The care of older people in care home facilities remains unaffordable for most people.
Providing long-term care is a challenge to states around the world. In rich countries, supporting frail and disabled adults is a major budget item, and even then, the care provided can be inadequate.
The population profiles of poorer countries are beginning to change, with the number of old people increasing. But the response of many African governments has been to bury their heads in the sand.
Take the case of Ghana. It is one of the countries with a higher percentage of older adults on the continent, but it’s failed to pass any meaningful legislation to reflect this. A policy was drafted in 2003 and updated in 2010. But Parliament has never passed it. Even this policy does not envision what long-term care might look like. Instead, it puts the responsibility for care of chronic conditions on families.
Yet families in Ghana are struggling to manage the long-term care of their ageing and frail relatives. Those with access to remittances and members of the elite are turning to commercial care services, including home care agencies and a few nursing homes in urban areas. Like commercial care services around the world, they are luxury services which cater exclusively to the wealthy.
It does not need to be like this. I have been doing research on changes in elder care in southern Ghana for the past eight years. In my research, as I travelled around the vast metropolitan area of Accra-Tema and to the small towns of the Eastern and Volta Regions, I encountered several initiatives that seemed promising as models for providing care for older adults living with chronic conditions across the nation, to the poor and rich alike.
Why Ghana can’t get its act together
In Ghana, the care of older people in care home facilities remains unaffordable for most people. Other than faith in the power of the Ghanaian family, four other factors constrain government action in addressing long-term care.
First, politically, what drives elections in Ghana is infrastructure, like new buildings or roads. These take precedence over social welfare, like long-term care.
Secondly, the government of Ghana has been constrained by thinking that the alternative to kin care is nursing homes or care homes, which it considers the Western model for long-term care. These facilities are rightly rejected as isolating and expensive.
Nevertheless, some Ghanaians idealise care homes, considering them like the boarding schools of their youth, where they can be with their friends, enjoy free medical care, and be regularly fed. This idealisation is one sign of ageing adults’ anxiety about how their families are going to take care of them.
Three, healthcare initiatives in Ghana have been driven by donor funds and oriented towards reducing infant and maternal mortality at the expense, in my view, of ageing issues.
Finally, the focus on youth is the result of biased thinking that youth are more essential for the development of the nation than older adults. But this is narrow thinking. Older women are key childcare providers in Ghana. People are intergenerationally connected, and what affects the older generation impacts the development of the country as a whole.
Governments in Africa do not have to build and fund care homes to support long-term care. Instead, there are other models which might work better for middle-income countries like Ghana.
One possibility for long-term care which I witnessed during my research on ageing in Ghana was volunteers visiting the aged in their homes. These volunteers provided massage, physical therapy, grooming, and bathing to several hundred individuals in several Ga villages on the outskirts of Accra.
The volunteers had taken a short course in nursing assistance. They were friendly visitors, spreading encouragement and support during the thirty or so minutes they stayed in each household.
However, over the course of five years that I followed the work of these volunteers, they drifted away, because they were not paid for their work.
If the government could pay home visitors to visit older people in their homes, this would be a substantial form of support for ageing adults.
Then there are community health nurses who are attached to local clinics.
I accompanied these nurses on their visits in the town of Akropong. They seemed committed and dedicated as they visited various households, checking on the health of babies and expectant mothers. However, their focus was exclusively on pregnant women and infants. Many of the households they visited included older adults, and these older adults were often involved in providing childcare and supporting young mothers.
It would seem simple and easy to expand the mission of the community health nurses beyond maternal and child health, to include the care of older adults.
The education of community health nurses could be enhanced to include massage, physical therapy, and some basic geriatric training to help individuals and households manage chronic conditions like falls, stroke, diabetes, hypertension, and dementia. Using the community health nurses to support long-term care would instantly create a nation-wide system to help families with the care of their frail and disabled older relatives.
Families in Africa are struggling silently with long-term care, and older adults are suffering with varying degrees of neglect. The need is imperative. Governments in Africa should look at the creative initiatives that nongovernmental organisations, churches, and families are developing, to respond to the long-term care needs of their current citizens.
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