Mothers and Fathers of the Nation: The Forgotten People

Report of the Ministerial Committee on Abuse, Neglect and Ill-Treatment of Older Persons

26 February 2001

MAIN REPORT

INTRODUCTION:

Following the screening of the Carte Blanche programme in March 2000, Minister of Welfare and Social Development received over 2,000 E-mail letters protesting at the ill-treatment of elderly residents at the retirement home, as exposed by a hidden video camera . They recounted similar stories and appealed to the Minister to do something about the situation in frail care centers. They called for abusive homes to be closed and those responsible to be prosecuted. They asked why facilities were not being inspected. This Committee was set up in response to this outcry.

TERMS OF REFERENCE OF THE COMMITTEE

The Ministerial Committee was mandated to conduct an investigation to:

• Determine direct and indirect causes of abuse, neglect and ill treatment of older persons in government and government funded residential care facilities, pension pay points, service centers as well as family settings.
   
• Assess current practices regarding the promotion and protection of the well-being and dignity of older persons in government funded residential care facilities, pension pay points and service centers.
  
• Make recommendations to the Minister of Welfare, Population and Development on measures to prevent and effectively deal with abuse, neglect and ill-treatment.
  
• Investigate specific reported cases of abuse, and make appropriate recommendations.
  
• Assess direct and indirect causes of abuse, neglect and ill treatment of older persons in organizations registered in terms of the Aged Persons Amendment Act.
  
• Determine the adequacy of existing legislation and regulations to respond to abuse, neglect and ill-treatment of older persons.
  
• Submit a final report to the Minister of Welfare, Population and Development within six months after its appointment.
  
• In addressing its mandate, the Committee was assigned the following tasks:
  
• Visits to subsidized and unsubsidized centers and facilities in urban and rural areas where older persons reside, visit or receive care
  
• Visits to pension pay points in urban and rural areas.
  
• Facilitate and organize public hearings in all main centers in all provinces as well as in rural communities
  
• Invite, receive and study written submissions and reports inter alia from the public, NGOs, CBOs, Departments, traditional leaders and churches.
  
• Collect and review research and other relevant data.
  
• Develop and operationalise a communication strategy.

COMPOSITION OF THE COMMITTEE

Members of the Committee were the following:

Mr. Tom Manthata, Chairperson
Mrs Pinky Vilakazi, Vice Chairperson
Mrs Ketiwe Kwazi
Mrs Mpho Maine-Oliphane
Mr Syd Eckley
Mr Monontsi Joseph Mzondeki
Mrs Mary Turok

WORK OF THE COMMITTEE

The Committee held its first meeting on 24 March 2000. The following programme of provincial visits was agreed:

The visits centred on public hearings which took place in two to four locations in each province and were arranged by provincial welfare departments. Not all Committee members were able to participate in all visits but wherever possible some members of the Committee visited residential and other facilities for the elderly while others attended the public hearings. From the start it was apparent that only a small number of such facilities could be visited so the Committee had to depend to a considerable extent on verbal and written reports presented to the public hearings or directly to the Committee and its members. The Committee also realized the limitations of single visits as a reflection of the true conditions in a home or other center.

In June the Committee was invited to attend Public Hearings on the abuse of older persons called by the Welfare Portfolio Committee in Parliament. Prior to the Hearings the two committees met and agreed to work together on the issue.

In the course of its work it was warmly received at public hearings and in most other locations. Provincial welfare authorities were cooperative and showed concern about improving the service to elderly people.

1. UNDERSTANDING ELDER ABUSE*

1.1 THE ELDERLY IN AN HISTORICAL CONTEXT.

Looking at relations between adults and their parents some authors maintain that on the basis of Greek myths, Biblical passages, legends, fairy tales, ceremonies and famous crimes, two contradictory themes can be seen: that of abuse of elders by their adult children and that of respect for elderly parents. Inter-generational relations are defined by the conflicting themes of respect and distain.

The aggression of adult children towards their parents takes many forms, murder being the most extreme. "Matricide", " patricide ", and "parricide" refer to mother-murder, father-murder, and parent-murder respectively. This theme is embedded in culture and thus can be taken as "natural". The other theme emphasizing respect, loyalty, love, honour is equated with civilization, morality, and religion. Within this paradigm the notion of harming one's parents is considered repugnant, immature, inhuman, a sign of madness, and an impossibility.

The theme of parental oppression of offspring and a son's need to kill his father is illustrated by the ancient Greek myth of Oedipus which was later developed by Freud in his theory of the seduction by a parent of children of the opposite sex.

Along similar lines, Sumner claimed that there are two types of society which socialized the young differently: those that taught respect for the aged and those that taught that the aged are societal burdens which waste the strength of the society. From the Darwinian perspective, protecting one's parents after reaching maturity is non-adaptive, as it only contributes to overpopulation which endangers the species. The pre-civilized approach of patricide for the sake of survival contrasts with the civilized post-Biblical approach of sustaining and honouring one's elders.

1.2. WHY ELDER ABUSE?

As the population is ageing and elderly people become more dependent, it is probable that the incidence of abuse will increase. In an increasingly mobile society, where the extended family is weakened, the elderly often find themselves cut off from their families and their communities, even if they are financially independent.

The subject of elder abuse is taboo in the same way that child abuse used to be. To many people, it is unthinkable that someone could batter a frail, dependent, old person. This is one of the reasons why it has remained the best kept secret of modern times. Douglass suspects that the mistreatment of the elderly is a sensitive problem because it involves such value-laden ideas as "home" and "family". People want to be seen as good, decent and caring and we use our homes to project this image. We tend to see our families through lenses tinted with the rosy glow of warmth and affection.

*(For a more detailed version of this section please contact pinkyv@housepta.pwv.gov.za)

Unfortunately, this does not always reflect the true situation. Home and family are no more immune to violence than any other sphere of our lives. Recently the image of domestic tranquillity has been challenged by the realities of increasing abuse. In 1975 Burston began writing about " granny bashing " but few Americans responded even though child abuse and spouse abuse were acknowledged. In 1978 Steinmezt "discovered" battered elders but was greeted with disbelief and denial . However, as more and more articles appeared awareness was raised and researchers began to investigate the nature and extent of this abuse.

In South Africa violence has become part of our daily lives. We read about it in the newspapers, see it on television and experience it on the streets of our cities and towns, but behind the closed doors of homes more violence takes place than we care to admit, parents abuse children, husbands abuse wives. And elderly people are abused and neglected by spouses, caregivers, children and grand-children. It is hard to believe that old age, respected and revered in many societies, could be so ill-treated. This problem has emerged only recently as a significant social issue that deserves to be thoroughly researched as well as addressed on a practical level.

Firstly, to enable us to help the victims, we need to understand the problem and develop detection, intervention and prevention strategies. Secondly, to help to reduce the incidence of abuse and neglect, we need to examine the underlying societal attitudes and institutional policies which set the stage for it .

1.3 DEFINING ABUSE:

In 1987 the term "abuse and neglect of the elderly" was used to describe situations in which individuals over the age of 65 experienced battering, verbal abuse, exploitation, denial of rights, forced confinement, neglected medical needs or other types of personal harm, usually at the hands of someone responsible for assisting them in their activities of daily living

By 1993 neglect and abuse of old people was no longer denied and there was an attempt to find out why it happened. Bennett called abuse " another iceberg phenomenon" and complained that definitions of it lacked clarity and precision. This was because investigators approached the abuse from various perspectives: the victim, the carer, the physician, the nurse, the agency, the social worker, social policy.

O'Malley sought to place abuse and neglect within the wider context of inadequate care, defining it as "...The wilful infliction of physical pain...mental anguish....or deprivation by a carer of services which are necessary to the maintenance of mental and physical health". But Hudson & Hudson maintained that the label of abuse could only be applied if it was clear that the carer or the caregiver intended no harm. According to them, O'Malley's definition excluded independent older people who could also be victims of abuse.

Bennett & Kingston ask: What about the carer who inflicts pain, but has no wilful intent ( perhaps because of lack of caring skills)?

An interesting argument comes from Pillemer & Wolf who see a tautological problem of using the word abuse to define itself . Even though forms of abuse are distinguished, neglect and abuse are basically defined as neglect and abuse. They prefer the term "elder mistreatment."

Elder abuse remains a taboo subject and professionals and the general public often do not believe that it exists. Pritchard feels that it will take many years before any meaningful agreement is reached on an all-embracing definition of abuse , during which time the problem will be getting worse.

1.4 TYPES OF ABUSE AND NEGLECT

Wolf divided elder abuse into three types:

1. physical abuse;
2. psychological abuse; and
3. material abuse.

He divides neglect into active and passive neglect or intentional or unintentional neglect.

1. Physical abuse:

Physical abuse of the elderly receives the most attention in the literature and is the most easily identified. "Physical abuse refers to acts of commission that involve the intentional infliction of physical discomfort, pain, or injury ( e.g. slapping, cutting, burning, physical coercion, or restraint, etc) and that lead to bodily harm to the aged individual,". (Douglas and Hickey)

Some authors limit elder abuse to acts involving caregivers and distinguish it from physical assault committed by someone other than a caregiver although this involves victimization.

One of the main problems is proving that an injury has been caused non-accidentally. If an elderly person presents with injuries, the assumption is usually that the bruising, cuts, fractures, etc. have been caused by falling.

2. Psychological Abuse

"...Psychological abuse involves the caregiver's intentional infliction of mental anguish or provocation of fear of violence or isolation in the elderly person. Such abuse may include verbal assaults upon the elderly ( e.g. name-calling), humiliation or intimidation, threats of placement in a nursing home or isolation, or treatment of the elderly person as a child."(Wolf)

The concept of psychological abuse is difficult to define and measure . It is more useful to concentrate on its major manifestations such as repeated insults or threats. Some prefer the concept of "chronic verbal aggression." (Podnieks)

3. Material Abuse:

Material abuse is characterized by the intentional, illegal, or improper exploitation of the older person's material property or financial resources (15). This would include theft, conversion of money or use of funds without the elderly person's authority. Material abuse may include attempts to persuade or influence the elderly person to give up money or relinquish control over finances.

4. Other types of abuse:

Douglass includes self - abuse and spouse abuse. Self abuse is typically the neglect and potentially life-threatening actions of a mentally deteriorating older person who lives alone and is unable to care for himself or herself adequately but who resists outside help.. While this type of abuse is a problem, it will not be covered by this report.

Spouse abuse normally refers to younger couples. But it crosses all racial, economic and age-group boundaries and has little or nothing to do with the age or ageing of its victims. It has been part of a marriage for many years, and many victims endure abusive treatment throughout their adult life. Husbands or wives who have been abusive through long marriages are not likely to change their behaviour at a later age.

However, there are cases in which an abusive spouse will become abusive to "get back at" the offender. Douglas calls this "Late-Spouse Onset". This is often associated with alcohol or drug abuse, unemployment, post-retirement depression, loss of self esteem, the perpetrator's history of being an abused child, or an unusual level of violence in the home.

5. "Normal violence"

Some suggest that certain acts of violence are part and parcel of daily living and can be differentiated from abusive violence of a criminal type. This is neither new nor unique to our society: the family is the most violent of social institutions. In addition, people seem to assume that family members will automatically know how to care for an elderly person. This contrasts with our approach to child-rearing where organised state health supervision is provided, generally both before and after a baby's birth. How do people learn to look after ageing parents? Most people simply do it by trial and error.

1.5. RESEARCH ON ABUSE.

Elder abuse has been focussed upon by researchers in the field of family violence and led directly from the "discovery" of child abuse and domestic violence/spouse abuse. The attention of researchers was combined with:

1. The increasing number of elderly frail people at risk;
2. The long-term effects of community care policies upon the care of older people; and
3. A greater interest in the sociology of old age

Abuse of an individual is an emotive and value-laden topic of inquiry. The effect of the abuse upon the victim and those who deal with it can be traumatic. Any research necessarily entails both how the methodology may affect respondents and the responsibilities of the researcher when abuse is discovered or disclosed.

Many attempts have been made to research elder abuse. Prior to 1982 research aimed at demonstrating the existence of abuse and describing its nature and scope. The main theories on the causes of elder abuse can be summarized as follows:

1. mpairment of the elderly, which increases dependency and vulnerability and may lead to learned helplessness;
2. individual pathologies of the abuser, including mental illness, retardation and alcoholism;
3. internal family dynamics, such as learned patterns of violence and the stress of family care-giving;
4. external stress, illustrated by income and employment status;
5. demographic and social changes which result in increased numbers of frail elders who place excessive demands on families; and
6. stereotypic and prejudiced attitudes toward the elderly and disabled persons that serve to justify their maltreatment.

A lot of early research was problematic. Conclusions were vague, definitions overly broad , samples non-random and the various forms of abuse were not distinguished. However, research has been influential in the construction of elder abuse as a social problem Numerous studies, mostly in the United States, document the existence and nature of elder abuse and neglect but few have focussed specifically on the prevalence or incidence of elder abuse and neglect . Current estimates of the number and incidence of elder abuse cases reported to social service agencies are misleading for a number of reasons:

1. Agency figures represent an unknown fraction of the total number of actual cases;
2. Reported cases most likely reflect a biased sample of the most extreme and cases;
3. Lack of uniform reporting laws and record keeping affects the number of reported cases;
4. There is still a low level of awareness of elder abuse among professionals, the public, and even victims themselves; and
5. The number of cases reported to agencies varies according to type of agency, its title, its location, etc.

Many studies have examined the extent and nature of elder abuse and neglect among the elderly. Respondents have included paraprofessional, professionals, elders and caregivers. Most of these studies have been exploratory and descriptive.

A variety of techniques have been used to collect information , mostly focussing on stress and dependency as precipitators to abuse. Others identified functional disability or impairment as antecedents of abuse. The O'Malley study found that significant disability and being female cut across all subcategories of age, while the Pillemer study found that a significant percentage of abusers were dependent on the elders and that the victims were no more likely to be seriously ill than the non-abused control group.

Research on detection was problematic due to lack of uniformity and standardized methods of detecting elder abuse. Less than one-third of professional respondents had written "procedures" or "protocols" for detection

Many other studies provide a background to the study of elder abuse but suffer from methodological weaknesses. Most of these studies are based primarily on cases uncovered through surveys of professionals (nurses, doctors, social workers, legal aid etc). The data on elder abuse has not come directly from victims. Second-hand information may distort the situation by failing to present the problems as they are perceived by the participants.

In the United Kingdom there has been no systematic research in this area. Several small scale studies were unpublished. A few studies have been undertaken in Sweden and France but more needs to be known about the extent to which elder abuse is be a problem in Europe.

1.6 ELDER ABUSE IN SOUTH AFRICA.

The 1968 Aged Persons Act was introduced to regulate homes for elderly white people. It was intended to address the exploitation and unjust treatment of aged persons in homes run for profit by ensuring these were registered, that standards of care were laid down and inspections carried out to ensure standards were maintained. (Assembly debates 21 April 1967 - 4639). Following this Act there was an explosion of homes for elderly white people. In succeeding years the focus on protection and inspection, even for white elderly in homes, seems to have been sidelined.

In 1981 The SA Council for the Aged spoke out against abuse of the elderly and held. seminars throughout country (Eckley and Vilakazi 1995). Friends of abused frail elderly in homes was formed 1992. A workshop on malpractices and mistreatment of residents of homes for aged that year concluded that a distinction be made between mistreatment (verbal, neglect, financial and over-medication) and abuse (physical, psychological, sexual, theft). SACA adopted a Declaration on Rights of Elderly in 1993 and started to negotiate for an ombudsman.

The correlation between number of reported incidents of abuse and advanced age as well as greater number of aged females than males is noted by Eckley and Vilakazi. They maintain that white elderly prefer to live apart from families whereas black elderly choose or are forced to live with their children. They quote a national survey in which more than 80% of black elderly said they experienced serious problems due to lack of basic health care , conveniences and over-crowding. "In communities with high levels of unemployment (and consequent poverty) heavy demands and pressure are placed on elderly who receive social pensions".

The August 1, 1995 "You" Magazine carried an article on abuse in white old age homes in Cape Town. The article was about a voluntary group called the Concerned Friends of the Frail and Aged. Over a period of two years the CFFA received 300 complaints from people mistreated in old age homes.

More recently, Focus on Elderly Abuse was set up in Cape Town with the object of exposing conditions on homes and lobbying for improved policies and practices.

In 1999, the International Year for Older Persons, the Health Department issued a report on Abuse of Elderly, quoting an opinion survey based on questionnaires sent to organisations dealing with elderly. No age or race breakdowns are given. Of the responses, 69% had heard of abuse 32% reported ill-treatment.37% knew of emotional or psychological abuse, 36% of financial abuse, 11% of general maltreatment. Sexual abuse is not mentioned. Elderly respondents considered financial abuse the most important form: it included theft of pensions and being made to work for children without payment. A breakdown of abusers was: 55% grandchildren, 16% children, 20% husband/wife, 4% caregivers. The most common strategies proposed to address abuse were that Government enforce laws to protect elderly , monitor abuse , educate the community to respect and care for the elderly and educate the elderly on their rights and the importance of reporting abuse. (Smaller numbers mentioned community facilities, life-line and pension security)

In March 2000 Keikelame and Ferreira published a report on Elder Abuse in black townships on the Cape Flats. Their research was based on focus groups of elderly people in three townships. They claim their study is the first to investigate actual elder abuse and they point out that the government's national strategy to prevent abuse is not based on any concrete local evidence. They found that more instances of emotional/verbal than physical abuse were reported and that this was linked with accusations of witchcraft. Instances of sexual abuse outnumbered all other types of abuse. Systemic abuse was also referred to and included bad treatment at clinics, pay points and offices.

In accounting for this some respondents blamed the government's marginalisation of old people. Generally groups felt the government had an important role in addressing the problem. Some favoured refuges for abused old people but others were not happy with what was seen as contrary to tradition. Some blamed unemployment and increasing alcoholism and drugs. There was disappointment with the reluctance of social workers, the police and street committees to act on reports of elder abuse. Disappointment was also expressed with the new government for which they had fought. They wanted a stronger stance on crime and more concern for the welfare of older people.

These researchers saw elder abuse as part of endemic domestic violence with contributory factors being the weakening of family structures and urbanisation. They also talk of "the demise of social welfare and the collapse of formal support structures following reprioritization".

The study of race and ethnicity in relation to old age abuse is still at a very early stage . Eastman states that there are two hypotheses regarding the interaction of ethnic/racial minority status and old age abuse. The first is that ageing somehow diminishes the strength of the adverse racial/ethnic factors and the risk of abuse is consequently decreased. The second is that elderly people in black areas are at an increased risk and are in "triple jeopardy" due to discrimination and poor health and social status, compounded by lack of access to services.

1.7 CRIME AGAINST THE ELDERLY

1998 figures are the most recent available from SAPS on crime against the elderly . They apply to persons over the age of 50 - statistics for older persons are not recorded separately

 Footnotes

Murder: Figures are high in KwaZulu Natal and Mpumalanga, fairly high in the Eastern Cape, Gauteng, Western Cape and the Northern Cape and lowest : in North West, Northern Province and the Free State.

Rape: The figure is highest in the Eastern Cape but high in Gauteng, Northern Province, North West and the Western Cape.

Assault: Figures are highest in the Eastern Cape but also high in all the other provinces.

Kidnapping: The figure for the Northern Province is very high. Elsewhere numbers are small.

1.8 WITCH HUNTING

Aan ancient form of persecution which continues to flourish in a modern society

65 year old Jessie Zikalala was branded as a witch by the community sangoma. The sentence: death. Jessie is just one of many elderly victims who die every year in rural communities. Despite the efforts of dedicated journalists to expose this practice, it nevertheless continues unabated.

Jessie Zikalala was burnt to death in Bluebank, a rural area south of Ladysmith. City Press reporter Elias Maluleka covered the story.The events leading up to Jessie's death started when three people died suddenly in the area. It was suspected that one death in particular was the work of "witches". A meeting was called and it was decided that every householder should pay R50.00. Jessie paid her R50,00. A group of people then went to visit a sangoma who allegedly gave them descriptions of the "witches". On their return the delegation called a meeting and named the "witches".

Jessie's granddaughter, aged 14, attended the meeting. She then rushed home to tell her grandmother she had been branded a witch. Her granny refused to hide because she said this was simply not true. During the night the young girl watched as the enraged mob dragged her granny from their home, punched, kicked and sjambokked her. Jessie was then brutally murdered. Her son Patrick said that she was innocent and knew nothing about witchcraft. She was a staunch member of the Methodist Church and a true Christian.

A few years ago Ruth Bhengu of the Sowetan was assigned to a story about a "witch" who was supposed to have been caught. When Ruth and her colleague got to the house there were crowds inside and outside the yard. They found an old lady sitting on the floor looking dazed. They spoke to the tenants who said the old lady had started acting strangely the previous night. They said she had too much to drink the day before. "I was somewhat relieved that the old lady, who was clearly confused, had not been caught in someone else's yard," said Ruth.

In the crowd was a 17 year old schoolgirl. She suggested that the old woman's house be brought down with a boom. "I felt a chill running down my spine" said Ruth. "There were other school kids who were supposed to be in class but had decided that witch-hunting was more exciting. I felt physical pain when I remembered how we, as teenagers, used to treasure these old ladies. Everyone of them was Mama. Today a pretty teenage girl can look at a 60 year old woman and sentence her to death".

According to the police in Lebowa, 66 elderly people have been killed in various villages of Lebowa since the beginning of 1994. Dozens have fled their homes and sought refuge at police stations. As politicians around the country intensified their campaigns for political freedom, youth stepped up their offensive against the " agents of forces of darkness."

Khathu Mamaila, Sowetan journalist, gave his views: "To the police those who execute 'witches' are villains who should be prosecuted to the fullest extent of the law. But to their communities, these youth are selfless heroes committed to 'freeing' people from 'supernatural evils'. Police are fighting a losing battle as they address only the symptoms of a deep-rooted problem. The problem is that police can only act against those who physically attack the victims - not against those who indoctrinate the youths to believe in witchcraft. The master-minds behind the killings are often left alone".

One of the cases reported by Khathu involved a 17 year old child who was struck by lightening while playing, and another who was injured at Ga-Molepo. A meeting was subsequently held by villagers at the local school. Contributions of R5.00 were made towards paying an inyanga (witchdoctor). A total of R690.00 was collected and the inyanga promised to flush out the culprits.

"The inyanga said that the culprits would voluntarily expose themselves after being afflicted by mental illness," said Khathu. "A few days later an old lady, Mrs. Nelly Mokgopa, became mentally ill. She and four others were stoned and burnt to death. Hardly a week after this incident, four others were also killed in Ga-Molepo, after being accused of witchcraft. These people were "picked" up after the inyanga failed to expose the people responsible."

In another incident in Seshego, Lebowa, a 73 year old man was saved by the quick intervention of the police after an angry mob accused him of being a wizard. This man was apparently found at a house at about 3 am. Residents claimed he was caught while trying to use muti to kidnap a youth who stayed in the house. The youth was allegedly to be turned into a zombie like his brother, whom township residents believed was transformed into a zombie in 1988. The man was questioned by residents for three hours and was rescued by police minutes before he was to have been burnt to death. Police were unable to find a zombie in his house.

According to Khathu several police stations have been turned into places of safety for the elderly and for pupils and toddlers who fled their homes after their relatives were identified as "witches". Some of their homes have burnt down.

Khathu said that the community would go to the extent of raising funds to help the suspects pay bail and lawyers. Police say the practice will not stop as long as people strongly believe in witchcraft. In many cases the youth are used as pawns in an adults' game. The captives are paraded before the adults who then leave it to the youth to carry out the executions. The police maintain that their main problem lies in rehabilitating the culprits after their conviction. Once released, the culprits usually continue with the witch-hunts because they believe they are serving the community.

"If no campaign is launched to eradicate this scourge," wrote Khathu Mamaila, "the killings are bound to continue from generation to generation."

The background to witchcraft in Venda is examined in "Witch killing and the elderly", an article by Dr Catherine Payze & Dr Anthony Minaar. At least 75% of the women who appeared as victims in witchcraft cases in the Thohoyandou Magistrate's Court ( Venda) were elderly. The physical appearance of old women lends itself to accusations of witchecraft. The above authors suggest the following reasons for the elderly being targeted as witches:

• They are often frail and less powerful as their assailants, they are therefore seldom able to resist attack;
• They are sometimes perceived to do no work for their share of the wealth. For example, they not yet working when the youths leave early in the morning for school or other activities and they have completed their daily tasks when the youths return late in the day;
• There is a belief in Venda that women have many secrets. By the time they are old they know about many things. Hence the Venda saying that: " All women are the same and all women are witches."

2. THE SOCIAL PENSION SYSTEM

Old age pensions for whites were introduced in 1928. African elderly were denied pensions because the Government claimed their "Native custom makes provision for maintaining dependent persons." Only in 1943 did black pensioners start to qualify for pensions, initially only in urban areas and at a very minimal rate. Subseqently pensions were extended to blacks in rural areas, at a lower rate. Only in 1965 did the Government decide to introduce a uniform pension to all black elderly and to give annual increments to them - in order to discourage the drift to the cities.

In 1975 the maximum pension payable to Africans was R15 a month but not many pensioners were paid the full amount. No pension was paid if other income exceeded R128 a year. The situation was complicated by the homelands system: for instance in the Transkei the pension was not means-tested. All pensioners received a pension of R22.50 a month.

Social Pensions: Amount Paid According To Race Since 1979

There was great excitement when parity was achieved in October 1993. Unfortunately parity did not extend to the delivery system. While most white, coloured and Indian pensioners received their pensions through banks and the post office Black elderly still had to queue in the open without facilities. There was a high security risk to staff and beneficiaries and payment problems included shortages of cash. At various times the media continue to high-lighted the plight of black pensioners.

It has been estimated that over 80% of the elderly have no income other than the social pension: they earned low wages as unskilled manual workers, were retrenched , are illiterate, did not contribute to pension funds , suffered from ill health , had no medical insurance and little access to health care.. Pensions play a crucial role in combating poverty in many families. One researcher found that pensions ranked second only to migrant remittances as a source of cash income without which families throughout the rural areas would have starved.

In 1979 the Soweto Care of the Aged met with the Deputy Minister, Dr Andires Treunicht, on the issue. Delays in the payment of pensions for Africans had again occurred, pensioners had been turned away because there was no more money or because the money had been stolen. Many pensioners spent the night at pay out points to ensure they would receive their pensions

In 1980 the Urban Foundation presented the Government with a report on the problems at pay points. In 1983 a survey was conducted under the auspices of the SA Council for the Aged which showed the desperate plight of pensioners. The findings were given to Government and follow up meetings with officials held but nothing improved. The Black Sash, the Legal Resources Centre and other welfare organizations have been involved for years in assisting pensioners at pay-points and in trying to get conditions improved.

In September 1991 a system of review was introduced without prior warning or explanation. Many pensions were cut . In a report in July 1992 : The Administration of Social Pensions for Blacks in RSA, the SA Council for the Aged lists the following problems facing pensioners at pay-points:

• Changes of identity books
• Incorrect dates of birth
• Shared ID numbers
• he means test
• Lack of communication regarding approval, review, cancellation, death
• Venues that lack shelter, toilet facilities, water, chairs
• Long queues
• Attitudes of paying staff
• Declaring the living dead
• Implications of going without a pension
• Payment of arrears
• Robberies and safety of staff and pensioners
• Lack of adequate funds at pay-out points
• Ratio of pay points per team

The Committee for the Restructuring of Social Security (CRSS), chaired by Rev. Frank Chikane, was set up in 1996 in response to the crisis in social grants. They reported to the Minister of Welfare in December 1996, recommending the establishment of a nationally organized system of social security and national standards and guidelines regarding outsourcing. Other recommendations included negotiations with financial institutions to reduce the risk of cash payments, steps to improve customer service and a communication strategy to inform beneficiaries of their rights and the changes in the system. There were insufficient service providers in the rural areas.

The Social Assistance Act of 1992 was finally proclaimed in 1996 and its administration assigned to the provinces.

The following year the Welfare Portfolio Committee in the National Assembly observed that many issues raised by the CRSS report had not been attended to including the following:

• Ongoing vacancies in the Welfare Department especially of senior management and IT staff;
• The appointment of a provincial assistance task team;
• The upgrading of SocPen5 computer system and the establishment of a computer audit function;
• Training and upgrading of staff and attention to disciplinary procedures;
• Amendments to the Social Assistance Act to provide comprehensive norms and standards.

The Welfare Laws Amendment Act was passed in December 1997. It repealed the assignment of the Social Assistance Act to the provinces and the social pension laws of the former homelands, thus implementing the first recommendation of the CRSS report. The Act provides for delegation of powers to the provinces. Parliament appropriates funds for the national budget and allocates to provincial revenue funds. The provinces then allocate to various departments.

The Public Service Commission investigation into Social Security Services in February 1998 recommended standardized application forms and information to applicants. In addition it recommended a client charter, the upgrading of SocPen5 (the data base), training of officials, in loco inspections , advice to the provinces, a joint strategy with the Public Works Department for the upgrading of accommodation at pay points and better management and control of private contractors including penalty clauses.

The Regulations to the Social Assistance Act did introduce a uniform, although complex application form for grants. Few of the other recommendations have been implemented to date.

In the year 2000 many problems remain as are described in this report.

2.1 The Social Assistance Act 1992:

This Act is a successor to the 1973 Social Pensions Act and consolidates the law on state pensions and grants.

• This legislation was assigned to the provinces to administer when it came into operation on 31 March 1996. The. National government retained authority to determine who qualified for a grant, how much was paid and procedures for applying for grants. Later these sections of the Act were amended but the administrative framework remained unlegislated upon. This includes the national data base, its operations, how grants are paid and by whom and conditions at pay-points - yet this is where major problems occur. Which level of government takes responsibility for this will need to be established - currently neither is addressing it.
  
• The Committee was advised that there is a Task Team looking into this and that sections of the Social Assistance Act may be unconstitutional.
  
• Recently a committee of enquiry was set up to look into comprehensive social security system for South Africa. It will cover old-age and retirement pensions, health care needs of those without medical schemes, unemployment benefits, child grants and poverty relief. It will also look at the results of other enquiries. Submissions have been sought before the end of November and public hearings will be held.

2.2. Problems with the Social Assistance Act:

The following problems were highlighted at the Public Hearings held by this Committee:

• Provinces have an "unfounded mandate" to pay grants. If a provincial budget allocation for social pensions is spent before the end of the financial year new applications are not processed. However, applicants are not informed of the reason for the delay and continue to call at offices and pay-points in the hope of getting their grants. The 1998 Regulations limit back payments to 90 days from the date of approval of the grant not from the date of application. This seriously disadvantages applicants in provinces where there are long delays for the above reason.
  
• Social relief grants and food parcels are not budgeted for in all provinces or publicized adequately, although this would relieve some of the suffering occasioned by delays and cancellations. Where such grants are paid the cost is deducted from the grant when it is paid or re-instated. This is not explained adequately to beneficiaries.
  
• Deductions from the social pension are not permitted under Section 11 of the Act but are made by some provinces and by some contractors. In Gauteng an amount is deducted to pay for facilities at pay points. CPS continues to deduct contributions to Cornerstone Funeral Society in KwaZulu Natal in spite of objections. This practice is open to abuse and contrary to the law.
  
• Increases in pensions have not been inflation linked so over the years the value of the pension has been eroded. The withdrawal of the State Maintenance Grant and its replacement by the smaller Child Support Grant paid for children aged 0 to 7 hit many pensioners hard especially in KwaZulu Natal. Many other pensioners are not aware they qualify for the Child Support Grant.
  
• There were many complaints about the means test: a full social pension is only paid if earnings are less than R142 a month. Many pensioners argued that they should be allowed to earn up to R500 before losing part of the social pension.
  
• The 1998 Regulations suspended pensions of people owning property valued at over R180,000. Many such people, without other income, were forced to sell or gift their properties in order to qualify for a pension. According to the Regulations they only qualify again five years after disposing of their property or assets. This is seen as very harsh.
  
• There is no uniform practice on the payment of pensions to people in institutions. Whereas pensioners in residential homes (Regulation 18) continue to qualify for pensions, the pensions of those in state homes are cancelled (Regulation 2). In the case of hospital admissions, it appears that pensions are cancelled unless the pensioner presents him/herself at the pay-point. This leads to people dragging themselves there at great risk to their health. Provincial staff appear to have been told admission to any institution (including hospitals) disqualifies a beneficiary (Western Cape guidelines). However, where pensions are paid into a bank account payment continues during periods of hospitalization.
  
• There are no national guidelines for the awarding of contracts to private companies to pay grants, nor are conditions laid down on the location of paypoints, facilities or staff ratios. In addition pensioners seem to have lost the option to receive their pensions at a bank or post office.
  
• There is no uniformity in the provision of pocket money - in the government run Kwabadala Home in Nkandla residents receive R3 a month pocket month, paid bi-monthly. Residents in some registered homes receive considerably more pocket money , others receive none.
  
• Non-SA citizens pensions, especially in the Northern Province, were summarily cancelled in 1998 although the Act defines SA citizen as including non citizens who were in receipt of grants prior to 1996 and other persons "defined by the Minister" by notice in the Gazette.

2.3 Recommendation:

While the social grant system needs a major overhaul , it would be advisable to first do a thorough review of its financial, management and administrative inefficiencies before introducing a new legal framework. The following issues need to be addressed:

• The means test and restrictions of social pensioners earnings
• Effective exclusion of property owners who are without income
• Adequate notice of reviews and suspensions
• Eligibility for social relief and procedures

In the meantime the action should be taken on the following::

• Uniform tender procedures for contractors
• Guidelines for contractors on minimum conditions at pay points and location
• Standards of staff performance and staffing quotas
• Ensuring beneficiaries have the option of receiving their grants at a bank or post office

3. OFFICIAL POLICY TOWARDS AGEING AND THE ELDERLY

This section in the report provides an overview of policy towards the elderly, a review of existing legislation and a status report on Social Services in line with the Committee's terms of reference. Finally a number of recommendations are made.

3.1 Overview

3.1.1 With the introduction of the National Welfare Act of 1965, all Social Services to older persons became part of institutionalised apartheid. This process was accelerated until the mid eighties by means of enormous capital injections in the form of government loans and subsidies to homes and housing for the aged, but only the white aged.

3.1.2 It is estimated (confirmed by the Presidents Council's report in 1985) that close to 600 homes and 400 housing complexes were built for white elderly between the mid sixties to mid eighties. Just over 58,000 persons lived there at an estimated cost of R200, 000 per bed / unit. This cost government billions of rands, excluding monthly subsidies and grants. Evidence before the Finance Portfolio Committee in 1999 indicated that over 15 billion Rand over 25 years (until 1990 ) was paid by the previous government towards services to white elderly.

3.1.3 During the same period 11 homes, were built or old buildings converted for 1200 black elderly. No housing complexes were built The capital costs of the above were just below R8 million and subsidies were one tenth of those for white elderly. The gross disparity is clear .

3.1.4 This legacy meant that the majority of organisations serving white elderly became dependent on government funding for their survival and became well off financially. This is still very much the situation today. Organisations previously catering exclusively for white elderly continue to prosper while organisations serving predominantly black people can hardly stay alive financially.

3.1.5 In 1985 the welfare sector began to organise in different formations and groups to reject and pressurise government to change its discriminatory policies. During this struggle, led by certain National Councils, Social Worker Associations, the Black Sash, academic institutions and religious bodies the main concern was about "privatisation".

3.1.6 As South Africa moved closer towards a democratic society particularly after 1990, pressure was placed on the government to support the discounting of government loans to welfare organizations to build homes for white elderly. This was agreed in 1993 to ensure these organizations would be in an "untouchable situation". We will return to this later.

3.1.7 Policies and services during the apartheid years were highly fragmented with entrenched racial inequalities and an emphasis on residential care. The Patel study in 1994 highlighted these disparities in welfare services as follows:

• relief and development 8,4%
• reconciliation and justice 2,5%
• literacy and training 4,4%
• counseling 2,5%
• alcohol and drug services 2,5%
• residential services 79,7%

3.1.8 Up to 1994 a number of attempts were made to develop a policy framework on ageing. The Department of Health however took the initiative in appointing a policy - making committee: Health Matters for the Aged. An attempt was made to develop an interdepartmental policy framework on ageing and a report was tabled in January 1991 under the auspices of the Department of Health. It made certain recommendations which would have transformed care for the aged into a multi sectoral, multi disciplined system, with the potential of becoming more affordable and integrated. The emphasis was to share costs between various departments and to shift funding away from residential to community based care. The Department of Welfare refused to support the proposals, as it would have had to give up its status as the principal stakeholder in ageing. In 1993 a desperate attempt was once more made to implement the recommendations, but this too failed.

3.1.9 In 1993 the Department of Welfare set up the Discussion Group on Ageing to develop policy. All role-players, including older persons, were included. Other departments like Health, Housing, Justice, South African Police Services etc. attended initially but gradually dropped out. In October 1995 a proposed policy framework was approved by the Discussion Group called: Management of Age. It's main objectives were:

• To shift services from residential to community care.
• To acknowledge the valued roles of older persons.
• To develop legislation to protect the aged against abuse and exploitation.
• To address the huge racial inequities in care for the aged.

3.1.10 The Reprioritization Committee in 1996, the White Paper on Social Welfare , the Aged Persons Amendments Act and the finalisation of the Dependency Questionnaire in 1998 followed.

• The Housing White Paper of 1995 acknowledged the need for special needs housing such as old age homes and the need for subsidies to redress anomalies created by past governments subsidy interventions. It undertook to give special attention to the modification of the subsidy program to this end. (4.5.4)
  
• The Welfare White Paper pointed out that 61% of total national welfare budget was spent on social security and welfare services for elderly. It drew attention to the backlogs of facilities in some communities and over-supply in others and the lack of appropriate and affordable accommodation for elderly. It promised collaboration with the Health Department on finance, health regulations and standards and with the Housing Department on appropriate and affordable housing - which it describes as " a cornerstone of the new dispensation." Home care would be encouraged with appropriate regulations and standards. And there would be a plan of action to terminate all forms of racial discrimination in government-funded services "immediately."

3.1.11 In evaluating the implementation of the 1995 policy framework the following need to be noted:

• Firstly the framework never became official government policy. It is still just a draft although a portion was included in the White Paper on Social Welfare. Unfortunately the policy omitted to set targets and strategies. Although the framework was publicly debated and a number of responses received, there was no follow-up or implementation.
  
• Secondly the policy achieved a decline in occupied beds in frail care centres with the phasing out of Groups I and II residents (the fit and semi-fit elderly). As a consequence the subsidy budgets for residential care decreased by ± 40%. It was estimated (not confirmed) that 23,000 fewer residents are subsidised in 2000 than in 1993. Unfortunately the savings on residential care was not passed on to community based care. Consequently community care did not become the priority it was meant to be.
  
• Thirdly the implementation of the policy increased the disparities between homes in "black" and "white" communities in the following ways:

1. Subsidies paid in accordance to a unit cost factor are paid to homes in disadvantaged communities and they are unable to increase the unit cost (average cost per resident). In the past these homes received as little as one-tenth of the subsidies paid to other homes. The continue to receive less In addition, they are situated in impoverished communities and serve the poorest of the poor exclusively. Recently the Vuyo old age home in Prieska closed for the above reason. In contrast white homes are serving fewer and fewer social pensioners.
   
2. Far more housing stock was built for white older persons than others. White elderly still almost exclusively occupy the 406 Housing schemes built with government funding. Displaced, homeless or abused black elderly are frequently forced to seek accommodation in private residences in black communities, which are unregistered and do not qualify for subsidies, particularly since group I and II residents were phased out.
   
3. Black homes have difficulty attracting quality personnel. This impacts on the services they render. In almost all homes operating in disadvantaged communities there are serious management and staffing problems.
   
4. Fewer and fewer frail persons in the lower income group are able to stay in residential homes as subsidies are inadequate despite a decision by Minmec in 1996 that financial incentives would be provided to homes serving predominantly the poorest of the poor. This has resulted in an increasing number of frail persons being forced to live at home or in private residential facilities where the quality of care is at best uncertain. At the same time abused elderly who need urgent and safe accommodation cannot access places in homes where there may be vacant beds.
   
5. Finally, the objective of providing more community care has failed. It is estimated that 25% of service centres have closed (unconfirmed) and clubs for the aged of which there are over 1200 are surviving on little or no subsidies. Less than 25% of clubs are subsidised. Only a few provinces provide some financial support. Home care services, which was the priority in the policy framework, hardly got of the ground, mainly as no funds were available and cooperation between the Departments of Health and Welfare was non-existent. The Committee believes that if the savings on homes for the aged could have been diverted to support clubs and homecare services the most vulnerable older persons would have been protected.

3.1.12 As part of the International Year of Older Persons in 1999, a policy workshop was held by the Department of Welfare. A technical work committee drafted a revised policy framework backed by standards and norms for services, a declaration on the rights of older persons and a discussion document on comprehensive legislation. The policy framework makes provision for an integrated care and support model which plans to remove the artificial boundaries between residential and community care, introduce flexible and people sensitive services with built-in protection and one stop service structures from which older and younger generations can be served. This policy on ageing was recently presented to the OAU where it was acclaimed for its focus on protecting older persons and serving them where they live. This Committee has seen very little of these ideals coming to fruition.

3.1.13 Will this new-look policy work? Will it provide care where it is needed including the necessary protection against abuse and neglect? As with the Management of Age policy, the potential is there, provided that there is political and community buy-in , all sectors are united and adequate funding is available. The apartheid past is still alive and very real in the field of ageing.

3.1.14 It is the Committee's view that the disparities which remain should be addressed up front, racial and financial discriminatory practises be stopped and support given to initiatives and programmes that will enable older persons to live in safe and secure environments. The success of policies lies in their implementation.

3.2 INTER-SECTORAL COLLABORATION: THE NATIONAL ELDERLY ABUSE STRATEGY.

The Department of Health developed the Elderly Abuse Strategy in 1999 following intensive consultation with government and other sectors. It is worth noting some of the strategies proposed by the various Departments and other stake-holders :

3.2.1 Justice.

• Establishment of a specialised family court system
• Training of prosecutors and magistrates
• Assistance during legal proceedings
• Legal aid.

3.2.2 Safety and Security.

• Crime prevention strategy to include awareness raising, training of officers and community police forums.
• Review of reporting, investigation and prosecution services to victims

3.2.3 Departments of Welfare.

• Comprehensive policy and legislation
• A developmental quality assurance strategy to ensure acceptable norms, standards and protocols
• Operation Dignity to promote rights and respect of older persons
• Support to victims of violence.

3.2.4 Department of Heath.

• Accessible, free, appropriate primary health care
• Promotion of healthy ageing
• Case management strategy for chronic diseases
• Caring ethos
• Medico - legal strategies focusing on elder abuse.

3.2.5 Non-Governmental Organisations.

• Code of conduct for service providers
• Advocacy
• Community support and care of victims
• National abuse line (Halt Elder Abuse)
• Capacity building and training for professionals and laypersons.

3.2.6 An Inter-Sectoral Task Team was proposed comprising Departments of Heath, Welfare, Justice, Safety and Security, Human Rights Commission, Religious Sector, Non Government Organisations, Employers Organisations and Trade Unions.

All the above was positive but what was not made clear was who was responsible for implementation. It does not appear that the Inter-sectoral Task Team ever got off the ground. In practice every department seems to function in isolation when it comes to the concerns of older persons.

Judging by the number of complaints heard at the Public Hearings about all the above departments as well as Home Affairs much more needs to be done to ensure elderly people receive fair and just treatment.

This Committee came to the conclusion that inter-sectoral collaboration should form the cornerstone of any action to bring about change in services to the elderly. This means that all departments, voluntary and other sectors jointly commit themselves to eradicating elder abuse and exploitation.

3.3 LEGISLATION THAT AFFECTS THE ELDERLY

One of the tasks of this Committee was to look at existing legislation to see what protection against abuse and ill-treatment was on the statute book, whether additional protection was required and , if so, how legislation should be amended.

The task of scrutinizing all legislation for its implications for elderly persons was far beyond the capacity of the Committee. It was therefore decided to concentrate on the only law which focuses specifically on elderly persons, namely the Aged Persons Act. The Social Assistance Act, in terms of which social pensions and other grants are paid, is dealt with earlier in this report. In addition , a number of other laws have been included which are particularly relevant to elder abuse.

3.3.1 The Aged Persons Act: 1968 is still the only legislation specifically targeted at the elderly. The Act deals with the establishment and maintenance of homes for the aged, the registration of homes and the payment of subsidies to homes, clubs, service centers and welfare organizations. The Act also provides for inspections by social workers and for the prosecution of persons running unregistered homes where abuse of residents is suspected. Responsibility for investigating reports of abuse lies with social workers and criminal justice officials but there is no obligation on the latter to prosecute after receiving a social workers report. The only penalty that could be imposed if a prosecution was successful was a prohibition on the person responsible from continuing to accommodate the aged. The Act did not cover abuse outside residential homes. Sections of the Act which dealt with pensions were repealed by later legislation.

3.3.2 In 1997 The Human Rights Commission investigated the possibility of a programme of action against elder abuse, including an ombuds office. In consultation with key stakeholders it proposed a three-point plan.

• Legislation: That the outmoded Aged Persons Act No 81/1967 be scrapped and replaced by a new act that would criminalize abuse and ill treatment.
  
• Awareness and training: That the Human Rights Commission in cooperation with all stakeholders inaugurate programs that would change perceptions from older persons as victims to being resources of wisdom and knowledge.
  
• Ombuds office: That an ombuds office be established to handle all reported cases of abuse, institute and coordinate investigations and to evaluate existing systems. The plan was to pilot the ombuds office in Cape Town.

3.3.3 Private Members Bill: Shortly after this Senator James Selfe initiated a Bill which aimed to provide more stringent regulation and accountability in the sphere of care of the aged, to criminalise aged abuse , to establish a charter of rights for the aged , set standards of care, establish residents committees with representation on management and mandate a Human Rights Commissioner to monitor homes.

The Minister of Welfare declined to support this bill but promised to introduce comprehensive, integrated legislation on the elderly within the coming year.

3.3.4 The Aged Persons Amendment Act 1998 did not claim to be comprehensive but attempted to improve the original Act in the following ways :

• Prescribing what subsidies may be used for and how they should be accounted for;
• Appointing a designated body to monitor compliance with conditions of registration;
• Establishing management committees in homes where more than 10 aged persons reside;
• Establishing a register for notification of abuse and requiring professionals to report cases of suspected abuse;
• The replacement of social worker investigations into homes with investigations by a designated body;
• The issuing of warrants for the removal of aged persons to places of safety;

However, not all these amendments were implemented when the Act was proclaimed and the Regulations published on July 28, 2000. In particular, the provisions of the old Act regarding social worker investigations and prosecutions remain in force. Included in the Regulations are the following:

• Management committees must be set up within 60 days of the publication of the Regulations. Between 5 and 9 persons on the committee must represent the local community, having regard to gender, race and geographic spread. Management and residents should also be represented.
  
• A National Register on which the details of the abused person and the abuser would be recorded. The information on the Register will be disclosed if this is in the interests of the aged person.
  
• Measures to prevent the abuse of residents should be put in place, namely a prohibition on restraints unless authorized by a doctor, the keeping of a register on restraints . A complaints register should also be kept.
  
• The obligation to report cases of suspected abuse or injury of aged persons is placed on registered dentists, medical practitioners, nurses and social workers.
  
• The issuing of warrants for the removal of the person to a safe place and arrangements for the necessary treatment.
  
• Service level agreements must be entered into between resident and management committees.

Doubts have been expressed to the Committee about:

• the responsibilities and powers of management committees,
• how the National Abuse Register would operate
• whether removal warrants could apply if the aged person objected
• the limited scope of service level agreements.

3.3.5 Recommendation :

In spite of the shortcomings of the Aged Persons Amendment Act and Regulations, the Committee strongly recommends:

• That the changes be publicized and implemented as a matter of urgency.
• That the introduction of new legislation to protect the rights of the elderly both within homes and in the community, promised since 1997, be speeded up and dead-lines set. Such legislation should cover finance, ownership , standards of homes and compulsory inspections. It should also introduce mechanisms through which elderly persons living in the community can access help.

3.3.6 The Domestic Violence Act 1998:

This Act provides for intervention by the SA Police Service or anyone who suspects that a person is being abused. The Act provides for protection orders to be issued on behalf of the abused person with or without his or her consent. It applies to persons who have any relationship with an abuser. They do not have to live together or share the same residence. The abuser may be arrested or evicted from the shared household and ordered to continue to provide financial support.

The implementation of this Act has been slow due to the lack of resources and training of the police, although there has been a flood of applications for protection orders. There is also a need for police and the public to be informed specifically about the application of this Act to elderly people living in abusive households or threatened by abusive children or grand-children. Failure to investigate a case of suspected abuse constitutes misconduct in terms of the SA Police Service Act 1995 and may be brought to the attention of the Independent Complaints Directorate or the Public Protector.

3.3.7 The Rental Housing Act 1999

The Act protects older persons from discrimination and unfair practices relating to the leasing of property. In terms of the Act a landlord may not unfairly discriminate against a prospective tenant on the grounds of advanced age, nor may the tenants home or property be searched or his or her privacy violated in any way. Any violation of the Act can be reported to the Rental Housing Tribunal which are to be established in all provinces. Tenants occupying premises controlled under the1976 Rent Control Act (which has been repealed) may not be evicted unless they commit a breach of the lease, the rent may not e increased by more than 10% a year and the Minister of Housing must monitor the impact of this on poor and vulnerable tenants and must take action to alleviate the hardship of such tenants. However, elderly tenants and landlords are unaware of these safeguards and many of the formerly protected tenants now face increased rentals and the threat of eviction.

3.3.8 Promotion of Equality and Prevention of Unfair Discrimination Act 1999: Parliament was required to enact this law in terms of section 9 (8) of the Constitution. In reporting on the Bill the Ad Hoc Joint Committee noted that there was evidence of a need to address specific forms of unfair discrimination against elderly persons and requested the Minister of Welfare and Population Development to investigate this area and to adopt appropriate measures where necessary. It added that a concerted and pro-active effort needed to be made to sensitise society on the issue.

4. STATUS REPORT ON SOCIAL SERVICES TO THE ELDERLY:

The Committee was confronted by a number of constraints in collecting evidence in respect of social services. Firstly the absence of reliable data, i.e. budget figures, number of homes for aged, residents. Secondly very few formal organisations submitted evidence to the Committee which consequently had to rely heavily on information provided at the hearings and visits and data available from the SA Council for the Aged and the Department.

The Committee was struck by the fact that most social services are inaccessible to older persons and their families in rural communities. Most of the care facilities and government offices are situated in cities and towns.

In this section the following will be dealt with:

• Residential care
• Community based care
• Housing
• Health
• Social Work Services
• Local Authority services
• Programmes to combat abuse.

4.1 RESIDENTIAL CARE.

4.1.1 Proportion of budget: From evidence it is clear that residential care absorbs the largest portion of the government budget for the aged. The percentage breakdown of provincial and national budgets in respect of the different services since 1994 was not available. In 1993 R253 million was spent on care for white elderly compared to R21, 8 million on black elderly, R37, 6 million in respect of Coloured elderly and R5, 6 million for Asian older persons. An additional R67 million was allocated to services to black persons of which only R2, 8 million was actually spent. 86% of the R319 million spend in 1993 was utilised for residential care.

4.1.2 Declining capacity: In the year 1999/2000 R290, 5 million was allocated to care for the aged, a decline of R29 million per annum over 7 years. It is estimated that over 75% of these funds go to the present 474 homes for the aged. There are also 7 homes, which are run by the State. It was impossible to determine the number of residents in homes. According to the National Department the capacity of the homes are 42,952 (private homes) and 1,083 (state homes). Unconfirmed data obtained from the provinces indicated a dramatic decline in the bed capacity of homes , presently estimated at 27,000. It is also not clear who occupies the approximately 16,000 beds, which make up the difference between the full capacity of 42,952 and the present occupation of 27,000. It is alleged that privately run homes have taken a substantial number of affluent older persons into their homes.

4.1.3 Access to social pensioners: From this information on budgets and capacity it is obvious that subsidies have only increased marginally over the past 7 years, that bed capacity is continuing to be lost, and that social pensioners are finding it increasingly difficult gain access to homes.

4.1.4 Prospects for white homes: In 1993 10,4% of white persons over 65 years lived in homes for the aged while less than 0,5% of black elderly resided in homes. It was not possible to determine the present number of black residents. But from the Committee visits it was apparent that homes are still largely divided on racial lines and very few historically white homes actively promote racially mixed services or outreach programmes. The impression is that significant number of the white homes have or are in the process of privatizing i.e. converting into Section 21 companies and selling portions of facilities and taking in more affluent persons in order to become independent from state funding. This is a very worrying trend as facilities built with government funds may be lost to the poorest and most frail.

4.1.5 Homes in disadvantaged communities: The Committee gained the impression that the majority of small homes and specifically those in disadvantaged communities are in a precarious financial position. The following factors have made an impact.

Firstly income of these homes is less than for white homes. Social grants were only brought on par in 1993. In 1990 subsidies were R1340 per month for white homes and R127 per month for black homes. Since the new political dispensation subsidies have officially been equalized, but the amounts paid out are based on monthly unit costs. This means that if a home's unit cost is R1000 per month per resident, it will receive a lower subsidy than if the unit cost had been R1500 per month. Disadvantaged homes cannot access the full subsidy as they do not have the means to increase their unit cost. For example Bill Buchanan home in Durban receives R1300 per month, Nazareth House R1521 per month per resident, while Zimbambeleni receives R845 and Abalindi R644 per month. The SA Council for the Aged proposed over many years payment up front of equal subsidies to help bring black homes onto a par with white, but to no avail.

Secondly, almost all of the residents in black homes are social pensioners. As a result, their contributions are limited. This may explain why there are very few black persons are in white homes - they and their families cannot afford the additional fees charged. Black homes find it more difficult to raise additional income.

Thirdly, lower unit costs mean lower salaries for staff and in all probability less qualified staff. The Committee was told that most black homes couldn't afford the same number of nursing staff as white homes. This must impact on the quality of care and the risk of abuse. Almost all black homes that were visited reported management problems directly related to the above scenario.

4.1.6 Standards of Care: These vary from home to home. Both government officials and staff at homes confirmed the lack of uniform standards. It was reported that cooperation between Health and Welfare officials has deteriorated to the point that inspections are almost non-existent in some areas, for example a social worker may have over 100 homes to visit. In spite of provisions in the Aged Persons Act for social workers to inspect homes this does not occur on any kind of systematic basis. Many homes reported that health officials might visit once in two to three years, generally after receiving a complaint. In one province a health worker is responsible for well over 100 homes, including homes for the disabled and children.

4.1.7 Health services to homes: These were reported to be problematic. Doctors are not readily accessible, medicines unavailable and control of medicines was found to be almost non-existent in some homes. A number of cases were reported and confirmed of seriously ill residents being left unattended. In other cases residents were given the wrong medication. A large number of cases were reported of incontinent residents left unattended for a day and longer. In general the standard of care in white homes were higher. This seemed to be due to more, better qualified and better paid staff.

4.1.8 Recreational and social activities: The Committee was concerned about a general lack of recreational and social activities in homes. Residents reported that they live from meal to meal with very little to keep them occupied during the day. Many homes impose strict controls on visitors which means that homes are closed entities. However in some homes the interaction between residents and the community is good.

4.1.9 Ombud system: It is a concern that few homes have an ombud system , proper procedures to detect and handle cases of abuse and proper record keeping on incidents. The Committee noted with concern the lack of knowledge among nursing staff of abuse, its causes, signs and remedial procedures. A number of homes with television monitoring systems were visited. All of these homes indicated that these systems are critical in preventing abuse, although not a guarantee against it.

4.1.10 Staffing: The Committee was struck by the lack of assessment criteria in respect of the appointment of care staff. Unsuitable staff seem to move from one home to another without any checks on their record being possible through SAPS. In a number of homes the Committee came to hear about care and nursing staff with social problems i.e. alcoholism, depression etc. This matter deserves serious attention.

4.1.11 The Dependency Questionnaire 1998 is intended to be a mandatory assessment instrument . It was developed by the Medical School at UCT and adopted by the Department of Welfare for screening admissions to homes. Only Free State, Gauteng, Mpumalanga and Kwa Zulu Natal have implemented it. Discussions with government officials applying DQ98 suggest that although the instrument is an improvement on previous practice, it lacks guidelines on facilities and does not apply to community based care.

4.1.12 Private unregistered homes: The Committee learned with concern that a growing number of older persons reside in unregistered homes, often under circumstances that result in neglect and abuse. Extreme cases of abuse in private homes in the Western Cape, Eastern Cape and Gauteng were reported.

4.1.13 Closures And Transformation Of Homes

Numbers of registered homes - based on information from the Department of Welfare

This table confirms that 60% of homes remain exclusively white. It also raises doubts about the accuracy of Departmental statistics - could 100 homes have closed between 1999 and 2000? It is clear that further investigation is needed on this issue.

4.2 COMMUNITY BASED CARE:

According to government policy this is the most important component of the service. Yet it receives much the lowest portion of the budget.

1. No data from the National Welfare Department was available on the current situation regarding community based care i.e. the numbers of service centres, clubs, home care services, equipment banks, training courses for community care givers. Community based care not is in practice a priority.
    
2. In 1994 a proposal was submitted to government by a work group on primary social services . It proposed the following:

1. Primary social services receive priority funding from a intersectoral pool.
2. A multi sectoral and multi disciplined approach be adopted, for example clinics and old age homes be utilized for home care services.
3. Capacity building and the development of infrastructure in disadvantaged communities be actively promoted and supported
4. A new category care workers trained at community level be introduced.

It is not known what happened to this report, except that none of these recommendations were implemented.

3. Service Centres: In 1993 there were 385 service centres (251 for White, 14 for Asians, 72 for blacks and 48 for coloureds). By 1998 the number of service centres had fallen to 188 with almost 200 either closing of being amalgamated. In 1993 in total 26,500 older persons attended service centres basically to receive a meal. In 1998 this number had fallen to 17,400. This means service centers experienced a decline of over 20% in 5 years. The present situation is unknown.
   
4. Clubs For The Aged: While service centres have experienced a decline, clubs for the aged (also called luncheon clubs) have experienced a sharp increase. In 1993 there were approximately 320 clubs. This number rose to 840 by 2000. Clubs are managed by volunteers and function predominantly in disadvantaged communities, addressing basic needs like meals, companionship, home care and income generation. The SA Council for the Aged has played a leading role in developing clubs. In a study by them of 628 clubs it was found that the average period of existence is 5.5 years, number of members 73 per club, number of family members 4.5 and the main services were meals, home care, socializing and religious activities. Of particular interest is that only 25% or 214 clubs receive government funding. In most provinces funding is either non-existent or very little. Provinces with a high level of poverty should give more attention to this.
   
5. Community outreach programmes: Very few residential facilities are involved in community services. Most of those involved do it by helping a club or running a soup kitchens or home industry project. As part of funding policy homes in mostly white areas are required to operate outreach projects mainly in disadvantaged communities. From the evidence before the Committee it was clear that while some homes go out of their way to empower community groups, most are not interested in this. This may be partly due to the way the subsidy policy is applied. For example, if a project becomes independent the home will lose the subsidy.
   
6. Home care services are of particular importance as these provide much needed support to frail elderly living at home who can fall prey to abuse and neglect. Home care services in communities where there are insufficient other services are particularly important. As this service has a strong health component both Health and Welfare should be involved in the funding of the training and deployment of care workers. The SA Council for the Aged is involved in this but lacks resources. Meals on wheels or meals on foot services are run in several urban areas by NGOs and CBOs but probably reach less than 20,000 elderly house-bound people nation-wide. This is a valuable life-line and a way of monitoring health and treatment.
   
7. Interim Homes (Safe houses) A few homes for the aged make beds available for abused and abandoned elderly i.e. St Joseph's in Middelburg. The SA Council for the Aged in Eastern Cape has pioneered the concept of interim homes, which is made up of an ordinary house, run by residents and volunteers. These initiatives need support.
   
8. Equipment banks (Lending depots) These banks provide care equipment to families of frail elderly living at home. The SA Council for the Aged has a number of these depots in most provinces. This enables a frail older person to be properly cared for.

In summary , a skeleton community based care service exists and is growing mainly through clubs. These clubs and services need to receive much more backing from the Department of Welfare. The Committee believes that the Department needs to pilot schemes in areas not presently served.

4.3 HOUSING

4.3.1 Private houses: The majority of older persons live in private homes, often in overcrowded conditions, lacking basic services and access to amenities. 36% of these households have two generations and 25.4% three or more generations. 16% of older persons, mostly women live in households with grandchildren which they normally care for.

4.3.2 Housing schemes: 406 housing schemes , housing 26,779, were built with government funding, almost exclusively for white elderly, between 1960 and 1980. At this stage it is not known how many black, coloured or Asian elderly have moved into these complexes, but indications are very few. A number of organisations like Huis Immergroen in Witbank, have developed integrated assisted living units where residents status is monitored.

4.3.3 Sale of government-funded facilities: Since organizations were allowed to sell portions of their facilities under the Discounting of Government Loans Scheme in 1993, the number of housing units still largely occupied by white elderly has probably increased. This has been at the expense of beds for frail persons. .

4.3.4 Special housing for the elderly: In the absence of housing for poor, abused and homeless elderly there is a growing tendency for individuals or groups to set up local "homes" in shacks or containers where conditions are sometimes wretched and over which there are no controls. The Committee received numerous appeals to influence government especially the Department of Housing to make funds available for special housing for older persons and reverse the earlier decision by the Department not to set aside funds for this because the provision of sheltered accommodation was a welfare issue.

4.4 HEALTH

Recently, the Human Science Research Council conducted a survey on the health status of older persons in all communities in South Africa. The findings give a vivid picture of the realities facing older persons:

4.4.1 Medical care: While most white (99%), coloured (90%) and Asian elderly (98%) regularly receive medical attention, less than 50% of black elderly receives medical care. In rural communities less than 30% of black elderly receive care.

4.4.2 Dependency: A higher percentage of black elderly are dependent on others for daily care, confirming that a substantial number of frail black persons are living at home. This situation must contribute to abuse.

4.4.3 Depression: Elderly blacks especially women show greater depressive symptom ontology than other elderly persons. This corresponds with evidence at the hearings where black elderly reported that they lived in a constant state of depression and anxiety.

4.4.4. Health Insurance: Virtually no elder blacks, coloureds or Asians have medical insurance. In 1990 95% of urban and 99% of rural black pensioners had no medical insurance although 90% had medical expenses. By contrast 65% of whites had medical insurance and only 1% relied on their families for medical expenses. It was noted that medical insurance does not cover the costs of frail care.

4.4.5 Conclusions

In the absence of a response from the Department of Health to invitations to submit evidence to this Committee and based on the evidence submitted by individuals and NGOs, the Committee came to the following conclusions regarding health care:

• Most elderly people live in poverty, with limited nutrition and little money for health.
• Access to health care services particularly in rural areas is difficult. The majority of older persons are never examined by doctors and cannot get medication.
• Numerous complaints were received about the treatment of elderly patients by doctors and nurses including doctors refusing to examine or even touch patients and nurses refusing to wash and feed frail patients.
• Social pensioners have to pay for health care at public hospitals, sometimes paying twice or more if they are being seen by more than one department.
• Some hospitals refuse to issue repeat prescriptions for chronic medication, compelling patients to report monthly or forego treatment.
• The withdrawal of geriatric care from local clinics had serious implications for the elderly
• There are few support services in the community

4.5 THE SOUTH AFRICAN POLICE SERVICE

Numerous complaints were voiced at Public Hearings about the inactivity of the police, particularly in rural areas and their refusal to attend to charges and complaints laid by older persons or to protect them. One example concerned the cross border stealing of cattle in the Herchel area , the inability of older men to trace their cattle and their fear of attack. Other old people reported that the police were often drunk and off duty. The police, in turn complained of a lack of transport.

4.6. CHURCHES AND TRADITIONAL LEADERS

4.6.1 Churches: Older persons across the board regard the church as very important in their lives. From evidence it appears that most churches recognise older persons as valued members. However it also indicated a limited number of projects where churches are directly involved in preventing or combating elder abuse i.e. the dissemination of information, training church wardens etc.

4.6.2 Traditional Leaders: The majority of older persons live in rural areas in conditions of dire poverty. If it were not for traditional support structures, many would not survive.

4.7 SOCIAL WORK SERVICES.

4.7.1 The Committee came to the conclusion that social work services are seldom available to older persons. The main reason seems to be that social work posts dedicated to the elderly in both in government and NGO's have been largely phased out.

4.7.2 Social workers at the Public Hearings expressed concern for the plight of older abused persons. Some said they had too many cases and older persons were not a priority as this work was not "statutory" i.e. they had no legislative responsibility. Others cited lack of resources, staff shortages and absence of safe houses. A number of social workers gave evidence that they did not know how to handle cases of elder abuse. Lack of knowledge of ageing, abuse, and legal procedures were mentioned.

4.7.3 However, there were numerous complaints from older persons at the Hearings that social workers did not show the necessary respect and patience. Most clubs reported that social workers hardly visited.

4.7.4 Enquiries about social work training courses revealed that only eight included modules on ageing or the elderly. These were the Universities of Pretoria, Potchefstroom, the Free State, Witwatersrand, the North, Natal, Stellenbosch and UNISA.

4.7.5 The general consensus was that the generic approach to social work services does not take the specialized nature of ageing and elder abuse into account. Also, the lack of resources for services to older persons has contributed to a decline in attention to their welfare.

4.8 LOCAL AUTHORITIES

4.8.1 Social Work Services: The policies of the previous government ruled out social work services by local authorities but some, as part of their health and housing services continued to render such services. The Green Paper on Local Government in 1999 made no provision for social work services. This leaves a gap as older persons are a vulnerable group who require special attention at the local level.

4.8.2 Basic Services: At all the Public Hearings older persons reported problems with local authorities in respect of basic services. Over many years older persons have been among the most consistent payers of rent and service charges. In the light of poverty , their large number of dependents and increases in rates and charges for electricity, water etc this has become unaffordable to many. Basic services to elderly residents are disconnected routinely and sometimes their properties are repossessed. Many older residents do not understand the huge accounts they are receiving, for example for R15, 000, or the procedures and undertakings they are expected to sign. Many complaints were received of officials behaving in an abrupt and rude manner.

4.8.3 Rates and Rent: There were many complaints about high rent and rates bills charged by local authorities, sometimes leading to eviction but causing great anxiety particularly to pensioners to whom it often appears that however much they pay their arrears continue to rise. Rent and rates and now supposed to be market related but tenants and owners on a limited income can apply for a rebate although in some areas even this appears to be too high for pensioners. The forms and procedures for applying for rebates are also very complicated. The Indigency Policy for reductions in rates and taxes is only a paper policy as there has been little or no implementation.

4.8.4 Fraud: A number of complaints were received of local town councilors exploiting older persons or interfering in the affairs of local NGO's. A number of cases were followed up where town councilors had swindled older people out of their houses and possessions.

4.9 ELDER ABUSE PROGRAMMES:

4.9.1 Halt Elder Abuse Line (HEAL)

This line was developed by the SA Council for the Aged and opened in 1998 as a pilot project for the Western Cape. Since 1999 it has been a national toll free line. The service appears to be worthwhile as shown by the steady increase in reported cases from 35 per month in 1998 to over 200 per month in 2000. All languages are catered for. Cases are reported to NGO's, the Council and provincial welfare offices. A number of successful prosecutions have taken place and severely abused older persons moved to safer places. The Council and corporate sponsors fund the line although the National Department of Welfare and the provincial department in Western Cape have made grants from time to time. This service is not accessible to persons unable to get to or use a telephone. Follow-ups are difficult in many areas. But a national help line is a valuable resource and ways need to be found to make this service more accessible and effective..

4.9.2 Awareness and Training:

Operation Dignity was launched in 1999 by the Department of Welfare. The campaign is visible at provincial levels and has received press coverage, alerting people to the rights of older persons. But the Committee considered that other sectors needed to become involved in the promotion of the rights and dignity of older persons. It is not convinced that this particular campaign made a significant impact in the community, rural communities in particular. Specifically churches should be more involved. There is a danger of nationally driven campaigns resulting in bottle-necks of posters and T-shirts lying in government offices and failing to mobilize and conscientize local communities.

Training Programmes for professional and non-professional persons have been started by SA Council for the Aged in cooperation with some provincial welfare departments . Those involved include social workers, doctors, nurses, policemen, lawyers, prosecutors, magistrates, and local authority officials. The objective is to make them aware of the needs of the older person and the problems they face. Trainees are alerted to the basics of elder abuse, how to detect it and what to do about it. These training programmes need to be extended to all provinces.

4.10 FINDINGS

4.10.1 No uniform policy: There is not a uniform policy on how to address the needs of the aged; consequently there is lack of forward planning, effective coordination and evaluation of services. With an ever-increasing number of older persons and expected mounting pressure on the financial resources, this is short-sighted. Throughout this report there is evidence of a lack of clarity, purpose and direction when it comes to ageing and the elderly .

4.10.2 Institutional approach: The overall impression of the Committee is that policies and services to older persons are still based on an institutional approach The bulk of resources go to residential care while community options to support older persons remaining in the community are extremely limited. The vast majority of older persons do not wish to live in residential homes. In most communities older persons are valued as people who should be cared for and who can continue to serve others, especially the young. The Committee noted with concern the increasing pressure on government to build residential facilities on the lines of those built for whites in the past. Policies regarding the elderly must be appropriate , affordable and in line with prevailing beliefs and values.

4.10.3 Fragmented services: Services are highly fragmented both at government and NGO level. Inter-sectoral collaboration leaves much to be desired in all provinces. Of special concern is that the two senior partners, Health and Welfare, do not seem not have a common vision and that there is little cooperation as far as services are concerned. Examples are:

1. Continued confusion on services and payments by social pensioners at clinics and hospitals,
2. Failure to promote home care services
3. Non-existent inspections of old age homes.

4.10.4 Inter-Sectoral Coordination: In respect of elder abuse, Safety and Security and Justice Departments should form part of a team together with Health and Welfare. This is not happening. Nor are NGO's working as a team among themselves or with the public sector. There was a lack of coordination between homes for the aged and other services like clubs and service centres. Despite official undertakings that the new financing policy will result in better cooperation and sharing of resources, this is not yet happening. However in certain areas like East London there appears to be a serious attempt to work together. Overall the Committee was struck by the lack of communication and cooperation between key role players including churches and traditional leaders.

• A Representative Voice for older persons is still a dream. The Discussion Group on Ageing founded in 1993 could have become a viable entity but has no status. The Committee strongly believes that a mechanism on ageing could fulfil a valuable role of promoting consultation and cooperation in the field.

4.10.5 Transformation: The lack of transformation is evident in all provinces.

None of the provinces had a transformation plan in place. Consequently services to older persons remain racially divided, residential care still forms the core of services, community options remain limited and care models that enhance the spirit of Ubuntu are not in evidence. A major concern is that the major service delivers do not take the Department of Welfare seriously. This is demonstrated by the following:

• Very few comply with legislation such as the Aged Persons Amendments Act,
• Very few have protocols in place to prevent and deal with elder abuse,
• Inspections are conducted superficially i.e. without speaking to older persons or their families and not checking records. In many cases the service provider dictates the terms of the inspection,
• Little attention is given to outreach programmes, , addressing the needs of the poorest of the poor in the community though these are supposed to be a top priority.
• Most boards of management of homes are not representative,
• There is no attempt to ensure compliance by organisations that discounted their loans with the terms of the contracts signed under this scheme.
• Community based care remains the stepchild of services to the aged. The bulk of funding goes to residential care and pioneering models like clubs, home care services, training of care workers, interim homes and lending depots do not receive the support they need.

4.11 OFFICIAL PROGRAMMES FOR THE ELDERLY

• National Help Line: Halt Elder Abuse Line (HEAL) is the only to help line aiming to combat elder abuse. The toll free line of the Department was found to be inaccessible, unreliable and not suitably staffed to handle cases of abuse.
• Provincial services: Departmental services do not regard older persons and their abuse as a priority. Very few provinces have assigned care for the aged to special units, little attention is given to training professional staff in or other staff in residential and other facilities on how to prevent and handle abuse. Several provinces, including the Western Cape have introduced a generic Customer Services division and specialists in the elderly or other client groups have been absorbed elsewhere.
• Local services: The Committee recommends that urgent attention be given by the Ministers and Departments of Local Government, Water Affairs and Minerals and Energy to the plight of low-income families, those solely dependent on the social pension in particular, so that they can receive basic services at affordable rates.

4.12 RECOMMENDATIONS

• There is a need for a national representative statutory mechanism or commission on ageing, as recommended by the United Nations, to ensure effective communication anc consultation in policy-making . This should be inter-sectoral, multi-disciplinary and culturally sensitive, possibly linked with the Human Rights Commission . This body could also take responsibility for the national abuse help line and for setting up the ombud system which is widely sought.
  
• In order to address the crisis in service delivery which faces the elderly, the Committee proposed that a Task Team be appointed with the brief of ensuring that this crisis is addressed at all levels of government and giving attention to the findings and recommendations of this report.
  
• A comprehensive new Act on the status of older persons is a high priority. Existing legislation is unable to protect residents in homes as the only mechanism available to the authorities is de-registration and cutting subsidies which can be damaging to residents.
  
• National norms and standards for all forms of care including the funding of services need to be developed and measures put in place to ensure they are complied with and that inequities are addressed.
  
• A Commission of Enquiry should be appointed to investigate the discounting of low-interest loans awarded by the previous government to organizations building and buying homes for white elderly on certain conditions.
  
• The HIV/AIDS pandemic is already placing a burden on elderly persons who are burying their children and being left to care for their grand-children. This burden will get much heavier . The provision of community based services for the elderly will lay the basis for services to the wider community and is the only realistic strategy for dealing with the effects of the pandemic.
  
• Social workers require more exposure , supervision and training to deal with problems facing older persons. Also, more attention should be given to discipline to address the disrespect shown by many social workers to older clients.
  
• An inter-sectoral committee of ageing must be set up to ensure and include representatives from all Departments which have contact with elderly people, namely Welfare, Health, Safety and Security, Housing , Home Affairs and Local Government so that there is maximum cooperation and coordination between them.
  
• The Ministers and Departments of Local Government, Water Affairs and Minerals and Energy should give urgent attention to the plight of families solely dependent on social pensions and grants so that they may receive their services at affordable rates.
  
• The Dependency Questionnaire (DQ98) should be expanded to include the assessment of frail elderly in the community as well as those living in homes and should be jointly applied by the Departments of Welfare and Health. It should be implemented in all provinces
  
• Community outreach programmes: The Committee recommends an amendment to the funding policy which will require a developmental approach to such programmes so that they build capacity and become self-sustainable and are not merely tokens.
  
• Private Homes: It is recommended that all provincial departments compile a list of private non-subsidized homes and undertake inspections to evaluate the care provided. These homes should not be allowed to operate without registration.
  
• Churches: Faith based organisations must commit themselves to serve older members with respect and dignity , be willing to be champions of their rights and commit themselves to be for them in times of crisis.
  
• Traditional Leaders: Any programmes to fight ageism and abuse must include traditional structures. Traditional leaders need to commit themselves with vigour to the needs of older persons.

Epilogue by Mr. Tom Mathata (Chairperson of the Committee of Inquiry into Abuse and Neglect of the Elderly.)

The Report reveals serious horrors many of our the Fathers and Mothers of the Nation have to go through. The situation is an indictment against our democracy and human rights culture for which many of the elderly fought tirelessly to bring about.

Forget not that it is their toil and sweat that has made SA the beauty and envy that it is today. Surely, they deserve better from all of us; black and white, young and old, male and female alike.

I hope that this Report will trigger decisive action to stop the abuse of the elderly persons, not only on the part of the government, but even most importantly, by society as a whole.

By establishing the Committee to investigate abuse and neglect of the elderly, the government has demonstrated the will and commitment to tackle this problem head on. Now, it is time for all of us as South Africans to fold our sleeves and join the fight against any manifestations of abuse in our families, communities, public or private institutions.

Lets us give the elderly persons love and affection in the true spirit of Ubuntu!

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