As we celebrated International Day of Older Persons with a new government of national unity (GNU) this week, it feels timely to call on the new leadership to make a real commitment to supporting older persons living in their homes within our communities.
The long-term care policy in SA is to move away from institutional care and support community and family care. Family care saves the government money, it is more affordable than residential or institutional care.
It keeps people in their community where older persons largely want to stay. We urge the GNU to be mindful of how current policies that seek to support and facilitate family care of older persons are making it difficult for families to care for older persons.
In our programme, family care of older persons in Southern Africa, we have been working with 100 families in SA, who are living in seven different sites across three provinces.
We have been listening to older persons and caregivers, to try and understand their experiences, challenges and to get a better sense of how family care can be supported.
Through this work, we have identified several assumptions that are being made at a policy level about family care of older persons.
The first assumption is that family caregivers of older persons are able bodied and can care. In our sample of 100 older persons who received assistance, 35 of the family caregivers were over 60 years and many were living with a disability or chronic conditions and found it challenging to physically lift and assist their spouse, sibling or family member.
Many other family caregivers couldn’t cope and felt trapped. In these cases, family caregivers needed, at the very least, regular, reliable and free home-based care support but this was not available to the vast majority.
The second assumption underlying the idea that family care is possible, is the assumption that family members are available to care.
In a context where employment is so scarce, family members have to prioritise employment over taking time off to care for family members.
One example that featured regularly was how employed family caregivers feared clinic days, which occurred monthly for some older persons.
The third assumption being made is that family members will help and that helping is evidence of good care. We found that many older persons were unhappy with the quality of care they received as it was not enabling.
OPINION | GNU must adequately support and address family care of older persons
Many elders are unhappy with the quality of care they receive
Image: Esa Alexander/Reuters
As we celebrated International Day of Older Persons with a new government of national unity (GNU) this week, it feels timely to call on the new leadership to make a real commitment to supporting older persons living in their homes within our communities.
The long-term care policy in SA is to move away from institutional care and support community and family care. Family care saves the government money, it is more affordable than residential or institutional care.
It keeps people in their community where older persons largely want to stay. We urge the GNU to be mindful of how current policies that seek to support and facilitate family care of older persons are making it difficult for families to care for older persons.
In our programme, family care of older persons in Southern Africa, we have been working with 100 families in SA, who are living in seven different sites across three provinces.
We have been listening to older persons and caregivers, to try and understand their experiences, challenges and to get a better sense of how family care can be supported.
Through this work, we have identified several assumptions that are being made at a policy level about family care of older persons.
The first assumption is that family caregivers of older persons are able bodied and can care. In our sample of 100 older persons who received assistance, 35 of the family caregivers were over 60 years and many were living with a disability or chronic conditions and found it challenging to physically lift and assist their spouse, sibling or family member.
Many other family caregivers couldn’t cope and felt trapped. In these cases, family caregivers needed, at the very least, regular, reliable and free home-based care support but this was not available to the vast majority.
The second assumption underlying the idea that family care is possible, is the assumption that family members are available to care.
In a context where employment is so scarce, family members have to prioritise employment over taking time off to care for family members.
One example that featured regularly was how employed family caregivers feared clinic days, which occurred monthly for some older persons.
The third assumption being made is that family members will help and that helping is evidence of good care. We found that many older persons were unhappy with the quality of care they received as it was not enabling.
Elderly couple gets a home after living in toilet for 33 years
Several older persons complained about how their well-being was impacted by the different social challenges experienced at a community and household level including crime, substance abuse and domestic violence. Whilst some older persons in our study expressed how their homes were not safe due to the misuse of alcohol or drugs, they also said that they didn’t have any other alternative.
Whilst some older persons were looking for more support from social work services, others were seeking safe spaces to rest.
A fourth assumption is that living at home within the community maintains and promotes the well-being of older persons. Yet the findings indicate that both the built environment and access to services at the community level are not adequately equipped for older persons especially older persons living with a disability.
Thembi, a family caregiver living in KZN, described the care work as hard due to the fact that her mother had only sparing access to incontinence products provided by the clinic but also how she didn’t have access to adequate sanitation facilities; “it is hard sometimes she cannot control her bowel and she has an accident, then I will spend the majority of the morning cleaning her bedding”.
Access to basic services needs to happen before family care of older persons can begin yet at least 20% of older person households in SA must make use of a public tap (this increases to 34% if living in a rural area), and a further 8% of older person households rely on water tankers and/or water from a flowing stream.
This means that at least one in five older person households (21%) have to walk between 200m and 1km to collect water which is the work that happens before personal care can begin. Poor access to water continues to be a feature of under-serviced urban areas and rural life and increases the family care work of older persons.
Supporting family care of older persons is making sure caregivers and older persons have proper access to services, including home-based care and social work services but also adequate sanitation, electricity, water and transport.
We need to re-centre the role of the GNU in supporting community and family care of older persons by allocating adequate budgets and calling on all provincial departments to come together and review how their policies impact the care of older persons, especially older persons living with disabilities.
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