26 FEBRUARY 2001
Foreword
Introduction - Report by the Committee to the Minister of Social Development
Executive Summary
Findings
Recommendations
Volume Two: Provincial Reports
By Dr Zola Skweyiya, MP Minister for Social Development
In response to media reports in March 2000 about the abuse of older people in residential institutions, pension queues and in the community, I established an independent committee to investigate this issue. This report details the often harrowing experiences and deep seated concerns of older people throughout our country and the recommendations of the committee.
It is imperative that this shocking report "Mothers and Fathers of the Nation: The Forgotten People?" mobilise all sectors of society and lead to action-oriented measures to protect older persons from neglect, abuse and exploitation.
Government has committed itself to urgently developing an implementation plan that addresses the specific immediate, short-term and medium-term recommendations made in this report. This implementation plan will ensure that elderly citizens receive sensitive and integrated services from the departments of Social Development, Health, Home Affairs, Justice, Safety and Security, Housing and Local Government. These measures, together with the integrated rural development strategy and the urban renewal programme will harness the resources of all three spheres of government and support multigenerational community development initiatives.
It is, however, imperative that all social partners - business, labour, faith-based organisations, and civil society organisations in general - share the responsibility of ensuring that older people are acknowledged, supported and protected
The research report "Contributions of Older Persons to Development: The South Africa Study" published by HelpAge International in July 1999 has already documented the substantial social and economic contributions that older persons make to the well-being of the family and community, particularly through their social pensions.
This report substantiates the brutal reality that despite these contributions, in the context of high unemployment and widespread poverty, older people are frequently vulnerable to both physical and mental abuse.
The distressing experiences of older persons who live in poverty, especially those living in rural areas, highlights the need to sustain our efforts to establish a society based on humane values, social justice and fundamental human rights.
Today, given the life course of our society, moral renewal is an issue of high priority on our national agenda. The Moral Summits that have been held and the debates in the National Assembly on "Restoring the Moral Fibre of Our Society" have all reiterated the need to restore and sustain the ethic that "any older person is my parent" and that "any child is my child."
The steady transformation that is reflected in all aspects of our national life must improve the social and material conditions of older people. All sectors of society must contribute to ensuring a comprehensive response to the challenges of ageing in South Africa at the turn of the millennium. In this regard, organisations like the SA Council of the Aged and its 860 member organisations must step up their development and advocacy work and ensure transformation.
We must all dedicate this year to building unity in action for change.
Thousands of older people throughout our country have spoken out during public hearings and given evidence to the Ministerial Committee. I am humbled and assure you that government has heard your cry. We cherish your continued contributions to the well being of families and communities in the face of extremely testing social and material conditions.
The members of the Ministerial Committee on the abuse, neglect and ill treatment of older persons have travelled the length and breath of our country and persevered in their difficult task. In addition to a main report, the committee has produced detailed provincial reports that will assist provincial governments in protecting older persons from neglect, abuse and exploitation.
I thank you for your commitment and the work you have done.
Because of your work it will not be said that the mothers and fathers of the nation are the forgotten people.
To the Hon. Minister of Social Development Dr. Zola Skweyiya
Elderly people in South Africa, especially the poor and those living in rural areas, are crying out to the government for help. Many of the problems they experience arise from poverty. In areas of high unemployment communities, not just pensioners, now wait for pension day. Some pensioners refer to it as the "worst day of my life" - it is the one day of the month when they are dressed up and taken out. But once their pension is paid they are waylaid by hawkers and loan sharks and by their children and grand-children all demanding a piece of their pension, often leaving them with little or nothing. The homes of pensioners who stay alone are targeted by criminals on pension day. They have nowhere to turn: the police are not interested, the churches do not help them. The delivery of social services to the elderly remains fragmented, poorly managed , racially divided , under-resourced and beyond the reach of the vast majority of the old.
In the course of its investigations this Committee collected a large amount of evidence of the cruelty which many elderly people experience. Some are neglected, ill-treated and even evicted by their families. The frail elderly are the most vulnerable yet few safe havens exist for them. In some provinces old people, women in particular, are labeled as witches and killed or driven from their homes and unable to find a refuge. Frail elderly living in residential homes have no-one who oversees them or protects them from neglect and abuse. The level of care received in homes in disadvantaged communities is often abysmal. Rape of the elderly by young people and even by family members has risen sharply. For many people, the majority of whom are women, old age is a time of fear, depression and anxiety.
The loudest cry to reach the Committee concerned the treatment pensioners receive at pension pay-points. Most still queue for hours every month, at the mercy of the elements, without water or toilets. Many are ill-treated by officials, some of whom are alleged to take money. The outsourcing of pension payments has not resulted in an improved service - the awarding of contracts does not follow proper procedures and guidelines for contractors are neither uniform nor monitored or enforced . Pensioners have no protection from money lenders who use the pay points as their playground, grabbing pensioners publicly, taking their identity documents and forcing them to hand over a large part of their pension every month. In Uitenhage the queue of money-lenders was longer than the queue of pensioners.
On top of this many pensioners had their pension suspended without notice or explanation in 1999, waited for months to have it restored and were not paid the arrears which were rightfully theirs. Many so-called "fraudulent" recipients of grants were accepted by the former homeland governments because of unemployment or poverty. Many "fraudulent" applications are poverty-related, reflecting peoples' desperate need for an income. This was particularly evident in the former Transkei. When Operation Clean-up cancelled such grants nothing was done to dove-tail the action with poverty relief programmes to lighten the impact of the stoppages. This in turn added to the burden of the pensioners.
The Committee concluded that little respect is given to the elderly either by government departments or by the community at large. Some are told: "You have had your life. What more can you expect?" This attitude needs to be countered in practical ways, at all levels and in all spheres where it prevails. The majority of elderly South Africans have had a life of struggle, deprived of a proper education, denied decent health care, excluded from labour laws, harassed by the pass laws and dispossessed of their land. They expected their lives would be transformed after apartheid. This transformation must now begin.
Mr. Minister, we have the honour to present to you this Report setting out our findings, and recommendations
In the course of its work the Committee visited all provinces, held public hearings, went to pension pay-points, homes and service centers and met with local leaders. Many individual cases of abuse were brought to its attention.
It is hoped that this report will make a contribution towards protecting older persons from neglect, abuse and exploitation and assist in improving their quality of life.
Signed in Pretoria on 26 February 2001
Mr. Tom Manthata, Chairperson
Mrs Pinky Vilakazi, Vice Chairperson
Mrs Khetiwe Kwazi,
Mrs Mpho Maine-Oliphant,
Mr Syd Eckley
Mr Monontsi Joseph Mzondeki M.P
Mrs Mary Turok
The Committee found abuse and neglect of the elderly is common in residential homes, hospitals, within families , in communities and in pension queues and government offices. Of great concern was the absence of a coherent strategy to address this and a lack planning, coordination and effective action. Social services for the elderly remain highly fragmented, poorly managed, racially divided and under-resourced - the bulk of the budget continues to be spent on residential care and in all provinces homes remain racially divided and predominantly white. Little funding or support is given to services based in communities where the greatest number of frail and vulnerable elderly people live. The special attention, promised in the Welfare White Paper, to the protection of the rights of older persons because of the prevalence of age discrimination, abuse and exploitation, has not materialized. The following is a summary of the findings and recommendations of the Committee in three spheres: residential homes, social pensions and the community.
Although the numbers living in homes are relatively small, the extreme vulnerability of many people in this setting requires special attention. The Committee found as follows:
- Some homes are dirty and pervaded by a strong smell of urine. There is a shortage of cleaning materials, including soap for laundry and bathing.
- The quality and quantity of food is often below standard. There is no fresh fruit. In some homes there are no storage facilities, inadequate cooking and eating utensils and no cool-room or fridge.
- There are no guidelines on facilities for the frail elderly. In some homes residents don't have their own clothing, laundry is not marked and face-cloths and toothbrushes are shared.
- Little recreation or social activity is provided. "Residents are not interested" was the common response. Many residents seem to spend their days seated in rows around a room or along a veranda -waiting for the next meal.
Finance:
- There is no uniform financing policy: homes for the poor and disadvantaged which lack basic facilities receive lower grants or subsidies than homes in advantaged communities with good facilities.
- Government subsidies to homes have not kept pace with costs.
- Many homes have been forced to close. Some residents are expected to "return to their families". Some make private arrangements. Others have joined the ranks of the homeless.
- Many organizations which built homes for white elderly with low-interest loans from the previous government had these loans discounted in 1993 and have since changed the use of the homes or sold them, disregarding a condition of the loans, namely that 60% of the residents be social pensioners.
- There is a mushrooming of unregistered private homes ("losieshuise"), accommodating an unspecified number of pensioners under poor conditions. Notably in Uitenhage, Parow, Johannesburg and Uppington.
- Records of closures and the number of residents affected could not be accessed.
Supervision:
Supervision by provincial authorities appears to be limited to scrutiny of financial returns for subsidy purposes and to rare visits after reports of abuse - provincial social workers lack expertise and this task sometimes falls on the Health Department.
Family contact:
In many residential homes contact between residents and their families is restricted and complaints are actively discouraged. They appear to be regarded as the private property of those who run them. Health and incident records are not accessible.
Planning:
There is an absence of long-term planning and coordination on homes for the elderly at national, provincial and local level: For example, in Pretoria there are empty beds in some homes while new homes are being built not far away at considerable cost and racially based residential divisions are being reinforced.
Admission policies:
Admission to homes is supposed to be restricted to the frail and dependent elderly. However, the following seems to prevail:
- The Dependency Questionnaire (DQ98) only applies in four provinces.
- There is a lack of clarity and consistency in the application of DQ98 and in practices regarding admission of indigents. In the five provinces where DQ98 does not apply the non-frail, including indigent elderly, are excluded.
- Admission to most registered homes not only depends on degree of frailty also on ability to pay additional fees. Those with only an old age pension are effectively excluded.
- Many homes, which were built or bought with low-interest loans from the previous government, have shifted their target group from lower to higher income residents due to increasing operating costs and shrinking subsidies, despite the terms of the loan requiring 60% of residents to be social pensioners. The effect is that most homes remain exclusively white.
Staffing:
Staff are generally low-paid and untrained and few qualified nurses are employed to care for elderly residents. A minimum ratio of nurses to other staff is no longer required, nor a minimum ratio of staff per frail resident. In-service training is neglected due to the shortage of professional staff. The Committee was told that homes can no longer afford to employ trained staff. However some homes with limited trained staff manage to maintain good standards.
Health:
Doctors visits to many homes are rare and there were numerous complaints about over and under medication of residents. The nutritional status of residents in some homes is poor. Sometimes there is no sick bay.
The Protocol for Elder Abuse: This document is still a draft. Although it
is available in some provinces and some homes, its status is unclear . Nor is
there evidence that it has been publicised or is being observed.
Security: The high level of theft in homes could be described as endemic
and nobody seems to take responsibility for addressing it. Some homes have been
targeted by criminal elements.
Transformation: There is an absence of transformation and little guidance is given on making homes culturally sensitive, hospitable and non-racial.
- Most homes are in white areas and still see their responsibility as confined to the elderly living under their roof. They have few black residents and no representatives of disadvantaged communities on their committees.
- Some faith-based homes receive subsidies but exclude persons from other faiths .
- Few homes have outreach programmes, although this is required in terms of the new national financing policy. There are no guidelines on home care and meals services to elderly in the community.
While many acknowledge the social pension as an effective poverty alleviation programme, the Committee found that it remains fraught with problems. In 1996 the Committee for the Restructuring of Social Security (CRSS) recommended improvements to customer service. In 1998 the Public Service Commission investigation into social security services, more specifically, recommended a strategy with the Public Works Department to upgrade services at pension pay points. But by the year 2000 little had changed:
2.1 Conditions at Pay-points
- The predominant method of pension receipt, namely queuing on particular days at a specified pay-point, and the problems associated with this over-shadowed all other problems faced by the elderly in most provinces. Well over 50% of pensioners at Public Hearings complained about one or other aspect of the pension pay-out system.
- Security at pay-points is a great concern of pensioners, particularly when they have to return home after dark. Negotiations with banks on the payment of pensions fell through in 1996. That year the CRSS recommended these be resumed to reduce the risks of cash payments. This has not happened.
- The length of time spent in the queue, lack of shelter, seating, insufficient and filthy toilets and lack of water at pay points are problems across the country. Even where there are halls, pensioners are not necessarily allowed into them, for instance in Barclay West and Welkom. In some parts of Gauteng pensioners queue at the rent and rates offices, causing severe congestion and confusion.
- People continue to arrive very early and to sleep at pay points. No preference is given to the very frail who have to wait in line along with everyone else.
Many pensioners experience rough and insulting treatment by staff at pay-points.
There is no uniform system of pensioners committees or consistency on the payment of committee members.
Since the Provinces took over responsibility for pension payments the involvement of local structures like churches, civics and traditional leaders, has fallen away.
No national or uniform standards are applied to private contractors who pay out pensions in most provinces: paymasters arrive late, machines break down sometimes the money runs out. One contractor has no computers. There are allegations of political interference in the awarding of pension payment contracts in some provinces. Privatization appears to have brought no improvements to the pensioner.
The large numbers of people at pay-points - where disability grantees and recipients of the Child Support Grant attend on the same days as pensioners - leads to great discomfort , especially for the frail.
Money lenders are active at pay points, take IDs, are subject to little control and harass pensioners. Hawkers and liquor vendors also cause problems, the latter particularly in the Northern Cape.
A large number of burial societies, largely unregistered, try to recruit pensioners. There were complaints that some do not deliver the service they offer and others do not deliver at all.
Security officers accept bribes to let people jump the queues. There are also allegations that pensioners are short-changed by officials.
2.2 Pension payment system:
- The stoppage of pensions without warning or explanation and the non-payment of arrears when pensions are restored have been a common experience for pensioners in all communities.
- Pensioners receive no clear information on the re-registration process, how often it will occur and what documents are required to re-apply. One pensioner had to produce evidence of his divorce which took place 30 years ago.
- Many people of pensionable age still do not have 13 digit IDs and they lost their pensions without warning when this became a condition for accessing a pension. Applying for a new ID is a slow process and entails long delays. There are complaints about treatment of elderly persons at Home Affairs offices, and the assumption that the applicant is responsible if s/he has been wrongly declared dead , assigned a wrong birth date or is found to have a duplicate pensioner on the system.
- Help desks are absent from pay points or arrive late. They cannot explain to pensioners why their pension is not being paid. Yet the Committee was assured that this information is available on the system well before every pay day.
- Many pensioners are illiterate, and many more do not have a good grasp of English. Yet all communications to them are in this language.
- The SocPen5 data system continues to be widely criticized and appears to be unequal to the tasks required of it. Furthermore, IT skills in some provinces are poor , leading to mistakes and further problems for pensioners.
- In some provinces pensioners find it difficult to get procurators or proxies accepted . Pensioners in hospital have to make their way to pay-points on pension day or face the prospect of losing their pension. Some have died in the queue. Frail pensioners are carried to pay points in wheel-barrows, There are also allegations that the proxy system is being abused with shop-keepers and other unrelated parties being accepted by the Department (Southern Cape).
While documents from the Department of Welfare claim to have introduced "a new dispensation which incorporates appropriate and affordable community-based services", this is very far from the reality experienced by a great many old people. While this Committee endorses the policy that elderly people should be able to remain in the community as long as possible, this has become increasingly difficult for many old people due to the absence of community services in most areas, inadequate housing and unaffordable service charges.
The 1995 Management of Age Policy has been a failure as it lacks a transformation plan, adequate funding, community buy-in and tangible community models, enabling legislation and leadership from the National Department of Welfare.
The Committee found the following:
The Committee makes the following recommendations:
- The establishment of a statutory representative mechanism or commission on ageing as recommended by the United Nations to ensure effective communication and consultation in policy-making. This should be representative, inter-sectoral, multi-disciplinary and culturally sensitive. It could be linked with the Human Rights Commission and be the base for a national elder abuse help line and an ombud system which has been widely advocated.
- The appointment of a Task Team to ensure that the crisis in the delivery of services to the elderly is addressed and give attention to the findings and recommendations of this report.
- A comprehensive new Act on the status of older persons since existing legislation in unable to protect residents in homes or in the community. At present the only sanction against abuse in homes is to stop subsidies and de-register a home which can be damaging to residents.
- The setting up of an inter-departmental committee which includes all Departments in contact with elderly people, notably Welfare, Health, Home Affairs, Justice, Safety and Security, Housing and Local Government to ensure elderly citizens receive sensitive and integrated services.
- The HIV/AIDS pandemic is already placing a burden on elderly persons who are burying children and being left to care for grand-children. This burden will get much heavier. The provision of community based services for the elderly will lay the basis for services for the wider community - the only realistic strategy for dealing with the effects of the pandemic.
- Provincial audits of all government-funded homes must be carried out as a matter of urgency to find out where vacancies exist and ensure they are accessible to those in the greatest need and to ensure that new homes are only built when the need is clearly demonstrated.
- A Commission of Enquiry should be set up to find out what happened to residential facilities built or purchased with low-interest loans from the previous government, which of these loans were discounted in 1993 and whether the terms of the loans have been honoured.
- In most disadvantaged communities the frail elderly and their families are unaware that residential care facilities exist so they do not get onto waiting lists. The attention of local structures (due to be set up under the Municipal Structures Act) needs to be drawn to this information gap.
- According to the Aged Persons Act 1968 registration of homes must be reviewed annually. This must be implemented and it cannot be done without in situ inspections.
- Minimum norms and standards must be laid down and enforced, as is now being done in pre-schools. Most homes in disadvantaged areas will require capital funding to upgrade them to such standards.
- A uniform, means-tested per capita subsidy must be paid to homes. The present two-tier system must be abolished
- Pre-employment and in-service staff training programmes must be a condition of the granting of subsidies and staff/frail resident ratios must be set and applied.
- The Protocol on Elder Abuse must be finalized in accordance with legislation and minimum standards set which will ensure that abuse is minimized and properly managed . The protocol must be jointly administered by welfare and health personnel.
- As part of the service level agreement laid down in the Regulations a staff code of conduct and a complaints procedure must be displayed prominently in every registered home. All staff members must wear name tags.
- The Aged Persons Amendment Act 1998 and the Regulations must be publicized and implemented, including the setting up of management committees and of the national abuse register.
- In the long term responsibility for supervising homes for the elderly should be devolved to local government health departments and community structures due to be established- this is the only way in which homes can be open to public involvement and scrutiny and the well-being of the residents safe-guarded.
New composite legislation on the rights of the elderly must be drafted and introduced as promised and must include:
- Machinery for the monitoring of standards in homes and the investigation of complaints.
- Written contracts on norms and standards between the Welfare Department and registered homes
- Minimum standards on staff ratios and training
- The mandatory inspection of homes - while responsibility lies with Welfare, this must be done in collaboration with the Health Department.
- A revised DQ98 which includes facilities for the frail elderly and community based health care
Short-term
- Negotiations with the banks and post office must be resumed without delay and issues such as access, savings-books, bank charges and minimum balances resolved so that pensioners have a choice of where to receive their pensions .
- It is too often assumed that the present payment system (which largely applies to blacks) is here to stay. This is unacceptable - it must be phased out and replaced with a uniform system for pensioners of all races.
- Contracts for the outsourcing of pension payments should be made public and reviewed. Costs and profits must be disclosed and the awarding of tenders must be open to public scrutiny.
- National standards must apply to all contractors. Regulations under the Social Assistance Act must include criteria for the location of pay-points, standards and maximum waiting time.
- Communication remains a priority - in 1996 the CRSS recommended a communication strategy to inform beneficiaries of their rights and of changes to the system.
- There must be help desks at every pay point so pensioners can get up to date information on the status of their pensions. Verbal and written notice must be given of reviews and other problems. Warnings of pending suspensions should be given on the payment slips accompanying the pension, advising pensioners to go to the help desk for further information.
- Social relief must be available to pensioners when their pensions are suspended or there are delays in sorting out ID problems.
- Welfare and Home Affairs systems must be coordinated as a matter of urgency.
- The Task Team must identify pilot projects to find ways of improving the regulation of micro-lenders and procurators.
Medium-term
While a great many pensioners complained that the pension amount was too little to cover the family expenses to which it is committed, in the light of the size of the pension budget and the current financial constraints on the Government, the Committee decided that rather than recommend a significant increase in the amount it would be more realistic to propose the following:
- A mandatory, contributory pension scheme for all employed persons, in the formal and informal sectors, to be established as a matter of urgency.
- The social pension should be index-linked with inflation
- Social pensioners should qualify for rebates and discounts on local and other services including transport and school and hospital fees, to reduce the financial pressures upon on them.
- The Care Giver Allowance should be publicized to pensioners and their families . This would also relieve the looming crisis over HIV/AIDS.
- The present pension system should be devolved to the community level in consultation with local, well-established structures including shops. Bodies such as churches and mosques, the Salvation Army, traditional leaders and local civics should be involved. This would be a cheaper option and would ensure a user friendly service. Pensions could be delivered to people in hospital, for example and pensioners could be given a choice of where to collect their pensions. This committee recommends that such a system be piloted in areas where the infrastructure exists.
- The establishment of services to care for the elderly in the community depends on inter-Departmental cooperation, the implementation of agreed plans and the availability of resources to do this. It is accordingly recommended that the National Department of Welfare approaches the Departments of Health and Safety and Security with a view to addressing this urgent issue.
- Clubs for the elderly are a valuable resource, fulfilling a nutritional, social and monitoring function. In order to flourish and expand they need help in the form of permanent bases and seed funding to procure basic essentials such as furniture and cooking equipment. They also need ongoing support and advice if they are to develop and extend their functions to addressing the HIV/AIDS crisis. Ways of accessing welfare funding, poverty relief funds and funds from the National Lottery must be simplified and explained to the public. And these funds must be released to those in greatest need.
- Rent and Service Charges: Households depending solely on the social pension must be able to qualify for rebates and be spared the anguish of facing mounting bills they can never settle and disconnections. There needs to be consistency across provinces and local authorities on an Indigency Policy and it needs to be implemented.
- Pilot home care projects should be started from clinics, with basic training and uniforms given to young, unemployed care-givers. This assistance to families to care for their elderly relatives should become a policy priority . It would make it possible for many single elderly to continue to live at home.
- Neighbourhood support systems to monitor the safety of elderly residents, linked to Community Policing Forums and clinics, should be set up with the assistance of churches and local organizations. Many retired nurses and doctors would be willing to help if a commitment was demonstrated by provinces.
- Safe Houses: vacant beds should be kept in every residential home to accommodate elderly people who have been abused, victimized or become homeless. Where such facilities are not available safe houses should be established
- Funding for community based organisations from the National Lottery must be made available as soon as possible.