draft a new Act.

The Minister for Welfare and Population Development as well as the Department are on record that the Aged Persons Act (Act 81 of 1967) is no longer appropriate. The current legislation is totally outdated and does not reflect the values as embodied in the Constitution as well as the new approach to ageing. The current legislation cannot therefore only be amended. A new set of appropriate legislation, with the focus on empowerment as well as protection, should be drafted as a matter of urgency. The Department prefers the drafting of new legislation, rather than amending the current legislation.

The Department and the Minister for Welfare and Population Development are, as indicated, not in support of amending the existing legislation and are committed to the drafting of new and appropriate legislation, which will repeal the current Act as well as the assignment of the current Act to the Provinces. The new Act will form part of comprehensive welfare legislation. The social integration and empowerment of older persons will be the primary focus of the International Year for Older Persons, 1999. The development of effective mechanisms to protect the dignity of older persons and to empower them to make a meaningful contribution to family and community life is regarded as a priority for 1998/99. The relevant National Councils and interest groups have been invited to submit proposals for new legislation to the Department and to participate in the piloting of an ombuds system. The closing date for the submission is 29 May 1998.

The current legislation, as mentioned, is totally outdated. It therefore serves no purpose to just amend the current legislation. Appropriate legislation cannot be drafted within the paradigm of the current legislation. The amendment of the Aged Persons Act (Act 81 of 1967) implies that the current legislation is regarded as the point of departure. It is merely impossible to develop new and appropriate legislation within the paradigm of Act 81 of 1967. A fresh approach is a prerequisite for the development of effective legislation.

2.4 Establishment of an ombuds system for older persons
The ideal is to bring protection as close as possible to the older people. One of the options to address abuse and neglect in residential care facilities, community based care and support facilities and housing schemes will be the appointment of voluntary ombudspersons on management committees or boards of trustees, in order to protect older persons against abuse and neglect. The ombudspersons will be elected by the residents of frail care centres, their families, the recipients of services as far as community based services are concerned, or the community, and will have access to all relevant information, the older persons in receipt of services and the staff. Complaints will be investigated by the ombudsperson and not the matron or manager of the service. The advantages of voluntary ombudspersons on the boards of trustees or management committees will be that the control is vested in the community and near to the place of possible abuse and neglect. It is affordable and will promote the principle of community involvement. A commitment by a community to accept the responsibility for the protection of the dignity of their older members will foster a culture of respect. A legal framework can then be developed to deal with perpetrators in order to strengthen the efforts of the community to protect their older members against abuse and neglect. It is important to take cognisance of the reality that there is no guarantee that all older persons will be protected by the proposed ombuds system. The majority of older persons are not recipients of services rendered by welfare organisations, NGOs or CBOs. The election of voluntary ombudspersons on the boards of management will be a natural extension of the proposed welfare ombudsperson on community level

Strategy for the drafting of new legislation on ageing
The focus of the International Year of Older Persons in South Africa will be the protection and promotion of the well-being of older persons. The Discussion Group on Ageing has, in collaboration with relevant national stakeholders, developed a draft strategic plan for the planning of the International Year of Older Persons. The development of a mechanism to protect and promote the well-being of older people is identified as a priority.

It is also envisaged that South Africa will be requested by the United Nations to ratify Resolution 46/91 of 16 December1991 during 1998. Resolution 46/91 is commonly referred to as the declaration of the rights of older people. The ratification of Resolution 46/91 will have a definite impact on the focus of new legislation. The proposed policy framework on Ageing is based on the principles reflected by Resolution 46/91.

All relevant stakeholders on national level have been requested to submit proposals for new legislation to the Department and invited to participate in piloting the ombuds system. The inputs from the stakeholders will be consolidated in a discussion document, which will be consulted with the relevant stakeholders and interest groups.

It is envisaged to have a first draft of the new Act ready by November 1998.

3 INTERNATIONAL YEAR FOR OLDER PERSONS, 1999.
1999 is not only an important date on the international agenda to promote the interest of older persons, it will also be the first time that the Government participates in the commemoration of the International Year for Older Persons. The involvement of the Government in the International Year for Older Persons not only illustrates recognition for the important contribution older persons made to our new founded democracy, but is a reminder that South Africa is fully accepted as a an important international role player in the development of policy and strategies to improve the quality of life of older persons.

The Department of Welfare is the lead department and facilitates the planning of the International Year. In order to ensure the involvement of civil society, all stakeholders, interest groups and a number of older persons have been invited to participate in the planning of the International Year. A three tier approach will be followed to ensure the involvement of all organs of society at all levels. A National Organising Committee will be responsible for the planning on national level. Provincial Organising Committees will facilitate the planning on provincial level and Local Organising Committees will take responsibility for planning on local level. The involvement of older persons at all levels is regarded as non negotiable.

The focus of the International Year will be on the empowerment and protection of older persons. The development of new and appropriate legislation is regarded as a priority.

Compiled by: Dr CM van den Heever (Director: Special Needs)
Date: 28 April 1998.

Annexure 2:
BRIEFING BY THE DEPARTMENT OF WELFARE REGARDING DISABILITY

INTEGRATED NATIONAL DISABILITY STRATEGY
The White Paper on an Integrated National Disability Strategy (INDS) puts an emphasis on integration of disability issues by all government departments in their development strategies.

Key policy areas identified include: prevention, health care, rehabilitation, public education, barrier free access, transport, communications, data collection & research, education, employment, human resource development, SOCIAL WELFARE AND COMMUNITY DEVEL OPMENT, SOCIAL SECURITY, housing and sport & recreation.

LEGISLATION
A document released by the United Nations General Assembly in 1993 stipulates that "States have a responsibility to create the legal basis for measures to achieve the objectives of full participation and equality for persons with disabilities"

The Constitution of South Africa, chapter 2 Clause 9 prohibits any form of discrimination, including disability.

DEPARTMENT OF WELFARE
The Department of Welfare is implicated and involved in the areas printed in bold and responsible for those in italic capital letters. While there are specific Departments attending to the issues either individually or in groupings, eg. the Department of Health is responsible for the first four areas, it is clear that no single Department can fulfil its responsibilities all on its own. Disability demands an integrated approach.

a) The Role of the Office on the Status of Disabled People
The Office on the Status of Disabled People (OSDP) has a co-ordinating role, ensuring that all Government Departments have a budget for Disability.

The previously held notion that disability is a Health and Welfare matter is irrelevant and inappropriate. As stated earlier, the integrated approach demanded by disability nullifies this notion, though not easily internalised in some Departments.

b) Department of Health
A process initiated by the Department of heath in 1997 has set the stage for developing interlinking policy between Government Departments. The development of Community-based Rehabilitation will have different departments' perspectives. Health has a draft policy on CBR, with specific identifications for other Departments' roles, which will be expatiated on by the respective departments.

c) Department of Education
The Department of Education recently released the report of the National Commission on Special Needs in Education and Training, with recommendations pertaining to Education for Learners with Special Education Needs (ELSEN) which includes learners with disabilities. There are specific Welfare related matters in the report in relation to support for the individual with a disability.

d) Department of Labour
Employment of people with disabilities is a thorny issue both in the open labour market and workshop (sheltered and protective) environment. The Department of Labour maintains that sheltered workshops do not form part of their core business, but accepting responsibility for vocational training and work placement. The Department of Welfare is subsidising protective workshops, a responsibility implemented at Provincial level, with dissatisfaction from the recipients of the subsidies. In recent discussions between Labour and Welfare it became clear that employment in these workshops needs fundamental transformation that will lead to them becoming self reliant, profitable and have a developmental approach to benefit the disabled person.

In all the three instances sighted above one fact merged often - that disability requires an integrated approach. A possible solution identified lies in an interdepartmental committee with sufficient commitment and authority to monitor the chain of responsibilities in any given situation.

A model indicating the inter-relatedness of policy in disability was developed by Welfare during 1997, accepted by the interdepartmental committee on disability. See attached copy.

If the nondiscrimination clause of the Constitution is to be operationalised, it is necessary that the tasks and social participation required by the natural developmental stages in a human being, from birth onwards, be taken into consideration.

e) Operationalisation of the White Paper on the INDS
1. Parent empowerment
Early identification and intervention would normally be the domains of Health. However, if sufficient knowledge and awareness of parents and family are absent, whatever measures put by Health may be unsuccessful. The Department of Welfare is entering into a partnership with Disabled Childrens' Action Group (DICAG) to implement a pilot project on empowering parents and caregivers of children with disabilities to enable them to respond to the needs of the children. The project will also have education elements, especially at the Early Childhood Development (ECD) stage. Besides Welfare, Education and Health, the need for Transport is also indicated.

2. Economic empowerment
Beyond the school going age, economic empowerment (employment being one method) was identified as another key area for immediate attention. The Medunsa Organisation for Disabled Entrepreneurs (MODE) is engaged in discussion with the Department of Welfare to implement another pilot project aimed at transforming workshops. The Department of Labour and Trade and Industry indicated interest in the project with negotiations with MODE already at an advanced stage. Education and Transport also have a role to play in the project.

It is clear from the two pilot projects above the interdepartmental collaboration is imperative. The pilot projects will inform welfare on developing policy for CBR from a Welfare perspective. The possibility that other Departments' roles will be identified through implementation cannot be ruled out.

CONCLUDING REMARKS ON LEGISLATION
Legislation on disability cannot, therefore, be the responsibility of a single Department. The recommendations in the White Paper for the INDS clearly indicate responsibilities of various Departments. Each Department has a responsibility to develop policy on its specific area of responsibility.

The principles of the White Paper for Social Welfare encompass aspects of the
Constitution on Human Rights, Democracy, Transparency, Non-Discrimination and
Equity. The broader concepts of Ubuntu, People Centredness, Partnership and
Intersectoral Collaboration prescribe the transformation processes that must be
adopted for social developmental services.

The Department of Welfare will prepare a draft policy on CBR, to be informed by the pilot projects, towards the end of the 1998/99 financial year.

Social services and community development hold the key to breaking the cycle of poverty that many people with disabilities are trapped in. An integrated approach -intra- and interdepartmentally as well as intersectorally, will facilitate social integration of people with disabilities.


THE RELATIONSHIP BETWEEN THE DEPARTMENT OF WELFARE AND THE
OFFICE ON THE STATUS OF DISABLED PEOPLE IN THE OFFICE OF THE
DEPUTY PRESIDENT

THE OFFICE ON THE STATUS OF DISABLED PEOPLE (OSDP)
The White Paper on an Integrated National Disability Strategy (INDS) was launched on 3 December 1997 by the Deputy President, T M Mbeki. The vision proposed in the INDS is a society for all, with emphasis on integration of disability issues by all
government development strategies.

Key policy areas identified include: prevention, health care, rehabilitation, public education, barrier free access, transport, communications, data collection & research, education, employment, human resource development, SOCIAL WELFARE AND COMMUNITY DEVEL OPMENT, SOCIAL SECURITY housing and sport & recreation.

The Department of Welfare is implicated and involved in the areas printed in bold and responsible for those in italic capital letters. While there are specific Departments attending to the issues either individually or in groupings, eg. the Department of Health is responsible for the first four areas, it is clear that no single Department can fulfil its responsibilities all on its own. Disability demands an integrated approach. While the Department of Health is responsible for health and physical rehabilitation, the Department of welfare takes the responsibility for social rehabilitation - helping the individual with a disability integrate socially, within various spheres of social life.

The identified role of the OSDP is co-ordination and ensuring that each Government Department has a budget for Disability issues.

THE DEPARTMENT OF WELFARE
The Department of Welfare is one of the key participants in an Interdepartmental Committee on Disability, co-ordinated by the OSDP. Some of the issues currently on the agenda of the committee are education and employment of people with disabilities. It is a historically known fact that Welfare in South Africa plays a major role in the two areas, even though responsibilities lie in the Departments of Education and Labour.

Disability has always been viewed as a Health and Welfare matter for a long time. With the advent of the new Government dispensation, enabling mechanisms are in place for all people with disabilities to occupy their rightful places in society. Disability is a Human Rights issue, and this fact must be imbedded in the policies of all Government Departments.

The White Paper on the INDS attempts to achieve this view through the 21 Recommendations, which total 61 when taking the subsections into consideration. The Department of Welfare is responsible for recommendations 12 and 13, which are for Social Welfare & Community Development and Social Security respectively. However, the Department is implicated in 19 other recommendations and subsections which require serious attention.

The principles of the White Paper for Social Welfare encompass aspect of the
Constitution on Human Rights, Democracy, Transparency, Non-Discrimination and
Equity. The broader concepts of Ubuntu, People Centredness, Partnership and
Intersectoral Collaboration prescribe the transformation processes that must be
adopted for social developmental services.

The Department of Welfare has a Sub Directorate for Disability. An attempt was made to address some of the key areas in the current business plan for 1998/99. The main thrust of the plan is to enhance family life and social integration, reducing the institutionalisation wherever possible.

VISION
Equal opportunities for people with disabilities.

MISSION
Facilitate the social integration of people with disabilities in consultation and partnership with Disabled People's Organisations and national stakeholders.

STRATEGIC OBJECTIVES
1. Promote integration and participation of children with disabilities into society
2. Promote and facilitate the socioeconomic empowerment of people with disabilities
3. Operationalise recommendations of the White Paper on the National Integrated Disability Strategy
4. Liase with international organisations
5. Provide general support and advice

Objectives 1 and 2 will be addressed through partnerships with Disabled Children's Action Group (DICAG) and Medunsa Organisation for Disabled Entrepreneurs (MODE) respectively, since the Department does not have the human resource capacity to fulfil them.

DICAG will oversee a pilot project in Venda on empowering parents to be responsive to their children's needs. Parents are the best advocates for their children, more so if they have disabilities. The Northern Province Department of Health and Welfare has bought into the project, and the National Department of Transport intends implementing a pilot project linked to the DICAG on.

The Department is subsidising protective workshops for people with disabilities. These workshops need to be transformed to be of lasting benefit to the individual with a disability. The engagement of MODE is at an advanced stage, to implement a pilot project that will include vocational and entrepreneurship skills training.

The pilot projects will inform development of policy on Community-based Rehabilitation.

Social services and community development hold the key to breaking the cycle of poverty that many people with disabilities are trapped in. An integrated approach - intra and interdepartmentally as well as intersectorally, will facilitate social integration of people with disabilities.