Understanding the law and ageing and how to protect the elderly

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1 Understanding the law and ageing and how to protect the elderly Sebastiana Kalula Albertina and Walter Sisulu Institute of Ageing in Africa International Longevity Centre South Africa University of Cape Town

2 Framework of the Rio Declaration, 2013 Aims To move beyond prevention and treatment, to develop a culture of care in response to the Longevity Revolution To call on governments to review health and care policies and practices for older people To develop and implement a culture of care that is sustainable, affordable, compassionate and universal

3 Country profile South Africa is a middle income country with a large poor section of the population Demographics: Total population: 52.9 million in 2014 Population aged 60 years: 4.1 million (7.8 % of total population) Set to increase to 6.4 million (13% of total population) by 2050

4 Current health care priorities HIV/AIDS epidemic and others infections disease Resource distribution Maternal and child health Young adults Older population

5 Migration Strong urbanisation trend of young persons Consequences: Diminished informal support base for older relatives Need for increased formal support, e.g. institutional care, home-based care, community support groups Rural aged suffer disproportionate deprivation and disadvantage

6 Socio-economic inequalities Marked historical, race based socio-economic inequalities Majority of households with an older person have limited resources Multi-generational households are common; older members are carers to young children Public transport neither available, affordable, accessible nor age friendly Frail older people experience difficulty in accessing health care and visiting social institutions

7 Healthcare system Three tier public health system: Primary care (92%) Secondary care (6%) Tertiary care (2%) Referral system is far from seamless No dedicated services for older persons at primary level Not all in need are able to access a higher level of care

8 Sub-optional training of health professionals Most training institutions have no curriculum on health care for older people Only four of the 8 offer training in Geriatric Medicine Only ten registered geriatricians in the country Gerontology nursing training has been discontinued

9 Access to health care services Free public health care for social pensioners But high levels of dissatisfaction with services due to barriers such as: Distance of service outlets and cost of travel Discriminatory and depersonalising behaviour of health professionals Overcrowding and understaffing of facilities Long waiting times Shortages of medication Non-availability of assistive devices All care, even for the frail must be accessed at community health clinics

10 Community care Senior centres, some day care, some home based care Sparse, unco-ordinated and not comprehensive Services for older persons are largely provided by non-governmental organisations Where available, home based care often provided by older volunteers, home care limited to bathing, home visits etc. Previous community nursing services were withdrawn to cover maternal and child health

11 Proposed solutions and strategies Towards building a culture of care from a human rights perspective: expanded and improved care services, expanded education and training, and age friendly caring environments

12 Training Reinstatement of training curricula such as gerontology nursing to offer career choices for the young and enhance care for older people Government should mandate institutions to train professionals and skill them in the care of older persons Career pathways in gerontology/geriatrics would influence choices in training

13 Training of carers for the provision of quality long-term care not embraced Non-governmental organisations dependent on fund raising to sustain services should be supported and encouraged by government to train and skill formal and informal caregiver

14 Enhanced holistic care services Senior centres to collaborate with community health centres and provide more substantial services Services should include empowerment of older persons in self care by: providing health education offering screening, counselling and follow-up services for health conditions Dispensing medications and assistive devices

15 Home visits from health professionals are only available only to a minority who can afford private health care There is an urgent need for government funded health teams to provide home assessments and care to those who are too frail to access services at community health clinics

16 Improve community support Changes in family structures are leaving an increasing number of older persons unsupported by kin Build on a culture of volunteerism and recognise contribution of volunteers Provide volunteers with basic skills needed to support and provide home care and companionship to older persons in their home

17 The government and other stakeholders should acknowledge a growing need for longterm care and should expand respite and longterm care facilities that provide formal care that meets minimum standards

18 Conclusions Care for the majority of older people in South Africa is inadequate and deficient The country and service delivery are confronted with numerous demands and challenges Political will, and appropriate planning and implementation of creative solutions by the government and other stakeholders will help to remedy deficiencies The National Health Insurance plan currently being piloted may ameliorate the situation in the long term

19 Too much assumption that family can manage to care Family unsupported in care provision Change in family structure and family insufficiency needs more support

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