Audit of Residential Facilities, Final report - Division for Social Policy ...

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4.6 Intersectoral CollaborationThe study by FEM Research consultants found that on average, nurses working in homes forolder persons receive three times less than those working directly for the Department of Health.Yet many residents in homes require a similar level of care to those in hospital. Furthermore it isoften the case that residents are moved from hospital directly to a home. A „burden‟ is thustransferred from hospital care to home care. Yet, there is an almost total lack of intersectoralcollaboration and cooperation between these two key departments providing services to olderpersons. The responsibility for the lack of adequate medical care and support for older personswho do not have private medical aid should rest with the Department of Health.4.7 Multiple use of old-age homesHomes are falling short with the subsidy grant for older persons; therefore a pattern that arisesdue to gaps in policy is that frail care centres are admitting psychiatric patients with goodintention to make up for the short fall in finances. In addition, many homes that offer care andsupport to Alzheimer‟s and dementia patients are often ill equipped to deal with these conditions.A few homes have taken in disabled people of all ages as well as psychiatric patients, and oftenthe residents with mental illnesses are mixed with othersThis negatively impacts on residents because psychiatric patient‟s moods affect older people infrail care, as was witnessed during the fieldwork. It also presents a danger to the residents andthe staff who are not equipped to deal with psychotic or aggressive patients.4.8 Basic Service DeliveryHomes in especially poorer rural and outlying areas experience the added challenges of nothaving access to basic services such as water supply. This was quite prominent in Limpopo andthe Free State, where there was not a constant supply of drinking water so homes that are ableto have to purchase huge water tanks to store water because this basic service is either lackingor not reliable. In one home in the North West they spent a month without water and no access toa water tank and only survived this ordeal through the generosity of a farmer that assisted thehome.64 | D S D A u d i t o f R e s i d e n t i a l F a c i l i t i e s
4.9 TransformationWhile the issue of transformation, or the lack thereof, is addressed in some sections of thisreport, a few additional issues need to be addressed. The Transformation Guidelines indicatesthat the critical elements of transformation in relation to governance are as follows:- Management structures that reflect the demographic profile of the region and the provincethey serve- There needs to be a balance between demographics and effective management- Demographic profiles of communities to be reflected in management structures oforganisations (skills transfer, capacity building, transparent processes etc.)If one were to take the above literally, it is easy to assume that transformation is happeningespecially as many communities have remained intact since 1994 with few areas reflectingchanges in the demographic profile of the community. Hence, on the surface it would appear thatthese homes are transforming as they reflect the demographic profiles of the communities inwhich they are based and which they still largely serve.It was also clear that some homes used cost as a way to exclude different groups of people. TheGuidelines notes that “…the same quality and standard of service is provided to all, irrespectiveof race, gender and ability to pay…” While this implies that a home cannot refuse someone whocannot afford the prescribed fees, in practice homes do not accept those who cannot afford thefees. Although some white families also battled to pay the monthly fees, sometimes as much asR8 000 – R15 000 per month, they were still however able to afford it, probably at the expense ofother priorities. Many indicated that they had no option but to pay it because they couldn‟t takecare of their relative.As the social construct of black families start to change and they continue to choose the option ofinstitutional care for their frail residents, the urgency to address transformation at various levels inthe homes must be addressed. Rather than using the reasons of culture and social norms as anexcuse to exclude people there has to be some incentive for homes to embrace diversity and tobe held accountable for transformation. While transformation is not going to be easy there has tobe an intention, a plan and an effective monitoring system to ensure that while there isconsideration for the "more advantaged" older people who might not be able to easily adjust, sotoo should we be mindful of those pensioners who are adversely affected by a continuation of thesystem.65 | D S D A u d i t o f R e s i d e n t i a l F a c i l i t i e s
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Final ReportAudit of Residential Fa
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4.5 Sustainability / Funding ......
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towards their conditions of employm
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The M&E role of the Department (whe
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6. With regard to management capaci
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14. Sharing, Learning and Networkin
Page 13 and 14: Director-General means the Director
Page 15 and 16: office-bearers except as reasonable
Page 17 and 18: 1.3 Process FollowedA number of oth
Page 19 and 20: This was recorded and submitted to
Page 21 and 22: The Population Reference Bureau est
Page 23 and 24: 2.4.2 Proportion of women versus me
Page 25 and 26: Africans comprise 67, 7% of the pop
Page 27 and 28: Where homes are situatedFormer Whit
Page 29 and 30: While the guideline for frail care
Page 31 and 32: The breakdown of these homes is as
Page 33 and 34: Just over a half (51%) of homes off
Page 35 and 36: that “…The Department of Health
Page 37 and 38: Cultural and recreational activitie
Page 39 and 40: one bed should be set aside for sho
Page 41 and 42: a. Although there were a few homes
Page 43 and 44: 100%90%80%70%60%50%40%30%20%10%0%81
Page 45 and 46: While in the majority of homes (62%
Page 47 and 48: The graph indicates that staff for
Page 49 and 50: The norms and standards indicate th
Page 51 and 52: Are there staff records and Perform
Page 53 and 54: In 92% of the homes the residents d
Page 55 and 56: ooIn addition, emergency exits were
Page 57: v. In some provinces, the coordinat
Page 60 and 61: egards to the Mangers carrying out
Page 62 and 63: some senior staff that were black.
Page 66 and 67: In terms of the Transformation Char
Page 68 and 69: from Alzheimer‟s disease, dementi
Page 70 and 71: the home as very poor, Umhlaba sugg
Page 72 and 73: Home Requiring InterventionHome Con
Page 74 and 75: Free StateFree State ResultsPoor /
Page 76 and 77: Vosloorus Society Care of the AgedL
Page 78 and 79: Beaconvale Poor YesFairHome for the
Page 80 and 81: Where a more positive relationship
Page 82 and 83: The shortage of nursing staff could
Page 84 and 85: major breakages and faulty equipmen
Page 86 and 87: . Meetings / Interviews with:1. Dor
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