A society in which persons are enabled to age with security and dignity and to continue to participate in their societies as citizens with full rights.

The Plan of Action adopted at the 2^nd World Assembly on Ageing focuses on three priorities, namely (A) Older persons and development; (B) Advancing health and well-being into old age; and (C) Ensuring enabling and supportive environments. Although addressed in terms of these priorities, it was decided for the purposes of this policy framework, to extract and expand on two additional priorities in the South Africa context. These are enhancing protection for older persons and residential facilities for older persons.

The need for a new dispensation is necessitated by several factors:

1. A significant percentage of the social development budget is being spent on care of the aged. This is being allocated specifically to residential care for a minority of the ageing population, which is in effect to the detriment of community-based services for older persons and their families;
2. There is an inequitable provision of services to disadvantaged communities;
3. Policy for older persons should be in concurrence with the overall programme of social reconstruction and development;
4. The provisions of the Plan of Action adopted at the 2^nd World Assembly on Ageing at Madrid in April 2002 require implementation.
5. The proportion of persons aged 60 and above is increasing at an unprecedented rate, given the impact of a declining birth rate as well as the increasing mortality rate of younger persons infected by HIV/AIDS.

The guiding principle for this policy on ageing is that older persons should be enabled to enjoy an active, healthy and independent life as part of a family and a community for as long as long as possible. The new dispensation recognises the importance of strong and open partnership between government, non-governmental, welfare and religious organisations within a caring and enabling society. The policy framework spells out the responsibilities of the partners. The government's responsibility regarding the plight of destitute, poor, frail older persons and the very old is confirmed and non-negotiable. Simultaneously, it is recognised that older persons are inextricably linked with their families and communities, who with government should share responsibility for their well-being.

This approach is holistic and positive, recognising ageing as a normal phase of life and that older persons have special needs and the right to be treated with dignity and respect. This approach reflects a positive management of ageing. Five goals are identified to ensure an effective transformation from the "care of the aged" paradigm to a more proactive "management of ageing":

1. Acknowledgement of and respect for the linguistic, cultural and religious diversity of older persons;
2. Income security and provision of social assistance;
3. Appropriate and affordable accommodation;
4. Comprehensive, integrated community-based support and care;
5. Recognition of older persons as full and equal citizens and social integration through use of their skills and expertise.

(A) From the World Assembly Plan of Action emerged eight issues concerning older persons and development, each of which it proposed to address in terms of one or more objectives:

1. Active participation in society and development, to be achieved by recognition of the social, cultural, economic and political contribution of older persons, and their participation in decision-making processes at all levels.
2. Work and the ageing labour force, to be facilitated by the promotion of employment opportunities for all older persons who want to work.
3. Rural development, migration and urbanisation, to be addressed by the improvement of living conditions and infrastructure in rural areas; alleviation of the marginalisation of older persons in rural areas; and integration of older migrants within their new communities.
4. Access to knowledge, education and training, to be addressed by promoting equality of opportunity throughout life with respect to continuing education, training and retraining as well as vocational guidance and placement services; and full utilisation of the potential and expertise of persons of all ages, recognising the benefits of increased experience with age.
5. Intergenerational solidarity, the objective being to strengthen solidarity through equity and reciprocity between generations.
6. Eradication of poverty amongst older persons.
7. Income security, social protection/social security and poverty prevention, to be achieved through the promotion of programmes to enable all workers to acquire basic social protection/social security, including where applicable, pensions, disability insurance and health benefits; and the provision of sufficient minimum income for all older persons, paying particular attention to socially and economically disadvantaged groups.
8. Emergency situations, the objectives being to facilitate equal access by older persons to food, shelter and medical care and other services during and after natural disasters and other humanitarian emergencies; and enhanced contributions of older persons to the re-establishment and reconstruction of communities and the rebuilding of the social fabric following emergencies.

(B) With regard to advancing health and well-being into old age, six issues were identified:

1. Health promotion and well-being throughout life, with three specific objectives, namely reduction of the cumulative effects of factors that increase the risk of disease and consequently potential dependence in older age; development of policies to prevent ill-health among older persons; and access to food and adequate nutrition for all older persons.
2. Universal and equal access to health care services, with four objectives in mind, namely, elimination of social and economic inequalities based on age, gender or any other ground including linguistic barriers to ensure that older persons have universal and equal access to health care; development and strengthening of primary health care services to meet the needs of older persons and promote their inclusion in the process; development of a continuum of health care to meet the needs of older persons; involvement of older persons in the development and strengthening of primary and long-term care services.
3. Older persons and HIV/AIDS, the three objectives being improvement in the assessment of the impact of HIV/AIDS on the health of older persons, both for those who are infected and older persons who are caregivers for infected or surviving family members; provision of adequate information, training in caregiving skills, treatment, medical care and social support to older persons living with HIV/AIDS and their caregivers; and enhancement and recognition of the contribution of older persons to development in their role as caregivers for children with chronic diseases, including HIV/AIDS, and as surrogate parents.
4. Training of care providers and health professionals, by means of the provision of improved information and training for health professionals and para-professionals on the needs of older persons.
5. Mental health needs of older persons, the objective being the development of comprehensive mental health care services ranging from prevention to early intervention, the provision of treatment services and the management of mental health problems in older persons.
6. Older persons and disabilities, the objective being the maintenance of maximum functional capacity throughout the life course and promotion of the full participation of older persons with disabilities.

(C) Achievement of the final priority identified at the World Assembly, ensuring enabling and supportive environments, is to be addressed in terms of four issues:

1. Housing and the living environment, the intention being the promotion of "ageing in place" in the community with due regard to individual preferences and affordable housing options for older persons; improvement in housing and environmental design to promote independent living by taking into account the needs of older persons, particularly those with disabilities; and improved availability of accessible and affordable transportation for older persons.
2. Care, and support for caregivers, the objectives being provision of a continuum of care and services for older persons from various sources and support for caregivers; and supporting the care-giving role of older persons, particularly older women.
3. Neglect, abuse and violence, the two objectives being elimination of all forms of neglect, abuse and violence of older persons; and creation of support services to address elder abuse.
4. Images of ageing, the objective being enhancement of public recognition of the authority, wisdom, productiveness and other important contributions of older persons.

To a degree, the three priorities identified at the Madrid Conference (A, B and C above) address the needs of older persons at different stages of life. Whereas the "development" component may be of greatest pertinence to younger old persons, the "health" and "supportive environments" might be more closely associated with the particular needs of the oldest and frailest amongst the broad older persons category. The role and importance of faith-based, non-government and community-based organisations in making inputs into the well-being of older persons’ lives at all three of these overlapping stages to which allusion is made above, is critical.

Of great pertinence to the South African context is that comprehensive home care services to older persons, addressing basic needs, should be an integral part of community-based services. Stakeholders and communities should be informed of this shift to community support and care. Resources are to be equitably distributed in accordance to the primary needs to older persons, funding being directed to the poorest and most vulnerable persons.

Interdisciplinary assessment units should be established at district level to ensure that needs are prioritised, that services are both needs driven and accessible, and that there is effective assessment of frail older persons. Appropriate and professionally sound admission criteria for care facilities must be developed. Facilities and services established for persons with lower incomes and managed with government and public funds must remain accessible to this group. Arrangements for the provision of such services should be made collaboratively between local government, NGOs, FBOs and other service providers and accountability structures should be established at local level. Criteria for future planning regarding the establishment of frail care facilities is limited to 2% of the aged population. Local authorities are to ensure that the needs of older persons are met in the rendering of services and town planning.

An agenda for research priorities should be established in collaboration with existing research institutions and universities. A representative forum on ageing should be established to ensure effective public-private planning and co-ordination on all ageing matters. An effective communication strategy and network to inform all stakeholders and communities of developments and of the shift towards community support and care should be implemented.

Finally, the vulnerability of older persons in many spheres of life should be recognised and addressed wherever possible. In particular, special attention needs to be given to vulnerable groups amongst older people, such as the childless, never-married, widowed and divorced persons.

All existing legislation that contravenes or contradicts the spirit of this new policy on Older Persons should be brought into conformity with the provisions of the new policy.

Income Tax Act, No. 58 of 1962. (amended: 32 of 1999.)

Restitution of Land Rights Act, No. 22 of 1994.

Maintenance Act, No. 23 of 1963.

Health Act, No. 63 of 1977.

Social Assistance Act, No. 59 of 1992. (Proclamation No. 8 of 1996)

Housing Development Schemes Act for Retired Persons, No. 65 of 1988.

The following documentation impacts directly on the protocol on elder abuse.

Older persons shall receive preferential treatment when it comes to public facilities. To ensure independent living and access to transport, the Department of Transport in collaboration with local government should provide subsidised public transport for older persons and free emergency ambulance services. This and other departments should establish desks that promote the user-friendliness of their services and the dignity of their older person clients in particular. Similarly, the Departments of Justice, Housing, Health, Safety and Security and others should facilitate the access of older persons to services under their jurisdiction.

The lack of adequate reliable and valid information regarding the well-being of older persons and services rendered to them is a critical blockage in the development of sound policies, legislation and programmes. A comprehensive audit of services rendered to older persons should thus be undertaken in order to establish a reliable and valid data bank to facilitate the further development of sound and appropriate policies, programmes and legislation.

The content of this chapter is based on a status report developed by Statistics South Africa; research on ageing trends in South Africa by Ferrari and Kindles; the 1998/1999 Annual Statistical Report of the Department of Social Development; a research report on elder abuse in black townships on the Cape Flats by the Centre for Gerontology (UCT); and interim results from a 2001 departmental audit of old age residential facilities.

Hitherto, eligibility for an old age grant has been gender differentiated, with females qualifying at age 60 and males at age 65. However, international consensus is moving towards a universal definition of older persons as those being aged 60 and above. In order to conform to international norms and as a means of increasing the social security net in South Africa, 60 should be accepted as the lower age limit for older persons of both genders in South Africa.

The October 1996 population census enumerated a total of 40,5 million people. Seven percent of the population was aged 60 years or older. This proportion is substantially lower than in the developed world, where the equivalent proportion is as high as 19% in Italy. It is marginally lower than the average proportion (8%) in equivalent developing countries, but higher than the average for Africa (5%), which has a very young population in comparison with the rest of the world.

The proportion of older persons in South Africa varies considerably between the nine provinces. The lowest relative proportions of older persons are in the two adjacent provinces of Mpumalanga (5,9%) and Gauteng (6,3%). The highest proportion, by a considerable margin, is in the Eastern Cape (8,4%). This is an indication of the economic vulnerability of the Eastern Cape population, with its relatively low proportion (51,4%) in the 15 to 59 year old (potentially economically active) category and exceptionally high proportion of dependant 0 to 14 year olds (39,3%), the highest in the country.

In terms of overall distribution of older persons, the largest concentrations are in KwaZulu-Natal (19,6%) and the Eastern Cape (18,8%). National resource allocations to older people should thus be based on these proportions. Another three provinces also have high concentrations of older persons, namely Gauteng (16,2%), Limpopo (12,4%) and the Western Cape (10,7%). In the cases of Gauteng and the Western Cape, however, these older persons have the benefit of larger proportions of 15 to 59 year olds than do those living in KwaZulu-Natal, the Eastern Cape and Limpopo.

Approximately 430 000 (23,1%) of older persons are disabled. The most common disability is the loss of sight (47,1%) followed by physical disabilities (20,4%). More than one-quarter (28,2%) of black older persons are disabled, in comparison with 10,5% of white older persons. The proportion of disabled amongst older women is 23,1%.

The proportional and absolute growth in the number of older persons, and especially the very old is of critical importance. This trend will inevitably have major policy and budgetary implications for the government. Content from the research report "Ageing Trends: South Africa", which includes a comprehensive analysis of the demographic changes in South Africa, has been included in this chapter.

The provincial departments of social development report that in the 1998/1999 financial year they subsidised 474 homes, with the overall capacity to accommodate 42 952 older persons. There were a further 7 state run homes with a capacity to accommodate 1083 older persons. The distribution of old age residential facilities is disproportionately in the wealthier provinces of Gauteng and the Western Cape (17%), with a distinct lack of facilities in poorer provinces such as Limpopo.

Services to older persons vary according to the level at which they are required. The following three chapters of the policy document outline the scope of issues and services that require attention at each of the three identified levels:

Level 1: Promotion and maintenance of independent living and active ageing.

Level 2: Prevention of continuous dependency.

Level 3: Continuous care.

The types of service required are to be determined primarily by the basic needs of older persons. Social integration, optimal independent living, promotion and the maintenance of the dignity of older persons as well as the prevention of social isolation are regarded as important outcomes of all services rendered to older persons.

The optimal utilisation of all resources is fundamental to the success of integrated community-based support and care services. Although the services should be developed to meet the specific needs of older persons, they would not be for their exclusive use. All persons in need of services that are or can be provided by the care and support system should be accommodated. The intergenerational nature of the services provides opportunities for the social integration of older persons as well as the transfer of skills and cultural practices.

Optimum operation of the three levels of service is predicated upon certain principles:

• The family, in its diverse forms, is the fundamental unit of society linking the generations and should therefore be maintained, strengthened and protected in accordance with traditions and customs.
• Older persons should have access to primary health care, curative care, welfare and other care and support systems in order to maintain their optimal level of physical, mental, spiritual and emotional well-being.
• Throughout their lives, all persons have a personal responsibility to contribute to their social and financial independence.
• Where independence is unattainable, the family, community and all spheres of government (national, provincial and local) have a shared responsibility to provide the necessary care and support.
• Services should enable older persons to remain independent and self-supporting for as long as possible.
• One-stop multipurpose service centres that provide a range of government services should be provided.
• Government should proactively support programmes that promote the provisioning and preparation for old age; supports promotion of a caring society; support NGOs, FBOs, CBOs and self-help groups to assist older persons; provides finance services to the poor to promote dignity and independent living; promotes sustainability by means of Old Age Grants, Child Support Grants; and develops mechanisms to protect older persons against neglect, abuse and exploitation.

As a developing country, South Africa needs to take seriously every aspect of development in its broadest sense, including the impact of and opportunities presented by the growing population of older persons. Although more people are reaching greater ages, many live in poverty and experience poor health, disabilities and discrimination. Nevertheless, older persons make a significant contribution to development through their families and communities. The voices of older persons express the desire to be of worth. The challenge is thus to create opportunities, to eliminate ageist discrimination and to facilitate full participation of older persons in the social, economic, cultural and political life of the nation.

Differences in quality of life and household income between urban and rural areas are stark. Almost three-fifths (59%) of households in urban areas have a water tap inside their homes, in comparison with only 9% of rural households (Statistics SA, 1999). Similarly, 50% of urban households, but only 10% of rural households have telephones. Nineteen percent of town dwellers are sometimes not able to feed their children every day. This is the case with 28% of rural households. This impacts heavily on older persons, who are disproportionately represented in certain rural areas, notably the Eastern Cape and to a lesser extent, Limpopo, where they are frequently left to care for grandchildren by their adult children who migrate to urban areas for work. Overall, poverty is distributed unevenly among the nine provinces of the country. The Eastern Cape, Limpopo, KwaZulu-Natal and the Free State have by far the highest poverty rates. In line with poverty distribution by provinces, 72% of poor people in South Africa live in rural areas, and 70% of all rural people are poor. Within both urban and rural areas themselves the situation is highly stratified, either spatially (i.e. specific pockets of extreme poverty), or by target group (e.g. women and children, older persons and the disabled). Rural communities are also highly dispersed and this presents difficulties in accessing appropriate levels of support or service. Some of the noticeable ways in which poverty manifests itself relate to issues of food insecurity, low income levels, unemployment and underemployment, social crime and HIV/AIDS, limitations of existing social assistance and reduced asset bases.

Food insecurity is one of the major indicators linked to poverty and vulnerability. For those members of society who are dependent on cash payments from government, most use these grants to improve food security. It is estimated that 39% of the population is vulnerable to food insecurity (Statistics SA, 1999), in spite of the state injection of cash into the household budgets of poorer people.

Increasing food production through the sustainable development of the agricultural sector, together with improvement of market opportunities and access to food by low-income people in developing areas should be regarded as national priorities. Existing programmes to alleviate poverty, eliminate malnutrition and raise standards of living should be complemented substantially. The availability of sufficient nutrition to older persons specifically, should be ensured through appropriate food schemes and the encouragement of older persons in the development of food production.

Education of the public, including older persons, in respect of correct nutritional and eating habits is important. Government should be aware of the knowledge gap with regard to the nutritional status and food poverty situation of older persons. A balanced and affordable diet to prevent dietary deficiencies, disease and disability should be facilitated through the development of national minimum dietary goals.

Older people are especially vulnerable to emergency issues, including food emergencies that arise from natural disasters, such as floods and droughts. Emergency situations usually pose a major risk to food security, access to food supplies, shelter and medical health care. In rural areas, emergency situations may even pose a bigger threat to older persons than in urban areas, owing to the state of infrastructure and basic services that do not sufficiently cater for major emergencies. Older persons are generally much less able to cope with emergency situations because of their physical vulnerability. Older persons should thus be consciously and deliberately targeted to ensure their equal and easy access to food, shelter and life-sustaining services and facilities during and after natural disasters and other humanitarian emergencies.

Current policy on social grants is based on Section 27(1) (c) of the Constitution, which entitles all citizens to social security and if they are unable to provide for themselves, to social assistance. The term social security is often used to include social assistance. The domains of social security are: poverty prevention, poverty alleviation, social compensation and income distribution. Many issues related to social security are sensitive as they touch on the material interests of organised workers and the unorganised poor, as well as the insurance industry and employer organisations.

The current forms of social assistance in South Africa include Old Age Grants, Disability Grants and Child Support Grants. Though social assistance is not aimed at meeting the total needs of the recipients, it is a means of enabling the most basic needs to be met. People who are unable to support themselves are eligible to access social assistance. Older persons who have applied for grants are eligible to receive food parcels until they are receiving their grants.

Awareness campaigns should be implemented to inform older persons about the grants for which they are eligible and the documentation that is required in order to apply for such grants.

Collaboration with the Financial Services Board to synchronise legislation and policies on contributory pension schemes to provide for a safety net continuum for older persons, thereby addressing the causes of dependence on social assistance.

Research must be conducted on the impact of the Old Age Grant on households and on the reasons for the high dependency by older persons on social assistance.

Social grants are insufficient to sustain older persons and there needs to be intersectoral collaboration between government departments and the business sector to maximise benefits to older persons.

Public Education programmes should be provided to promote retirement planning, thereby reducing the burden placed on the state to provide retirement benefits in the future.

Older persons who migrate to different provinces for various reasons should be able to have their grants easily transferred for payment.

Retirement age should not be mandatory but flexible thus allowing older persons to stay in employment for longer.

A new retirement scheme should be developed for self-employed people, people in the informal sector and others who choose to join. The emphasis should be on appropriateness to the economic realities of non-formal employment.

Government provides a contributory Government Employee Pension Fund (GEPF) to public servants. Individuals working in the private sector are expected to take responsibility for their own retirement through private savings such as retirement annuities and endowment insurance policies. The Smith Committee estimates that some 80% of formally employed workers are covered by retirement funds.

The South African Revenue Services (SARS) should be able to identify non-contributing employees. An appropriate enforcement mechanism should be instituted to ensure that all employers contribute to an approved retirement fund. Provision should be made to take action against employers who fail to comply.

Retirement funds’ rules should be amended so that benefits may be transferred on a member’s withdrawal to their new employers fund, or a retirement fund of the member’s choice, if the member remains in employment in the formal sector, thereby ensuring that members do not continue to withdraw their benefits when changing jobs.

The importance of adequate planning for retirement should be highlighted to young and middle-aged adults. This will pre-empt the necessity for costly investments much later in the working career. Planning should incorporate the financial dimension of ensuring the provision of an income that will be appropriate to sustain the lifestyle to which people aspire when they are no longer economically active.

Retirement Annuities are popular saving vehicles, particularly for self-employed people or for those people who do not have a pension fund. The government offers a tax incentive to purchase a Retirement Annuity, thereby reducing personal tax liability. Section 11(n) of the Income Tax Act states that the following amounts will be tax deductable: "So much of the current contributions to any retirement annuity fund or funds made during the year of assessment by any person as a member of such fund or funds as does not in the case of taxpayer exceed the greatest of 15% of non-retirement funding income, or R3 500 less allowable pension fund contributions, or R1 750." This monetary limit for current deductible contributions to an approved retirement annuity fund has remained static since 1978 and is due for revision. The monetary limits for all taxpayers should be set at a minimum of R4 000 per year. Such a revision would help improve the low levels of personal savings in the economy and assist middle to lower income earners and the self-employed to provide for their retirement.

The Immigration Bill (paragraph 13) proposes that a retired person permit may be issued for a period exceeding three months to a foreigner who is older than 60 and intending to retire in South Africa, subject to two financial criteria. Firstly, the person should have the right to a pension, irrevocable annuity or retirement account that entitles him/her to a prescribed minimum payment for the rest of his/her life. Secondly, that the person should have a minimum prescribed net worth. Additionally, the Bill proposes that once issued with a retired person permit, the person may be permitted by the Department of Home Affairs to work under terms and conditions that it would determine. The permit would have to be renewed at least every four years. Immigrants would therefore not be eligible to receive Old Age Grants from the South African government.

Programmes that facilitate the integration of older migrants into the social, cultural, political and economic life of South Africa should be encouraged. In particular, language (including sign language) and cultural barriers to older migrants in public services should be eliminated.

Early retirement effectively constitutes a loss of valuable human resources to the economy. In a developing country like South Africa, this contention must be balanced against the critical shortage of formal employment opportunities and the consequent massive unemployment levels, especially amongst youth.

Social security and employment policies with regard to retirement ages should be coordinated in order to eliminate disjuncture. In South Africa, few people retire with sufficient means to live independently and comfortable retirement is a rare luxury. Worldwide more than 50% of older persons are excluded from any form of social security. Growth of employment is a specific requirement for the promotion of active older persons’ lifestyles. In the context of a growing economy, the employability of older persons can be improved by lifelong learning, especially IT training and by ensuring adequate and safe working conditions. Age diversity can and should be used as an enhancement to business.

In line with the provisions of the Constitution, older persons should have the right to work and to retire and there should be no discrimination against older persons in the labour market. No employer should be permitted to discriminate against any older person in relation to the advertisement of or recruitment for employment, or the creation, classification or abolition of jobs or posts. Similarly, age should have no bearing on the determination or allocation of wages, salaries positions, accommodation, leave or other such benefits; the choice of persons for jobs or posts, training, advancement, apprenticeships, transfer, promotion or retrenchment; or the provision of facilities related to or connected with employment. Proper trained medical staff in occupational medicine should be available to protect and treat employees.

Further provisions to facilitate employment for older persons would be that the retirement age should not be lowered except on a voluntary basis and measures should be taken to prevent industrial and agricultural accidents and occupational diseases. Pension and provident funds should introduce greater flexibility in their policies in order to accommodate members who wish to work beyond the age of 60 or 65, and to continue contributing to such funds. Employers should be required to take measures to ensure a smooth and gradual transition from active working life to retirement and make the age of entitlement to a pension more flexible. It should be recognised that older persons, both as individuals and as a group, have a range of resources that should be explored, catalogued and put to effective use. Retirement should not be mandatory and special placement and career counselling services should be available for older workers.

In view of the provisions of the Constitution, every possible effort should be made to eliminate ageism in any form. Section 9.3 of the Constitution indicates that "the state may not unfairly discriminate directly or indirectly against anyone on one or more grounds, including race, gender, sex, pregnancy, marital status, ethnic or social origin, colour, sexual orientation, age, disability, religion, conscience, belief, culture, language and birth. " Government should overtly recognise the authority, wisdom, dignity and restraint that come with a lifetime of experience. The role of older persons as attractive, diverse and creative individuals, making vital contributions, should be promoted.

The mass media should be encouraged to promote images that highlight the wisdom, strengths, contributions, courage and resourcefulness of older women and men, including older persons with disabilities. Ageism in the workplace should be eliminated and positive images of ageing presented. Educators should recognise and include in their courses the contribution made by persons of all ages including older persons.

Lifelong learning entails continuous learning throughout life in both formal and informal environments. It is essential for effective personal and social development and contributes to economic and social well-being. As a consequence of the pace of technological development and change, it becomes increasingly difficult for ageing and especially older persons to keep up with new information, communications and other technologies. Their full participation in all dimensions of social, economic and political life thus becomes impossible. In order to combat the marginalisation and dependence that is a consequence, attention should be given to the provision of lifelong learning programmes that target older persons in particular.

Lifelong learning opportunities, programmes and support should be provided so that older persons can participate or continue to participate in cultural, economic, political, social life.

The capacity of ageing farmers should be strengthened through continued access to financial and infrastructure services and training for improved farming techniques and technologies.

The promotion of ongoing adult education, training and retraining, including basic literacy, as well as advanced technology should occur in all areas, especially rural and remote areas.

Local research should be encouraged to better determine the relationship between the training of older persons and their productivity so as to clearly demonstrate the benefits thereof.

Opportunities should be provided within educational programmes for the exchange of knowledge and experience between generations, including counselling on issues such as sexual behaviour. Older persons should act as mentors, mediators, advisors and as teachers and transmitters of knowledge, culture and spiritual values.

Older persons should be encouraged to volunteer to offer their skills in all fields of activities, especially in information technologies. The differential needs and skills of female and male older persons should be recognised in the design of volunteering programmes. Government and civil society, especially FBOs, should assist with the provision of transport that will facilitate volunteering activities.

A directory of teaching and self-learning resource materials relating to ageing issues should be compiled and made available to old age homes and community care providers.

Older persons should be provided with easier physical access to cultural institutions in order to encourage their greater participation in leisure activities and creative use of time. Such centres should organise workshops in fields like handicrafts, fine arts and music, where older persons can play an active role both as audience and participants.

The Skills Development Fund should be used to finance the acquisition of skills by older persons.

Older persons have a right to access recreation facilities and programmes. Cultural, sports and recreational activities that are suited to older persons should be organised so as to enrich their cultural life. These should include community services and networks for daily life, cultural and sports activities. Recreation clubs should be located for easy access to offer a range of activities such as music, reading, theatre, dance, gymnastics, swimming, yoga, walking, exercise, keep fit classes, relaxation, art and craft and educational and social activities. Subsidised transport should be provided where required.

The promotion and protection of all human rights and fundamental freedoms, including the right to develop, is essential for the creation of an inclusive society for all ages in which older persons participate fully and without discrimination and on the basis of equality (Madrid: 14).

Many pensioners rely on loans to survive between pension payout days. There is a high reported incidence of pensioners being confronted with different types of funeral policies and micro loans (loan sharks / amashonisa) at pay points. Most of them are not registered with the Micro Finance Regulatory Council, which recently implemented new rules requiring standard written agreements including information on interest rates being charged. Some micro-loan companies are accessing direct deductions from pensions. In addition to small loans they are providing food-parcels, the cost of which is deducted from the pension. High interest rates are charged in spite of it being a very secure loan.

Protection of vulnerable older persons should be provided by various methods:

• Funeral cover schemes are socially desirable and a policy framework should be developed to effect the deductions of their premiums from grants, subject to the discretion of the Minister.
• A regulatory body, possibly partnered with the Financial Services Board should be empowered to authorise and monitor companies offering loans and funeral policies.
• Insurance companies and loan companies should be required to provide consumer education about their products and services that empower older persons to make informed decisions.
• A single, specialised, well-funded, properly staffed Pension Complaints Tribunal with exclusive jurisdiction over all pension fund disputes arising from whatever quarter and in relation to all pension fund matters should be established.
• That there should be an introduction of an Unfair Clauses Act to assist in protecting the interests of consumers when policyholders fall prey to small print in their contracts.
• The practice of micro-loan companies being allowed to confiscate the identity documents of pensioners once they have received their grants should be outlawed.
• The Financial Services Board should co-ordinate a national initiative to find missing beneficiaries through extensive advertising in all media.
• Consumer protection pamphlets should be designed to educate older persons about retirement, funeral and insurance policies, as well as investments and property, to eliminate their vulnerability to falling victim to fraudulent schemes.
• Service providers should be regulated by means of uniform norms and standards. Uniform agreements should include controls and conditions on companies permitted to make direct debits from pensions. A government-accredited national funeral insurance scheme should be implemented.
• Ideally all older persons should have access to banking facilities. Government and banking institutions should address the issue of high bank charges that discourage low-income older persons from operating accounts. Additionally, banks should be made more accessible to residents of rural areas and officials should more actively encourage transfers to banks.

"Good health is a vital individual asset. Similarly, a high overall level of health of the population is vital for economic growth and the development of societies. The full benefits of healthy longevity have yet to be shared by all humanity, evidenced by the fact that entire countries, especially developing countries and certain population groups, still experience high rates of morbidity and mortality at all ages" (Plan of Action, Madrid document). A broader definition states "Health is created and lived by people within the settings of their everyday life; where they work, play and love. Health is created by caring for oneself and others by being able to take decisions and have control over one’s life circumstances, and by ensuring that the society one lives in creates conditions that allow the attainment of health by all it’s members."

Health is not only a vital asset but also a fundamental right. It is defined as a "complete state of physical, mental and social well-being" (World Health Organisation). Health thus has implications that extend far beyond medicine and a health care system. It includes a temporal, socio-economic and political perspective as well as biological, behavioural and psychosocial processes that operate from conception to old age. All have potent influences on health outcomes and chronic disease risks. Most illnesses and diseases require not only medical solutions but also political and social interventions.

Although many chronic diseases or conditions experienced by older persons are not curable, they are preventable as are most complications associated therewith. Older persons and their caregivers should receive person-centred care and services, emphasising the patient’s central role and responsibility in his/her health care.

Good health behaviour should be encouraged amongst learners throughout the school curriculum, by inclusion of life skills programmes in School Health Services and the Health Promoting Schools initiative. This should be complemented by continuous education to prepare the public for ageing. Legislation and regulatory policies that ensure safe and healthy rural, peri-urban, and urban environments should be enforced to allow individuals to make healthy decisions, bearing in mind that children and older persons are the most susceptible to unhealthy and unsafe environments.

Age-friendly health facilities with environmental access, access to a health professional, information, education, drugs, assistive devices and guaranteed quality dedicated care should be ensured. Older persons should be included in research, surveillance, needs assessments and other forms of statistical data collection. Maintain a minimum data set on older persons.

Strategies that would achieve health risk reduction are:

• Implement best practice guidelines to actively prevent, reduce negative lifestyle risk factors and to recognise and act on symptoms related to the associated disease and biological risk factors.
• Implement best practice guidelines to prevent and manage the incidence of substance abuse, mental and neurological illnesses and falls in older persons.
• Develop and enforce legislation to control environmental and external health hazards and prudent use of natural resources.
• Provide high quality scientific and medical information about risks, to facilitate informed decision-making.
• Ensure government responsibility to ensure protection of health and safety related to basic human requirements, including drinking water, sanitation, food, public transport, working environments and literacy (basic education) requirements.
• Increase access to health services, disease management and acute health care to reduce the burden of chronic diseases, disabilities and mortality, and to maintain the highest possible level of functional capacity (Secondary and Tertiary Prevention).

Older persons should have access to emergency care, appropriate specialist care, ongoing general medical and surgical care, mental health and dental care and discharge planning.

As indicated in Health legislation, pharmaceutical services, namely the safe and effective supply of specialised drugs as arranged with higher level of care and primary EDL drugs for common chronic diseases and conditions of ageing should be ensured. Transport should be provided through partnerships with community-based organisations and service centres. Community Health Centres (CHCs) should provide Primary Health Care Services.

Hospitals should render secondary services to older persons, at a specific user fee. Secondary level hospitals normally have different specialist services, but geriatric services as a speciality at this level should be initiated. Disease specific specialists (e.g. pulmonologists, surgeons and nephrologists) attend to all age groups. Specialist geriatric services should be provided for inpatients (diagnostic and therapeutic care and outpatients (referral, continuity and condition specific care). Tertiary centres for older persons should provide additional care for complex or rare conditions. Laboratory services, radiography services and other diagnostic support services should be provided at district hospitals.

The country’s seven (7) medical schools that are directly linked to tertiary hospital complexes should provide Tertiary Health Services. A full range of specialised, medical, surgical, psychiatric, diagnostic, therapeutic and rehabilitation services should be offered. These should include multidisciplinary services, including social services; specialist multidisciplinary care for older persons with complex and multiple chronic conditions/diseases; therapeutic education; support for secondary specialists/doctors and other relevant care providers; the generation of detailed reports on older persons treatment for other levels of service; liaison with support groups and other relevant role players (less common conditions, highly specialised services); research; quality of care audits; training; and education.

Step down facilities should be targeted at people who would otherwise face unnecessarily prolonged hospital stays or to avoid acute in-patient care, long-term residential care or continuing/recurrent in-patient care. These should be designed to maximise independence and to enable patients to remain or resume living at home. The facilities should involve short-term intervention, be integrated within the whole system of care and should focus on responding to and averting crises, and active rehabilitation following acute hospital stays where longer-term care is considered.

The impact of HIV/AIDS has added strain to already dire circumstances in the rural areas. With HIV/AIDS patients returning home, older persons are forced into using their meagre resources to care for their ailing family members affected by the disease. The location of larger numbers of NGOs in urban areas makes urban residents less vulnerable to such circumstances. The fact that older persons are often ignored by HIV/AIDS programmes lays them open to infection, both as caregivers and as sexually active people. It has become a common phenomenon that young and middle-aged adults or parents who die as a result of AIDS-related illnesses leave orphaned children behind to be reared by grandparents or older relatives. While an increasing number of older persons have been charged with roles and responsibilities as caregivers and childminders in the face of the HIV/AIDS epidemic, older people will also increasingly be left behind without relatives to support them in old age. The role of older people in terms of the manifestations of the HIV/AIDS epidemic is only slowly being recognised. The material and psychological strains placed on older persons who have to cope with HIV-infected family members and friends, and AIDS deaths, and the additional burden of bringing up and educating AIDS orphans, have major financial, physical and psychological impacts on the quality of life of older persons. The poverty of many older people who are faced with the cost of the epidemic amidst meagre resources needs to be explicitly addressed.

Statistics show that older persons are sexually active, at risk and are also infected with HIV. They are thus also at risk of HIV infection themselves. Secondly it is well known that caregivers’ health is negatively influenced. Carers have higher stress levels, suffer more from sleeplessness and take on average more drugs than the person for whom they care.

Older persons need to be supported as educators of their grandchildren. They should be empowered to inform their grandchildren on sensitive and complicated issues like safer sex and HIV/AIDS and should therefore become primary targets in all development policies. Older caregivers should receive the same support from community-based support mechanisms as any other caregiver.

In respect of their own sexual health, this is one of the most neglected areas in the total care of older persons. Older persons are not sexually inactive and improved sexual relationships in older age should be promoted through health education and counselling. Assistive technology or treatment for specific sexual problems in old age (e.g. vaginal dryness or erectile dysfunction) should be provided. Use of condoms should be promoted amongst those unsure of their spouse’s sexual behaviour, to prevent sexually transmitted infections.

As prescribed in health legislation, there should be decentralised provision of care for patients with chronic diseases and disabilities and the views and preferences of older persons should be accommodated whenever possible in planning their care. Surveillance systems should be implemented for traditional disease categories as well as non-communicable diseases, disabilities, associated risk factors, human rights issues and other social issues. Caregivers should be included in the management plan. Given the susceptibility to chronic diseases that exist amongst older persons, medical aid companies should be obliged to make adequate provision for assistance to patients suffering from chronic illnesses. These should include cardiovascular disease, certain cancers, chronic pulmonary disease and diabetes.

With the ageing population come increases in chronic diseases and degenerative conditions and the problems of multiple pathology or co-morbidity. Reforms in undergraduate training have taken place (e.g. integration of service and practice, community-orientated training, evidence-based care), but the medical model is still used in the training of health care providers. A person is still treated as a set of organs and systems rather than a complex whole being and the curriculum is discipline-based. A cadre of academic geriatricians who will educate health care providers in the care of older persons should be developed. Specialist training in the medical schools of South Africa, with Geriatrics a registrable subspeciality should be expanded. Geriatric training should be included and integrated into the undergraduate training of all health care providers and other social disciplines (excluding paediatrics). Trainees should be required to undergo mandatory rotation through the continuum of care of older persons, from community-based care to end-of-life care, preventive and promotive to rehabilitative care. Information about professional opportunities available for specialist geriatricians and gerontologists should be disseminated.

Also, many older persons in rural areas rely on practitioners of traditional medicine for their primary health care needs. Similarly, churches play an important role in accessing and providing health care to older persons. These sectors should thus be accommodated in policy planning.

The incidence of disability in South Africa is 2,6 million (6,7%). Amongst older persons, 23,1% of females and 22% of males indicate that they are disabled. The most common disability among the older population is loss of sight (47,1%), followed by physical disabilities (20,4%), hearing impairment (14,3%), multiple disabilities (10,5%) and mental disability (2,9%) (1996 census). Age-related vision and hearing disabilities should be addressed by the implementation of enabling programmes to prevent and cure activity limitations and to restore participation of older people in community life. Early life interventions ensure the highest possible level of function and adult interventions should be aimed at slowing down functional capacity decline. Barrier-free access to cataract surgery should be guaranteed. For those below the disability threshold, interventions should be aimed at recovering the best possible level of function and improved quality of life.

Basic medical and psychosocial rehabilitation services at primary level should include community-based and institution-based services; disability preventive services; early detection and diagnostic services, starting at a young age and facilitated by the Department of Education; best practice evidence-based rehabilitation and intervention services; counselling services for people with disabilities and their families and caregivers; training in self-care; provision of technical/therapeutic aids, psychotropic drugs and supplies as prescribed; follow-up and support services/groups/senior peer counselling groups; referral services; in-service and continued education for service providers; outreach services; basic research activities.

Specialised rehabilitation services should include regional tertiary or institutions; spinal, burns and stroke units and high security psychiatric care units; training of specialist rehabilitation providers; diagnostic services and appropriate diagnostic technology; management and rehabilitation of complicated cases; provision of technical /therapeutic aids and supplies as prescribed; a research programme; follow-up and support services; and a referral system

Racial discrepancies in the availability of residential care facilities for older persons are a unique feature of South Africa. The provision of large residential institutions for older persons, "the old age home," emerged in South Africa over a century ago (in line with British practice at the time). The number of homes expanded rapidly after World War II. In 1964 there were 120 homes subsidised by the government. There were also homes for white older persons run for profit, over which the government had no control. A survey found that 68% of older whites lived alone or in boarding houses and were at risk of neglect or exploitation.

The Aged Persons Act (No. 81 of 1967) provides for the registration, standards and inspection of homes for older persons. Twenty years later the number of subsidised homes had increased to 405 homes for 35 032 persons. In comparison, by 1986 there were eight homes for black, 37 for coloured and 2 for Indian older persons - a total of 3 145 people. More than 8% of whites over 65 lived in homes and less than 0,5% of black over-65s were in homes. The justification for this disparity was that the care needs of older persons from different cultures varied. It was not until the 1980s that the negative features of institutional care were raised and the problems of institutionalisation and abuse were highlighted for the first time.

Loans to build or buy homes had been provided to utility companies or registered welfare organisation by the National Housing Fund at an interest rate of 0,5%, repayable over 30 years. The Department of Provincial and Local Government laid down standards. The cost to government of the building loans and subsidising residents escalated. By the 1980s the growing demand for equitably distributed services and international trends away from residential care led to a shift in official policy towards community. From 1984 only new loans for homes for frail older persons were approved. But by 1993 the bulk of the R319 million spent on care of older persons was still spent on residential care and most of this was spent on the care of white older persons. The Discussion Group on Ageing was set up in 1993 to review policy. The same year the Discounting of Government Loans Scheme allowed organisations running homes to discount their loans and sell off portions of their facilities. Such discounts were on condition that a strictly enforceable minimum of 40% of accommodation was utilised by social pensioners.

In 1995 the Discussion Group on Ageing recommended that residential care be restricted to the mentally or physically frail. Additional facilities, consisting of four bed units, could be part of multi-purpose centres in rural areas and small towns.

The Aged Persons Amendment Act (No. 100 of 1998) was an attempt to make residential homes more accessible, accountable and representative. Implementation has been uneven, partly owing to drafting problems and lack of coordination with other laws. This Act addressed elder abuse for the first time. Many homes have appointed management committees, are applying the assessment tool DQ98 for new admissions and are observing protocols on elder abuse.

The Provincial Departments of Social Development report that in 1998/1999 474 homes were subsidised. These homes had an overall capacity of 42 952 persons. There were a further 7 state run homes with a capacity of 1 083 older persons. Occupation of these facilities was 15% to 20% below capacity. By 2001 353 homes were being subsidised. In 2002 over R11 million had been paid out of Lotto proceeds by Uthingo to old age facilities, predominantly in Gauteng, the Western Cape and KwaZulu-Natal. The distribution of old age residential facilities is predominantly in the wealthier provinces of Gauteng and the Western Cape, with a lack of facilities in poorer provinces, especially Limpopo.

A previous survey indicated that the facilities cater predominantly for white residents. The majority of residents (78%) are women and the facilities are located mainly in urban areas.

Management of the residential facilities was reflective of the predominantly white population of the facilities, with 77% of Board members and 77% of management committee members being white. Black membership of these bodies was 12% and 14% respectively. The proportion of coloured members on Boards and Management Committees was 8% and 11% respectively, these figures being much higher in the Western and Northern Cape, where coloured people form the majority of the population. Only one percent of these bodies comprised Indian membership. Nevertheless, 66% of facilities indicated that they had set up Management Committees in compliance with Section 3 of the Aged Persons Act. Almost two-thirds (64%) of management committees had been elected, with 29% having been appointed and 7% formed in other ways. Controlling bodies of the facilities comprised mainly church and para-church organisations, non-profit organisations and private trusts.

Care and nursing assistants comprised almost four out of every ten (39%) employees of the old age residential facilities. A further 19% were registered or enrolled nurses and 10% were employed in the administration of the facilities. More than one-quarter (28%) were cleaners and 4% were security personnel. Additionally, the facilities had the assistance of several thousand volunteers countrywide.

Provision of frail care for those in need of twenty-four hour care is official policy. Due to the projected increase in the number of older persons such provision will need to be increased. For existing facilities to remain viable, funding will need to be maintained at a realistic level. Future financial assistance to institutional care is to be limited to a maximum of 2% of the target group (older persons in receipt of a social grant or the equivalent income) and to institutions that are strategically placed to reach the target group.

A funding framework was accepted at a consultative conference called by the then Department of Welfare in October 1995. It proposed the phasing out of subsidies to group one and group two residents (the fit or semi-fit). This hit low-income residents who were living in institutions primarily because there was no alternative affordable accommodation available. The maximum subsidy payable was based on the estimated monthly cost per resident and was means-tested. This was to be revised annually but in most provinces this amount has been frozen at the 1996 level, imposing considerable strain on those running residential homes. Many residential care facilities have, as a result of financial constraints, reduced the number of beds available to the most vulnerable and poorest older persons.

In terms of the new model for integrated community based care and support services, emphasis is placed on the prevention of dependency on continuous care. To address imbalances in provision in disadvantaged and rural areas, funding for prevention programmes will need to be enhanced and developed. Currently, funding for these services is insufficient to cover operating costs and the funding formula is cumbersome to administer.

To be effective, a funding formulae must be simple to implement; costed correctly to provide an incentive to service providers to render the service to the target group (the poorest and most vulnerable); and be easy to administer. All the services envisaged in the new integrated model have a small number of cost drivers, which represent the majority of the costs of each service. Two examples of this are:

• Continuous care – Here, two drivers account for approximately 80 – 90% of the operating costs, namely, salaries (70 – 75%) and food (10 – 15%).
• Sheltered environment housing – Here, again two main cost drivers account for the bulk of the operating costs, namely, salaries (55 – 60%) and property costs (water, electricity, maintenance and rates), (20 – 28%) with transport accounting for some 5% of costs.

Other costs items have a relatively minor effect on the overall operating costs. Costs of services will differ not only from province to province, but also from area to area within provinces, dependent upon the infrastructure and local conditions in each area. A model (Welstrat) that takes such differences into account has been developed.

Funding formulae must be flexible enough to take account of specific circumstances and needs which are to be addressed by the service. The income generating ability of the service must be evaluated utilising pre-prepared, unambiguous questionnaires. Prior to implementation, any new service envisaged must be evaluated on its potential viability; its ability to meet the needs of the poorest and most vulnerable; its affordability; and the capacity of the service provider to render an efficient and effective service.

The Aged Persons Act (No. 81 of 1967) provided for the registration of residential homes for older persons. The present policy proposes that the following services are also required to register if they are in receipt of a state subsidy or charge for their service:

1. assisted living facilities;
2. shelters for older persons;
3. accommodation for more than six older persons;
4. community and home-based services.

Homes caring for family members would not need to register. Persons accommodating fewer than six older persons would need to notify the responsible Provincial Department of the names of those accommodated and the terms and conditions of the service provided.

1. Governance of Service Providers

The Aged Persons Amendment Act (No. 100 of 1998) laid down provisions for the appointment and composition of management committees for residential homes and sought to establish representativity and accountability. However the line between management responsibility and residents’ involvement was blurred and caused some confusion and conflict. This should be remedied as follows:

1. Governing bodies: The governance structure of a facility of service for older persons will depend on the Act under which such a facility is registered: Companies Act 1973, Housing Schemes for Retired Persons Act, 1988 or Non-Profit Organisations Act. Where such a facility is only registered under this Act the governing body shall consist of 3 to 10 members and terms and conditions of such a body shall be laid down in Regulations.
2. Management of services: The governing body shall set up a management committee to be responsible for the administration of the facility of service. Such committee shall submit annual reports to the Minister on compliance with service standards, measures to prevent and combat abuse and the content of service level agreements.
3. Residents/Users Committees: Such committees shall be established in all facilities and services registered under this Act. The function of such committees shall be to represent the interests of the residents/users on domestic arrangements within the facility.

Elder Abuse constitutes a single or repeated act or lack of appropriate action, which causes harm or distress to an older person. This occurs within a relationship where there is an expectation of trust. Harm includes physical, psychological, financial, material and sexual abuse, as well as neglect, violation of rights and systemic abuse (Implementation of the National Strategy on Elder Abuse: Protocol for KwaZulu-Natal, August 2002). Ageing brings with it declining ability to heal, so that older victims of abuse may never fully recover from trauma. The impact of the trauma may be worsened because shame and fear cause reluctance to seek help. This chapter addresses the issue of providing protection for older persons from all forms of abuse.

More that a million older persons worldwide are victims of violence each year (Lundy, et al. 2000). As a form of domestic violence, elder abuse or maltreatment is defined as the willful infliction of physical pain, injury, or debilitating mental anguish, unreasonable confinement or willful deprivation of services that are necessary to maintain physical and mental health (O’Malley, 1987, in Lundy et al; 2000).

In South Africa, over 630 000 persons aged 60 or more indicated in a survey that they had a poor or very poor relationship with the head of the household in which they lived. Most of these (81%) were black Africans and about two-thirds were residents of rural areas of South Africa. The rest (19%) were either white, coloured or Indian and mostly (90%) living in urban areas (October Household Survey 1996, Statistics South Africa). Adversarial household relationships of this nature are further complicated by poverty that is the lot of many older persons.

Any person who abuses an older person should be found guilty of an offence and liable to conviction to a fine or imprisonment, or to both such fine and such imprisonment. A professional needs to recognise the risk of potential neglect, abuse or violence by formal and informal caregivers both in home and in community and institutional settings.

An older person who is in need of protection; is one who:

• has his/her old age grant taken against his/her wishes;
• has been removed from his/her property against his/her wishes;
• has been neglected or abandoned without any visible means of support;
• lives or works on the streets or begs for a living;
• is addicted to a dependence-producing substance and is without any support or treatment for such dependency;
• lives in circumstances likely to cause or be conducive to seduction, abduction or sexual exploitation;
• lives in or is exposed to circumstances which may seriously harm that older person physically, mentally or social well-being;
• is in a state of physical or mental neglect;
• has been or is being maltreated, abused, neglected or degraded by a care –giver or family member;
• has been deprived of fundamental rights (e.g. respect for dignity; personal privacy; freedom of thought, belief, opinion, speech, expression and movement; security; accurate information)
• has been or is being subjected to cruel, inhuman and systematic abuse.

Importantly, the right of older persons to self-determination should be respected when they are capable of making decisions. In all instances, assistance should be offered and older persons given the choice of whether or not they accept the assistance.

Any care-giver, medical practitioner, nurse or any other person involved with older persons in a professional capacity and who on personal observation concludes that the older person is in need of care protection must report that conclusion to a social worker, police officer or family court registrar. Any other person in the local community who believes that an older person is in need of care may report that belief to a social worker, police officer or family court registrar. The person who reports the abuse should substantiate the allegation or belief with facts available to that person.

The social worker, police officer, family court registrar to whom a report has been made should make an initial assessment of the report. Unless the report is frivolous or obviously unfounded, the truthfulness of the report should be investigated. In the event of the report being substantiated by the investigation, steps should be taken to ensure the safety and well-being of the older person.

An older person, family member and/ a representative of an older person or a person who bears witness may apply to the court for protection order as provided for by the Domestic Violence Act, 116 of 1998.

Any person who obstruct or hinders a social worker in the performance of his/her functions or refuses to furnish to a social worker or designated person or a representative of an older person at his or her request of any information in connection with the accommodation of an older person at his disposal which such officer requires for the purposes of an investigation, shall be guilty of an offence. Older persons who complain may not be evicted because of this action.

A magistrate may issue a warrant for the removal of an older person to a place of safety. The Director-General must be informed of the removal on older persons under such a warrant.

Age in Action (formerly SA Council for the Aged) set up the Help Elder Abuse Line (HEAL) in 1998 and now operates a toll-free line. It receives about 2 000 calls a year countrywide. Recently it set up three response units in the Western Cape and is recruiting volunteers and linking up with community networks. There are plans to extend the service to other provinces.

Services for victims of abuse and rehabilitation arrangements for abused or abusers should be provided. Older persons who are self-abusive should be subjected to rehabilitation. The right to self-determination should, however, be respected.

Service providers or government officials who do not treat older persons with respect, gratitude, dignity and sensitivity will be guilty of an offence. Any service provider in receipt of a social grant on behalf of an older person, who acts irresponsibly with such, to the detriment of the recipient, shall be guilty of an offence.

Places of safety for victims of abuse should be made available should it be deemed necessary that the victims should not return to their normal places of residence. Such places of safety should include hospitals, clinics or other institutions and even individuals. Places of safety should be subject to official government accreditation.

A Committee may be appointed at local level to inquire into the allegations of abuse. The Committee may call witnesses and cross-examine any other witnesses giving evidence at the enquiry. The person against whom the allegations in question were made, may give evidence him/herself, and he/she, or on his/her legal representative, may cross-examine any witnesses and call witnesses himself/herself. If necessary, assistance should be provided to complainants who are not able to access legal representation.

Regulations relating to criminal trails in magistrates’ courts shall "mutatis mutandis" apply in respect of a subpoena, the calling and examining of witnesses for the purpose of or at the enquiry, the taking of evidence and the production of documents and other articles thereat, and the payment allowances of witnesses. The proceedings at the enquiry shall be conducted in an open courtroom or in camera, in consultation with the complainant and at the discretion of the Committee.

The provisions of section 159(1) of the Criminal Procedure Act, 1977 (Act No. 51 of 1977), in so far as they relate to the conduct of the criminal in trial in the absence of the accused, shall "mutatis mutandis" apply in respect of an enquiry held in terms of this section. The provisions of section 198 of the magistrates’ Court Act, 1944 (Act No. 32 of 1944) shall "mutatis mutandis" apply in respect of any proceedings in connection with an inquiry held in terms of this section.

The Committee may direct the district surgeon, or a psychiatrist or a clinical psychologist or a social worker designated by the body to examine the older person in question and to furnish the body with a report on findings. The contents of this report shall be disclosed to the person against whom the allegations were made. The legal representative shall be given an opportunity to cross-examine the person who made the report, in relation to any matter arising out of the report, and of disapproving any allegation occurring therein.

If, after consideration of evidence or report it appears to the designated body that any allegation against the person in question is correct, the body may:

• Prohibit person from accommodating or caring for the older persons in question anywhere in South Africa, except subject to such conditions and in accordance with such requirement as the designated body.
• Prohibit that person from accommodating or caring for the any older person for such period, but not exceeding 10 years, as my be determined by the designated body.
• Any person who contravenes or fails to comply with such requirements or prohibitions imposed shall be guilty of an offence and shall be liable to conviction to a fine or imprisonment for a period not exceeding five years, or to both such fine and such imprisonment.
• It shall be defence to a charge alleging that the accused accommodated or cared for an older or frail person in contravention of a condition, requirement or prohibition, that the older person or frail person was unable to find any other accommodation or care.

The Minister shall, in the manner prescribed by regulation, cause a register both at national, provincial and local level, to be kept of all notifications together with a description of circumstances regarding such notification. A similar register shall be kept of convicted abusers.

Intersectoral collaboration between the Departments of Social Development; Justice; and Safety & Security must be formed. To ensure the protection of assets of older persons being administered by family, friends, curators or any other designated person or body.

Older persons who are victims of crime and violence have varied needs. Their needs must be addressed from a multi-disciplinary perspective in an attempt to create an enabling environment for them. Of importance is to highlight the victim’s rights and highlight the responsibilities of government departments and NGOs in empowering older persons who are victims of violence and crime. The Victim Empowerment Programme (VEP) is intended to contribute to a more peaceful South Africa where the rights and needs of victims of crime and violence are addressed so that the balance between victims and communities and offenders is restored, thus contributing to the prevention of victimisation.

The Department of Social Development as the co-coordinating department of the VEP should ensure that the Departments of Health, Justice, Correctional Services and Education, as well as the SAPS develop policies and programmes that address the needs of older persons who are victims of violence and crime.

The Department of Health should address physical and emotional needs. This shall entail the prioritisation of victims in health care facilities, such as clinics and hospitals, and the provision of counselling services.

The Department of Social Development should address social welfare and spiritual needs. This shall entail the implementation of preventative measures in the form of integrated multi-disciplinary training and information sessions to older persons on the following areas:

• Rights as laid out in the constitution: especially the rights to be free from harm; to health; to proper accommodation
• Taking measures to create a safe and secure environment
• Ensuring the availability of facilities to report crime
• A national telephonic support line for older persons who are victims of violence and crime; the line is to be manned by volunteers; opportunities for anonymous callers shall be made available; counselling services shall be provided
• The development of Minimum Standards for Victim Empowerment Services, including services to the older persons who are victims of violence and crime
• Ensure that the VEP caters for the needs of the older persons
• Mobilising communities, NGOs and FBOs for services that address the needs of older persons who are victims of violence and crime
• Developing shelters to temporarily accommodate older persons who are victims of violence
• Developing a resource directory for services available in all provinces
• Establishing a register for older persons who are victims of violence and crime

The Departments of Education; Correctional Services; Justice and the South African Police Services (SAPS) should provide training to learners on predisposing factors to and prevention of violence against the older persons; and legislation and facilities for older persons who are victims of violence and crime. Training is to be given to Correctional Services personnel on restorative justice; perpetrator programmes; the Domestic Violence Act; and on informing the perpetrator about the perpetrator and victim mediator programme.

The SAPS should provide opportunities for victims, their relatives or relevant professionals to lay a charge against the perpetrator and to provide information on court processes and procedures; progress of the case; and the whereabouts of the perpetrator (i.e. whether in jail or out on bail). The Department of Justice should provide opportunities for legal representation in court and to ensure that government departments providing services to victims adhere to the principles outlined in the Draft South African Victims’ Charter.

In order to promote and maintain the rights of older persons, the Minister and provincial MECs shall implement an Ombuds system. The functions of the Ombuds system shall be to identify, investigate and resolve complaints made by or on behalf of older persons in relation to action or lack of action that may result in adverse effects on their health, safety, rights or well-being. The system should provide or refer older persons to services that provide protection to their health, safety, rights and well-being. Similarly, the system should represent the interests of older persons in their dealings with government departments or agencies that pertain to their health, safety, rights or well-being.

The Minister should appoint a national Ombudsperson, who in turn shall appoint provincial ombudspersons. The legitimacy and the personal attributes of national and provincial ombudspersons will determine the success of the ombuds system. The following personal attributes are regarded as prerequisites for acceptance of the ombudsperson:

• A good standing in the community
• Democratic and pragmatic leadership
• An ability to be impartial at all times
• A track record of non-racism
• A sound understanding of the needs of older persons
• A sound understanding of the environment in which staff of residential care facilities are working
• A sound understanding of management processes
• Sound listening skills
• Commitment to protect the rights of older persons

Although the Ombudsperson shall have free access to older persons living in or outside of residential facilities, and visa versa, she or he shall under no circumstances directly or indirectly interfere with the operational management of such facilities. The intention of the ombuds system is to strengthen existing procedures and protocols for the promotion and the maintenance of the status and rights of older persons. The manger of the facility is primarily responsible to manage the facility and the staff.

The terms of reference of the ombudspersons shall be as follows:

• Protection and promotion of the rights of older persons
• Investigation of complaints and grievances of older persons and propose remedial action
• Ensure implementation and monitor the outcome of decisions taken regarding complaints and grievances
• Annual report to the Minister regarding the violation of the rights of older persons and measures to promote adherence to their rights

Older persons, their representatives, family and/or friends should have direct access to the ombudspersons in order to lodge a complaint or grievance. Complaints shall be lodged in writing. The ombudsperson has the right to call witnesses and to access relevant documentation. The ombudsperson shall report any complaint of abuse to the relevant provincial Department of Social Development to ensure that appropriate action is taken.

A National Consultative Forum on Ageing should be established to ensure effective public-private planning and co-ordination on all issues pertaining to older persons in South Africa. The issues should be inclusive of but not restricted to those included in this policy document. The Forum should comprise from seven to ten members and should be representative of the older persons population of South Africa.

The Forum should be tasked to ensure observance of the rights and promotion of the well-being of older persons. The Forum so appointed may, for the purposes of that inquiry summons any person:

• Who, in the opinion of the designated body, is able to furnish information or material importance to the inquiry, or
• Who, the designated body has reason to believe has in his or her possession or custody or under his or her control, any book, document or record relating to the subject of the enquiry, to appear at a time and place specified in the summons to be examined or to produce that book, document or record and may retain for examining any book document or record so produced.
• Through the person presiding at the enquiry.

The Forum may, generally or in any specified case, appoint a Committee to exercise and perform all powers and duties of the designated body. If the Forum so appoints a Committee, those powers and duties are regarded to have been delegated to the Committee. The Committee should in turn appoint investigative task teams at local level to deal with the issues that arise.

Any person who, having been duly sworn or having made affirmation, renders false evidence at an inquiry, knowing that evidence to be false, shall be guilty of an offence and shall be liable on conviction of the penalties which may be imposed for the offence of perjury.