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

Published online by Cambridge University Press:  28 May 2018

PETER LLOYD-SHERLOCK
PETER LLOYD-SHERLOCK*
Affiliation:
School of International Development, University of East Anglia, Norwich, NR4 7TJ, UK email: p.lloyd-sherlock@uea.ac.uk
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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.

Type
Article
Information
Journal of Social Policy , Volume 48 , Issue 1 , January 2019 , pp. 147 - 167
Copyright
Copyright © Cambridge University Press 2018 

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References

Aboderin, I. (2004), ‘Intergenerational family support and old age economic security in Ghana’. In: Lloyd-Sherlock, P. (Ed.) Living longer: Ageing, development and social protection. London: Zed Books/United Nations Research Institute for Social Development.Google Scholar
Alzheimer's Disease International (ADI) (2015), World Alzheimer's report 2015. The global impact of dementia. https://www.alz.co.uk/research/WorldAlzheimerReport2015.pdfGoogle Scholar
Ardington, C., Case, A., Islam, M., Lam, D., Leibbrandt, M., Menendez, A. and Olgiati, Analia (2010), ‘The Impact of AIDS on Intergenerational Support in South Africa: Evidence From the Cape Area Panel Study’ Research on Aging, 32, 1, 97–121.Google Scholar
Bigala, P. and Ayiga, N. (2014), ‘Prevalence and predictors of elder abuse in Mafikeng Local Municipality in South Africa’. African Population Studies, 28, 1, 463–474.Google Scholar
Bowen, P. (2009), Childhood socioeconomic status and racial differences in disability: evidence from the Health and Retirement Study (1998-2006), Social Science and Medicine, 69 (3): 433–41.Google Scholar
Brijnath, B. (2012), ‘Why does institutionalised care not appeal to Indian families? Legislative and social answers from urban India’ Ageing and Society 32, 4, 697–717.Google Scholar
Burman, S. (1996), ‘Intergenerational family care: legacy of the past, implications for the future’ Journal of Southern African Studies 22, 4, 585–598.Google Scholar
Calò, L., Caielli, P., Maiolino, G. and Rossi, G. (2013), ‘Arterial hypertension and cardiovascular risk in HIV-infected patients’ Journal of Cardiovascular Medicine 14, 8, 553–558.Google Scholar
Camarano, A., Kanso, S., Leitão e Mello, J., and Fernandes Carvalho, D. (2010), ‘As instituições de longa permanência para idosos no Brasil’ [Long-term care facilities for the elderly in Brazil]. In Camarano, A. (Ed.) Cuidados de longa duração para a população idosa: Um novo risco social a ser assumido? [Long-term care for the elderly population: A new social risk to be faced?] Rio de Janeiro: IPEA (Instituto de Pesquisa Econômica Aplicada/Institute for Applied Economic Research).Google Scholar
Chabeli, M. (2003), ‘Health care needs of older people living permanently in a residential home setting in Gauteng’ Curationis, 26, 4, 14–21.Google Scholar
Cheung Wong, Y. and Leung, J. (2012), ‘Long-term care in China: Issues and prospects’ Journal of Gerontological Social Work, 55, 7, 570–86.Google Scholar
Chimere-Dan, O. (1993), ‘Population policy in South Africa’ Studies in Family Planning 24, 1, 31–39.Google Scholar
de Jager, C., Joska, J., Hoffman, M., Borochowitz, K. and Combrinck, M. (2015), ‘Dementia in rural South Africa: A pressing need for epidemiological studies’ South African Medical Journal 105, 3, 189–90.Google Scholar
Department of Social Development, Government of South Africa (2005), South African policy for older persons. http://gapdesign.co.za/hosting/sa.../HSD-SA-POLICY-FOR-OLDER-PERSONS-2_.docGoogle Scholar
Department of Social Development, Government of South Africa (2010), Audit of residential facilities. Final report. http://social.un.org/ageing-working-group/documents/FINAL%20REPORT%20DSD%20Audit%20of%20Residential%20Facilities%20April2010.pdfGoogle Scholar
Department of Social Development, Government of South Africa (2012), Strategic Plan 2012–2015. http://www.dsd.gov.za/index.php?option=com_frontpage&Itemid=1Google Scholar
Duflo, E. (2003), ‘Grandmothers and Granddaughters: Old-Age Pension and Intra-Household Allocation in South Africa.’ World Bank Economic Review, 17, no. 1 (2003): 1–25.Google Scholar
Feinstein, C. (2005), An economic history of South Africa. Conquest, discrimination and development. Cambridge University Press, Cambridge.Google Scholar
Fish, J. (2006), ‘Engendering democracy: Domestic labour and coalition-building in South Africa’. Journal of Southern African Studies, 32, 1, 107–127.Google Scholar
Giraldo-Rodríguez, L., Rosas-Carrasco, O. and Mino-León, D. (2015), Abuse in Mexican Older Adults with Long-Term Disability: National Prevalence and Associated Factors. Journal of the American Geriatrics Society 63 (8):1594–600.Google Scholar
Gradín, C. (2013), ‘Race, poverty and deprivation in South Africa’ Journal of African Economies, 22, 2, 187–238.Google Scholar
Harttgen, K. et al. (2013), ‘Patterns of frailty in older adults: comparing results from higher and lower income countries using the Survey of Health, Ageing and Retirement in Europe (SHARE) and the Study on Global AGEing and Adult Health (SAGE)’ PLoS One 8, 10, e75847.Google Scholar
Hamoudi, E. and Duncan, I. (2014), ‘Endogenous coresidence and program incidence: South Africa's Old Age Pension’, Journal of Development Economics, 109, 1, 30–37.Google Scholar
He, W., Muencrath, M. and Kowal, P. (2012), Shades of gray: a cross-country study of health and wellbeing of older populations in SAGE countries, 2007–2010. United States Census Bureau, Washington DC.Google Scholar
HelpAge International (2003), ‘Forgotten families. Older people as carers of orphans and vulnerable children’, Help Age International, London http://www.helpage.org/Worldwide/Africa/Resources?autocreate_RelatedHelpagePublicationList_start=21Google Scholar
HelpAge International (2005), ‘A better deal for older carers in South Africa’, HelpAge International, London. http://www.helpage.org/Researchandpolicy/HIVAIDS/ResourcesGoogle Scholar
Kimuna, S. and Makiwane, M. (2007), ‘Older People as Resources in South Africa: Mpumalanga Households’. Journal of Aging and Social Policy, 19, 1, 97–114.Google Scholar
Kinsella, K. and Ferreira, M. (1997), Aging trends; South Africa. US Bureau of the Census, Center for International Research.Google Scholar
Lloyd-Sherlock, P. (2016), ‘Barriers to linking research and policy: the case of long-term care in low and middle-income countries’, Population Horizons, 12, 2, 62–7.Google Scholar
Lloyd-Sherlock, P. and Barrientos, A. (2002), Non-contributory pensions and social protection. International Labour Office, Issues in Social Protection Discussion Paper 12, Geneva.Google Scholar
Lloyd-Sherlock, P., Barrientos, A., Moller, V. and Saboia, J. (2012), ‘Pensions, poverty and wellbeing in later life: comparative research from South Africa and Brazil’ Journal of Aging Studies, 26, 3, 243–252.Google Scholar
Lloyd-Sherlock, P., Ebrahim, S., Prince, M. and McKee, M. (2016), ‘Institutionally ageist? Global health policy in the 21st century’, British Medical Journal Aug 31;354:i4514.Google Scholar
Lloyd-Sherlock, P., Minicuci, N., Beard, J., Ebrahim, S. and Chatterji, S. (2014), ‘Hypertension among older adults in low and middle income countries: prevalence, awareness and control’ International Journal of Epidemiology, 14, 1, 116–128.Google Scholar
Lloyd-Sherlock, P., Penhale, N. and Redondo, N. (2018a), The admission of older people into residential care homes in Argentina: Coercion and human rights abuse. The Gerontologist (forthcoming).Google Scholar
Lloyd-Sherlock, P., Ayiga, N. and Penhale, B. (2018b), Financial abuse of older people in low and middle-income countries: the case of South Africa, Journal of Elder Abuse and Neglect (forthcoming).Google Scholar
Lund, F. and Budlender, D. (2009), Paid care providers in South Africa: nurses, domestic workers and home-based care workers. UNRISD Research Report 4 www.unrisd.org/.../$FILE/SouthAfricaRR4.pdfGoogle Scholar
Makgoba, M. (2017), The report into the ‘circumstances surrounding the deaths of mentally ill patients: Gauteng Province. No guns: 94+ silent deaths and still counting. Health Ombud, Republic of South Africa http://www.ohsc.org.za/images/documents/FINALREPORT.pdfGoogle Scholar
Malherbe, K. (2007), ‘Older Persons Act: out with the old and in with the older?’ Law, Democracy and Development, 54, 4, 53–68.Google Scholar
Maredza, M., Bertram, M. and Tollman, S. (2015), Disease burden of stroke in rural South Africa: an estimate of incidence, mortality and disability adjusted life years. BMC Neurology, 15:54.Google Scholar
Mayosi, B., Flisher, A., Lalloo, U., Sitas, F., Tollman, S. and Bradshaw, D. (2009), ‘The burden of non-communicable diseases in South Africa’, Lancet, 374, 9693, 934–47.Google Scholar
Merli, M. and Palloni, M. (2006), ‘The HIV/AIDS epidemic, kin relations, living arrangements, and the African elderly in South Africa’ in Cohen, B. and Menken, J., eds. Aging in sub-Saharan Africa: recommendations for furthering research. National Research Council. Washington D.C.Google Scholar
Mooney, G. and McIntyre, D. (2008), ‘South Africa: a 21st century apartheid in health and health care?’ The Medical Journal of Australia, 189, 11–12, 637–40.Google Scholar
National Treasury, Government of South Africa (2015), Provincial Budgets and Expenditure Review: 2010/11 - 2016/17 http://www.treasury.gov.za/publications/igfr/2015/Google Scholar
Noumbissi, A. and Zuberi, T. (2001), Household structure and aging in South Africa: a research note. http://www.pop.upenn.edu/africahh/NoubissiZuberi.pdf.Google Scholar
Nyirenda, M., Mutevedzi, P., Hosegood, V., Falkingham, J. and Newell, M. (2015), ‘Who cares? Implications of care-giving and -receiving by HIV-infected or -affected older people on functional disability and emotional wellbeing.’ Ageing and Society, 35, 1, 169–202.Google Scholar
OECD (2011), Help Wanted? Providing and Paying for Long-Term Care. http://www.oecd.org/els/health-systems/47884889.pdfGoogle Scholar
Perold, A. and Muller, M. (2000), ‘The composition of old age homes in South Africa in relation to the residents and the nursing personnel’. Curationis, 23, 1, 87–94.Google Scholar
Pfau-Effinger, B. (2012), ‘Analyses of welfare-state reform policies towards long-term senior care in a cross-European perspective’. European Journal of Ageing, 9, 2, 151–54.Google Scholar
Protasia, N. and Torkington, K. (2000), Community health needs in South Africa, Ashgate, Aldershot.Google Scholar
Robbins, R., Remien, R., Mellins, C., Joska, J. and Stein, D. (2012), ‘Screening for HIV-associated dementia in South Africa: potentials and pitfalls of task-shifting’. AIDS Patient Care and STDs, 25, 10, 587–93.Google Scholar
Sagner, A. (2000), Ageing and social policy in South Africa: Historical perspectives with particular reference to the Eastern Cape. Journal of Southern African Studies, 26, 3, 523–553.Google Scholar
Sagner, A. and Mtati, R. (1999), ‘The politics of pension sharing in urban South Africa’ Ageing and Society, 19, 4, 393–416.Google Scholar
Sasat, S., Choowattanapakorn, T., Pukdeeprom, T., Lertrat, P. and Aroonsang, P. (2013), ‘Long-term care institutions in Thailand’, Journal of Health Research, 27, 6, 413–8.Google Scholar
Schatz, E. (2007), ‘“Taking care of my own blood’’: Older women's relationships to their households in rural South Africa’ Scandinavian Journal of Public Health 35, 69, 147–54.Google Scholar
Schatz, E. and Gilbert, L. (2014), ‘“My Legs Affect Me a Lot. . . . I Can No Longer Walk to the Forest to Fetch Firewood”: Challenges Related to Health and the Performance of Daily Tasks for Older Women in a High HIV Context’, Health Care for Women International, 35, 7–9, 771–788.Google Scholar
Schatz, E. and Seeley, J. (2015), ‘Gender, ageing and carework in East and Southern Africa: A review’, Global Public Health, 10, 10, 1185–1200.Google Scholar
Schatz, E., Madhavan, S., Collinson, M., Gómez-Olivé, F. and Margaret Ralston, M. (2015), ‘Dependent or Productive? A New Approach to Understanding the Social Positioning of Older South Africans through Living Arrangements.’ Research on Aging, 37 (6),: 581–605.Google Scholar
Schatz, E., Seeley, J., Negin, J. and Mugisha, J (2017), ‘They “Don't Cure Old Age”: Older Ugandans’ Delays to Health-Care Access.’ Ageing & Society, published online: https://doi.org/10.1017/S0144686X17000502Google Scholar
Seedat, E. (1984), Crippling a nation. Health in apartheid South Africa. London. International Defence and Aid Fund for Southern Africa.Google Scholar
Shisana, O., Rehle, T., Simbayi, L. C., Zuma, K., Jooste, S., Zungu, N., Labadarius, D. and Onoya, D. (2014), South African National HIV Prevalence, Incidence and Behaviour Survey, 2012, Cape Town, HSRC Press. http://www.hsrc.ac.za/uploads/pageContent/4565/SABSSM%20IV%20LEO%20final.pdfGoogle Scholar
Sinunu, M., Yount, K. and El Afify, N. (2009), ‘Informal and formal long-term care for frail older adults in Cairo, Egypt: Family caregiving decisions in a context of social change’, Journal of Cross-cultural Gerontology, 24, 1, 63–76.Google Scholar
South African Human Rights Commission (SAHRC), (2010), Investigative hearing into systemic complaints relating to the treatment of older persons. www.sahrc.org.za/home/21/files/SAHRC%20Investigative%20hearing%20report.pdfGoogle Scholar
Statistics South Africa (2014), Census 2011: Profile of older persons in South Africa. Pretoria. http://www.statssa.gov.za/publications/Report-03-01-60/Report-03-01-602011.pdfGoogle Scholar
UNAIDS (2006), Report on the global AIDS epidemic UNAIDS, New York.Google Scholar
UN Population Division World Population Prospects. The 2015 revision. http://esa.un.org/unpd/wpp/DVD/Google Scholar
UN Women (2017), Long-term care for older people: A new global gender priority. http://www.unwomen.org/en/digital-library/publications/2017/12/long-term-care-for-older-people#viewGoogle Scholar
van Pletzen, E. (2014), ‘The Size, Characteristics and Partnership Networks of the Health-Related Non-profit Sector in Three Regions of South Africa: Implications of Changing Primary Health Care Policy for Community-Based Care’ Health Policy and Planning 29, 6, 742–752.Google Scholar
WHO (2015), The World Health Organisation report on ageing and health, WHO, Geneva.Google Scholar