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2016 Conference Presentation

(Inter)national systems South Africa

7 September 2016

The future of long term care for vulnerable older adults in South Africa

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


Background: The number of care-dependent older adults in Sub-Saharan Africa is expected to rise dramatically over the next 30 years. In countries with limited private or public sector provision of long term care this will place growing pressure on families. However there are already profound inadequacies in familial care provision due to major economic, mental and physical caregiver strain. Subsequently, ageing has been identified as a significant risk to development by governments across Africa. While policy makers continue to look to families as the primary providers of care for older adults, more attention is being paid to new alternatives of care, including formal, non-familial long term care providers, facilities and services. This attention is not all positive however, with key stakeholders (albeit excluding older adults) raising both economic and cultural challenges to non-familial care models. The paper presents work from a broader project exploring how formal provision of long-term care for vulnerable adults aged 50+ can be reconciled with informal provision in order to plan interventions that can meet the care needs of growing populations of older adults in Africa.

Data: The paper focuses on experiences in South Africa, where social, demographic and health changes mean that population ageing and increase in the size of the older population are significant, some older adults are especially vulnerable to unmet needs for long term familial care, and an expansive range of formal care is available (for some). This case study provides an in-depth examination of older and younger adults’ and organisational stakeholders’ attitudes to, and experiences of, care in older age.

Objective: The objective of this paper is to establish a nuanced understanding of perceptions about providing formal and informal care for older adults and the challenges of providing formal care to older adults. It will do this by seeking to understand what older adults in need of long-term care themselves feel about informal and formal provision and whether informal carers and potential informal careers would welcome formal support.

Methods: Fieldwork will be carried out in contrasting Gauteng and KwaZulu-Natal provinces. In each setting data will be generated using repeated in-depth qualitative interviews with:

• older adults receiving formal care (residential care, day care and home-based care) (n~30);
• older adults with functional limitations receiving familial care only (n~30);
• older adults with functional limitations not receiving any care (n~30);
• younger and older adults providing care to older adults (n~30);

Constructivist grounded theory will be used to generate and analyse data simultaneously.

Results: Fieldwork, incorporating preliminary descriptive results, is planned for July-August 2016. A full paper based on these findings will be ready for submission by September 2016.

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