Little action from government to help older people live healthier, happier lives

More than two years into the United Nations Decade of Healthy Ageing, the South African government has yet to finalise its action plan on how to help older people live healthier and happier lives.

• According to StatsSA, South Africa has five million people older than 60. Many of them face discrimination, abuse and neglect.
• The South African government has yet to create the Healthy Ageing plan it signed up for as part of a United Nations initiative.
• Government has no structured approach to combat ageism, create age-friendly environments, and provide integrated and long-term care for older people.

South Africa is a signatory to the Decade of Healthy Ageing (spanning from 2021 to 2030) that aims to bring member countries together to meet the needs of older people.

It follows the concept of “active ageing”, which emphasises the need for opportunities for older people to enjoy healthcare and participate in society. Active ageing has been embraced by the World Health Organisation and other global healthcare bodies. 

“Our seniors are going through a lot,” says Buhle Maseko-MacArthur, an occupational therapist at the non-profit organisation Grannies Against Poverty and AIDS (GAPA), based in Khayelitsha.

“They are often the ones picking up the slack and filling gaps in social support mechanisms. They are at the coalface of many of our social ills,” says Maseko-MacArthur.

Older people take on childcare duties at home and they often have to use their old age grant to support the household.

“They often feel invisible,” says Maseko-MacArthur. “They won’t call it depression or anxiety, but when they say how they’re feeling, you realise that they are really struggling with their mental health.”

GAPA and other non-profit organisations, such as Ikamva Labantu, have created clubs that promote active ageing, yet there is little support from the government for older people to overcome the significant challenges they face at home.

Eleanor Plaatjie has lived in Khayelitsha since 1986. When she turned 60, she was forced to retire as a domestic worker. Her employers said that they feel uncomfortable making an old woman work. But Plaatjie says she was still able and willing to work. Her household of seven people now depends on her old age grant.

Plaatjie says she has no backup plan for when she grows older and can no longer care for herself, and she doubts her family members will be able to support her.

“I hope I do not become so old and frail,” she says.

What a Healthy Ageing plan could look like

The United Nations Decade of Healthy Ageing has four pillars: combatting ageism, creating age-friendly environments, providing integrated care, and ensuring access to long-term care.

Spokesperson for the National Department of Health Foster Mohale told GroundUp that the department is in the process of “reviewing, revising, and creating a policy framework” to address the four pillars. He did not provide a timeframe for when this would be finalised.

Femada Shamam, CEO of The Association of the Aged (TAFTA), which offers support services and accommodation for older people in KwaZulu-Natal, says that there is a dire need for a coordinated effort by the government to address the needs of older people in the country.

Government policies in South Africa have not taken into account the rising proportion of people over the age of 60, Shamam says. According to recent StatsSA estimates, five million people in South Africa are over the age of 60; an increase of 900,000 since 2011.

Older people in South Africa face discrimination on various levels, says Shamam.

“It’s fascinating that once you reach 60, people assume you become stupid and invisible,” she says. “We need to create an environment where we can have dialogues about ageism and challenge it. Otherwise, it becomes fertile ground for human rights abuses.”

TAFTA launched an elder abuse hotline in 2022, and it has received hundreds of reports of older people being abused by their family members. This includes physical, emotional and financial abuse.

The general attitude in South African society towards older people is reflected in government policy and an apathetic approach toward service provision for older people, says Shamam.

“Older people are not safe in their homes,” says Elda Sidlabane, a field worker at GAPA. “They are facing challenges from their grandchildren and children. They will leave the granny at home for a whole month, coming home only to rob them of their grants.”

Shaman says that it is also difficult to find decent, suitable accommodation that is affordable on an old age grant. She suggests that municipalities consider concessions on utilities and rates for older people and extend these concessions to organisations supporting and housing older people.

Efforts also have to be made to create age-friendly environments, says Shamam. For example, older people often struggle to use transport services, especially if they use wheelchairs. There is a global network of cities committed to becoming age-friendly, but no South African city is part of it.

Integrated healthcare is among the most pressing needs for older people. Older people often have several health issues, yet health services are not packaged in a suitable way. They will have to spend their days standing in different queues at different facilities to access the services, says Shamam.

For instance, Plaatjie says that in order to collect her hypertension and cholesterol medication from the clinic in Khayelitsha, she needs to wake up at 4am in the morning and will only leave the clinic by 4pm. Older people spend their days in clinic queues without even eating, she says.

Sidlabane had a cataract operation several months ago and needs specialist dark glasses to protect her eyes. But she could not get these glasses at Tygerberg Hospital, where she had the surgery. She had to get them from the clinic. Yet months later, the clinic still has not been able to give her the glasses.

“The system is not sensitive to the needs of the older person,” says Shamam. A hospital should be able to provide a comprehensive assessment and a basket of services to older people, she says.

Furthermore, age-specific conditions, like dementia, often go undiagnosed.

Long-term care is also neglected, says Shamam. The Older Persons Act of 2006, which was implemented in 2010, talks about training for caregivers to work with older people, but 13 years later no structured training programme exists.

TAFTA is subsidised by the Department of Social Development for some of the services it provides, but the subsidies are woefully inadequate to provide the services.

It is important that as far as possible, long-term care is provided in communities as well as in facilities and institutions, says Shamam. But there is little structured support for in-community, long-term care, she says.

“The government is not helping us enough,” says Sidlabane. “There should be people who are trained to look after the grannies and help those who have problems in their home. There are very few social workers who you can report to. You’ll see the social worker once and you won’t see them again. Some of them are afraid to come to the townships because of crime.”

Published originally on Groundup | By Daniel Steyn