REPORT ON THE COSTING OF THE OLDER PERSONS BILL Tuesday 05 APRIL 2005 A

INTRODUCTION  The process of developing legislation for Older Persons was initiated in 1999, and it culminated with the development of a draft Bill in 2002  The Bill has incorporated both the recommendations of the Ministerial Committee and the three priorities of the Madrid International Plan of Action-on-Ageing  A new legislation had to be developed as the legislation was no longer addressing the needs of Older Persons  A significant percentage of the Budget was focusing on residential care

BACKGROUND Objectives of the Older Persons Bill  BACKGROUND Objectives of the Older Persons Bill  Maintain and promote the status, safety and security of Older Persons  Maintain and protect the Right of Older Persons as recipients of services.  Regulate the registration of facilities for Older Persons, and Combat the abuse of Older Persons The costing had to consider  Fiscal risks  Administrative costs and cost drivers, and  Institutional Arrangements

DEFINITION OF KEY CONCEPTS  DEFINITION OF KEY CONCEPTS  Older person is a female person aged 60 or over and a male person who is 65 years old and above  Community-based care refers to domestic and personal care that a consume can access nearest to home, which responds to need, encourages local involvement and supports family and community values and responsibilities  Vulnerable Older Person is a person over the age of 60 who is in receipt of a social security grant by qualifying through a means test and is eligible for other state social services. These are Older Persons in the community that are at risk of not having their needs met due to inadequate or inaccessible resources, and as a result are susceptible to deprivation or relative deprivation

DEFINITION OF KEY CONCEPTS CONTINUE  DEFINITION OF KEY CONCEPTS CONTINUE  Home based care is the provision of health and personal care services rendered by formal and informal caregivers in the home in order to promote, restore and maintain a person’s maximum level of comfort function and health including care towards a dignified death (World Health Organisation)  Capital Programme is a programme for government and community infrastructure development in service delivery to Older Persons  Administration Programme is the internal programme for government at national and provincial level, responsible for, amongst other co-ordination, policy and legislative development, monitoring and evaluation, funding and the maintaining of relevant registers

PROJECT OBJECTIVES  Understand the contents of the Bill in terms of an implementation plan  Analyse each component of the Bill in order to cost the OPB  Assess the fiscal and budgetary implications  Determine the cost implication at a National, Provincial and Local levels across the various sectors  Determine the cost implications of priorities as determined by the DSD for the Two-year MTEF cycle period  Analyse the various components of the Bill, and thereafter cost the components  Facilitate consultative processes jointly with National department and Treasury

CHALLENGES . Short timelines . Draft/wording of the Bill  CHALLENGES  Short timelines  Draft/wording of the Bill  Unavailability of adequate and valid information on Older Persons  Non-standardisation of services resulting in disparity in current costing

LEGAL ASSESSMENT Legal assessment of the Bill was done with a view to:  Identify and determine cost drivers  Identify the rights and obligations (both compulsory and discretionary obligations) of the various parties recorded in the Bill  Identify the risks of litigation related to the implementation or enforcement of certain provisions of the Bill

Table 4: Distribution of Total Vulnerable Older Persons (60+) by Province

PROGRAMMES Costing was done for the following programmes.  PROGRAMMES Costing was done for the following programmes  Residential Care Programme  Integrated Community Care and Outreach Programme  Home-based Care Programme  Poverty Relief and Economic Development Programme  Capital Programme  Administration Programme for National and Provincial

TABLE 3 DISTRIBUTION OF TOTAL OLDER PERSONS (60+) BY PROVINCE

PROJECT: APPROACH  Comprehensive analysis of the Older Persons Bill and proposed amendments  Comparative analysis between the Older Persons Bill, its proposed amendments and the Aged Persons Act, and  Cost Driver analysis to effect implementation and maintenance of Older Persons Bill

PROJECT: METHODOLOGY METHODOLOGY  PROJECT: METHODOLOGY METHODOLOGY  Legal Matrix – compulsory and discretionary obligations  Costing Model  Social Services Delivery Model

NORMS . The norms upon which the costing was done is based upon NORMS  The norms upon which the costing was done is based upon policies and service delivery models of the Department of Social Development  The baseline data of Older Persons used is based on the number of older persons who are currently in receipt of the Old Age Grant, as these have been means tested for vulnerability  Target groups - 2% of the total vulnerable older persons is a target for accommodation in a residential care facility (old age homes)

NORMS CONTINUE  3% of the total vulnerable Older Persons for home-based care. For those Older Persons who require frail care services whilst remaining in the community  20% for integrated community care and outreach programmes. This is to ensure that the Older Persons remain independent at the highest possible level of functioning in the community

COSTING MODEL The Model used to cost the various aspects of the Bill was based on a range of variables, namely:  Demand variables – indicating the volume of a particular service that is required, for example the number of vulnerable Older Persons to be serviced as per the Core Programmes identified  Process and input variables – that give information on the different types of inputs (cost drivers) required to deliver the services, for example the number or health care professionals/social workers needed to manage a day-care facility, and  Costing variables – namely the costs of the different inputs required to provide the service

LEVELS OF CARE The programmes have been costed according to the following levels:  Basic care – the minimum level at which the service can be provided  Intermediate care – minimum level plus additional services such as: - ancillary health services occupational (therapy and physio- therapy) - recreational activities and others  Tertiary care – more advanced and luxurious care such as that which is provided in retirements or private homes (Please refer to attachments)

FINDINGS AND ANALYSIS . Current allocation for 2005/06 = R462m  FINDINGS AND ANALYSIS  Current allocation for 2005/06 = R462m  For 2006/07 = R514m  Projected estimates as set out in table 7, exceeds the Department’s budgetary allocation  Consideration must be given to the fact that costing models give the actual cost of basic services required for Older Persons  Provision regarding monitoring processes will increase the number of social service personnel, required to execute the Bill  Innovations introduced by the Bill e.g. register of older persons will increase administrative functions

FINDINGS AND ANALYSIS CONTINUE  FINDINGS AND ANALYSIS CONTINUE  The new processes to manage and operate a facility expands the administration function of the facilities and the Department  The right to reasonable access to basic service, places a burden to the government to make services available  Notification of Older Persons’ Abuse and the notification for thereof demand an increase of professionals to notify, investigate, report and take action

KEY OBSERVATIONS  The demand for services outway the available services  Provision for frail care is critical  Service points are more required in rural areas as revealed in poverty gaps  The implementation of the Madrid Plan of Action on Acting demand a different scope of services  The development of community based care and support services is critical

Table 2: Current Expenditure and Coverage per Province for Old Age Homes, Service Centres and NGOs NPOs* Poverty Relief programme No. Old Age Homes Subsidy No. Residents Subsidy / Person No. Service Centres Subsidy / Person / Month Total Subsidy Provincial Projects R’000 Eastern Cape 54 R 45,772,000 3,643 R 1,047 75.18 5,530,000 1,064,282   5,000 Free State 38 R 12,906,000 717 R 1,500 78 8,259,000 160,187 2,500 Gauteng 99 R 62,358,809 9,403 R 1,157 120 78.00 5,288,879 4,933,378 750 KwaZulu Natal R 48,468,240 2,362 R 1,710 73 80.00 2,472,000 2,436,198 Limpopo 8 R 9,060,592 893 R 2,470 50 78.25 3,408,101 181,215 Mpumalanga 19 R 9,387,479 1,228 R 1,215 50  165.00 3,947,107 1,010,800 North West 26 R 23,852,400 1,529 R 1,300 42 70.43 2,738,318 87,429 Northern Cape 27 R 5,836,800 1,216 R 400 120.00 1,455,708  1,333,712 Western cape 136 R 81,500,000 10,854 168 93.90 11,532,000 1,099,000 1,000 National 1,700,000 Total 461 299,142,320 31,845 654 446,311,113 R 12,306,201 R 25,000 TOTAL Expenditure: R382 779 634  * The second last column of Table 2 represents social work services rendered by NGOs

CONCLUSION  Government has to invest in community based services and target programmes that reach the poor of the poorest  Resources should be driven by the needs, with the intention of keeping Older Persons independent within their community, functioning at the maximum potential level T H E E N D