ARTICLES

 

An evaluation of the community-based care and support services for older persons in a specific community

 

 

Mpho Tshesebe^I; Herman Strydom^II

^ISocial Worker, Department of Social Development in Bloemfontein, North-West University (Potchefstroom Campus), South Africa
^IIDepartment of Social Work, North-West University (Potchefstroom Campus), South Africa. herman.strydom@nwu.ac.za

 

 

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ABSTRACT

Community-based care and support services for older persons aim at enhancing their quality of life and keeping them in their communities for as long as possible. The aim of this study was to evaluate these services in a specific community, namely the Motheo District, Free State Province. The views of three groups of participants were obtained, namely management committee members from organisations for older persons, older persons benefiting from these services, and social workers involved in these services. Findings from the three groups of participants were triangulated throughout the study and some recommendations were made for enhancing these services.

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INTRODUCTION

In terms of the Older Persons Act, Act 13 of 2006 (Department of Social Development, 2006) older persons are encouraged to remain in the care of their families and their communities. However, older persons are often abused by their own families and community members. Help Age International (2003:14) point out that in most cases when an older person is expected to be looked after, they also have to take on the role of caring for other family members without even the basic necessary resources. This article will discuss the results obtained from the participants on the evaluation of the community-based care and support services of older persons in the Motheo District, Free State Province. The focus of this study was to determine whether the current programme is meeting the needs of older persons and then to suggest possible improvements to the programme.

 

PROBLEM STATEMENT

The United Nations Declaration (2002:1) pointed out that less than three decades before the Declaration was issued, the global population was viewed as "young" rather than "old"; 35% of the world population were 14 years of age or younger and 8.5% were 60 years and older. Aboderin and Ferreira (2008:54) state that the proportion of persons aged 60 years and above in Sub-Saharan Africa will rise from 4.8% to 8.8% by the year 2050. According to Statistics South Africa (2011:4), the 2001 census showed that in South Africa the population of older persons was at 7.3% and the number increased to 7.7% by 2011. This shows a huge increase in the number of older persons. The world population of older persons is projected to increase by 22% by the year 2050.

Keigher, Fortune and Witkin (2000:3) believe that older persons should benefit from the family and community care and protection in accordance with each and every person's cultural values. Community care should take place in a supportive and caring environment, and this also reduces the level of dependence on expensive institutional care, which is a major benefit for society at large (Jansen van Rensburg & Strydom, 2010:381). The HIV and Aids pandemic has impacted negatively on the welfare of older persons and caused a certain role reversal. Many of the elderly are now taking care of others, even though they themselves are already at an age when they could have expected to receive the care, respect and rest associated with old age (Boon, James, Ruiter, Van der Borne, Williams & Reddy, 2010:2). Older persons are currently made to assume both productive and child-raising duties with little or no support, and to endure the emotional, physical, financial and social costs that arise from their role as caregivers (Kakooza, 2004:6; Makiwane, Schneider & Gopane, 2004:14; May, 2003:54). Older persons in deep rural areas, who are often illiterate and without access to basic facilities, do care for people with chronic illness without any care-giving training. Community-based care and support service are programmes specifically designed to address the interests and needs of older persons in the community and also to assist them to cope with the difficulties of life. These services have both a health and social component (Timonen, 2008:109) and can be helpful to older persons if they are well implemented.

The research questions for this study were:

• Can older persons receiving services from the Department of Social Development benefit from an evaluation of these services?
• How can the current programme be enhanced to deliver better services to older persons?

 

AIM

To evaluate the community-based care and support services strategy as implemented by the Department of Social Development in rendering services to older persons within communities in the Motheo District (Free State Province).

 

RESEARCH METHODOLOGY

Evaluation research was utilised in this study and can be regarded as the systematic application of social research procedures in assessing the conceptualisation, design, implementation and evaluation of the effectiveness and utility of a particular programme or social intervention. Information can thus be obtained for further planning and adjustments to a particular programme (Fouché, 2011:449-472; Logan & Royse, 2010:221-240; Royse, Thyer & Padgett, 2010:12-13; Rubin & Babbie, 2010:200-210; Strydom, 2013:156-157). The researchers in this study evaluated the community-based care and support services of the Department of Social Development. The research approach followed to do the evaluation was qualitative and exploratory in nature; in order to enhance these services for better service delivery to older persons, the viewpoints, perceptions and experiences of the following groups were sought: older persons who are recipients of the service; members of the management committees of the community based organisations; and the officials of the Department of Social Development.

Semi-structured interview schedules were used to collect data from all three groups of participants (Bryman, 2008:438-439; Greeff, 2011:351-352). The researcher utilised purposive sampling, which depends on the judgement of the researchers in that a sample is composed of elements that contain the most characteristic, representative or typical attributes of the population that serve the purpose of the study best (Claire, 2012:1; Grinnell & Unrau, 2014:309; Strydom, 2011a:392). The sample was drawn from six of the funded organisations that render services to older persons in the three municipalities which form the Motheo District in the Free State Province. An attempt was made to include participants from all three municipalities. Two management committee members were selected from each organisation to represent their organisation, which meant there were twelve committee members participating. Four beneficiaries (older persons) from each organisation also participated in this study, giving a total number of 24 older persons who could still function independently. Ten frail older persons, who were receiving services in the comfort of their homes, were also interviewed. Ten social workers who were rendering services to older persons were selected to participate in this study. In total there were 56 participants.

For the purpose of this study the researchers utilised all four research objectives namely, the exploratory, descriptive, explanatory and evaluative designs (Babbie & Mouton, 2010:79-81; Fouché & De Vos, 2011:95-99). The data were analysed according to Tesch's approach into specific themes (Poggenpoel, 1998:343-344). Trustworthiness of the data was ensured by way of four standards: truth value, applicability, consistency and neutrality (Botma, Greeff, Mulaudzi & Wright, 2010:232-233). Triangulation, member checking, dense description, peer examination, reflexivity and rigour played a role in ensuring the highest level of trustworthiness possible (Carey, 2012:42; Gray, 2014:30, 185-186, 606-607; Probst, 2015:37-39). The total spectrum of ethical issues was taken into consideration in this study. Written permission was obtained from the Department of Social Development in Bloemfontein, where the researcher is employed as a district coordinator for the Older Persons Sub-directorate, as well as from all participants in the study. Confidentiality, privacy, deception and informed consent were explained to all participants and they were requested to keep all private matters discussed in the study confidential in order to protect the other participants (Bryman, 2008:121-125; Engel & Schutt, 2013:62-70; Strydom, 2011b:115-126). The study was approved by the ethical committee of the North-West University, Potchefstroom Campus (Ethical approval number: NWU-00140-11-S1) and all data will be computer password protected for a period of three years.

 

RESEARCH RESULTS

Fifty-six participants were selected from the Motheo District. Of the 56 participants, 34 are beneficiaries of community-based care and support services, 12 participants were from the management committees of the community-based care and support services, and 10 were officials of the Department of Social Development.

Demographic profile

Home language

Ten (29.4%) of the beneficiaries of the services were Sesotho speaking. The second largest group were Setswana speaking, namely 8 (23.5%). The other large groups were Afrikaans, namely 7 (20.6%) and IsiXhosa, namely 6 (17.7%). The other language groups (IsiZulu and English) consisted of 3 (8.8%). Will a table not make it easier to see all the data in one. You can also add that the reason for the mainly Sesotho and Tswana speaking people is the fact that this is the dominant groups in the Free State.

Age and gender

According to the Department of Social Development (2006:12), an older person means a person who is 60 years of age and upwards. The largest group of participants, namely 18 (52.9%) were in the age group 60 to 69 years of age, while 11 (32.4%) participants were in the age group 70 to 79 years. Three (8.8% participants were over 80 and two (5.9%) were in their 90s. Of the 34 participants, 10 (29.4%) were frail older persons who received services at home, including meals on wheels, transport and home-maker services. However, these services reach a very limited number of older persons because insufficient funds are available for service delivery. However, 24 (70.6%) older persons were still mobile and active, and are members of luncheon clubs and day-care centres. Of the participants, 29 (85.3%) were female, and 5 (14.7%) were male. Davidson, Daly & Arber (2004:93) add that male older persons are often not willing to participate in the community-based care and support services, the reason being that the activities in these programmes do not always attract older male persons.

Marital status

Of the 34 aged participants 15 (44.1%) were widows/widowers, 12 (35.3%) were married, 3 (8.8%) were divorced, 2 (5.9%) are living together and 2 (5.9%) never married. According to Scrutton (1999:167), it was found that the most isolated older persons are unmarried or childless, with few surviving relatives. Yet all people need the company and stimulation of friends. Loneliness lowers morale and dims any hope that older persons might have in their lives. Waite and Gallagher (2010:1) agree that for some divorced adults new romantic relationships help to rebuild self-esteem and happiness.

Level of education

Of the 34 aged participants, 13 (38.2%) have a primary education, 11 (32.4%) have no formal education, 8 (23.5%) received training in the Kharigude programme (ABET), while only 2 (5.9%) have a secondary education.

Evaluation of the views of the three groups of respondents

The results obtained from the three groups of respondents, namely the social workers, members of management committees and the older persons themselves, are categorised into six themes. The six themes will be discussed with reference to the three groups of participants in each theme, with a concluding statement on the similarities and differences found in each group on each theme. The themes can be represented as follows before the detailed discussion takes place.

 

 

Theme 1: Stakeholders' understanding of their roles within the services

It is crucial that the service providers as well as the beneficiaries have knowledge and understanding of their roles. Adirondack (2006:150) agrees that even if an organisation acts irresponsibly, it may have problems with its accountability, including being clear about who has a right to know what the organisation is doing with its money, and how much control those people have over financial decisions. Therefore there is a need for people to understand and be clear about their roles in their organisations.

The social work participants had the following to say on this issue:

"Social workers have the role of advocating for the rights of older persons - they, however, experience many administrative obstacles such as lack of transport and resources."

"To ensure that older persons are treated with the respect and dignity they deserve and are protected from abuse."

"Social workers are too busy with their high caseloads, especially foster care of children, so that they cannot give their full attention to older persons in need of care."

"To assist the non-profit organisations which are funded by the Department of Social Development to adhere to the norms and standard in terms of the Older Persons Act, Act 13 of 2006."

The following viewpoints were expressed by the members of the management committee:

"To oversee the day-to-day running of the organisation. To give direction to the organisation by way of keeping proper minutes, correct bookkeeping, financial administration, marketing of services, capacity building and fund raising."

"Besides everything, people involved in these services should possess special human skills."

"Management committees should act as coordinators of all services to older persons in line with the objectives of the Department of Social Development."

The recipients of services had the following to say:

"Legislation makes provision for these services to older persons and we should do our best to participate in these activities. Older persons should not be scared of officials and realise that they are there to support and help them."

"As older persons we should not only understand our rights, but also take responsibility for our own actions."

"We are also protected from all forms of abuse and domestic violence and have the responsibility to report these matters to officials and social workers."

All three groups of respondents seem to understand their role. Social work participants could explain the duties that they are supposed to undertake, such as protecting older persons from abuse and domestic violence, treating older persons with respect and dignity, observing the rights of older persons and implementing legislation regarding older persons, but this differs from reality, Even though the social workers of the Department of Social Development understand their role in terms of service delivery towards older persons, they are neglecting these duties, because foster care for children consumes most of their time. Some participants mentioned the lack of resources in the execution of their duties. There is a need for government to improve service delivery to older persons in terms of resources and manpower.

The members of management committees also had a good idea of what their tasks entail. They mentioned the proper management of services, such as sound financial systems and bookkeeping. Networking, fundraising and marketing of services were also mentioned (British Heart Foundation, 2009:1). Members mentioned that they have to function in line with government policies and legislation, and that the people involved in these services should have special characteristics, such as enthusiasm, motivation, good communication and listening skills, and organisational and planning skills (British Heart Foundation, 2009:1). Regarding the viewpoints of the older persons, they mentioned that older persons should participate in services and even contribute towards these services; they should know their rights and to be protected from abuse and violence; and they should be able to admit to and report abuse and family violence. McGarry, Lombard and Lewis (2011:3) add that the consequences of domestic abuse have a significant impact on the long-term and emotional wellbeing of those affected.

Theme 2: Understanding of the services themselves

It is important that community-based care and support services are correctly interpreted and implemented by all three groups of participants.

The viewpoints of the social work participants were:

"Community based care and support services mean any programme designed within the community and at the homes of frail persons to enable them to stay in their communities for as long as possible."

"Besides the real community part of the services home based care is important for older persons staying alone, who are frail and bedridden."

"Residential care is expensive and older persons should be supported to remain in their communities within their families for as long as possible."

"These services can be formal or informal and includes all services for older persons in the widest sense of the word - programmes should focus on the promotion of African cultural values."

The viewpoints of the management committees were:

"We are supposed to deliver certain community services, such as meals, nursing service, recreational services and transport. The funding of these services remain a major challenge."

"Especially the home-based part of services is valuable to meet the needs of bedridden persons."

"These services are mostly delivered on an informal basis in terms of money, transport and human resources."

"Many of our volunteers are older persons themselves taking care of other older persons - this brings its own challenges. We are also losing caregivers due to small stipends being paid and eventually they leave for greener pastures."

The older persons mentioned the following:

"Certain services must be delivered to older persons in the community, although all the services are not always available. We realise that there is not enough money for all of these services - government should care better for older citizens."

"Many older persons think that these projects are not well managed and that the funding does not reach the older persons. Government pays these organisations for the services they render and should thus deliver it free of charge."

"The meal, laundry and bathing services, including changing nappies and linen, are very important to me as a bedridden person. I wish that I can have a round-the-clock service of a trained caregiver - during the nights I am lonely and I am afraid."

"Some caregivers do not treat us with respect and shout at us if we do not react quickly - some are not trained properly."

In the Motheo district there are three old age homes that extend their services to provide outreach programmes to the communities. These old age homes do not have enough resources, but they are rendering all of the above services to the community even though the services do not reach everybody in the community. Other community-based organisations are rendering only a few of these services to older persons. Because of a lack of human resources and not enough funding, the community-based organisations are unable to provide the expected services and activities effectively and efficiently. The government should consider increasing the funding for the services to older persons and also provide the non-profit organisations with the necessary training.

From the viewpoints of all three groups of participants it is clear that they have a good understanding of what community- and home-based care and support services are. All three groups have knowledge and understanding that the following services are provided as part of the community-based care and support services: meals on wheels/foot, balanced meals, home-based care, handwork and income-generating projects, educational talks, counselling services, music/choir activities, recreational activities, physical exercise, religious activities, outings and intergenerational contacts. Uys and Cameroon (2003:22) defined home-based care as a placement of informal and formal caregivers in the home to promote, restore and maintain a client's maximum level of comfort, functioning and health, including care towards a dignified death - the aim being to enable older persons to remain at home for as long as possible (Kelly & Orr, 2009:65; Renwick, 1996). According to Adirondack (2006:160), it is important to have knowledge about the scope of the service, including its political, social and economic context, accepted standards and expectations, what the other parties are doing and how this organisation fits into the bigger picture. The promotion of African cultural values should be high on the list of priorities when planning services (Aboderin & Ferreira, 2008:60).

Theme 3: Office space and venues pose challenges for hosting services

The issue of appropriate venues seems to be a major challenge for most welfare organisations in South Africa, including the non-profit organisations in the Motheo District working for the welfare of the older persons.

Viewpoints of the social workers were:

"Most of the non-profit organisations in the Motheo district that are rendering services to older persons in the community do not have a place of their own. They are mostly dependent on the goodwill of private persons or churches to use their facilities."

"Renting premises is not one of the fundable items in terms of the Department of Social Development's service specification. "

"Some of these organisations who have acquired their own sites have often built in sections as they acquire money or receive donations from the public. These premises are often too small and in dilapidated condition."

"The situation is especially difficult in the deep rural areas where the communities are far from each other, services cannot reach all the older persons in those areas and officials and social workers do not want to work or stay in these rural areas."

The following comments were made by the management committees:

"Due to the lack of our own premises, we are using community and church halls, old age homes, rented places, private houses and even shacks. We are thankful for the goodwill of these people supplying us with venues of some sort, but because it is not the older persons organisations' own premises, we have no say in the times and days that we use their sites and therefore experience challenges."

"Due to all the logistical problems we face, our daily programmes are sometimes disrupted or disturbed due to other members of the public who want to use the facilities."

"Rent is not included in the fundable items, according to the Department of Social Development's service specification, and this results in not complying with the Memorandum of Agreement signed between us and the Department of Social Development."

The following opinions were expressed by the older persons as beneficiaries of the services:

"Some of the venues are private houses and we do feel that we impose on the owners and they cannot carry on with their daily activities. Sometimes these families act as if they own the organisation and try to control and utilise the organisation and its assets for their own private needs."

"These venues are often overcrowded, very hot in summer and cold in winter, and become a health risk."

"In some cases the services are rendered from an old age home as an outreach programme to the community - this works much better than the small and overcrowded premises."

From the views of the three groups of participants in this study it is evident they are faced with many challenges. Again, it is the deep rural areas that face the biggest challenges because of the long distances, inadequate venues and other logistical problems (South African Older Person's Forum, 2010:6). These services are mainly funded by the Department of Social Development and do not in all cases cover the expenses for office space and venues for meetings. The organisations that are experiencing the most challenges are those that provide their services in the semi- and deep rural areas. It can be added that by 2025 the majority of older persons in the developing world will still live in rural areas (African Conference on Aging, 2004:1). Bruce, Jordan and Halseth (1999:iii) add that a critical ongoing issue for volunteer organisations is finances to cover operations, ongoing programmes and special projects or events. Added to this is the issue of acquiring and training more volunteers to assist in rendering the necessary services (Jansen van Rensburg & Strydom, 2013). Often the conditions in these organisations do not meet the norms and standards as stipulated in the regulations of the Older Persons Act, Act 13 of 2006 (Department of Social Development, 2006). The poor conditions in these organisations make it difficult for the officials to do the proper monitoring, assessment and evaluation of service delivery to older persons. Government should consider assisting the community-based organisations with available venues and, if possible, provide funding for them to be able to rent bigger venues that are in good condition. The government should also consider increasing the number of officials in the rural areas in order to render effective services to the older persons in these areas.

Theme 4: Advantages of these services

In this theme the importance of these services is discussed from the perspective of the three groups of participants.

Viewpoints of the social workers:

"These services are important and beneficial in order to support older persons so that they can lead a dignified life and to protect older persons from abuse."

"It enhances the worth of older persons in society and helps them to remain involved and to promote older persons' participation, skills, knowledge and wisdom in the community."

"The services offered, such as a daily well-balanced meal, clinic and socialisation services, assist to keep older persons active, healthy and independent as part of society."

Viewpoints of the management committees:

"These services empower older persons to identify and report abuse so that these cases can be dealt with."

"The needs of older persons are well taken care of by these services."

"These services can especially identify vulnerable older persons, such as those living on their own and living in poverty."

"Older persons are cared for in the community and kept out of expensive institutions such as old age homes and hospitals."

Viewpoints of the beneficiaries of these services:

"Through these programmes we get lots of knowledge, learn new interesting things every day and we meet our peers and enjoy being together."

"It assists me in my loneliness - if I meet other people with similar situations I feel better. These programmes keep us fit and healthy and we are taught a healthy lifestyle."

"These programmes make me feel of importance to the community, like taking part in a choir competition or visiting a creche in order to mix with young people and for storytelling and advice to the younger generation."

"I am so thankful towards government for supplying me with these services."

All three groups expressed their opinions on the advantages of the community-based care and support services, but the common view amongst them is that these programmes are important and valuable in meeting the needs of older persons in the community. These respondents believe that these programmes are important in the sense that they are a way of preventing older persons from being institutionalised and give them the opportunity to remain in the community for as long as possible. All forms of abuse are present among the aging population, but seeing that pensioners are often the only persons with an income in many households, financial abuse is most evident (Schenck & Louw, 2010:370). Abuse of the elderly can also be detected, seeing that these services are in frequent contact with older community members (Ananias & Strydom, 2014). This saves a lot of money for the government as people does not need to be admitted to a hospital or residential care facility. Uys and Cameroon (2003:4) and Van Dyk (2002:327) reiterate the importance of community-based care and support services by saying that these services allow older persons to remain in the familiar environment being cared for by family and other persons in the community. According to the Department of Social Development (2010:17), the objective of the programmes is to keep older persons functionally independent and living with dignity in the community for as long as possible, in other words to increase the quality of life (Victor, Scambler & Bond, 2009:82-85). Mowat and O'Neil (2006:1) add that living longer not only brings possibilities of enhanced health, happiness and productivity, but also increasing frailty, chronic illness and diseases of old age such as dementia, diabetes and heart diseases.

Theme 5: Disadvantages of these services

The following disadvantages of these services were indicated by the three groups of participants.

The social workers voiced their opinions as follow:

"Some people take advantage of such programmes - therefore proper screening and evaluation of participants are important, families should be encouraged to participate in caring for their older family members and the monitoring of these organisations should be done in a professional and prescribed manner."

"Social workers are not doing enough in terms of proper guidance and support to the organisations rendering these services to older persons - this affects growth and stability in these organisations."

"There is not enough manpower from the Department of Social Development to do the job properly."

"Some management committees are only involved in the programmes for their own personal gain and the financial incentives attached and are not there for the best interest of older persons."

Viewpoints of the management committees:

"The number of older persons needing home-based care and day-care services is increasing at an alarming rate and they live far apart, spread out over the area. We have a lack of manpower and transport to deliver a proper service."

"Seeing that there are a huge demand for these services, exceeding the supply of available services by far, put a huge burden on existing services. At the same time there is a lack of sense of urgency from the side of social workers."

"We are struggling due to the fact that family members abuse older persons' grants and fail to contribute to the services rendered to their family members."

"Families often argue that community services and the caregivers are responsible to care for their older family members."

Viewpoints of the older persons are:

"We do not have a place of our own to meet which is very bad for us."

"Our venue is too small and if many people attend, I feel like suffocating."

"We do not have a safe and proper meeting place."

In this theme the following aspects were identified as common experiences from the viewpoint of the three groups of participants, namely the issue of families being reluctant to take responsibility for their family members in a home-based care service, the inadequate infrastructure which affects the service delivery, and lack of guidance and support from the Department of Social Development (2010). These issues can be blamed partially on the lack of manpower to execute these services in a proper way. Older persons should be supported, loved and protected by their family members, which often does not happen. Bungane (2012:45) considers it important that older persons should have people who will support them and that the services being delivered should be provided in a caring and systematic manner.

Theme 6: Recommendations to improve services

The three groups of participants had the following to say about improving service delivery to older persons in the community.

Viewpoints of the social workers were:

"The funding of these organisations should be improved, proper guidance of organisations should take place and the training of paid staff and volunteers should be a priority."

"Training in financial management and protection of the infrastructure of these organisations should be high on the list of priorities."

"All the necessary policies are in place to render an effective service to older persons - somehow, somewhere something goes wrong!"

"A Help Desk for Older Persons and a Forum for Older Persons is in place in the province to create a platform for older persons."

Viewpoints of management committee members were:

"Government should improve service delivery to older persons. We need more funding and proper infrastructure to manage the services properly."

"Why do some services function well and others not? Government should monitor and assess these services on a regular basis."

"There should be more social workers and other officials assisting us with management and other skills to run such a service professionally."

"My organisation is in dire need of transport - if you have no transport you cannot deliver meals to the home bound and transport older persons to the centre."

Viewpoints of the beneficiaries of these services were:

"Oh yes! Some of these services are almost non-existent - if you take the services older persons receive from some pension pay points, municipalities, clinics, police stations and other places visited by older persons it really breaks your heart."

"We would really like a one-stop service at the luncheon club where all activities are presented for the older persons."

"We rather keep quiet than speaking out, because older persons are not taken seriously - many older people are not reporting cases of abuse, because they are afraid of being intimidated and ill-treated."

"The various government departments and NGO's should work together in order to address the issues that are affecting older persons, instead of being send from one place to another."

In this theme the beneficiaries and management committees agreed that there is still a lot that the government needs to do in order to improve service delivery to older persons in the community. The three groups of respondents agreed that the government needs to improve funding of the non-profit organisations that render services to older persons to increase the effectiveness of such service delivery. Proper infrastructure and transport for these organisations are also suggested (Makiwane et al., 2004:33). Proper guidance, support and training of members of these organisations are recommended in order for them to be able to render a better service. The officials tend to differ from the older persons and management committees regarding the issue of existing policies and legislation for older persons. Community-based organisations by their nature are dependent on government funding to provide effective service delivery. Adirondack (2006:1) adds that the voluntary sector is shrinking because volunteers in these organisations also need an income and cannot deliver their services free of charge.

 

DISCUSSION

The focal points of this article are based on the results obtained from the views of the three groups of respondents. The results obtained identified the challenges and needs experienced by older persons and the representatives of the management committee for the organisations for older persons in the Motheo District. The respondents believed that community-based care and support services are very powerful and important programmes, aiming at meeting the needs of older persons in the community if they are well implemented. This is a challenge to the government, which introduced a programme in need of resources such as funding, manpower, commitment and the dedication of all government departments for the programme to be well implemented.

Rosenberg et al. (2005:16-35) states that it is difficult to provide care where there is a high rate of poverty, where people do not have enough resources and lack information on the availability and accessibility of resources or services. People need to be informed about basic services. A report prepared by the South African Older Person's Forum (2010:7) stated that non-governmental organisations running the community-based care and support services are not properly funded. The non-profit organisations are unable to provide high-quality services to the beneficiaries as a result of poor funding.

The other challenge identified is that there are only a few services for older persons in the rural area. There is a need for the government to improve service delivery to older persons in the rural area, because older persons in the rural area are more vulnerable and subjected to abuse of any kind. May (2003:54) pointed out that in most cases older persons care for people with chronic illness without any training and/or access to the necessary information that might capacitate them to take the necessary precautions. Makiwane et al. (2004:23) add that this burden is even worse in the rural areas where there are few, if any, resources available.

The lack of proper infrastructure is another challenge. Most of the non-profit organisations rendering community-based care and support services to older persons do not have their own infrastructure where they work or meet. The non-profit organisations make use of community halls, church halls and shanties. In most cases the spaces are too small or too big; sometimes they are overcrowded and during winter the halls are too cold, carrying a health risk. These conditions affect the attendance of the programmes. This matter requires the attention of the municipality and the Department of Public Works, who need to provide sites and vacant buildings to organisations for older persons.

Home-based care services were also identified as a need and present their own challenges for implementation as required by Older Persons Act, Act 13 of 2006 (Department of Social Development, 2006) chapter 3 section 11(3). The proper implementation of the home-based care services for older persons needs the commitment and dedication of the Department of Health. The respondents agreed that caregivers need proper screening so as to protect older persons from any form of abuse. The caregivers also need proper training and supervision. The programme needs resources in terms of manpower and finances in order to be well implemented. The service providers in the Motheo district are rendering the home-based care service both formally and informally, with trained and untrained caregivers. The standard of this service does not meet the needs as required by the Act. According to the South African Older Person's Forum (2010:2), non-governmental organisations believe that for home-based care to be properly implemented as required by the Older Person's Act, Act 13 of 2006 (Department of Social Development, 2006), a substantial budgetary increase is needed. The non-governmental organisations reported that they are losing quality caregivers because of the poor salaries. These caregivers opt for careers offering better remuneration.

The educational level and concentration of older persons is also an issue of concern. Most of the training sessions and workshops are conducted in a language and standard above the older persons' and management committees' level of understanding. Some management committee members believe that the inclusion of a middle-aged group, who are educated in their programmes, will make a difference, because such persons will be able to understand and do what is expected from them. The level of understanding in older persons slows down the progress in their organisations, as some older persons are not trainable.

 

RECOMMENDATIONS

• For the effective and efficient service delivery to older persons, the government will need to increase the funding allocated to the sub-programmes of older persons. The focus should be on service provision to older persons.
• Service provision to older persons requires collaboration and cooperation between government departments, the private sector, civil partners and non-governmental organisations.
• The role of each government department should be clearly defined with respect to service delivery to older persons.
• Capacity and skills development are needed for non-profit organisations to improve service delivery to older persons in the community.
• For effective and efficient service delivery, there is a need for the Department to increase the number of officials working with older persons in the Motheo District.

 

CONCLUSION

This article presented an overview of the results obtained from interviews with three groups of participants on the evaluation of community-based care and support service. The three groups gave their views on the programme and its categories. The aim of the article was to evaluate the community-based care and support services of older persons in the Motheo district and to suggest improvements to the current programme. From the findings it can be concluded that the implementation of the programme in this area is fairly effective for those who received it, but there is still much that needs to be done for proper implementation and improvement of the community-based care and support services in this area.

 

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