A new report released by the Family Caregiving Programme at the University of Cape Town (UCT) has shed light on the lived realities of family caregiving for older persons in South Africa – a form of care often assumed, under-resourced and profoundly undervalued in both policy and public discourse.
Titled Family Caregiving of Older Persons in South Africa, the report was compiled by UCT’s Professor Elena Moore, Zeenat Samodien and Vayda Megannon. It was funded by the Wellcome Trust Fund.
The report reviewed how family caregiving of older persons happens. Based on the experiences of 103 caregivers and 96 older persons across 100 family units in seven sites in the Western Cape, Eastern Cape and KwaZulu-Natal, the report outlined the costs of family care of older persons.
“We argue that family care of older persons is overstretched, fragile and not infinite and not sustainable. While most older persons had their care needs met, this came at a significant cost to caregivers and families, especially given high unemployment, poverty and migration,” says Professor Moore.
There are almost 5,5-million older persons in South Africa and just over 4-million older person grant beneficiaries. The country’s long-term care policy, supported by the Older Persons Act 2006, foregrounds ageing in place, a policy that promotes older people to live at home with mainly community-level support. Family care, as the policy suggests, is the bedrock of the policy.
However, in South Africa, Moore says ageing in place policies will rely more heavily on family care than many other parts of the world, given the constrained environments in which older persons in poorly resourced settings live, not to mention the lack of funding and provision for community-level services.
“Therefore, understanding family care of older persons is critically important,” she adds.
The report found that almost all of the older persons had their care needs met but this came at considerable costs to the caregivers, older persons and families. “We found that daughters and female kin are typically primary caregivers, but older persons cannot always rely on them, and the demands of care are intensified by poor access to basic services like water, transport and healthcare,” says Moore.
Moore notes that many households are under financial strain, forcing older persons and their caregivers to go without food or essential items, and both caregivers and older persons often experience invisible emotional stress, loneliness and depression.
According to Moore, support is required to create enabling environments as older persons face insecure and inaccessible basic and care services, increasing the need for care.
“Many assumptions are made about family care, and we remind policymakers that the presence of a family member in the household does not always mean that elder care needs are met. We argue that family care is not always performed by able-bodied, engaged family members and in such cases, in the absence of support, the needs of older persons can be left unmet.”
The report showed that elder care work is physically and emotionally depleting, as caregivers navigate the competing demands of caring for children and older persons, and meeting work responsibilities. This strain is intensified in environments where care is often undervalued – both by the older persons receiving it and by their families.
“Caregivers face challenges in managing the diverse and complex tasks associated with elderly care, along with the emotional labour required to deliver quality care amid often difficult and layered relational histories,” says Moore.
The researchers outlined three urgent strategies to support family caregivers and protect older persons: compensation for caregivers, expanded access to home-based care, and improved provision of essential supplies such as incontinence products, medication and nutritious food.