Long-term Care for Older People in South Africa: The Enduring Legacies of Apartheid and HIV/AIDS

Abstract

This paper sets out a general framework for analysing long-term care (LTC) systems for older people in different countries and then applies this framework to a specific national setting. The paper considers the extent to which South Africa's emerging LTC system conforms to broader patterns observed across low- and middle-income countries and how far it has been shaped by more local effects. It finds that patterns of demand for LTC vary across different racial categories. Despite having lower rates of ageing that the white population, Africans account for the majority of LTC demand. Residential services cater primarily for older whites and there is a widespread perception that LTC for Africans should be a family responsibility. Across the sector there is evidence of gaps in service availability, limited state oversight and uneven service quality. In 2016 this led to a high-profile political scandal which may prompt more effective state responses to this growing societal challenge.

Improving early detection of infection in nursing home residents in South Africa

“…South Africa has one of the fastest-aging populations on the continent; the United Nations predicts that between 2009 and 2050, the country’s population over the age of 50 will double to 14% ( AARP, 2016 ). In comparison to the UK, US and other western countries, the provision of care for older people in South Africa has historically been quite different with care being provided at home within the family environment ( Lloyd-Sherlock, 2019 , van Biljon and Roos, 2015 ). Changes to family structures in African families, caused by HIV/AIDS and marked by a lost generation who previously cared for older persons ( WHO, 2020 , World Health Organization, 2017 ), means that over a third now require help and assistance with daily living ( World Health Organization, 2017 ).…”

“…Firstly, the pension grant of R1860 per month (approximately £89/month), only received by those who are eligible ( South African Government, 2020 ), is insufficient to support a basic living standard. The situation is complicated further as it is widely observed that older people frequently share pensions with household members, and that this arrangement is not always consensual ( Lloyd-Sherlock, 2018 ). Similarly to other parts of the world the basic pension allowance in South Africa only covers a fraction of the cost of residential nursing care ( Ranchod, Childs, Abraham, & Taylor, 2015 ).…”

“…Similarly to other parts of the world the basic pension allowance in South Africa only covers a fraction of the cost of residential nursing care ( Ranchod, Childs, Abraham, & Taylor, 2015 ). As a result, charitable and government nursing homes, historically the main providers of care home services in South Africa, are subsidised to cover the costs for the poor: the total cost of this scheme in 2014 being £50 million ( Lloyd-Sherlock, 2018 ). Despite the limited available data in South Africa, concerns have been raised about the economic viability of services provided by nursing homes; treatment of residents and the growing number of informal unregistered nursing homes across the country, limited state oversight of the situation, and the additional resultant strain this places on the workforce ( Lloyd-Sherlock, 2018 , van Biljon and Roos, 2015 ).…”

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“…South Africa has the second largest economy in Africa [7] and a predominantly black population with increasing life expectancy [8]. e country has a dynamic academic and healthcare environment and the skills and infrastructure to conduct world-class scholarly activities and provide modern healthcare services.…”

Evaluating the quality of long-term care services in the city of La Plata, Argentina

“…The few studies of LTC service quality in LMICs reveal widespread quality shortcomings and limited state regulation (Gutiérrez-Robledo et al, 1996;Giacomin and Camargos Couto, 2010;Cheung Wong and Leung 2012;Lloyd-Sherlock, 2018). For example, a review of care homes in Brazil found that around 40 per cent of residents had pressure ulcers: considerably higher than acceptable standards in highincome countries (Souza and Santos, 2007).…”