Consultancy to Develop Minimum Standards for Elderly ...

REPORT Consultancy to Develop Minimum Standards for Elderly Residential Facilities in Guyana


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DISCLAIMER

The information in the body of this report is based on expert knowledge, has been drawn from

engagements with the Ministry of Social Protection and interested stakeholders, and is enhanced

with material in the public domain on caring for the elderly and management of elderly care

facilities. It has also been reviewed by and validated with the Ministry of Social Protection.

This report is largely based on information received or obtained, on the basis that such information

is accurate and complete. This information has not been subject to an audit, and the author accepts

no responsibility or liability for the information (all statements and statistics) contained herein.

Without prejudice to the generality of the foregoing paragraphs, the author does not warrant or

guarantee that the guidance provided in this report will lead to any particular outcome or result.

This disclaimer governs the use of this report. By using this report, you accept this disclaimer in full.

CREDITS: COVER PHOTOGRAPHS

Aubrey Odle, Ministry of Social Protection

Source: Ministry of Social Protection’s Facebook Page

COVER PAGE DESIGN

Sharissa Barrow

President and Consultant, Dochas Consulting

PREPARED BY: Sharissa Barrow, President and Consultant, Dochas Consulting

Dochas Consulting is a social enterprise that aims to empower vulnerable women and girls in

Guyana, and provide quality and reliable value-added services to governments, businesses, and

international organisations seeking to build economic and social foundations in Guyana and across

the Caribbean. On the business end, Dochas Consulting offers consultancies in the international

development and business, project management, disaster risk management, social development,

and education sectors. On the social end, the team works to empower vulnerable girls in the formal

Child Protection System by providing ongoing and focused mentoring and life skills development

support. Dochas Consulting further contributes at least 5% of all revenue earned doing consultancies

to expand its work with and support of vulnerable girls in Guyana.

[email protected] ₪ 592-222-4943 ₪ www.dochasconsulting.com

mailto:[email protected]

http://www.dochasconsulting.com/


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TABLE OF CONTENTS

1. Introduction ........................................................................................................................................ 1

2. Assignment Overview ......................................................................................................................... 2

3. Contextual Framework........................................................................................................................ 6

4. Situational Analysis of Elderly Residential Facilities in Guyana ........................................................ 13

5. Proposed Minimum Standards for Elderly Residential Facilities in Guyana ..................................... 19

6. The Way Forward .............................................................................................................................. 34

LIST OF APPENDICES

Appendix 1: Site Observation Checklist Used for Field Visits to Elderly Care Facilities. ....................... 35

Appendix 2: Summary Reports for Field Visits to Elderly Care Facilities .............................................. 39

Appendix 3: Data Collection Protocols Used for Field Visits to Elderly Residential Facilities ............... 45

Appendix 4: References and Resources ................................................................................................ 51

LIST OF FIGURES

Figure 1: Population Pyramid: Guyana 2002 .......................................................................................... 6

Figure 2: Distribution of Elderly by Tenure of Dwelling Unit Where They Reside .................................. 7

Figure 3: Distribution of Elderly with Disabilities .................................................................................... 7

Figure 4: Actors in the Elderly Residential Care Sub-Sector ................................................................. 18

ACRONYMS

BP Blood Pressure

CPR Cardiopulmonary Resuscitation

DSS Director of Social Services

GBTI Guyana Bank for Trade and Industry

GPHC Georgetown Public Hospital Corporation

MoPH Ministry of Public Health

MoSP Ministry of Social Protection

NBS New Building Society

NCE National Commission on the Elderly

NGO Non-governmental Organisation

OAP Old Age Pension

OHS Occupational Health and Safety

PA Public Assistance

PCA Personal Care Assistant

TOR Terms of Reference


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1. INTRODUCTION

The Ministry of Social Protection is the premier agency charged to ensure the welfare—health,

happiness and fortune—of Guyanese citizens. Its mission is to “contribute to economic and social

development by maintaining a stable industrial relations climate, formulating policies, and providing

integrated employment, training, and social and welfare services”1. The Ministry thus promotes safe

and healthy work environments for all Guyanese, and provides critical social services for poor and

vulnerable populations, including children, women, the elderly, and the disabled.

The Ministry’s 2015-2020 strategic priority is to reduce poverty and inequality, and thus plans to

enhance the quality of services and benefits provided to old age pensioners, public servants,

children, the differently-abled, vulnerable women, youth, and other underprivileged and

underserved populations, including the elderly. To this end, the Ministry allocates a significant

portion of its budget to providing old age pension (OAP) and public assistance (PA) services. In fact,

of the $8,881,262,000 allocated to Programme II (Social Services), 90.57% ($8,043,682,000) was

spent on OAP and PA in 2015. This continues a multi-year trend of allocating the majority of the

programme’s budget to these welfare and social security services.

As a critical part of this work, the Ministry oversees all of the elderly care facilities in Guyana, and

administers the Palms Geriatric Facility. Established in 1874 under British rule, the Palms has been

the final home of thousands of Guyana’s senior citizens. It is fully funded by the Government of

Guyana ($71.78 million in 2013, $92.94 million in 2014 and $82.99 million in 2015) and provides free

care for the indigent. This care covers medical, nursing, dietary, and social needs, and includes the

provision of rehabilitative therapies to both residents and out-patients and of a hospitable physical

and social environment for the long term care of its residents2. The Palms has the capacity to house

240 residents, and admission is primarily based on age, indigence, and medical need.

Despite considerable investment (public and private) at the Palms and other elderly residential

facilities, they still face significant challenges, including the inability to attract and retain committed

human resources, limited ownership from the families (where available) to assist in the general care

and welfare of the elderly, and poor management and accountability. These issues are generally

common across the country’s elderly residential facilities. Still, because of differing management

arrangements, geographic vulnerabilities, and local realities, each facility operates differently and

faces some unique challenges. This not only complicates the management and oversight of these

facilities, but underscores the need for core minimum standards to establish a national framework

for the care and protection of elderly in residential care, provide a common system for monitoring

and regulating public and private elderly residential facilities, and allow for improved allocation of

resources to elderly care facilities.

1 Ministry of Social Protection. < https://www.facebook.com/Ministry-of-Social-Protection-

107102069644775/info/?tab=page_info>. 2 Ministry of Social Protection. <

http://www.mlhsss.gov.gy/index.php?option=com_content&view=article&id=188&Itemid=77>.

https://www.facebook.com/Ministry-of-Social-Protection-107102069644775/info/?tab=page_info

https://www.facebook.com/Ministry-of-Social-Protection-107102069644775/info/?tab=page_info

http://www.mlhsss.gov.gy/index.php?option=com_content&view=article&id=188&Itemid=77


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2. ASSIGNMENT OVERVIEW

2.1 Purpose

The overarching purpose of this consultancy is to propose minimum standards for elderly residential

facilities in line with international best practices and Guyana’s obligations under international

treaties and agreements. The intention is to then use the minimum standards developed to inform

decision-making on the future operations of elderly care facilities across Guyana, and recommend

mechanisms for the efficient monitoring and oversight of these facilities.

2.2 Scope

The goal of this assignment is to develop a comprehensive national framework, vis-a-vis minimum

operational standards, for residential care facilities for older persons in Guyana. Consequently, it has

included a review of the existing state of elderly residential care facilities and the care provided to

residents, the identification of critical areas for action to bring the facilities’ operations into

alignment with international standards and best practices, and the gathering of tacit and expert

knowledge to ground the standards in local realities.

That notwithstanding, it is recognised that the status of the elderly nationally and the ability of

national systems to respond to the unique psychosocial, economic, health, and development needs

of older persons have an impact on the operations of residential care facilities. This assignment thus

underpins the assessment of elderly residential facilities within the wider perspective of the national

cultural, political, economic, and social perspectives of older persons; their care and well-being; and

human rights.

2.3 Approach

With this emphasis on developing locally-grounded minimum standards based on stakeholder needs

and international best practices, the Consultant adopted a participatory, utility-driven approach. This

approach has helped to engender stakeholder buy-in of the process, inform the structure of and

considerations addressed in the proposed minimum standards, and increase the probability of

stakeholder acceptance of the standards proposed. It has involved:

Engaging a number of key stakeholders, including representatives of the requisite

departments in the MoSP and Ministry of Public Health, as well as members of the National

Commission on the Elderly, and management teams of elderly care facilities across Guyana;

Incorporating stakeholder recommendations into all of the assignment deliverables;

Facilitating a Technical Consultation Meeting with key technocrats in the sector;

Conducting visits to a sample of elderly care facilities and engaging senior citizens at those

facilities; and,

Seeking input from the MoSP into the design of the Technical Consultation Meeting and the

list of persons for focused stakeholder interviews.

2.4 Methodology

A number of qualitative methods have been utilised in the collection of data to inform the

elaboration of Minimum Standards for Elderly Residential Facilities in Guyana. These methods were


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participatory-driven and accounted for differences in the size, management, location, and

experience of elderly residential facilities across Guyana.

2.4.1 Literature Review

A targeted review of available literature on elderly in Guyana was undertaken to ensure that the

standards articulated are grounded within the local context. There was also a substantive review of

the Minimum Standards of Elderly Residential Facilities of countries around the world (like Trinidad

and Tobago, Ireland, Anguilla, and South Africa) to facilitate the adoption of international best

practices and avoid ‘reinventing the wheel’ on regulatory standards and operational practices that

have been tried, tested, and proven.

2.4.2 Document Review

A comprehensive review of MoSP workplans, budgets, and reports of capacity-building efforts at the

Palms Geriatric Facility was also undertaken. This included a review of Follow-up Performance Audit

Report: An Assessment of the Living Conditions of the Residents of the Palms Geriatric Institution

published by the Audit Office of Guyana in 2015, which provided insight into the level of resources

provided to the facility and the quality of care made possible by those resources.

2.4.3 Observation

Site visits to a sample of residential care facilities in Georgetown were also conducted to allow the

Consultant to gain a firsthand understanding of the realities at some of the facilities in Guyana. A key

component of these site visits was a walkabout to document and photograph the operations and

physical conditions of the facilities. To ensure consistency in the observational assessment

performed and promote transparency, a site observation checklist was utilised. This checklist is

enclosed as Appendix 1 and a summary reports for each visit is included under Appendix 2.

2.4.4 Semi-Structured Stakeholder Interviews and Focus Group Discussions

The site visits to the residential care facilities began with semi-structured interviews and focus group

discussions with the management, staff, and residents of the facilities. These interviews and

discussions helped to capture the nuanced experiences, observations, and knowledge of the

interviewee as well as facilitate exploration of issues and ideas as they emerged. The data collection

protocols used for these interviews and discussions are enclosed as Appendix 3.

There were also discussions with key resource persons within the Ministry of Social Protection

(Director of Social Services, Head of the Child Care and Protection Agency, and the Assistant Chief

Probation and Social Services Officer) to enhance the Consultant’s understanding of past efforts, as

well as current constraints and opportunities, to improve the quality of services provided to senior

citizens.

2.4.5 Technical Consultations

A Technical Consultation Meeting was held on Tuesday, March 8th, 2016 to capture the experiences

of sector experts and technocrats involved in the operation and support of elderly residential

facilities. Specifically, this Meeting allowed for the generation of a cross-sectoral list of challenges

experienced by and opportunities available to these facilities, as well as exploration of possible


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solutions to these challenges. Importantly, this process also helped to engender stakeholder buy-in

of the consultative process being undertaken.

2.4.6 Debriefs

In keeping with the consultative, utility-driven focus of this approach, continuous updates and

debriefs were provided to the Ministry of Social Protection to identify information gaps and

engender continued confidence in the process to articulate minimum standards for residential

facilities for senior citizens in Guyana.

2.5 Sampling

The entire population of relevant duty-bearers were engaged through focused stakeholder

interviews. However, because of the focus of the assignment’s mandate and time constraints, only a

sample of elderly care facilities in Georgetown were visited. These facilities were chosen based on

purposive sampling, specifically maximum variation sampling. Maximum variation sampling allowed

the Consultant to choose facilities that represented a range of differences and extremes3 necessary

to develop a holistic picture of the operation, challenges facing, and opportunities available to

elderly care facilities across Guyana.

The criteria used to select the facilities for site visits were as follows:

Administered by the State, Church, and private owners;

Single and mixed-sex institutions;

Small and large resident populations;

Well- and newly-established institutions; and,

Publically-perceived ‘good’ and ‘bad’ facilities.

In the end, the elderly residential facilities that were visited included the Palms Geriatric Facility,

Uncle Eddie’s Home, St. Thomas Moore Men’s Homestead, Salvation Army Ladies’ Senior Citizen’s

Home, Sister’s Missionary of Charity, and the Holy Family Elderly Facility. Attempts to visit the Gentle

Women’s Home and Demerara Paradise Inc. proved unsuccessful due to time constraints and

competing priorities, but representatives of both facilities were invited to participate in the

Technical Consultation Meeting.

Importantly, all of the facilities visited were in Georgetown due to time and resource constraints.

This did not affect the representativeness of the data gathered as the capital city has the majority of

residents and facilities, and sector experts and oversight agencies with national perspectives were

able to speak to the experiences of the sub-group of facilities outside of Georgetown in the

stakeholder interviews and focus group discussions.

Finally, the Consultant recommended stakeholders for participation in the Technical Consultation

Meeting based on expert sampling. Expert sampling involves selecting a group of persons with

demonstrable experience and expertise in a particular subject area to gather tacit knowledge and

validate the approach taken and the data gathered from another sampling approach4. This allowed

3 Singh, Kultar. Quantitative Social Research Methods. Sage Publications. India, 2007.

4 Singh, Kultar. Quantitative Social Research Methods. Sage Publications. India, 2007.


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for the data gathered during the document and literature reviews and semi-structured interviews

and discussions to be triangulated and cross-validated.

2.6 Data Sources

The Consultant drew contextual information from MoSP reports and budgets, interviews and focus-

group engagements with key stakeholders, site visits to a sample of elderly residential facilities, and

discussions with elderly persons who utilise the services at those facilities. Information on

international best practices to care for the elderly and the experiences of sister countries in

administering residential care facilities were drawn from publically available plans, studies, and

reports.


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3. CONTEXTUAL FRAMEWORK

3.1 Overview: Elderly in Guyana5

In Guyana, the retirement age is 55 years for the public service and 60 - 65 years for the private

sector. Persons become eligible for retirement benefits at age 60. The elderly (interchangeably

referred to as older persons or senior citizens) will thus be considered to be those persons aged 60

years and over.

In 2002, the number of persons in Guyana aged 60 years and older was 46,839, with a male-to-

female ratio of 87 (21,725 males and 25,114 females). This represented 6.2% of the total population

and a steady increase in the country’s elder population (5.4% in 1970, 5.7% in 1980, and 5.9% in

1991), likely in part because of enhanced life expectancy (60 for males and 67 for females in 20136).

While the increase itself is not significant, this trend signals a need to consider age demographics in

economic and social development planning, and to consider the phased reallocation of resources

among age groups.

Still, Guyana’s population is relatively young, with a median age of 22.9 years and 11 elderly for

every 100 economically-active persons. Guyana thus has an expansive population (larger numbers of

young people) as depicted in Figure 1 below.

Figure 1: Population Pyramid: Guyana 2002

Data Source: Bureau of Statistics, Guyana

Of the elderly population, 30,349 were heads of their households while 15,227 were living in

households where they were not the head (1,263 did not report their head of household). Of those

who were household heads, 42.3% were female. 38% of those who were not heads of their

households were residing in a household where the head of household was 65 years or older,

representing moderate age liability.

5 Unless otherwise stated, data used has been taken from Beaie, Sonkarley Tiatun. 2002 Population & Housing Census –

National Census Report. Guyana, 2007. 6 World Health Organisation. Guyana: Country Profile. 2016. <http://www.who.int/countries/guy/en/>.

8 6 4 2 0 2 4 6 8

0 - 4 5 - 9

10 - 14 15 - 19 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 74

75+

Percent of Population

Age

Gro

up

Female

Male

http://www.who.int/countries/guy/en/


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31.4% of elderly men and 9.4% of elderly women continue to participate in the workforce past age

60. Among those who want to work, approximately 94% were gainfully employed. Consequently,

28.4% of elderly men’s and 8.1% of elderly women’s main source of livelihood was employment or

their own monies. Pension benefits are the main source of income for 55.3% and 52.2% of men and

women respectively. 14.3% and 14.7% of elderly women’s main source of livelihood was from

parental or spousal support and support from other persons respectively, compared to 1.6% and

6.1% for elderly men.

Interestingly, 37,623 persons aged 60 years and older owned the dwelling unit where they lived.

3,484 rented their dwelling (from a private owner or the government) and 3,694 lived in their

dwelling rent-free.

Figure 2: Distribution of Elderly by Tenure of Dwelling Unit Where They Reside


Finally, 39.4% of persons (18,052) aged 60 and above had some form of disability. The most common

disabilities were related to sight (5,675), mobility (3,875), body movement (2,492), hearing (1,933),

and gripping (1,247). A complete breakdown of the common disabilities among the elderly is

presented in Figure 3 below. This breakdown helps to shed light on the required areas of focus for

the minimum standards that follow.

Figure 3: Distribution of Elderly with Disabilities


82.10%

1.20%

7.40% 8.70% Owned

Squatted

Rented - Private

Rented - Government

Leased

Rent Free

Not Stated

31.40%

10.70%

4.20%

21.50%

13.80%

6.90%

2.30% 4.30%

1.20% 3.60% Disability Type

Sight

Hearing

Speech

Mobility

Body Movement

Gripping

Learning


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3.2 National Context

The Laws of Guyana mandate children to take care of their parents. Section 4 of Chapter 45:03, the

Maintenance Act, reads thus:

Everyone born in wedlock is hereby required to maintain his or her father and mother, and

grandfathers and grandmothers; and everyone not born in wedlock is hereby required to

maintain his or her mother, and also the man (if any) with whom his or her mother openly

cohabitated at the time of his or her birth, provided that man recognised and treated him or

her as the man’s child during his or her infancy, and also the man who is his or her father,

whether or not his or her mother openly cohabitated with that man at the time of his or her

birth, provided that during his or her infancy that man had acknowledged him or her as the

man’s child and contributed towards his or her maintenance, if the father or mother or other

person aforesaid , or all or any of those persons are, by reason of old age, or bodily or mental

infirmity, unable to maintain himself, herself, or themselves. (4-5)

Culturally, this law is generally respected and many children support the social, economic, and

physiological health of their parents. Some parents reside with their children and, often

grandparents by that time, aid in caring for their grandchildren. However, many are left alone during

the day when children are at work and grandchildren at school due to the lack of non-resident

centres that offer social and recreational activities for senior citizens, and little involvement or

support from NGOs and community-based centres.

Many others continue to reside on their own after retirement. These senior citizens enjoy their

independence, are able to have the benefit of aging in their homes and, in many cases, continue to

work (in the formal or informal sectors). However, they are particularly vulnerable to accidents,

exploitation, theft and, in the case of elderly women in recent years, murder. Moreover, public

infrastructure and transportation systems are not easily accessible to the elderly, especially the

physically infirmed, and basic services (like banking and utilities) are still being adapted to respond

to the unique needs of the elderly.

Some others are forced into residential facilities due to poverty, migration, poor health, and

negative changes in societal values and norms. Too often, persons enrolled in these facilities are ‘left

to die’, with few children in an economic or social position to visit their parents and contribute to

their psychosocial care while at the facility. The result is the overwhelming of many of the existing

care facilities, and poor mental and emotional health among residents.

Against this backdrop, in October 2015, the Government of Guyana reiterated its commitment to the

elderly in Guyana at the launch of the Month of the Elderly. Specifically, the Government committed

to addressing administrative and quality-of-care issues at the Palms, and more deeply incorporating

population dynamics and demographics into economic and social development planning in the short

term. In the medium- to long-term, it has committed to seeking funding to construct a modern,

elderly facility and develop a non-resident social and recreational programme for senior citizens.

This commitment has resulted in a plethora of initial activities including training for the staff at the

Palms, introduction of a robust schedule of social activities for senior citizens during the month of

October, and the resuscitation of the National Commission on the Elderly.


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Established in 2012, the National Commission on the Elderly was intended to:

Support community outreach programmes to raise awareness of the needs of and issues

affecting senior citizens, and children’s responsibilities to their parents;

Oversee residential care facilities across Guyana;

Organise social, educational, and recreational activities for senior citizens in and out of

residential care;

Advocate for the enhancement of critical services provided to (like Old Age Pension) and

used by (like public transportation and health) the elderly;

Conduct awareness campaigns to address abuse of the elderly in care facilities and at home;

and,

Develop minimum standards for residential care facilities.

The Commission functioned for a short period, but quickly went dormant, leaving many of its

activities incomplete. It has recently been re-established and had its first meeting on Wednesday,

February 3rd, 2016.

Ultimately, the reprioritisation of the completion of the minimum standards for elderly residential

facilities is a result of the focus on providing quality services to elderly in residential care and the

reestablishment of the NCE.

3.3 Global Context

Worldwide, life expectancy increased from 46 to 68 years from 1950 to 2010, and the proportion of

older persons in the population is expected to increase exponentially over the next 35 years7. This

has implications for national health, social security, and welfare systems. It will also affect labour

laws and the roles of families, communities, and societies in caring for the elderly.

Guyana’s observance of International Day of Older Persons and renewed commitment to supporting

its elderly is in line with its commitment to the United Nations Principles for Older Persons adopted

in 1991 and the Madrid International Plan of Action on Ageing adopted in 2002. Both the Principles

and the Action Plan were the result of the need to directly and more strategically protect the human

rights of and develop responsive programmes and policies for the elderly due to the existing and

expected continued increase in the elderly population of the world.

The United Nations Principles for Older Persons revolve around five key themes: independence,

participation, care, self-fulfilment, and dignity8.

3.3.1 Independence:

Older persons should have access to adequate food, water, shelter, clothing and health care

through the provision of income, family, and community support and self-help.

Older persons should have the opportunity to work or to have access to other income-

generating opportunities.

7 United Nations. Background: International Day of Older Persons. 2015. <

http://www.un.org/en/events/olderpersonsday/background.shtml>. 8 United Nations General Assembly. United Nations Principles for Older Persons: Adopted by General Assembly resolution

46/91 of 16 December 1991. New York, 1991. <http://www.un.org/documents/ga/res/46/a46r091.htm>.

http://www.un.org/en/events/olderpersonsday/background.shtml

http://www.un.org/documents/ga/res/46/a46r091.htm


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Older persons should be able to participate in determining when and at what pace

withdrawal from the labour force takes place.

Older persons should have access to appropriate educational and training programmes.

Older persons should be able to live in environments that are safe and adaptable to personal

preferences and changing capacities.

Older persons should be able to reside at home for as long as possible.

3.3.2 Participation:

Older persons should remain integrated in society, participate actively in the formulation

and implementation of policies that directly affect their well-being, and share their

knowledge and skills with younger generations.

Older persons should be able to seek and develop opportunities for service to the

community, and to serve as volunteers in positions appropriate to their interests and

capabilities.

Older persons should be able to form movements or associations of older persons.

3.3.3 Care:

Older persons should benefit from family and community care and protection in accordance

with each society's system of cultural values.

Older persons should have access to health care to help them to maintain or regain the

optimum level of physical, mental, and emotional well-being and to prevent or delay the

onset of illness.

Older persons should have access to social and legal services to enhance their autonomy,

protection, and care.

Older persons should be able to utilize appropriate levels of institutional care providing

protection, rehabilitation, and social and mental stimulation in a humane and secure

environment.

Older persons should be able to enjoy human rights and fundamental freedoms when

residing in any shelter, care or treatment facility, including full respect for their dignity,

beliefs, needs, and privacy and for the right to make decisions about their care and the

quality of their lives.

3.3.4 Self-fulfilment:

Older persons should be able to pursue opportunities for the full development of their

potential.

Older persons should have access to the educational, cultural, spiritual, and recreational

resources of society.

3.3.5 Dignity:

Older persons should be able to live in dignity and security, and be free of exploitation and

physical or mental abuse.

Older persons should be treated fairly regardless of age, gender, racial or ethnic background,

disability or other status, and be valued independently of their economic contribution.


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The Madrid International Plan of Action on Ageing reaffirmed and elaborated the UN Principles, with

particular focus on the protection of human rights, elimination of age discrimination, and promotion

of the right to work, health, and participation by the elderly. It articulates 35 objectives for elderly

persons, including9:

Recognising the social, cultural, economic and political contribution of older persons;

Creating opportunities for older persons to participate in decision-making processes at all

levels;

Creating employment opportunities for all older persons who want to work;

Improving living conditions and infrastructure in rural areas;

Alleviating the marginalisation of older persons in rural areas;

Integrating older migrants within their new communities;

Ensuring equality of opportunity throughout life with respect to continuing education,

training and retraining, as well as vocational guidance and placement services;

Fully utilizing the potential and expertise of persons of all ages, recognizing the benefits of

increased experience with age;

Strengthening of solidarity through equity and reciprocity between generations;

Reducing poverty among older persons;

Promoting programmes to enable all workers to acquire basic social security, including

where applicable, pensions, disability insurance and health benefits;

Providing a sufficient minimum income for all older persons, paying particular attention to

socially and economically disadvantaged groups;

Ensuring equal access by older persons to food, shelter, medical care and other services

during and after natural disasters and other humanitarian emergencies;

Enhancing the contributions of older persons to the reestablishment and reconstruction of

communities and the rebuilding of the social fabric following emergencies;

Reducing the cumulative effects of factors that increase the risk of disease and consequently

potential dependence of the elderly;

Developing policies to prevent ill-health among senior citizens;

Ensuring all older persons have access to food and adequate nutrition;

Eliminating social and economic inequalities based on age, gender or any other ground,

including linguistic barriers, to ensure that older persons have universal and equal access to

health care;

Strengthening of primary health-care services to meet the needs of older persons and

promote their inclusion in the process;

Developing a continuum of health care to meet the needs of older persons;

Involving older persons in the development and strengthening of primary and long-term

care services;

Improving the assessment of the impact of HIV/AIDS on the health of older persons, both for

those who are infected and those who are caregivers for infected or surviving family

members;

Providing adequate information, training in care-giving skills, treatment, medical care and

social support to older persons living with HIV/AIDS and their caregivers;

9 United Nations. Political Declaration and Madrid International Plan of Action on Ageing: Second World Assembly on

Ageing. New York, 2002. < http://www.un.org/en/events/pastevents/pdfs/Madrid_plan.pdf>.

http://www.un.org/en/events/pastevents/pdfs/Madrid_plan.pdf


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Enhancing and recognising the contribution of older persons to development in their role as

caregivers for children with chronic diseases, including HIV/AIDS, and as surrogate parents;

Providing improved information and training for health professionals and para-professionals

on the needs of older persons;

Developing comprehensive mental health-care services ranging from prevention to early

intervention, the provision of treatment services and the management of mental health

problems in older persons;

Maintaining maximum functional capacity throughout the life course and promotion of the

full participation of older persons with disabilities;

Promoting “ageing in place” in the community with due regard to individual preferences and

affordable housing options for older persons;

Improving housing and environmental design to promote independent living by taking into

account the needs of older persons in particular those with disabilities;

Improving the availability of accessible and affordable transportation for older persons;

Providing a continuum of care and services for older persons from various sources and

support for caregivers;

Supporting the care-giving role of older persons, particularly older women;

Eliminating all forms of neglect, abuse and violence of older persons;

Creating support services to address abuse of the elderly; and,

Enhancing public recognition of the authority, wisdom, productivity and other important

contributions of older persons.

These objectives, and the UN Principles on which they are founded, underpin the Minimum

Standards for Elderly Residential Facilities that follow.


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4. SITUATIONAL ANALYSIS OF ELDERLY RESIDENTIAL FACILITIES IN

GUYANA

The site visits to the sample of homes for the elderly and engagements with key stakeholders and

duty bearers uncovered common themes that influence the operations of elderly residential care

facilities across Guyana.

First, stakeholders almost unanimously agree that this exercise to develop minimum standards to

govern the operations of elderly residential facilities is grossly overdue. The lack of regulation of the

sector leads to the emergence of facilities being run by charitable organisations and individuals that

are moved to try to help elderly in need of care but have neither the resources, training or

experience required to successfully provide quality care to older persons. While the goodwill of

these organisations and individuals is commended, the State must put systems in place to ensure

that the care provided to older persons respect their person, dignity, privacy, and identity.

Secondly, duty bearers are generally unable to provide a definitive list of functioning facilities and

basic details of the operations of those facilities. This is due in large part to the registration of

facilities under the Friendly Societies Act without any required form of licensing or accreditation by

the Social Services Department of the MoSP. This is exacerbated by a lack of resources and

inadequate mechanisms within the MoSP to monitor the work and regulate the groups registered

under the Friendly Societies Act.

Thirdly, there is no established procedure for the inspection and regulation of the facilities. None of

the kitchen facilities have been certified by the sanitation and health authorities (only a few of the

facilities have ever had a health inspection at all), and there are only a handful of cooks with valid

Food Handler’s Certificates. Moreover, while a social worker visits the facilities to distribute

pensions, there is no system for providing ongoing psychosocial or welfare services to residents

outside of the government-run Palms. There is also no established process through the government

system to address complaints or issues of abuse within the homes, as a last option for recourse if an

issue is unsatisfactorily addressed by the facility.

Finally, the operation of elderly residential facilities in Guyana is symptomatic of the deteriorating

culture within the society and lack of regard for the contributions, capacity, and rights of the elderly.

Many of the facilities felt like a place for older persons to go to die instead of like a home away from

home. All of the homes reported challenges engaging families on the welfare of their elderly in care,

and too many of the care assistants observed lacked the personality and interpersonal skills

necessary to effectively and professionally care for the elderly.

4.1 Infrastructure

Safe, clean and appropriate infrastructure is a key element in the provision of quality care to

residents in elderly care facilities. The layout of a building informs the type of residents that can be

accommodated (ambulatory or physically disabled), the flow of operations of the facility, the type of

systems required for efficient communication, and the mechanisms required to protect the safety


14

and security of residents. It also has a considerable impact on the feel of the building and can help to

create a vibrant, engaging environment for residents.

The physical conditions of the homes visited vary significantly. Some, like the Sister’s Missionary of

Charity and St. Thomas Moore Men’s Homestead are in excellent condition and appear to be well

maintained. They are clean, residents are visibly comfortable, and there are no signs of any issues

that would cause authorities to label the buildings unfit for use. Others, like Holy Family, are poorly

maintained, with inadequate lighting, small and unclean bathrooms, and deplorable kitchen

facilities.

Importantly, many of the residential facilities that exist were not originally designed to

accommodate the elderly. They are essentially homes that have been adapted to serve the elderly,

without sufficient consideration for the space, layout and type of structure required to respect the

privacy and needs of the residents, staff, and visitors. For example, none of the multi-storeyed

facilities visited have elevators or stair lifts to accommodate residents who may be unable to

traverse steps or to do so with ease. Only some of the facilities have sufficient, easily accessible

recreational spaces on each wing or storey, and only two have wheel-chair accessible baths and are

outfitted with non-skid tiles. Additionally, none have plumbed hot and cold water (a necessity and

not a luxury when caring for the elderly), and only a few have secured windows throughout the

building and grab bars in the bathrooms.

All of the facilities are especially dearth of mechanisms for efficient and effective emergency

management. A few have marked exits, smoke detectors, sprinklers, fire extinguishers or sand

buckets (none have all five), and only one has fire escapes. There are also no formal emergency

plans, established mechanisms for evacuation of residents in times of crisis, or emergency lighting in

stairwells and hallways. Additionally, none of the facilities visited have directional signs or posters

outlining emergency posters or procedures. This is of grave concern since many of the buildings are

wooden structures and, save floods and drought, Guyana’s biggest hazard risk is fire. As they are

currently operating, the potential for catastrophic loss of life during an emergency situation is high.

Furthermore, none of the facilities have buzzers in the rooms or on the person of the residents to

allow a resident to signal that there is an emergency and he/she is in need of assistance. There are

also no intercom or video monitoring systems in place, and no mechanisms to allow staff to readily

communicate with each other without having to walk across the facility or make a cellular phone

call.

The inadequacies of the infrastructure of many of the elderly residential facilities are not limited to

the building they occupy, but also include the furnishings in the building. At the Palms, residents

were seen precariously perched in plastic chairs that were neither comfortable or safe. PCAs in some

of the wards even told stories of residents falling out of those chairs as they often break or skid. In

other cases, the furniture generally include sofas and accent chairs, but they are visibly dated.

The physical inadequacies also extend to the immediate environs of the facility. Those located in

urban communities within the capital city often do not have adequate yard space for outdoor

physical, social, and recreation activities, and many of those that do have considerable yard space


15

have not developed and maintained those spaces. In fact, except for the Palms and Sister’s

Missionary of Charity, none of the facilities had benches or zones on the facility grounds to

encourage reading, discussions among residents, or relaxation.

That aside, as the Government-run facility, the condition of the physical facilities of the Palms

deserves special mention. There is no denying that considerable work has been undertaken to

improve the facility. A new laundry building and recreational room have been built, the grounds

have been developed and are well maintained, exit signs (not lit) have been installed, and there have

been minor repairs to the building. However, a walkthrough of the facility suggests that the Palms

has likely reached the point of diminishing returns, where additional investment to upgrade the

current infrastructure will yield increasingly less benefit and minimal value for money. Having been

constructed some 142 years ago, the bones and foundation of the building are deteriorating, the

plumbing is outdated, and the structure is rotting. The ward-style accommodations do not respect

the dignity or privacy of the residents; there are no elevators or stair lifts even though there are

three storeys in each of the buildings; there is little recreational, closet, and storage space and no

designated staff quarters on each ward; there are holes in the walls which encourage an influx of

stray animals and rodents; and the mini-kitchens in the wards are unfit for the serving of food. What

is sure is that the Palms does not set a standard for other facilities to follow or demonstrate the

Government of Guyana’s stated commitment of serving the elderly.

4.2 Finances

All of the facilities visited share a common experience: whether owned and managed by the

Government, a church or an NGO, and despite differences in number and characteristics of

residents, all of the facilities are underfinanced and under-resourced. Most facilities require some

payment from residents, but many residents are behind on their payments and themselves only earn

a meagre monthly pension. This lack of a robust cost structure within the homes is exacerbated by

the absence of consistent support from families and little, if any, support from Government—those

homes that receive a Government subvention report that the annual contribution is only $40,000 (or

$3,333.33 a month).

Many homes thus complement their income with donations from NGOs, churches, the private

sector, and private individuals. However, these contributions are sporadic and insufficient to have a

noticeable impact on the facilities’ finances. The result is many homes are forced to continue to

accommodate residents despite lack of payment, which over time leads to a dilution of the services

that the home can provide, retardation of the number and quality of staff that can be engaged, and

ultimately, a reduction in the quality of care delivered to residents.

Importantly, while some of the facilities follow established accounting practices in the collection and

use of donations, many do not, and only a few facilities have audited accounts. Furthermore, only

some of the facilities have planned budgets that can be compared with actual expenditure for a

financial analysis, signalling a lack of financial forecasting and planning within the facilities.


16

4.3 Operations

All of the facilities visited allow residents to have visitors; encourage the active participation of

families, where available, in the care of the elderly; and allow residents to retain basic storage and

personal items. There are established visiting hours and, at a few of the homes, procedures for

leaving and entering the facility that allow the administration to provide information re last known

whereabouts to authorities in emergency situations. In addition, while none of the homes except the

Palms have an assigned social worker to support the admissions process or handle other

psychosocial and welfare issues, the social worker from the Palms goes to the private homes

monthly to distribute pensions to the residents.

A few of the homes have regular, planned, social and recreational activities for residents, including

concerts, movie and game nights, birthday celebrations, and library visits. The other facilities

generally have no programmes, often because of a dearth of funding and a lack of interest among

residents in homes that target able-bodied persons. None of the facilities organise physical activities

for residents, although the residents of the St. Thomas Moore Men’s Homestead organise exercise

programmes on their own. In some cases, residents are involved in day-to-day activities at the home

(like distributing meals, locking windows, updating the notice board, etc), but most are generally left

to look at television, talk with friends or visitors, or stay in bed for much of the day.

Only one of the facilities has a published meals calendar and involve residents in the creation of the

menu. In most cases, residents are required to eat whatever is prepared, and there are many

complaints of unpalatable and nutritionally unbalanced meals being provided. On a few of the visits,

cooked food was improperly stored and unhygienically moved from the kitchen to the food

distribution area/dining room in the facility. Additionally, snacks are seldom provided and there are

only a few cases where residents have easy, 24-hour access to potable water.

4.4 Human Resources

Interestingly, staff challenges have been identified as the biggest hindrance to quality care at the

homes. There is general agreement among stakeholders that most of the persons that apply to jobs

related to caring for the elderly lack the interpersonal skills and personality necessary to navigate

the myriad of ways that persons age. In fact, while some were genuinely interested in their work and

passionate about caring for the elderly, most of the staff interviewed admitted that they applied to

and accepted their job offers because they needed a consistent salary. Sadly, the prospects of

attracting better-suited candidates are slim, because of the salary and benefit packages offered

(especially at the private homes).

This lack of soft skills and interest among staff is compounded by poor training. The more popular

Care for the Elderly Courses do not sufficiently equip students to serve as personal care assistants,

and there is weak uptake of the MoPH and MoSP programmes that are tailored to training certified

PCAs. Moreover, none of the facilities have orientation programmes and job aides for staff, and few

have made efforts to encourage and facilitate the continued education of their staff.

That said, the human resource issues at the residential care facilities are not only about the quality

of staff—the staffing process and working environment of all of the homes are deficient. None of the


17

homes have firm, established criteria (education, training, and experience) for the varying staff

positions within the facility, and only a few have clearly articulated disciplinary and grievance

processes for staff. Few perform background checks during the interview process and only one of

the facilities visited conduct regular, formal performance appraisals. Many do not have sufficient

staff, with one facility having no one at all and another having 1 PCA to as many as 35 residents.

Finally, some have irregular working hours, none have functional OHS committees, only a few have

properly outfitted staff quarters, and none require the staff to have regular health inspections or be

up to date on their vaccinations, thereby placing both the residents and staff at risk for contracting

communicable diseases.

4.5 Management

As per local law, elderly residential facilities in Guyana are registered under the Friendly Societies Act

and are governed by rules that are developed and submitted for approval during the registration

process. However, while there are written rules that address the governance of the facilities, the

rules are generally not sufficiently elaborated to be used as guides for the operation of the homes.

This results in a vacuum of established norms, core values, and documented standard operating

procedures in many of the facilities.

Still, all of the facilities visited and administrators of homes engaged confirmed that there are

established criteria for the admission of persons to the facility. These criteria generally include age

(60 and above), a recent medical, ability to care for self, and need. Exceptions to these criteria are

rare and usually involve cases where facilities are equipped to care for sick patients or where

persons age 18 – 59 are unable to care for themselves, have no familial support network, and/or

aged out of the Child Protection System or an orphanage.

In addition to the absence of an operations manual for the facility, most of the homes also do not

have documented guidelines for residents that outline the care to be provided, process for making

complaints, expected behaviours, etc. In fact, of the facilities visited, only one require residents to

review and sign a contract upon admission to the facility and two have documented house rules that

are given to each resident. Moreover, while some hold weekly or monthly house meetings and one

has a resident representative that raises resident issues with the facilities’ administration, none have

established complaint mechanisms.

4.6 Health Care

Of the facilities visited, the Palms Geriatric Facility, Sister’s Missionary of Charity, and Uncle Eddie’s

Home are the only facilities with bedridden residents. Of these, the Palms is the only one with an

onsite doctor, nurse and medices. One of the sisters at Sister’s Missionary of Charity has been

trained as a nurse, while Uncle Eddie’s has doctors on call in case of emergencies. Moreover, Uncle

Eddie’s, like many of the other homes, has developed a partnership with the Ministry of Public

Health that sees medical teams from the neighbourhood health centres visiting the homes monthly

to check and support the continued good health of residents in care.

The challenges providing regular, quality health care to residents is compounded by the specialised

nature of the medical attention required by the elderly. The MoPH reports that 8 of every 10 deaths


18

among the elderly are due to non-communicable diseases, but there are little or no mechanisms for

health education and decreasing risks to these diseases within the homes. Additionally, while all of

the homes visited require a medical as part of the admission process, it is unclear how much these

medicals are used to inform the care delivered to residents beyond adjustments to the menu to

cater for residents that suffer with diabetes or hypertension. In fact, none of the homes have formal

care plans for the residents and only one of the facilities check to ensure that residents have

received all of their vaccinations.

Only a few of the homes visited have PCAs that can deliver CPR and none of the facilities require

PCAs to have received CPR certification. In fact, only a few of the homes have certified care

assistants and so PCAs generally only help to clean and feed residents, as well as aid residents with

their medication (often for diabetes or hypertension) in accordance with doctor’s orders. In some

cases, however, PCAs support the administration of more involved medical care even though they

have no formal medical training and are unqualified to handle or administer medications.

At best, some of the facilities have a small first aid kit on the premises, but most have none at all.

There is also improper disposal of sharp implements, and inconsistent use of safety and protective

gear, like gloves, masks, hairnets, etc.

4.7 Actors in the Elderly Residential Care Sub-Sector

A multiplicity of actors support the work and operations of residential care facilities. Their

involvement has been through established mechanisms, though these mechanisms have not evolved

to respond to emerging local realities and are not based on an established standard. The critical

actors are depicted in Figure 4 below:

Figure 4: Actors in the Elderly Residential Care Sub-Sector

•Palms Geriatric Facility • St. Joseph's Home

•Archer's Senior Citizen's Home • Uncle Eddie's Home

•Demerara Paradise Inc - Nursing Home and Medical Services • Holy Family Home

•Homestead of St. Vincent De Paul • Ivy Hall Memorial Home

• Byer's Senior Citizen's Home • Gentle Women's Home

• St. Thoman Moore Men's Home • New Nazareth Home

•Salvation Army Ladies Senior Citizen Home • Sister's Missionary of Charity

Elderly Care Facilities

•Ministry of Social Protection • National Commission of the Family

•Georgetown Public Hospital Corporation (GPHC) • Ministry of Public Health

•National Commission of the Elderly • Regional Democratic Councils

Government

•Private Hospitals and Medical Facilities • Pharmacies

•Banks DIH • John Fernandes Limited

•Courts • Private Individuals

Private Sector

•Food for the Poor • Donor Agencies

•Bethel Gospel Hall • Mother's Union

•Guyana Pensioner's Association • Trade Unions

•Religious Organisations • Ladies of Charity

•Guyana Chest Society

NGOs/Charities

•University of Guyana - Institute of Distance and Continuing Education • St. John's College

•Guyana Red Cross Society • Venezuelan Institute

Academia/Training Institutions


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5. PROPOSED MINIMUM STANDARDS FOR ELDERLY RESIDENTIAL

FACILITIES IN GUYANA

The minimum standards for elderly residential facilities that follow consider and respect the

Government of Guyana’s responsibility to care for the elderly as per its international commitment

under the United Nations Principles for Older Persons and the Madrid International Plan of Action on

Ageing. These standards are the result of a facilitated, consultative process with key sector

stakeholders and duty bearers, and have been amalgamated with recognised international best

practices.

The proposed minimum standards are aimed at establishing a framework that respects the privacy,

dignity, person, individuality, and rights of the residents that occupy these care facilities. The goal is

to ensure that older persons are respected; treated equally, fairly and with dignity; live a productive

life; are in contact with those dear to them; are involved in the making of decisions that affect their

lives; and receive quality care in a comfortable and secure environment.

PROPOSED MINIMUM STANDARDS FOR ELDERLY RESIDENTIAL CARE FACILITIES

1. Elderly residential care facilities have a documented and publically available admissions policy.

2. Residents’ human rights are respected and maintained within the facility.

3. There is an established procedure to receive, act upon, and respond to complaints from residents or

their sponsors and advocates.

4. Every resident and prospective resident has ready access to information required for informed decision-

making.

5. Residents of elderly residential facilities are consulted on the care they require and desire.

6. Residents’ are encouraged to retain and continually develop their self identity, and their personal

belongings are safeguarded.

7. Residents are encouraged to participate in the day-to-day operations of the facility.

8. Residents receive social care that fosters their productivity and encourages active ageing.

9. Residents receive sensitive and personalised care to retain and encourage their physical well-being.

10. Residents are provided safely prepared, nutritious, and palatable meals that they enjoy.

11. Elderly residential facilities promote the health of residents in care.

12. Elderly residential facilities source, store and administer medicines in accordance with best practices

and local laws and regulations.

13. Elderly residential facilities strive to continuously provide a high standard of care to residents.

14. Elderly residential facilities are staffed as necessary to provide quality services to residents.

15. Human resource issues are handled in accordance with established professional best practices and local

laws and regulations.

16. The physical infrastructure of elderly residential facilities are designed and maintained to cater to the

special needs of the elderly.

17. Elderly residential facilities have established procedures to prepare for and respond to emergencies, so

as to protect the life, health, and liberty of their staff and residents.

18. Elderly residential facilities dispose of waste in an environmentally-friendly manner and in accordance

with local laws and regulations.

19. Standard accounting and financial systems are adopted to ensure the continued viability of the facility.


20

The expected practices of each of these standards are elaborated below.

Expected Practices:

The facility has an established and well articulated admissions policy and process that

considers the requirements of this Minimum Standard as well as any legal or licensing

requirements. Information about the policy and process are publically available.

Admissions to residential care facilities are generally based on age (60 and above), social or

housing need, medical condition, and indigence. A person below sixty (60) years of age is

only admitted to the facility in extraordinary circumstances where the admission of that

person is the only humane course of action.

A social worker, assigned from the State Authority or employed by the facility, is involved in

the admissions process. The social worker reviews and investigates the information in the

admission application, and confirms that the request for admission is not based on a need

that can be met by another social safety net (like public assistance or familial support).

Once the admission of the resident has been approved, the facility collects key emergency

information, including coordinates for the emergency contact (and next of kin, if they differ),

and details about any allergies, physical limitations or special needs of the resident.

Expected Practices:

Elderly residential facilities respect, maintain, and protect the human rights articulated in

the Universal Declaration of Human Rights by the United Nations in 1948.10

Staff of the facility demonstrate awareness of and respect for the rights of residents in their

deportment, behaviour, mode and style of communication, and dress.

The residents’ right to choose is respected by the facility. This is maintained even when the

facility disagrees with the decision or choice made by the resident (or his/her

sponsor/advocate where appropriate).

Care practices are personalised to respond to the needs, preferences, and changing

capacities of residents.

Residents’ have timely access to quality health care, in or out of the facility.

10

United Nations. Universal Declaration of Human Rights. Paris, 1948. <http://www.ohchr.org/EN/UDHR/Documents/UDHR_Translations/eng.pdf >.

STANDARD 2: RIGHTS

Residents’ human rights are respected and maintained within the facility.

STANDARD 1: ADMISSIONS

Elderly residential care facilities have a documented and publically available admissions policy.

http://www.ohchr.org/EN/UDHR/Documents/UDHR_Translations/eng.pdf


21

Arrangements are in place to ensure residents’ privacy and dignity are respected at all times.

Special attention is paid to discussions about sensitive topics (including illness and medical

treatment); entering bathrooms and bedrooms; dressing and undressing; residents having

their own clothing; assistance to eat, drink and maintain good personal hygiene; sexual

expressions; and care provided during illness and at the time of death.

A screen that ensures the protection of residents’ privacy is used if more than one resident

shares a room.

Residents are allowed to communicate with family and friends, and participate in

community activities and hobbies (unless that participation hinders the safety of that or

other residents or the facility).

Residents are allowed to receive mail at the facility. Mail for residents are unopened and

promptly delivered.

Residents are free to participate in the political process and that involvement is facilitated by

the facility.

Policies and mechanisms are established to protect residents from physical, sexual,

psychological, financial and material abuse, as well as neglect. These policies and

mechanisms address abuse prevention as well as the reporting, investigation, and handing

of abuse complaints.

Residents are free to discharge themselves from the facility at any time, provided that they

have met their financial obligations to the facility.

Expected Practices:

The facility promotes a culture of openness and partnership that encourages residents,

sponsors and advocates to raise issues or file complaints without fear of consequence.

The facility encourages residents, sponsors and advocates to raise issues directly with the

personal care assistants and move up the chain of command if the response at any level is

unsatisfactory.

The facility’s complaints procedure is elaborated in the Resident Handbook, included in staff

orientation and training programmes, and prominently displayed within the facility. The

facility includes any recourse available with the State as the final tier of the complaints

procedure.

STANDARD 3: COMPLAINTS

There is an established procedure to receive, act upon, and respond to complaints from

residents or their sponsors and advocates.


22

Details of the complaint, response, resulting action, and status are documented in the

resident’s file.

Expected Practices

The admissions policy and process, as well as the facility’s cost structure (including due dates

and fees for any activities or services that carry additional costs), are outlined in all

marketing material (including brochures and websites) and provided to all prospective

residents.

Elderly residential facilities host Open Houses to allow prospective residents and their

sponsors to visit the facility before making a decision to stay. These Open Houses include a

tour of the facility as well as opportunities to interact with residents and staff.

A Resident Handbook (in English and Braille for visually-impaired persons) is provided to

every resident and prospective resident. Inter alia, this guide includes a description of the

services provided and activities planned by the facility, the established complaints process

(including any Government recourse available), the core values that govern the operation of

the facility, visiting hours and conditions, curfew times and the details of any check-in

procedures, a description of the physical layout and accommodations of the facility, the

emergency procedures of the facility, the general staff to resident ratio, an outline of

circumstances under which residents may be expelled from the facility, the general

procedures adopted in the case of illness or death of a resident, and the process and terms

of discharge of a resident. Within seven (7) days of receiving the Handbook, residents sign a

simple contract to confirm receipt of the Handbook and indicate understanding of and

agreement to adhere to the terms articulated therein.

Information necessary for residents to make informed decisions is provided at the earliest

opportunity and presented in a manner (language and format) that he/she can understand.

Residents have access to radio and television programmes and newspapers.

A notice board within the facility highlights information about upcoming activities and

events, and reminders about important announcements.

Expected Practices

Residents and prospective residents are presumed to be capable of making informed

decisions in the absence of evidence to the contrary. When there is evidence to the

STANDARD 4: ACCESS TO INFORMATION

Every resident and prospective resident has ready access to information required for informed

decision-making.

STANDARD 5: CONSULTATION AND CONSENT

Residents of elderly residential facilities are consulted on the care they require and desire.


23

contrary, the sponsor or an advocate appointed by the State Authority is engaged in

decision-making about the care to be provided to the resident. The sponsor or the advocate

takes the resident’s past wishes, needs, changing capacities, preferences, well-being, and

religious convictions into account when making decisions on the resident’s behalf.

Upon admission, every resident and, where appropriate, sponsors or advocates are involved

in the development of a care plan that informs the resident’s stay at the facility. The care

plan to be developed outlines the procedure for attaining consent for any treatment or care

not addressed in the plan, and the actions to be taken when consent has not been provided.

Once the care plan is developed and agreed upon with the resident (or his/her advocate), a

representative of the facility and the resident (or his/her advocate) sign to signal their

agreement with the terms set out in the plan. If the resident’s wishes re care change, the

care plan is amended, and again signed and dated by both parties.

The resident, his/her sponsor or advocate where appropriate, Personal Care Assistants and

other persons providing care to the residents have access to the care plan.

In medical, residential care facilities, consent is sought and documented for care or

treatment not addressed in the care plan. Standard consent forms are developed for this

purpose and the signed forms maintained in the resident’s file. The resident, or his/her

advocate or sponsor, is provided with information and explanations required to allow for

informed decision-making at the earliest possible opportunity.

Residents (or their advocates) decide what steps are to be taken in instances of illness and

death, in accordance with national laws, regulations, and customs. These steps are outlined

and agreed to in the individual care plan developed.

Residents, their sponsors or advocates, and the facility discusses the individual terms and

process for discharge, and these details are reflected in the care plan.

Consent is sought from the sponsor or advocate, and reflected in the care plan, for a

resident incapable of identifying his/herself to be fitted with an identifying bracelet or other

means of identification that cannot be removed or easily lost.

Expected Practices

Residents’ individual choices of address are respected at all times.

Residents are allowed to maintain and respectfully express their personal identity within the

facility.

STANDARD 6: IDENTITY, INDEPENDENCE, AND PERSONAL BELONGINGS

Residents’ are encouraged to retain and continually develop their self identity, and their

personal belongings are safeguarded.


24

Residents’ social, religious, and cultural norms are respected and reasonably accommodated

within the daily routines of the facility.

There is a policy and culture of fostering and maximising residents’ independence.

Residents (or their advocates) decide what information is to be shared about their stay at

the facility, and indicate with whom that information is to be shared. This is captured in the

care plan developed.

Residents handle their own financial affairs for as long as they desire, and decide how their

finances will be handled thereafter.

Elderly residential facilities avoid collecting and managing residents’ monies. When this

cannot be avoided, detailed, signed records are maintained of all monies received and

handed over.

Residents are allowed and encouraged to bring a reasonable volume of personal items

(including clothing, bath and personal care supplies, and storage units) to the facility.

Upon request from a resident, the facility stores documents and personal effects for

safekeeping only if said documents and effects are kept in a safe or locked room in the

facility, and signed records of the receipt and handover all items in storage are maintained.

If a resident dies while at the facility, all of his/her possessions are handed over to the next

of kin on file. Where there is no next of kin on file, the possessions of the residents are

lodged with the State.

Expected Practices:

There are established mechanisms to allow residents to raise issues about and contribute

ideas for the enhancement of the day-to-day functioning of the facility. This might include

the establishment of a Resident Representative Committee that supports the planning of

recreational and social events within the facility, and raises issues of common concern

among residents with the administration of the facility. Ideas presented and issues raised by

residents are acknowledged and responded to, and a record of the issue and the resulting

action taken is maintained.

The involvement of residents in the day-to-day operations of the facility is not for the

convenience of the facility or to fill staff gaps, but is geared towards respecting the

independence and fostering the participation of residents in their care.

While resident participation in the day-to-day operations and activities of the facility is

encouraged, the right to choose is respected and maintained. Residents are given the choice

to opt out of any and all individual and/or communal social and recreational activities.

STANDARD 7: PARTICIPATION

Residents are encouraged to participate in the day-to-day operations of the facility.


25

Resident involvement in the day-to-day operations of the facility (meal distribution, opening

and closing of windows, etc) is only encouraged and permitted when it does not endanger

the health and safety of that or other residents or the security of the facility.

Expected Practices:

At a minimum, the facility plans biweekly social and recreational activities for residents. Such

activities might include, inter alia, movie or games nights, tours, concerts, fashion shows,

and book club meetings.

The facility provides opportunities for exercise and physical activity, on or off site, at least

three times a week.

Residents’ relationships with their families are encouraged and fostered.

Residents are allowed to receive visitors during established visiting hours and choose who

he/she wishes to see. Residents choices are respected and recorded.

Residents’ rights to access telephone and internet services are respected and, where

possible, facilitated.

Residents receive required psychosocial and welfare services from a social worker attached

to the facility or dispatched by the State Authority.

Expected Practices:

There are a sufficient number of staff on call to assist residents with the activities of daily

living.

Staff aid residents with grooming and meals as is necessary or agreed in the care plans to

maintain residents’ hygiene and physical well-being.

The facility is outfitted with the necessary equipment to meet residents’ mobility needs.

Residents receive support from staff based on their individual needs, changing capacities,

wishes, and preferences.

Staff provide support to residents sensitively, respectfully, professionally, and discreetly.

STANDARD 9: PHYSICAL CARE

Residents receive sensitive and personalised care to retain and encourage their physical well-

being.

STANDARD 8: SOCIAL CARE

Residents receive social care that fosters their productivity and encourages active ageing.


26

The health, safety, and comfort of persons in care are checked on regularly.

Expected Practices

Residents are involved, as desired and as is safe, in meal planning, meal preparation, food

service, and related activities.

A weekly meal calendar is displayed within the facility so that residents know the options

that will be available at each meal.

Residents are entitled to and receive a minimum of three complete meals per day.

Nutritious snacks are provided to residents as can reasonably be expected.

Residents have access to a variety of fluids (hot and cold) and 24 hour access to potable

water.

Residents are provided with a balanced diet, and allergies and individual ailments are

considered in food preparation and handling.

There is a nutritionist on staff at the facility. Where this is not possible or practically feasible,

the facility arranges ongoing nutrition training for relevant staff, and work with the Ministry

of Health and other Government Authorities to ensure nutritious and tasty meals that are

hygienically prepared are provided to each resident.

Every person involved in the preparation of meals has a current Food Handlers’ Certificate

and is appropriately trained for the roles they assume.

Food is transported to residents in a manner that considers and respects the dignity and

rights of residents, and adheres to public health food hygienic standards.

Staff responsible for the preparation and delivery of food wear appropriate protective and

safety gear.

Expected Practices

Elderly residential facilities require prospective residents to have their health assessed as

part of the admissions process.

The facility provides opportunities for residents to pursue healthy lifestyle choices and

recreational activities.

STANDARD 11: HEALTH CARE

Elderly residential facilities promote the health of residents in care.

STANDARD 10: FOOD OPTIONS, PREPARATION AND HANDLING

Residents have access to safely prepared, nutritious, palatable meals that they enjoy.


27

Residents have regular access to counselling and other required psychosocial support

services.

The facility aids the resident’s access to quality health services by having qualified medical

persons in house or facilitating regular visits from a neighbourhood health authority.

The facility maintains records of fundamental medical information (including basic vital

statistics, blood pressure, and blood glucose levels) as required to reflect changes in the

resident’s health during his/her stay at the facility.

The facility is equipped with basic medical implements (like a BP machine, oxygen tanks, and

blood sugar kits).

Only persons appropriately trained and certified should administer medical care (including

CPR).

Expected Practices

Residents of the facility have the right to keep, manage, and self-administer medication

approved by professionals and local and international law for self-administration. If required

or requested, assistance with the administration of this category of medication is provided

by a duly certified Personal Care Assistant. All other medication, including scheduled

controlled drugs, is administered by a qualified nurse or other medical professional.

First aid kits are properly stocked, maintained, and located in readily accessible areas across

the facility’s premises.

The facility is stocked with adequate medication for the needs of residents in care. An

account of all medication procured and administered by the facility is maintained.

Medications are stored in clean and secure conditions, in accordance with international best

practices and local laws, regulations, and customs.

All errors and incidents in the acquisition, storage, and administration of drugs are

documented.

A record of all medications and medical care provided within the facility is documented and

kept in the residents’ files. Adverse reactions to medications are also noted.

STANDARD 12: MEDICATION MANAGEMENT

Elderly residential facilities source, store, and administer medicines in accordance with best

practices and local laws and regulations.


28

Expected Practices

There is a clearly articulated policy that governs the management and operation of the

facility. This policy sets out the framework for the Resident and Employee Handbooks, and is

a requirement for obtaining the necessary license to operate.

The core values espoused in the abovementioned policy are prominently displayed within

the facility, and are included in the Resident and Employee Handbooks.

The facility prominently displays a copy of its valid license in the reception/waiting area.

The facility accommodates inspection visits from State Authorities as outlined in licensing

regulations.

The facility undertakes an independent, quality audit at least once every three years. The

facility demonstrates how it has addressed the issues raised by and implemented the

recommendations of the audit.

Employees have job aides that, inter alia, include key reminders, tools, and measures of

success for the job to be performed.

Feedback is sought from residents, sponsors, and advocates, and incorporated into the

facility’s operations.

The facility collects, manages, and analyses data (like number of illnesses, deaths and

accidents; occupancy rates; and resident satisfaction statistics) to facilitate informed

decision-making about and continuous improvement of the services offered.

Video monitoring systems are installed in common areas within the facility. The presence of

these video recording systems is communicated to staff and residents, and tapes are kept

for at least six months.

Expected Practices

There is at least one patient care assistant on call for every five residents in the facility.

At least one floor supervisor, preferably with some medical training, is present to oversee

the work of every fifteen personal care assistants.

STANDARD 14: STAFFING LEVELS AND REQUIREMENTS

Elderly residential facilities are staffed as necessary to provide quality services to residents.

STANDARD 13: QUALITY ASSURANCE

Elderly residential facilities strive to continuously provide a high standard of care to residents.


29

All staff hired as patient care assistants have completed an accredited patient care assistant

training programme (that includes CPR).

The Administrator of the facility has been trained by the Ministry of Social Protection and/or

the University of Guyana.

The Administrator of the facility has the personality, deportment, and temperament

necessary to manage an elderly residential care facility, and demonstrates the training and

experience required to competently run the facility.

Employees have the personality and temperament necessary to work at a residential care

facility, and demonstrate the training and experience required to provide quality care to

elderly residents.

Expected Practices

The facility has a clear and independent recruitment process that does not discriminate

against job applicants and employees because of race, colour, religious beliefs, political

affiliation, age, disability, gender, sexual orientation or nationality.

Comprehensive background and reference checks are completed before job applicants are

hired.

Prospective staff are required to prove that they have received and are up-to-date on all of

their vaccinations.

The facility has a robust orientation programme in place for all new staff.

The facility provides a safe, clean, and healthy work environment for staff.

The facility provides clean, well lit, well ventilated, and appropriately furnished staff quarters

for staff meals, wardrobe changes, storage, and other use.

At a minimum, all staff receive employment benefits in accordance with local laws and

regulations.

Staff have binding contracts that govern their terms of employment. These contracts are

supported by an Employee Handbook that, inter alia, addresses conditions of employment,

working hours, promotion conditions, leave benefits, and the handling of overtime.

There are clear disciplinary and appeals procedures for violations of the terms and

conditions of employment. These procedures are documented in the Employee Handbook.

STANDARD 15: HUMAN RESOURCE MANAGEMENT

Human resource issues are handled in accordance with established professional best practices

and local laws and regulations.


30

Employee grievances are handled promptly, formally, and directly. The grievance process is

elaborated in the Employee Handbook.

The facility has a clearly defined organisational structure that specifies roles and

responsibilities, and identifies the lines of authority and accountability.

The facility maintains comprehensive staff files, that are easily accessible by the

administrator for effective management of all staff.

There is an active Occupational Health and Safety Committee at the facility.

Staff are provided with the equipment and tools and are encouraged to adopt working

practices that minimise risk to health and safety.

Staff are provided with the information, supervision, and instruction necessary to protect

the health and safety of the residents and staff of the facility.

Continuous training and education activities are encouraged, facilitated, and when possible,

initiated by the management of the facility.

All staff are appropriately attired while at work. They wear uniforms so that they can be

easily identified.

The facility has an annual performance management system that allows for continuous

assessment, review, and improvement of staff performance.

The facility has an established system to reward productivity, quality, service, and teamwork

while penalizing underperformance.

At minimum, the facility has a monthly (but ideally, a quarterly) staff roster. Staff understand

that this roster is subject to change based on prevailing realities and needs of the residents.

Expected Practices:

The physical infrastructure of elderly residential facilities meets the applicable standards set

out in the National Building Code.

All electrical fittings are in good working condition and safe. Bedrooms, bathrooms, and

common areas are lit sufficiently for use and to protect the health and safety of residents.

The electrical wiring of the facility has been approved by the relevant certifying national

agency.

STANDARD 16: SPECIFICATIONS FOR PHYSICAL INFRASTRUCTURE

The physical infrastructure of elderly residential facilities are designed and maintained to cater

to the special needs of the elderly.


31

The facility has running hot and cold water and a back-up water supply that allows for the

continued care of residents for at least 48 hours.

The facility is accessible to differently-abled persons.

Rooms in the facility are clearly labelled.

Directional signs critical for easy navigation of the facility are mounted.

Where the building has more than one storey, it is equipped with elevators. The number of

elevators is determined by the bed capacity of the home and allows for the swift evacuation

of residents.

Windows are secured in a manner to prevent falls, but can easily be opened for fresh air.

All rooms within the facility are well ventilated, in good condition, secure, and clean.

All rooms within the facility are appropriately furnished for their intended purpose, respect

the dignity and meet the needs of residents, and cater for residents’ comfort.

The facility has a designated waiting area that is appropriately furnished and located away

from the bedrooms occupied by residents.

Ward style accommodations are avoided unless the medical condition of residents make it

the most practical option. In such cases, screens are used to protect residents’ privacy and

dignity. In all other cases, each resident is assigned his/her own bedroom, which is outfitted

with electrical outlets and ample storage systems, and decorated as he/she sees fit.

Each bedroom has a lock that can be closed from the inside and opened from the outside in

case of emergency, except in atypical cases where a lock exacerbates a risk to the health and

safety of a resident.

Each bedroom has a window providing natural light, with window coverings to moderate

light and protect resident privacy.

All bedrooms in the facility are accessible from the hallway without having to pass through

any other room.

There is at least one (1) shower stall for every eight (8) persons and one (1) lavatory for

every six (6) persons in residence.

Bathroom doors can be locked from the inside but opened from the outside in cases of

emergency.

The bathrooms have adequate space to facilitate residents’ free movement.


32

The bathrooms have non-skid floors, are well lit, and are outfitted with well-placed and

secure grab bars.

Where there are self-contained bedrooms or bathrooms are a reasonably far distance away

from living, dining, and recreational areas, a half bath is provided.

There is a specifically designated dining area that is sufficiently furnished to accommodate

all residents in care.

The facility has an area that is specifically designed as a kitchen. The kitchen is well

equipped, includes cold storage facilities, has non-skid floors, and is appropriately outfitted

for cooking large quantities.

The kitchen is subject to an annual inspection of the relevant health authorities.

Documentation of these inspections are maintained by the facility.

The facility has a designated food storage area that is free from rodents, well lit, well

stocked, and secure.

The facility has a specified, well equipped, well lit, and clean area for laundry. The laundry

area includes secure storage space for cleaning agents and chemical products.

The facility includes recreational spaces that are easily accessible to residents during normal

waking hours of the day. These spaces are comfortably furnished and equipped for

recreation.

Outdoor activity areas include a reasonable amount of shelter from sun and inclement

weather, have comfortable seating, and are safe and secure.

The facility is cleaned regularly and the building well maintained.

The environs (including the compound and drains) of the facility are clean and there is a

schedule for continued maintenance.

The facility has a back-up power supply that allows for the continued comfort and care of

residents for at least eight (8) hours during power outages.

Expected Practices

The facility has a robust emergency preparedness, response, and recovery policy in effect.

STANDARD 17: EMERGENCY PREPAREDNESS

Elderly residential facilities have established procedures to prepare for and respond to

emergencies, so as to protect the life, health, and liberty of their staff and residents.


33

The facility provides all necessary training and equipment to support the implementation of

its emergency preparedness, response, and recovery policy. This includes an annual fire drill.

The facility has, at minimum, basic emergency infrastructure (including adequate fire

escapes and extinguishers, emergency lighting in hallways and stairwells, smoke alarms, and

lit exit signs). Emergency exits are not obstructed and are clearly identified.

The facility has alarm systems to allow residents to signal a need for help in cases of a fall,

illness at nights, or other emergency situations. These systems may include individual alarm

buttons (often worn as necklaces), bed buzzers, or emergency buttons in easily accessible

areas across the facility.

Signs of emergency procedures are displayed throughout the facility.

There is at least one security officer on the premises at all times.

The facility has insurance coverage to protect against losses or damage to its assets.

Expected Practices

The facility disposes of medical implements and waste in accordance with local laws and

regulations, and international best practices.

As much as is possible, the facility separates other waste for collection and recycling by local

authorities.

Expected Practices

The facility has established mechanisms for revenue generation.

The facility has clearly outlined arrangements to ensure transparency and accountability,

including the annual independent auditing of its accounts.

The facility has established procedures to promote the efficient and effective management

of its operations.

The facility adheres to standard accounting procedures for the receipt and accounting of all

capital and current donations and expenditure, including cash and in-kind donations.

STANDARD 18: WASTE MANAGEMENT

Elderly residential facilities dispose of waste in an environmentally-friendly manner and in

accordance with local laws and regulations.

STANDARD 19: FINANCIAL MANAGEMENT

Standard accounting and financial systems are adopted to ensure the continued viability of the

facility.


34

6. THE WAY FORWARD

If the minimum standards proposed are accepted and implemented, it will result in a marked change in the

operations of elderly residential facilities in Guyana. The reality, however, is that many of the existing facilities

do not have the financial or technical resources required to effect the changes necessary to meet these

standards in the short term—even the Government-run Palms Geriatric Facility is unlikely to be able to meet

these standards before 2018.

That said, the minimum standards articulated here are not overly ambitious, unrealistic or unattainable.

Instead, they have been developed to attain a level of care that meets the Government’s international

commitments, considers Guyana’s development priorities, and ensures that the elderly in residential care

facilities receive a respectable level of care that is responsive to their unique needs and realities.

The implementation of these standards will no doubt require cooperation, commitment and concerted effort,

but they are attainable within the next three to five years. During that time, all of the existing facilities should

be able to transition successfully to meet the new requirements, while new facilities are established in line with

the approved standards. That time will also allow the Government Authorities to devise the licensing

mechanism and introduce multi-disciplinary inspections that are required to underpin the operation of elderly

residential facilities if these standards are to have an impact on the level of care delivered.

Moreover, the time will allow for required government support of this process in the short term. While

resource constraints are understood, the Government is ultimately responsible for the care of the elderly, and

so must find new and innovate mechanisms for providing the support required to help existing charitable and

non-profit facilities better serve the elderly in their care. This should not only include a revision of the existing

subvention allotments, but also the introduction of platforms for the sharing of experiences and maximisation

of resources, provision of technical support to develop transition plans for each of those facilities, and the

development of objective criteria for the future allocation of resources to elderly residential facilities.

While these minimum standards are an important component of the work to transform the operation of

elderly residential facilities, the most critical steps in this process should be the raising of awareness about and

enforcement of the Maintenance Act, and addressing the condition of the elderly in Guyana generally. This will

ensure that families assume their moral and legal responsibilities for their elderly relatives, help to decrease

the elderly population in residential facilities, better facilitate active ageing, and begin the groundwork for the

required cultural shift in how Guyanese treat, think about, address, and plan for the care of the elderly.

Finally, the proposed minimum standards are not intended to fix all of the issues experienced in residential

care facilities. Further, the assumption is not that all of the existing facilities are functioning at the same

standard and that that standard is low. Instead, these proposed standards are intended to capture and respond

to the nuanced experiences and realities within existing homes in Guyana, and formalise normal practices that

have proven to be best practices. They are intended to provide a framework to ensure that the quality of care

at all residential facilities meet a respectable minimum level, and allow for the regulation of elderly homes to

the same standards. Most importantly, the aim of these minimum standards is to move elderly care in

residential facilities forward, and make tangible and substantive differences in the lives of persons living in

elderly residential facilities in Guyana.


35

APPENDIX 1: SITE OBSERVATION CHECKLIST USED FOR FIELD VISITS TO ELDERLY

CARE FACILITIES11.

NAME OF FACILITY:

ADDRESS:

MAIN POINT OF CONTACT:

TELEPHONE:

E-MAIL:

ITEM OBSERVATION COMMENTS

Physical Attributes (indoor and outdoor areas)

Adequate directional signs/information are visible Yes No

All areas are accessible to all persons in care Yes No

Hallways are sufficiently wide for unhindered use

(including by persons in wheelchairs) Yes No

If there is more than one storey in the facility, elevators

are present, commensurate with the number of residents

in care, and operational

Yes No

Monitoring system/emergency signalling device is in place

and appropriate to resident needs Yes No

Controls for signalling devices/lights/elevators are

accessible and easy to use Yes No

Windows are secured in a manner to prevent falls or

exits but can easily be opened for fresh air Yes No

Bedrooms, bathroom and common areas are lit

sufficiently for use and to protect the health and safety

of residents

Yes No

Residents have access to

telephone services Yes No

Communication mechanisms and devices allow staff

to easily communicate with each other across the

facility

Yes No

Electronic surveillance is in place at the facility Yes No

Interconnected smoke alarms are installed Yes No

There is emergency lighting in the hallways and stairs Yes No

Furniture/equipment meet the needs and respect the

dignity of residents, are maintained in good condition and

are clean

Yes No

11

Adapted from the Residential Care Inspection Checklist used by the Vancouver Island Health Authority. 2012 < http://www.viha.ca/NR/rdonlyres/4B9CD362-8AFE-4EC2-A946-BD5D0D45AC61/0/RESIDENTIALCAREROUTINEINSPECTIONCHECKLISTAugust202012.pdf>.

http://www.viha.ca/NR/rdonlyres/4B9CD362-8AFE-4EC2-A946-BD5D0D45AC61/0/RESIDENTIALCAREROUTINEINSPECTIONCHECKLISTAugust202012.pdf



36


All rooms/common areas are well ventilated, in good

condition, and clean Yes No

Emergency exits are not obstructed and are clearly

identified Yes No

Signs of emergency plans are displayed prominently

throughout the facility Yes No

There are no more than 2 persons assigned to a bedroom Yes No

Doubly occupancy rooms are screened for privacy and

dignity Yes No

Bedrooms are directly accessible from the hallway

without having to pass through any other room Yes No

Bedrooms can be locked from the inside Yes No

Locked entrance to the bedroom can be unlocked from

the outside in cases of emergency Yes No

Double occupancy bedrooms are of adequate size to

comfortably accommodate two persons Yes No

Each bedroom has a window providing natural light

with window coverings to moderate light and

protect resident privacy

Yes No

Windows provide visibility to the outdoors for

non-ambulatory persons in care Yes No

Ample closet space is available to each resident Yes No

Persons in care are permitted to bring in/keep/display

any furniture/ornaments/personal possessions in their

bedroom

Yes No

Bathroom doors can be locked from the inside but

opened from the outside in case of emergency Yes No

Bathrooms floors are slip resistant Yes No

Well placed and secure grab bars are in place in all

bathrooms (showers and toilets) Yes No

If differently-abled persons are admitted to the

facility, bathrooms are designed to accommodate

these persons

Yes No

These are sufficient bathroom facilities for residents in

care. Minimum requirement below:

Residents on floor/in

wing

Bathing facilities on

floor/in wing 3-6 1

7-25 2 26-40 3

41-60 4

61-75 5

Yes No

A half bath is accessible from the living/dining room Yes No


37


Bathrooms are clean, have running water, and in good

working condition Yes No

Dining room is sufficiently furnished to accommodate

all residents in care Yes No

Lounge/living facilities are comfortably furnished for

recreation Yes No

Lounge/recreational areas are accessible at all times Yes No

Administrative/staff work area is appropriately

furnished/ equipped and secure Yes No

Safe and secure storage locations are available for

medications and records Yes No

There are safe/secure/adequate storage areas

for cleaning agents/chemical

products/hazardous materials

Yes No

There are separate utility areas for clean

and soiled clothes/bedding/other articles Yes No

There are no unpleasant odours in the

facility Yes No

Outside activity area includes a reasonable amount of

shelter from sun and inclement weather, has comfortable

seating, is safe, and is secure

Yes No

Staffing

The administrator for the facility is on site Yes No

Individual employee files are kept on site and are

easily accessible to manager and supervisors to be

regularly updated

Yes No

Administrator has the personality and temperament

necessary to manage a residential care facility and

demonstrates the training and experience required to

competently run the facility

Yes No

Employees have the personality and temperament

necessary to work at a residential care facility and

demonstrate the training and experience required to

provide quality care to residents

Yes No

At least one floor supervisor is present to oversee the

personal care assistants Yes No

There are a sufficient number of care providers on duty to

meet the needs of the persons in care and assist persons

in care with activities of daily living

Yes No

First aid supplies are readily accessible to all

employees across the facility Yes No

Care providers engage residents kindly and professionally Yes No

Staff are clean and appropriately dressed Yes No


38


There is at least 1 medical professional on staff for every

50 residents in care Yes No

Operations

There is order and the facility appears to be run well Yes No

There is a feeling of life and activity about the facility Yes No

There is a pleasant feeling about the facility Yes No

The health, safety, and comfort of persons in care are

checked on regularly Yes No

Persons incapable of identifying themselves have been

fitted with an identifying bracelet or other means of

identification that cannot be removed or easily lost

Yes No

Laundry room is operational, clean, safe and secure Yes No

Assistance is provided to residents to maintain good

dental and physical hygiene Yes No

Care plans are available for all residents and easily

accessible to staff to inform their care of residents Yes No

Employees administering medications are

trained/qualified to do so Yes No

Weekly menu is prominently displayed Yes No

Snacks are provided at times to meet needs of persons in

care Yes No

Persons in care are encouraged to participate in menu

planning, meal preparation, food service, related activities

(but not for the convenience of staff)

Yes No

Persons in care are receiving adequate food to meet

their needs Yes No

Sufficient quantity and variation of fluids is provided to

meet needs and preferences of persons in care Yes No

Water is easily accessible 24 hours a day Yes No

Food is prepared in a sanitary environment Yes No

There is running water in the kitchen Yes No

Staff in charge of preparation and delivery of food wear

protective and safety gear Yes No

Residents

Residents are dressed and clean Yes No

Residents appear happy Yes No

Residents are allowed to interact with each other and are

participating in physical, recreational, and social activities Yes No


39

APPENDIX 2: SUMMARY REPORTS FOR FIELD VISITS TO ELDERLY CARE FACILITIES

NAME OF FACILITY: Palms Geriatric Facility ADDRESS: Brickdam, Georgetown, Guyana CONTACT PERSON: Ms. Douglas, Administrator TELEPHONE: 226-6924 EMAIL: [email protected]

OPERATIONS: - Furniture provided to residents unsafe and unfit for use by

elders - Laundry area and baskets and ward storage rooms not

clean and well maintained - Recreational room operational and furnished but games

not present on inspection and room unused - Residents with mobility problems on upper floors and so

confined to ward unless moved by a porter—no stretchers used during visit

- Day passes used to allow residents to go out and visits by family allowed and encouraged

- No dietician or nutritionist on staff but working with MoPH for technical support to ensure nutritious meals are provided and cater to medical conditions of residents

- No care plans for residents—needs are picked up from resident charts or by trial and error

- Residents wear anything that is clean—are not assigned own clothes

- Recreational and social activities planned periodically—especially for national holidays and Month of the Elderly. Exercise programmes not arranged

- Health inspections are usually performed semi-annually but report not shared with Palms to allow adjustments to be made

- Resident complaints are generally handled by the social worker—comfortable reporting issues to current admin

OCCUPANCY: 240 residents (mixed-sex)

ASSIGNED SOCIAL WORKER: Ms. Rogers

LAST INSPECTION DATE: Unknown

MEDICAL: - MoH doctor present from Mon—Friday along with 2

Medices (1 from MoPH and the other hired by MoSP) - Neither staff or residents required to be up to date on

vaccinations - 1/2 PCAs per ward on shift at nights and weekends but no

doctor or medex. Nurse or medex comes to dispense medications and leaves

MANAGEMENT: - Administered by the MoSP – all hiring handled by the

Ministry. No formal disciplinary measures in place for staff - Admission based on age, family situation, and need.

Medical required but more to allow the staff to be aware of care needs than to determine admission

- No core values or management policies elaborated. No job orientation or job aides provided

STAFF: - 129 staff total –PCAs and nurses insufficient to provide

quality care to residents. 25 – 35 residents seen in each ward. Max of 2 PCAs seen at a time per ward with no supervisor—residents seen dragging selves in wheelchairs

- Staff work in shifts—schedule generally prepared anywhere between one week to a month in advance

- Generally provided with necessary safety equipment but supplies not always on time or in needed quantities

- Morale varies but there are obvious issues between the staff and management and there is little confidence in established grievance process

- Problems with staff reporting for work at nights and on weekends

- Admin, residents and staff agree that most PCAs are not sufficiently trained for their jobs

- No talent management plan in place. Try to provide re-education opportunities for staff when possible

PHYSICAL:: - Building is very old—more than 100 years old. - Back-up power present. H&C water to be installed in 2016 - Ward-style facilities for residents. No screens seen being

used - All bathroom floors do not have non-skid tiles and there

were large puddles of water on 3 of the 4 bathrooms inspected. No grab bars installed and doors do not have appropriate locks

- Windows allow for good light and free flow of air, but are not sufficiently secure to protect against falls or jumps. (A woman with signs of dementia fell out of a third storey window a week after the visit)

- 6 wards in 2 buildings with 3 storeys each—no elevators - Exit signs present and cleared exits, but no emergency

lighting in stairwells and halls, and exit signs do not light up in darkness

- No smoke alarms visible during walk through – fire extinguishers present and assembly point identified but no emergency plan

- Well manicured grounds with ample shade provided and benches strategically located across the grounds

- Large holes visible in the walls of the bottom flat of both buildings and cats flow freely in and out of the building.

FINANCIAL: - Fully funded by Government (no fee for residents) but also

receive donations from private individuals, Food for the Poor, and the private sector

- Finances are linked to the Ministry so budgetary allocations are made according to the Ministry budget approved by Parliament for each year


40

NAME OF FACILITY: Uncle Eddie’s Home ADDRESS: 826-829 Jackson St, Tucville, Georgetown CONTACT PERSON: Ms. Christine Hales, Administrator TELEPHONE: 226-0298 EMAIL: [email protected]

OPERATIONS: - Residents are allowed free movement but no formal pass

or ‘tracking’ system in place - Quarterly recreational and social activities (luncheons,

concerts, etc). No physical activities planned—residents generally entertain selves

- There is a resident representative that raises resident issues with the administrators—also monthly meetings between residents and the Board

- Residents that want to be are engaged in basic activities for the operation of the home (gardening, locking windows, laundry, washing dishes, etc)—proven to build morale and help residents feel respected and important

- No water dispensers for 24 access to water seen - Guard services in the evening for security and to prevent

wandering - Residents are sometimes asked to leave if found to affect

the comfort of or endanger other residents - No formal operating procedures in place. Current admin

there in part to document and introduce procedures, duties, core values, donation and leave policies, etc.

- No social worker employed or assigned from the MoSP - No individual care plans for residents—needs are picked up

from admissions interview or by trial and error - No known health inspection from authorities - No dietician or nutritionist on staff but cooks do cater for

nutritional needs based on info from Admin.

OCCUPANCY: 24 residents (mixed-sex)

ASSIGNED SOCIAL WORKER: None

LAST INSPECTION DATE: Never

MEDICAL: - Caters for able-bodied residents so no medical staff in

house—both a nurse and a doctor are on call in addition to monthly visits from neighbourhood health centre

- Administers basic medication (pressure and diabetes tablets, etc) to residents (separated by days into pill box)

- Neither staff or residents required to be up to date on vaccinations

MANAGEMENT: - Managed by a Board of Directors. 2 members and the

administrator (Resident Care Committee) review applications for admission and make decisions

- Admission based on age, ability to care for self, medical and in-person interview. Aim is to admit persons to provide a space for them to livee a fruitful life.

- Background and reference checks conducted during hiring process. Target past PCAs at GPHC.

STAFF: - An admin, 5 PCAs, 1 supervisor, 4 cleaners, 2 cooks and a

relief cook (cooks have food handlers certificates) - Draw on students of training institutes that are seeking

practical experience - 2 persons on duty at night. Weekend operations mirror the

working week - Most persons hired at the facility have been trained in care

for the elderly, but there are questions on the comprehensiveness and effectiveness of training provided as there are obvious gaps in the knowledge of persons who are hired by the facility after completing courses

- No significant turnover of staff even though there is only a modest benefits package ($35,000 salary with NIS and vacation leave)

PHYSICAL:: - Building is clean but old. Attempts to do renovation work

(including current work to refurbish a wing for self contained rooms) but need a new roof, a complete paint job, replacement of rotten wood, cleaning/replacement of tiles and windows throughout the facility

- Flat building with wide hallways so accessible to all - Windows are barred and so prevent entry by intruders or

unplanned exits by residents - One bedroom provided for each resident. Rooms include

closet space and residents encouraged to bring belongings to design room as desired. Bedrooms can be locked from the inside and if done, can be opened from outside in case of emergency. Bed ridden residents in a ward with 5 to 7 persons. No screens seen. 2-3 shower and lavatory stalls in every wing of about 5-10 residents

- Bathrooms (shower and toilet) do not have grab bars. There are a few wheelchair accessible baths. Mold visible in bathrooms

- Furniture is dated but clean and include sofas and accent chairs—no plastic chairs seen

- Insufficient exit and directional signs but exits unobstructed. Some smoke detectors seen. No emergency lighting

- Large yard space but significant drainage issues so not developed for use by residents—also affects foundation

FINANCIAL: - Privately funded with no subvention from Government (in

part due to lack of audited accounts) - 40,000 per resident per month; 45,000 per month if

bedridden. Many residents in arrears on payment and family engagement low.

- Depend heavily on private donations (individuals, Banks DIH, NBS, GBTI, etc) and partnerships with agencies like Prison Service for cleaning of yard

- Expenses: approx $1M per month. Exceeds revenue.


41

NAME OF FACILITY: St. Thomas Moore Men’s Homestead ADDRESS: 216 Lamaha Street, Kitty, Georgetown CONTACT PERSON: Mr. Winston Playter, Administrator TELEPHONE: 226-8594 EMAIL: [email protected]

OPERATIONS: - Residents are allowed free movement-6pm curfew. Check

out system in place to track who is in house and who isn’t - Regular social (men’s fellowship, games night, church

service, monthly library visits to borrow books and participate in guest lectures, etc) and physical activities (resident organised walks in yard or on the seawalls)

- Water cooler in kitchen provides 24 access to water - Residents have basic utensils in room and prepare snacks

for selves. Also wash, hang out and pickup own laundry and wash their dishes from meals. Clean their own rooms while staff deal with hallways and common areas

- Residents are sometimes asked to leave if found to affect the comfort of or endanger other residents or break house rules. Written copy of rules given to residents upon admission—rule book currently being updated

- No social worker employed or assigned from the MoSP - Health inspections in the past from the Bureau of

Standards and Vector Control Unit of MTC - No dietician or nutritionist on staff but cooks do cater for

nutritional needs based on info from Admin (gathered from admissions process). Weekly meal menu present and ‘fancy’ meals prepared for birthdays and big holidays

- File for each resident present on site and accessible by staff

- Board deals with any issues or complaints from residents—holds monthly meetings and report submitted to Superior Council of the Church

OCCUPANCY: 20 residents (male)




house—monthly visits from neighbourhood health centre - Administers basic medication (pressure and diabetes

tablets, etc) to residents (separates by days into pill box) and help to deal with simple dressing

- Neither staff or residents required to be up to date on vaccinations

MANAGEMENT: - Managed by the Society of St. Vincent De Paul. A voluntary

Board is in place (Chairman, Finance Officer, Administrator)—review applications for admission and make decisions

- Admission based on age (60 – 70), ability to care for self, medical and in-person interview. Aim is to admit persons to provide a space for them to lie a fruitful life.

STAFF: - Two full time staff (senior care assistant and cook) and a

part time care giver. Also a house father – there 24hrs a day

- Cook trained at YWCA and has an expired food handlers certificate. PCA did a course on caring for persons with disabilities at UG, used to work at an HIV care centre and then transitioned to caring for the elderly

- No significant turnover of staff even though there is only a modest benefits package provided (approx $30,000 salary with NIS, 2 weeks vacation leave, one day off per week and sick leave)

PHYSICAL:: - Three storeyed building but no elevator. One resident in

wheelchair on the ground flat. Hallways wide to allow free movement of the wheelchair but no wheelchair accessible bathroom seen. Slip resistant tile used.

- Building is relatively new and is in good condition (although there is some odour is the bathrooms). Main kitchen setup is basic and could be improved, but is functional. Mini-kitchens on each of the upper floors but without any appliances to make fully functional

- Windows on the bottom floor are barred but not the top 2 floors. Falls aren’t likely but someone can jump out

- One bedroom provided for each resident. Rooms include closet space and residents encouraged to bring belongings to design room as desired. Bedrooms can be locked from the inside and if done, can be opened from outside in case of emergency. 3 shower and lavatory stalls on every floor with about 10 - 12 residents

- Furniture in the common areas are dated but clean and include sofas and accent chairs—no plastic chairs seen

- No directional signs but exits unobstructed and marked. No emergency lighting in stairs and hallways or smoke detectors. Fire extinguishers and sand buckets seen. Fire escape present on every floor.

- Very little yard space. What is there is used for laundry, back-up water supply and storage

FINANCIAL: - No financial support from Government or Catholic Church - 30,000 per resident per month. Depend heavily on private

donations (individuals, Banks DIH, etc) and involvement from families (which come to take out residents and purchase required personal items)

- Biggest bills are the utilities (water and electricity) and once food is bought, all of the remainder generally goes to these utilities. Formal financial records kept


42

NAME OF FACILITY: Salvation Army Ladies Senior Citizen’s Home ADDRESS: 69 Bent and Haley Street, Wortmanville CONTACT PERSON: Captain Leba Hayling, Administrator TELEPHONE: 226-8846 EMAIL: -

OPERATIONS: - Residents are allowed free movement—7pm curfew and

exceptions can be made if residents have evening functions and give advance notice. No formal tracking system in place

- No planned activities for residents outside of devotion and weekly house meetings.

- No water dispenser for 24 hour access to water seen (NB: kitchen was being remodelled at time of visit)

- Residents deal with own laundry but are supported as needed by the Admin. Clean their own room and volunteers clean the hallways and common areas

- Residents are sometimes asked to leave if found to affect the comfort of or endanger other residents

- Residents sign agreement on admission. Also given written rules of the home

- No social worker employed or assigned from the MoSP - No known health inspections from authorities - No dietician or nutritionist on staff but cooks do cater for

nutritional needs based on info from Admin (from registration form on admission).

- Records (but not formal care plans) for each resident present on site and accessible by staff

- Issues or complaints are dealt with by Administrator during weekly house meetings

- No emergency plan - No articulated core values or policy for operation of home - Only home visited with Wi-Fi available

OCCUPANCY: 9 residents (female)




house—no regular visits from community health centre, but some residents go to the centre for care. Private doctors’ services engaged for other residents when ill

- Residents receive medication from visits to doctor—volunteers do not dispense

- Resident up to date with vaccines. Volunteers not required to be

MANAGEMENT: - Managed by Salvation Army Corps through placement of a

Admin - Admission based on age (60+), ability to care for self,

medical and in-person interview. Aim is to admit persons to provide a space for them to lie a fruitful life.

STAFF: - No staff—workers volunteer their time and are given a

small stipend: Cook, handyman/driver and administrator. Admin on site 24 hours a day.

- Cook does not have a food handlers certificate. Admin has no formal training in elderly care but was trained by the Salvation Army on social care. Also has an Associate’s degree in Law and has more than 28 years experience doing social work

- No significant turnover of staff except for rotation of Admin based on Salvation Army system

-

PHYSICAL:: - Two storeyed building, with home on the top floor but no

elevator or chair lift (Church and living accommodations for Admin on the bottom).

- Building is in relatively good condition and clean. Kitchen being refurbished to include proper kitchen cupboards and upgrade floor covering.

- Windows are not barred—falls aren’t likely but someone can jump out

- One bedroom provided for each resident. Rooms include closet space and residents encouraged to bring belongings to design room as desired. Bedrooms can be locked from the inside and if done, can be opened from outside in case of emergency. 2 shower and lavatory stalls present—laundry sink in bath area for residents to do laundry.

- Furniture in the common areas are dated but clean and include sofas and accent chairs—no plastic chairs seen

- No directional signs and exits unobstructed but not marked. No emergency lighting in hallway or smoke detectors. No fire extinguishers or sand buckets seen.

- Some yard space available—residents can use for recreation with chairs from Church

FINANCIAL: - 40,000 annual subvention received from the Government - 35,000 per resident per month. Depend heavily on private

donations (individuals, Banks DIH, supermarkets, etc) and involvement from families (some of which come to take out residents and purchase personal items)

- Revenue just enough to buy food and cover utilities. Formal financial records kept and submitted to Salvation Army Corps


43

NAME OF FACILITY: Sister’s Missionary of Charity ADDRESS: 16 Public Road, Houston, East Bank Demerara CONTACT PERSON: Sister Lucinda, Administrator TELEPHONE: 226-1772 EMAIL: -

OPERATIONS: - Operate a day-care on site. 42 children, ages 1-3. Children

go over to elder’s facilities to spend time with residents - Physical, social and recreation activities facilitated by an

NGO once a week. Also plan celebrations for birthdays and special events. Priest performs mass at the home once a week

- Persons that can move around on their own and want to go out to handle private issues are allowed to—few do and since most don’t have families present, visitation isn’t an issue

- Water dispenser for 24 hour access to water seen - Staff deal with all laundry (by hand) and cleaning needs - No formal agreement or rules of the home - No social worker employed or assigned from the MoSP, but

have had interactions with MoSP and MoH in the past for meetings and inspections

- Residents who are able bodied and want to, help out with basic chores like watering plants, dishing out meals, etc

- No dietician or nutritionist on staff but cooks do cater for nutritional needs based on info from medical records

- Records of medication dispensed, etc maintained but no formal care plans

- Resident issues are first handled by the Sister in charge of the facility; if resident not satisfied with recourse, the issue is then raised with Sister in charge of the entire complex

- No emergency plan or procedures - Residents allowed to bring a chest of drawers and small

possessions if any




MEDICAL: - Although caters for persons who can’t care for themselves,

only a trained nurse on site. Nurse purchases and dispenses medication according to doctors’ orders

- Three private doctors are on call that they contact in emergency situations. No consistent visits by neighbourhood health centre.

- Room assigned and equipped for doctor’s visits—locked storage room which houses medication and other personal item supplies attached to room for doctor’s use.

MANAGEMENT: - Subsidiary of an international charity. Managed in line with

policies of parent org as well as adopt the practices of the Catholic Church

- Admission based on age (60+), family status, medical and need. Geared for persons who can’t take care of themselves and have no familial support. Also house persons who have been in the orphanage system their entire life and have nowhere else to go.

STAFF: - Admin as well as the 2 persons who deal with cleaning,

laundry and care for the residents are at the facility 24 hours a day. Soup kitchen manned by a Sister and an assistant. Day-care is also manned by another Sister.

- Sisters have training on caring for the elderly (online courses) and through programmes put on by the parent organisation. Also have on-the-job training to administer first aid, change dressings, and do other medical support functions. Cook does not have a food handlers certificate. Generally have temperament to do the work and skills based on years of experience but not formal training.

PHYSICAL:: - Elderly facility is a flat building. Building is relatively new

(with a shaded porch) and in excellent condition (donation to the Church from a private citizen that died and then Church donated to organisation for home). Separate buildings for storage, laundry and kitchen, but there is a food distribution station in home. Plans underway to convert an empty room into a therapy room for residents.

- Kitchen is rustic and designed for cooking large quantities—likely because of soup kitchen. Could be improved (eg: enclosed cupboards) but no major issues.

- Expansive grounds with gardens—also includes a pool that is not operational and slated to be turned into a covered playground and garden

- Windows are not barred—falls aren’t likely. No concern about residents jumping out since most are bedridden and yard is well secured.

- Ward style accommodations for residents—20 beds; no privacy screens used. 6 shower and toilet stalls with non-skid floors and grab bars in each

- Furniture in the common areas are clean but sparse - No directional signs and exits unobstructed but not

marked. No emergency lighting in hallway or smoke detectors. No fire extinguishers or sand buckets seen.

FINANCIAL: - Parent organisation covers all costs (including any hospital

bills or burial costs). Residents not required to make any financial contributions.

- Do receive some donations from private individuals and companies

- No clear indication of operating costs—financial sheets include expenses for soup kitchen and day-care also operated by the facility


44

NAME OF FACILITY: Holy Family ADDRESS: 73 Vlissengen Road, Wortmanville, Georgetown CONTACT PERSON: Mr. Beharry, Administrator TELEPHONE: 664-9449 or 220-2684 EMAIL: -

OPERATIONS: - Residents care entirely for selves. Home just provides

shelter—no other services (meals, laundry, activities). So no care plans or weekly menu or activity schedule, etc. Some residents have friends or interested parties who come in and care for them on a regular basis

- Participate in events held by private agencies (like the Lion’s Club, St. Sidwell’s Church, Banks DIH, UG, John Fernandes and Republic Bank)

- Residents are allowed free movement—gate is closed at 6:30pm. Residents can go spend weekend or longer visits with family—just need to let the Admin know

- Residents are sometimes asked to leave if found to affect the comfort of or endanger other residents

- No social worker employed or assigned from the MoSP - No known health inspections from authorities - Issues or complaints are dealt with by Administrator during

weekly-biweekly house meetings, and then raised with wider Board if necessary

- No formal emergency plan - No articulated core values or policy for operation of home - Have been numerous break-ins in the past, but no

resources for a security guard or to put better security measures in home.




MEDICAL: - No medical staff in house or arrangement for visits from

neighbourhood health centre. Residents go to hospital for all care and administer own basic medication (pressure + diabetes tablets) based on doctor’s orders

- Residents not required to be up to date on medication

MANAGEMENT: - Owned by the Bishop of Georgetown/St. Vincent De Paul

and run by a volunteer Board of 8 persons - Admission based on age (60+), ability to care for self,

medical and in-person interview. Aim is to provide shelter for ambulatory persons with nowhere else to go. Persons sent to hospital if ill, and go to Palms if eventually unable to care for selves

STAFF: - No staff as facility provides no services but shelter. There

was a house matron in the past but no longer so there is also no one present but residents on a day to day basis

PHYSICAL:: - Two storeyed building; no elevator or stair lifts. - Outside of building is painted and looks to be in decent

condition. Inside is dark, dreary and not well maintained. No real kitchen area—a tiled area for cooking and laundry but it’s a small area for each resident, dirty and not up to any standard for a cooking area. Residents also complain about problems with the electrical (overheats any appliances they buy)

- Windows are not barred—falls aren’t likely but someone can jump out—thieves gain access through windows often

- One bedroom provided for each resident. Rooms house all of residents belongings including stoves (generally hot plates or kerosene stoves) because of theft. Bedrooms can be locked from the inside—resident’s personal lock. Shower and lavatory stalls present for every 4-6 residents but not clean (some sinks and toilets overflowing) or with enough space for easy movement

- What furniture is present in the common areas are old and run down but are sofas and not plastic chairs

- No directional signs. Exits unobstructed but not marked. No emergency lighting in hallway. Smoke detectors seen. No fire extinguishers or sand buckets seen.

- Decent yard space available but not maintained or set up for use by residents

FINANCIAL: - 40,000 annual subvention received from the Government - Don’t have a set monthly fee but ask residents to

contribute if they can to help take care of utility bills ($1,000). Depend heavily on private individuals and companies to help pay bills.

- Residents pay a $30,000 burial deposit, which is returned to family if facility doesn’t deal with burial


45

APPENDIX 3: DATA COLLECTION PROTOCOLS USED FOR FIELD VISITS

TO ELDERLY RESIDENTIAL FACILITIES

Appendix 3.1: Facility Management

The Consultant introduced herself and outlined the engagement by the MoSP to develop minimum

standards for elderly care facilities across Guyana. She underscored the confidentiality of the

process, explaining to the participant/participants that no individual would be identified in the

reports produced. Participants were encouraged to be open and provide frank responses to the

questions posed to help the Consultant develop a true picture of the operations, issues, and

challenges at the facility.

Note: The questions that follow served as a guide for the discussion, and so illustrate the general line

of questioning. Follow-up and additional questions were asked as appropriate based on the initial

responses provided.

General:

Are you registered with the State? If so, for how long?

Have you ever had an inspection visit? If so, when was the last such visit?

How many persons can the facility comfortably accommodate?

How many persons are there currently in the facility? (seek a breakdown by sex and age

group: <60, 60 – 65, 66-70, 71-75, 76-80, 81 – 85, 86-90, 90-100, above 100)

Operations:

On what basis are persons admitted to the facility?

Does your facility accommodate persons with special needs (physical and mental)? If so,

how? If no, why not?

For residents who are confused, how does the facility prevent them from wandering away?

What happens to persons who:

Are incontinent and can no longer take care of themselves?

Are unable to bathe or dress alone anymore?

Are confused and need redirection?

Have socially inappropriate behaviours?

Need help with injections or other medications?

Are unable to walk unassisted, or get in or out of bed?

Need night-time help?

Are dying?

Do you have an established system to develop care plans for residents? If so, please describe

that system. Are residents involved in discussions to establish their care plan? If not, why do

you not have one? What alternate systems do you use to determine required care for

residents? What are the hindrances to establishing a system of individualised care plans?


46

How is food prepared for residents? What best practices are adopted? Does the facility have

a food permit? Are the medical conditions of residents factored into meal plans? If so, how?

If not, why not?

Do you plan activities for the residents in your care? If so, what are those activities and how

often are they conducted?

How is laundry handled for residents in care?

When someone complains, what happens?

What causes residents to be asked to leave the facility? In these cases, does the facility assist

with alternative placement?

Is there an emergency preparedness, response and recovery plan in place? If so, how often

is it tested? Are staff au fait with planned processes and procedures? If no, why not?

What arrangements are in place to clean the facility? How often is it cleaned?

How do the operations on weekends vary from during the week?

Medical:

Are residents required to be immunised before admittance to the facility?

How is medical care provided: Is there a medical practitioner on site? Does a physician or

nurse practitioner come to the facility? Does the facility provide a van to take residents to

doctor’s appointments? Are family members required to take their relative to

appointments?

How do residents receive required medication? Who absorbs the cost of procuring the

medication?

What happens if a resident is temporarily admitted to the hospital?

Management:

How long has the facility been in operation?

Who owns the facility? Is this different from the individual/company that manages it?

Does the owner have other elderly care facilities? Is the owner involved in any other sector-

related activities?

What would you say is the overarching goal of the facility?

Does the facility have core values that inform its treatment of staff and residents? If so, what

are those core values?

Is there a benefits package available to staff? What is included in the package?

Are staff insured for on-the-job injuries?

Do you have an employee orientation programme? If so, what does it involve?

What would you say is the facility’s reputation among sector stakeholders? Why do you

think so?

Do you have a talent management plan in place? What do you do to retain staff?

Has the facility ever been in trouble with the State? If so, when and why?

Staff:

What are the required qualifications for your managers and care-giving staff? How does this

inform and/or correlate with the salary structure of the facility?


47

What are the facility’s hiring policies? Are reference checks performed? Background checks?

For how long have key staff (manager, social worker, nurse, etc) worked at the facility?

What is the staff-to-resident ratio at the facility? Is this your ideal ratio or do you believe it

needs to be higher? Please explain.

How are staff’s competence and skills updated and tested? If there a capacity building plan

in place?

Are staff required to be up to date on their vaccinations? What systems are in place to

ensure this happens?

Are staff required to be trained in CPR and basic first aid? Does the facility provide refresher

training for staff in these areas?

Is staff performance regularly accessed and documented? How?

How are staff rewarded (penalised) for good (poor) work?

Financial:

What is the cost structure for residents at your facility?

Does the revenue generated cover the facilities operational costs? What are those costs?

Does the facility receive donations? If so, what is the estimated monetary value of the

annual donations received? Who are those donations received from?

Does this facility receive or has it applied to receive an annual subvention? If so, what has

been the value of the subventions received over the last five (5) years?

Closing:

Those are all of the questions I have. Have I missed any areas that you think need to be

explored? Is there anything you would like to add?

Appendix 3.2: Facility Staff




reports produced. Participants were encouraged to be open and provide frank responses to the

questions posed to help the Consultant develop a true picture of the operations, issues, and

challenges at the facility.



responses provided.

General:

How long have you been working here?

Do you like what you do? What motivated you to take this job?

What are some of the things you enjoy most about this job?


48

What are your biggest frustrations about the job?

Staff:

Do you feel empowered to do your job? Why/why not?

Are there enough staff to provide quality care to residents?

Do you think the staff here are well trained and appropriate for the job they perform?

Is there a plan in place to administer leave efficiently to ensure that it doesn’t affect the

operation of the facility?

Are staff treated well?

Is the management approachable?

Do you feel engaged in decision-making that will affect how you perform your job?

Is there high staff turnover?

Residents:

Do you know the names of all of the residents here?

Do you think the residents are comfortable here? Happy?

Have you ever seen a resident mistreated here? If so, can you describe what happened?

Facilities/Operations:

Is this a healthy work environment?

Do you have the equipment and the infrastructure here to provide quality care to residents?

How do you handle difficult residents?

If there is an emergency, do you know what to do? Have you ever been trained in

emergency management? Do you have a copy of the facility’s emergency plan?

Do you know the specific care needs of each resident? If so, how?

What do you think of the operations of the facility overall?

Closing:

Would you encourage friends/family to work at similar facilities? Why? Why not?

Thinking ahead, if this facility continues to run as it currently is, would you want to be a

resident here in your elder years? Why? Why not?

If you could change anything about this facility or how it is run, what would that be?

Those are all of the questions I have. Have I missed any areas that you think need to be

explored? Is there anything you’d like to add to what we’ve discussed?

Appendix 3.3: Residents in Care




reports produced, and asked the residents if they are willing to have a chat. Participants were


49

encouraged to be open and provide frank responses to the questions posed to help the Consultant

develop a true picture of the operations, issues, and challenges at the facility.



responses provided.

General:

How long have you lived here? What were the circumstances that prompted your move

here?

Do you have living family? Do they come to visit? How often?

Do you feel at home here? Why? Why not?

Staff:

Do the staff call you by your name? Do they treat you with dignity and respect?

Are you comfortable with the staff that provide your care? Do they check on you regularly?

Do you think they are well trained?

Do the staff take time to talk with you and the other residents?

Do you think the staff here truly care for you?

If you had concerns about something that occurred here, how willing would you be to report

it to a supervisor/manager/social worker?

Do you think there are enough staff on duty at any given time? How about on weekends?

Holidays?

If you have trouble moving/bathing/eating, do you receive assistance from the staff?

Do you think the staff are motivated at work? Do you think they enjoy their jobs?

Have you ever seen a staff member mistreated by management?

Does the staff change regularly?

Operations:

What do you like to do for fun? Can you continue your hobbies here? Have the staff ever

asked you about that and tried to ensure those activities are available?

Are you given opportunities to interact with your friends and other residents of the facility?

Can you be alone if you want to?

Are there opportunities for you to exercise or become involved in the day-to-day chores of

the facility?

Are social activities planned? If so, how often? What was the last one planned? Did you

enjoy it? When there are activities, are there enough staff to help? If not, do you think you

would enjoy social programmes?

How do you like the food prepared here?

What is your favourite food? Do they ever cook that here?

Do you think the meals prepared take into consideration your medical history and any

dietary restrictions you may have?


50

Do you have access to snacks and water during the day?

Are you involved in any discussions on the type of care you require/would like to have?

Do you have access to telephones or computers here?

Have you ever seen a resident here harassed or mistreated?

Facilities:

How often is this place as clean and well-maintained as you would like?

Do you like your room here? What do you like/not like about it?

Do you think your valuables here are safe?

Are you able to move around comfortably? How about at night?

If there were an emergency, do you know what to do? Can you easily find the exits? How

confident are you that the staff know what to do to get you to safety?

Are there any problems here with rodents or other pests?

Medical:

Do you receive regular medical treatment while here?

Is there usually a nurse or other medical practitioner on site?

Are you required to take medication regularly? Is your medication provided to you when you

need it?

If your health deteriorates, how confident are you that the facility will be able to make

arrangements to meet your future medical needs?

Closing:

Would you recommend this facility to your friends? Why? Why not?

Is there anything else you would like to tell me?


51

APPENDIX 4: REFERENCES AND RESOURCES

Audit Office of Guyana. Follow-up Performance Audit Report: An Assessment of the Living Conditions

of the Residents of the Palms Geriatric Institution. Guyana, 2015.

Beaie, Sonkarley Tiatun. 2002 Population & Housing Census – National Census Report. Guyana, 2007.

Caribbean Community Secretariat. Press Release: Caribbean Charter on Health and Ageing Launched.

Guyana, 2009. <http://www.caricom.org/jsp/pressreleases/pres105_99.jsp?null&prnf=1>.

Cloos, Patrick, et al. Active Ageing: A Qualitative Study in Six Caribbean Countries. 2009.

<http://www.globalaging.org/elderrights/world/2010/active-ageing.pdf>.

Department of Health. Care Homes for Older People: National Minimum Standards and the Care

Homes Regulation 2001. London, 2006. <

http://www.dignityincare.org.uk/_library/resources/dignity/csipcomment/csci_national_minimum_

standards.pdf>.

Economic Commission for Latin America and The Caribbean. Population Ageing In The Caribbean: An

Inventory Of Policies, Programmes And Future Challenges. Chile, 2003. <

http://repositorio.cepal.org/bitstream/handle/11362/38861/LCCARG772_en.pdf?sequence=1>.

Fredvang, Marthe and Simon Biggs. The Rights of Older Persons: Protection and Gaps Under Human

Right Law. Australia, 2012.

Government of Guyana. National Development Strategy (Guyana).Guyana, 2005.

Health Information and Quality Authority. National Quality Standards for Residential Care Settings

for Older People in Ireland. Ireland, 2008. <

https://www.hiqa.ie/system/files/HIQA_Residential_Care_Standards_2008.pdf>.

Jones, Francis. Ageing in the Caribbean and the Human Rights of Older Persons: Twin Imperatives for

Action. Chile, 2016.

<http://repositorio.cepal.org/bitstream/handle/11362/39854/S1501220_en.pdf?sequence=1>.

Laws of Guyana. Chapter 36:04: Friendly Societies. Guyana, 1998.

Laws of Guyana. Chapter 45:03: Maintenance Act. Guyana, 1998.

Laws of Guyana. Chapter 99:10: Occupational Safety and Health Act. Guyana, 1997.

Ministry of Labour, Human Services and Social Security. Minimum Operational Standards and

Regulations for Children’s Homes in Guyana. Guyana, 2006.

http://www.caricom.org/jsp/pressreleases/pres105_99.jsp?null&prnf=1

http://www.globalaging.org/elderrights/world/2010/active-ageing.pdf

http://www.dignityincare.org.uk/_library/resources/dignity/csipcomment/csci_national_minimum_standards.pdf

http://www.dignityincare.org.uk/_library/resources/dignity/csipcomment/csci_national_minimum_standards.pdf

http://repositorio.cepal.org/bitstream/handle/11362/38861/LCCARG772_en.pdf?sequence=1

https://www.hiqa.ie/system/files/HIQA_Residential_Care_Standards_2008.pdf

http://repositorio.cepal.org/bitstream/handle/11362/39854/S1501220_en.pdf?sequence=1


52

Ministry of Finance. Budget Speech 2016 by Finance Minister Winston Jordan. Guyana, 2016.

Ministry of Health and Social Development. National Policy on Residential Care Facilities for Older

Persons. Anguilla, 2012.

<http://www.gov.ai/documents/health/National%20Policy%20on%20Residential%20Care%20Faciliti

es%20for%20Older%20Persons.pdf>.

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