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9 September 2022

The search for freedom: reflecting on inequity and the “acceptability’ of formal long term care to older women in Soweto, South Africa

Emily Freeman , London School of Economics and Political Science , United Kingdom

Abstract

South Africa's post-Apartheid policy changes included a roll-back of State responsibility for long term care in older age, described as being "inappropriate". Today the normative bottom line remains that filial obligation and intergenerational solidarity will and should underpin the nation's response to caring for older people in need, with subsidised formal provision - whether from State or civil society - relevant only for the destitute. This paper presents a Critical Discourse Analysis (CDA) of two focus groups with later-middle aged (60s and 70s) Black women in Soweto, South Africa, discussing what older adults and their families consider "appropriate" care for those with long term care needs. We identified an overall discourse of transition that was contextualised by experiences extremely high youth unemployment, the availability of the Older Persons Grant but absence of job-seeker welfare, high mortality, an emerging middle class, availability of formal long-term care for wealthy South Africans, and a lifelong emphasis on the value of freedom and possibility for self-actualisation for Black South Africans post-Apartheid.

Narratives about care practices and expectations centred on the processes in which some women become - or might become - active agents in the organisation of their own biographies, rather than playing out the caregiver roles dictated to them by institutions. A macro-discourse of oppression was central to their positioning of the *question* of care. In the discussions, participants pushed against the normative assumption of their caregiving labour, both upwards through the generations in the provision of instrumental care for dependent older family members and downwards in the continued care for children and grandchildren. Formal care for older people in this view becomes an attractive option not only for family members reluctant to sacrifice their life to care for an older person with high dependency, but also for older people who have limited functional disability who are called upon to care for children and grandchildren. A range of residential care services for older adults are presented as enabling older adults to finally live a life of their own' away from family care responsibilities. The paper will reflect on the stark care inequalities highlighted by the analysis. Given the poor provision of accessible formal care, the desire for a life of one's own voiced by participants is likely to leave those called upon to care ultimately disappointed and frustrated, or older people with functional limitations without needed care.

Slides


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