Co-ordination, targeted spending can help elderly people access care: HRW

South Africa's elderly are often unable to access basic care and support services despite a legislative framework that is good on paper, says Human Rights Watch (HRW).

A report released on Tuesday documents the experiences of 63 older people of all races across the Eastern Cape, Gauteng and the Western Cape, 61 of whom received the Older Persons Grant.

Ben Zolile, 75, lives in River Park, Johannesburg, with health he says goes “up and down”. He used to eat lunch every day at a service centre for older people but now he cannot make the trip due to bad knees.

“No-one comes to my house. There are no other services that come to my home,” he said. 

For Thembisa Loyila, 70, who lives alone in Mdantsane, Eastern Cape, service delivery depends on whether you have children.

“The government doesn’t have any responsibility for us,” she said. “As older people, we have to take care of each other. We only have ourselves.”

Elderly people who receive the Older Persons Grant may be eligible for a social security entitlement to cover the costs of full-time home-based care and support. The Grant-in-Aid is, however, woefully inadequate as it only provides 20 hours of full-time care and support per month, based on a caregiver receiving the national minimum wage, said HRW.

Private care and support services are available but unaffordable for all but the very wealthy, worsening existing inequalities. Rates for 24-hour live-in care for one month can equal four years’ worth of the Grant-in-Aid.

In addition, HRW found, few older people know the Grant-in-Aid exists.

It cited the example of Ben Movenda, a 76-year-old man who uses a wheelchair who had not heard of the Grant-in-Aid. Instead he has to rely on help from his neighbours to use the communal toilet and enter or leave the shack in which he lives in Alexandra, Johannesburg. There are high steps and no ramps, the road surface is uneven, and he does not have the upper body strength to wheel himself.

“I’ve got no support. I need someone to help me but who is going to pay for that?” he said. 

A lack of home-based services negatively impacts older people’s physical wellbeing and safety and may impede their dignity, autonomy and independence, the agency said.

“Challenges in elder care are exacerbated by the government’s continued over-reliance on family members to provide home-based care and support, even in circumstances where they are unable or unwilling to do so.”

HRW said among the factors that contribute to the unavailability of services are disparities in provincial plans to increase access to services, insufficient numbers of social workers and a lack of co-ordination between government departments responsible for realising the rights of older people.

“In addition, though the government contracts with non-profit organisations to deliver community and home-based care and support services, overly prescriptive rules on the range of services and insufficient funding impede the organisations’ capacity to deliver the services.”

The managers of service centres in the Eastern Cape, which are tasked with providing community and home-based care and support services, told HRW government funding covered only 40% to 50% of their costs.

In the Western Cape, one private non-profit service centre has to charge older people an annual membership fee and monthly contributions for food to help cover their costs. 

“South Africa’s democratic government has introduced a promising legal framework to protect the rights of older people, including those enshrined in the constitution, the Social Assistance Act and the Older Persons Act,” HRW said.

“The Older Persons Grant is an important pillar of South Africa’s social security system on which the country spends a relatively large portion of its GDP compared to other upper-middle income countries. Despite this promising framework, most eligible older people are unable to access the basic care and support services they are entitled to, and the government has failed to respect protect, and fulfil older people’s right to live independently and within the community.

“To increase access to these services, the department of social development should put in place a system to determine the number of older people who require community and home-based care and support. It should urgently review the funding model for the services and allocate sufficient funding to ensure those entitled to such services have access. This should include adequate funding to non-profit organisations and public service providers so they can effectively deliver the support older people require.”

The government should also review and reassess whether the Grant-in-Aid is sufficient to guarantee older people the resources necessary to access adequate care and support to live independently and within the community, and develop a public plan of action to increase as expeditiously as possible the level of the grant to cover the full costs of such services, it said.

An important step would be for national and provincial departments of social development to improve co-ordination and collaboration, as well as among the department of health, non-profit organisations and other service providers to improve older people’s access to services.

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