It is indeed a privilege to comment on the Bill as it gives an opportunity to improve circumstances in which elderly live.

I am the Deputy Director: Chronic Care, Rehabilitation, Home Based Care & Geriatrics in the Western Cape Provincial Department of Health. I am based at the Provincial office in Cape Town. I have been in this programme for 5 years.

Some of the challenges that older persons face and that get reported relate to the quality of care or the lack of it in certain OAH’s. Recent examples are lack of supervision in an unlicensed facility leading to the burning of an Alzheimer’s patient and her subsequent demise. Nutrition not adequate or patients not fed adequately if not able to swallow or feed themselves. Elderly living with their working children being locked up in their houses for the whole day, as there is no support system or community based service.

Another challenge is inadequate health education and information available to carers of the elderly and older persons themselves e.g. older persons looking after their HIV+ children and grandchildren without the knowledge of disease. They are at risk of being infected themselves.

Lack of information and training of carers of older persons and their families about dementia care result in an older persons not adequately cared for, being regarded as difficult and treated in an undignified way without the necessary compassion and insight.

Many elderly who develop complications as a result of other diseases / falls e.g. cataracts, other eye conditions glaucoma / diabetic retinopathy – have to wait up to 2 years. Wait for hip replacements for 2-3 years as a result of lack of funding. This make them more dependent on family and carers and the state to provide disability grants where an operation would have made a difference, restored their independence and their productivity and support to their families. Some of the elderly die blind before they can be operated on due to lack of funds and adequate resources.

Community based care should be more fully described especially community based health care. The necessary infrastructure in terms of teams of multi-professionals / disciplines consisting of occupational- & physiotherapists, registered nurses, doctors, psychologist, dietician, should be created to make this possible.

The PACE (Program of all inclusive Care for the Elderly) Model or on LOK Model is an example of a community based – Geriatric Managed Care Model. This Model was founded in San Francisco in 1971. This model has proved that it is possible to keep the vulnerable frail older person in the community receiving care that is sound and ensures that the person is cared for in a dignified way.

The important factor in S.A. presently with the scarcity of certain health professionals can be overcome with professional teams provided per district, but working with appropriately trained midlevel workers. The network of the team per district should include Day Care Centres attached to Old Age Homes, multi-purpose centers (new one’s should be provided where there are none) and also support groups.

The word is used in clauses

10 (a) 14 (i) (a) (b) 15 (8)

(b) 14 (2) (3) (b) 15 (10) (a) (b)

10 (3) (b)

Frail does not only refer to older persons, however in this bill it should refer to an older person.

It is important to mention "frail person" specifically in the Older Person’s Bill as it has implications for the type of care, and resources needed e.g. equipment, adequately trained human resources, medication, rehabilitation etc. Therefore, since the object of the Bill is the protection and the promotion of their safety, well-being and security etc, the term "frail person" as vulnerable and in need of care, should be added in the definitions.

If the definition is not replaced – the need for frail persons to receive 24-hour continuous care might not be met and inadequate support could be supplied.

The Bill must include the Dept. of Health in monitoring / registration of homes for older persons as mandatory. This is essential. The Health act legislates that the department of health is responsible for health care. There fore the Bill must make provision that the Department of Health ensures it has the capacity to monitor the care of Older persons in the various settings as well as Old Age Homes

Should particularly address the development of policies and the implementation of those policies to prevent ill health among older persons. In particular the provision of infra structure to prevent the priority chronic diseases that are costly to manage and lead to increase in the burden of disease.

Screening programmes in the elderly e.g. men for prostate cancer and women for breast and cervical cancer. Many elderly women have experienced poor nutrition, reproductive ill health, violence and lifestyle related disease. These factors exacerbate the post- menopausal increase of breast and cervical cancer. The necessary resources in terms of human resources, funding, equipment and training should be made available as well as the monitoring and evaluation structures. This section also applies to the development / provision of local strategies to improve the prevention, timely detection and treatment of mental illness in old age, including diagnostic procedures, appropriate medication, psychotherapy and education for professionals and informal caregivers to support. Programmes should make provision for the development of self-help support and provide respite for patients, families and other carers. Promote public information about the symptoms treatment, consequences and prognosis of mental conditions. Provide ongoing training to health care professionals in the detection and assessment of all mental disorders and of depression.

The provision of assistive devices including spectacles / and operations for the removal of cataracts for the prevention of blindness and dependency should be addressed according to Prevention of Blindness Strategy of the WHO. No discrimination should be practiced where older persons are concerned. Resources should be found for this. This is also addressed in the constitution as a right to health for disabled/older persons.

The Bill should make provision for occupational health programmes for older persons.

If we are to accept the figures that are frequently presented on the HIV/AIDS pandemic, then it becomes logical that in a few short years, there will be a great gap in the economically active people of the world. There will remain a "young" population and "ageing" population who are trying to keep the economy going, and the generation between will be greatly depleted.

Although ageing is a natural phenomenon and causes a slowing down of one’s capabilities, research has proved that older workers, although slower from a motor point of view, are still able to work accurately.

The ageing worker forms part of a "vulnerable group" in the workplace, but these are people who can offer wisdom, better integrated knowledge, greater responsibility, positive work attitudes and management skills.

The Bill should address employers to seriously consider that the support this group would require at work, far outweighs the productivity or output this group can offer.

This section should also address programs that affect older persons as carers – To provide support especially for older women as carers. This should include financial, nutritional, education, psychological support.

NB!! The referral systems of person’s diagnosed with the various chronic conditions that older person’s are prone to should ensure that there is a support structure in the community that will follow up/should be accessed by the client. A database of support structures should be made available to the client who can be advised what they could do further for assistance. This should be for all diagnosed chronic conditions that older persons are diagnosed with.

It is sincerely requested that the committee will seriously consider the comments made – these were consulted with older persons and carers, families and other health programme managers.

Thank you for the opportunity to give input.