The changing needs of older people

Older Peoples CareOlder People

A South African Experience

by Val Kadalie.

‘In an African setting it is quite unusual to have a home for the elderly.’ While this is very true in the rest of Africa, the South African situation has many differences concerning the care of older people.

Historical perspective

South Africa is a young and rapidly changing democracy. Before 1994 there were huge inequalities in every area of life among our different population groups. Living arrangements vary widely for older South Africans. One of the main differences is that among wealthy groups, older people prefer to live independently while poorer families tend to have several generations living together.

Apartheid policies have left a legacy of great inequality, although things are slowly improving. Some examples of this inequality are:

  • Before 1994, the government provided little in the way of either funding for residential care or pensions to elderly black people. Many older black people lived in great poverty, and this often continues today.
  • Over twenty times (10.5%) as many older white people live in residential care as elderly blacks (0.5%), (though many would say that this reflects poorly on white society).
  • South Africa has no compulsory pension system. Few older black people receive a pension, though the majority of white people do. For those without a pension on retirement, the State provides a social grant provided the person passes a means test. Most older South Africans, of whom 90% are black, depend on this grant of about US $80 per month.
  • Black pensioners often support unemployed family members and grandchildren. It is not unusual to find 7–9 persons dependent on an old person’s monthly State grant.
  • In traditional society, children are the most important source of support for their elders, with 90% of older black people living with children.

Looking ahead

The problem of poverty in old age is a very real one. The South African economy will not be able to support increasing numbers of older people, so the priority will be the very poorest. Many others are at risk of falling through the safety net.

The number of older persons is likely to increase from the present 2 million to over 3 million over the next twelve years, with the most rapid increase being of females, 85 years and older.

Traditional family care networks facing the strain of rapid urbanisation and post-apartheid challenges are often under immense strain. They may have few, if any, resources to help provide special care for older people, particularly the very frail or demented.

However, only 5% of all older persons are seriously ill or very frail. Old people make up a huge pool of potential which is little used in our country.

Light, colour, noise

The GH Starck Centre in Cape Town opened its doors in 1982 as a miracle of answered prayers against the above background and the effects of forced removals of whole communities under the Group Areas Act. It was made possible by the foresight and generosity of the late George Henry Starck, originally from the UK, but who had settled in South Africa.

We are registered for 52 resident older persons. We run on a family system with residents in family units with about ten people in each. Each family unit has a housemother who lives with them and is responsible for them. Housemothers are ordinary people from the community who are trained here in all aspects of caring for older people. Medical care is the responsibility of trained nursing staff.

Our centre is welcoming and full of light, colour, noise and choices. Old age homes can easily become isolated from the community. However, we believe that our residents must never become passive recipients of care but should be informed and involved in community issues.

Choices

We have begun many events which have brought great joy and excitement into the lives of many hundreds of older people, both here and in other centres.

Annual Olympiatrics This combines the words ‘olympics’ and ‘geriatrics’ and is a fun sports day for people aged 60 years and over. Events range from a spectacular march, fun races and relay sprints involving 45–50 teams of elders from various old age homes and clubs. Special events for the very frail run alongside track events for the more able aged.

As a result of this event, the government has now set up a national programme of sport and recreation for older people.

Holiday exchanges During this annual event we literally swap beds with residents in other old age homes for twelve days. This has been a wonderful way to expose rural elderly to life in the city and vice versa. It has led to deep friendships and resulted in three marriages over the years!

Usually about 80–90 older people take part each year. Each home commits itself to providing a full programme of activities and visits to places of interest, both for their own residents and their visiting guests during the ‘holiday’ period.

Cooking competition Older people in homes are rarely able to continue traditional cooking skills, so we challenge other old age homes to a cooking competition each year. Residents are invited to provide favourite recipes of dishes they used to prepare for their families. Twelve of these are then selected by a cookery expert. The competition takes place before a panel of judges. We finish by eating the dishes prepared by our old residents. These are of a very high standard. A popular family magazine publishes these recipes.

Church-related activities Our old age home is a ‘church home’ to many in our community. A Sunday School serves the children, while youth meetings, Bible study/prayer groups, drug counselling and meetings for women all draw the community into our home constantly. This prevents isolation from the wider community.

Community care workers We have trained a group of people from the community to help us with caring for older people living at home, those recovering from strokes and as extra help for our own staff at our centre. This community work is mostly voluntary, though we do pay for the times when they work here. We provide the professional support, supervision, practical resources and ongoing training that they need.

Stroke rehabilitation The nearby hospital is understaffed and under great pressure. They are unable to provide adequate healthcare for our older people.

Because of this, we run a very happy and active stroke club. About 40–45 people who have survived a stroke come each week. Most are older people but, because of the need, we also take younger people with strokes. We raise our own funding to provide trained therapists. The club is largely staffed with volunteers who are God’s gift to us.

Day and respite care We provide day care for older people so that their carers at home can continue working to support their families. In addition, respite care for weekends or up to four weeks is available to provide times of rest for carers who may often be elderly themselves.

Social responsibility projects Housemothers encourage their ‘families’ to work together to raise funds during the year for charities of their choice. This helps to remind residents that they are still of value in their old age. It gives them a great sense of self worth to contribute to the lives of others.

HIV/AIDS Our old age home is also a resource for people with HIV/AIDS. Emergency relief care is provided for those in desperate need while alternative care is found. We have had the privilege to minister in a practical way to many adults and children.

Activities with children Some local schools have adopted our centre. We have a collection of very old objects and crafts which prompt fascinating discussion with the children about life, times and methods in years gone by. Children are also very involved in activities like our Olympiatrics, both as volunteers and as team supporters.

Further life and learning

We recognise the importance of helping older people to stay with their own families and communities for as long as possible, but the reality of life in our country today is that support services are just not there for the great majority of our old people. Though the generosity of GH Starck in setting up this home may not be available elsewhere, the attitudes and activities can certainly be repeated anywhere.

It is our conviction that Christ promises abundant life even into advanced old age. When admission to our home becomes necessary for any older person, we want that time not to be one of despair and hopelessness but a positive opportunity for continued choices, life and learning.

Val Kadalie is a highly qualified geriatric nurse who has been Matron of the GH Starck Centre for the Cape Town City Mission for 17 years. PO Box 36091, Glosderry 7702, South Africa.