Caregiving for older people perpetuates poverty and inequality in SA

Preliminary results that emanate from the novel University of Cape Town (UCT)-led Family Care of Older Persons in Southern Africa programme reveal that caregiving for older people, particularly in households dominated by women, contributes to poverty and inequality and perpetuates racial and gender inequity in South Africa.

The Family Care of Older Persons in Southern Africa programme is spearheaded by Sociology Associate Professor Elena Moore from UCT’s Department of Sociology in the Faculty of Humanities. The study seeks to explore and provide a better understanding of the meaning of family care for older people in southern Africa.

Since publishing her preliminary research findings in a policy brief titled: “Insecurity amongst female family caregivers of older persons in South Africa”, UCT News sat down with Associate Professor Moore to unpack some of the outcomes and discuss her recommendations. This leg of Moore’s research, which focused on family caregivers in Cape Town and Johannesburg, was funded by the Centre for Excellence in Human Development, and the Global Challenges Research Fund.

Niémah Davids (ND): For context, how many people over the age of 60  need care in South Africa?

Elena Moore (EM): The country is home to approximately 5.59 million people over the age of 60 … and they make up about 9% of the total population. This figure is expected to increase rapidly by 2050. And by then we’ll likely record roughly 11.5 million older people who are over the age of 60 – many of whom will be in need of care.

“People living in under-resourced communities experience greater degrees of disability.”

Estimates on the number of older persons in South Africa who need care vary. One study suggests that this number currently sits at 38% for those aged between 65 and 74, and 49% for those who are 75 years and older. Care for older people is strongly related to both age and to socio-economic status, and people living in under-resourced communities experience greater degrees of disability.

ND: How significant is the role of caregivers in South Africa?

EM: It is an essential job. By undertaking this work, caregivers allow others in the household to participate in the labour workforce. So, care work supports the country’s economy, but it also supports the health system. Carers meet the care needs of older people at home and prevent them from accessing costly institutional and medical care interventions.

ND: What are some of the key points that have emerged from this leg of your research?

“It is very important to note that the number of older people who require care in South Africa is increasing dramatically.”

EM: I think it is very important to note that the number of older people who require care in South Africa is increasing dramatically. And this, in turn, will place an unsustainable burden on overall family care, especially in homes where long-term care for older people takes place. Caring for older people also comes with many direct and indirect costs. Some of the indirect costs are not well understood, but include lost time because carers’ work often starts at the crack of dawn and continues long after dusk, as well as many missed opportunities to earn an income. What is concerning is the high expectation on women and family caregivers to care for older people without open conversations about the costs of such care for these women and their families. In South Africa black, low-income earning women are hit hardest by these costs.

ND: What does your research reveal about the role of women as caregivers?

EM: There are a few answers to this question. Let me start with the fact that women reported feeling invisible, like their work is not recognised or compensated in any way. They’re also severely depleted for a very difficult job that requires time, dedication and much effort. Women as family caregivers might be paid informally between R500 and R1 000 a month. That is far below the national minimum wage and demonstrates why some caregivers struggle financially.

Yet, even despite the financial implications associated with this work, many women choose not to walk away. Handing over their responsibilities to others is often not possible, either because they can’t afford it and/or it is their moral obligation to keep caring for the older folk, or there is no one else to do the job. Added to this, caregivers also indicated that while practising the caregiving role, their lives have come to a griding halt. Their social lives are non-existent and because of certain time limitations, they’re unable to engage in further education and training programmes. They also feel like their roles and contributions are exploited.

ND: What’s one of the most important research findings?

EM: As a result of the circumstances associated with this work, which include working long hours and not being able to financially support themselves and their families, the findings show that women as caregivers for older people directly contributes to poverty and inequality in South Africa. 

ND: What does your findings indicate about gender inequity?

EM: These findings indicate the dire economic and social consequences of overlooking the racialised, classed and gendered aspects of family care work of older persons and argues that the lack of policy in this area is a failure against government’s commitment to fight gender inequality.

ND: Based on this work and your list of findings, what do we need to do better to support both older people and their caregivers in South Africa?

EM: To start, the needs of older people and their caregivers must receive added prominence in government. In other words, our government has a much bigger role to play when it comes to supporting women caregivers who care for older people. This is critical if government wants to prepare for an ageing population and if they want to transform the gender and racialised inequalities that these women currently experience.

We need to place older people on the national agenda, [and] make their needs visible to give government a better grasp of the kind of support they and their families need. Introducing a desk at National Treasury to ensure that the needs of older people are prioritised is one way of getting us on course.

“Supporting family careworkers with a care grant similar to the existing social grant could be one way of doing it.”

I also propose that women in families like daughters, nieces and cousins who provide this care should be brought into the social grant system. Their work should be recognised. Supporting family care workers with a care grant similar to the existing social grant could be one way of doing it. The Grant in Aid – a government payment system provided to current social grant recipients who are unable to care for themselves, in order for them to pay someone to do the job – does exist, but the uptake remains low. It is not clear why, so we need to conduct more research into this issue to find out.

Finally, when it comes to policy implementation, National Treasury could support employed family caregivers by designing tax policies or family-care policies that assist employed caregivers more concretely. Extending family responsibility leave or introducing tax incentives when covering the cost of care for family members are other initiatives we can put in place to assist employed family caregivers. Government should deeply consider how caring for older people is carried out in different households. By doing so and placing it firmly on the national agenda, the insight will assist healthcare professionals, non-governmental organisations and policy makers to understand their needs in order to support them adequately.

Preliminary results from Assoc Prof Elena Moore’s second policy brief will be published in due course.