How should I set up annual leave for my elderly mother's caregiver, as they will be needed more as her condition deteriorates?

The long answer

As you note, the Basic Conditions of Employment Act (BCEA) requires people to take the leave due to them rather than be paid out at the end of the contract, or in this case, when the elderly person passes. The BCEA limits the maximum full-time working hours permitted for domestic workers, under which category caregivers fall, to 45 hours a week. 

SA Nanny conforms that caregivers must get at least 21 consecutive days’ (15 work days and three weekends) annual leave after 12 months of continuous service, or one day for every 17 days or shifts worked, for less than 12 months of service.

Leave must be granted not later than six months after the end of the annual leave cycle (12 month periods from date of appointment). An employer may not require or permit a caregiver to work during any period of annual leave.

You are only allowed to pay out annual leave rather than grant it when the contract is terminated. 

The problem here is, as you say, that elderly people will require more care as they grow frailer, but on the other hand, this cannot deprive the caregiver of the right to take the leave that they are entitled to, within six months of completing a 12-month cycle. 

So what can you do? In case this is helpful to you, I will outline here what a friend did to solve this problem in terms of her own elderly and ill mother, whom she had taken out of a frail care home as her mother had been unhappy there. 

At first, one carer was sufficient, but eventually her mother needed both day and night care. So the carer recruited her cousin, and they shared a room in my friend’s house. One did the day shift and one the night shift, and they swopped shifts according to their own needs and convenience. This worked extremely well, and her mother grew very close to both her carers; when she died, they both spoke at her memorial service.

Not being entirely dependent on one carer was much easier on everybody, it seemed. Just a thought.

Wishing you the best,
Athalie