Outline Background −Emerging research debate on long-term care in SSA Realities of care...
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Transcript of Outline Background −Emerging research debate on long-term care in SSA Realities of care...
![Page 1: Outline Background −Emerging research debate on long-term care in SSA Realities of care −‘Informal’ family care −Formal care Dominant policy discourses.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649ed05503460f94bdecc2/html5/thumbnails/1.jpg)
Outline
• Background−Emerging research debate on long-term care in SSA• Realities of care−‘Informal’ family care−Formal care• Dominant policy discourses• Human rights implications
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BACKGROUND
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Emerging research focus on long-term care for older persons in SSA
• Small, but rising number of studies on aspects of long-term care for dependent older people
• Within context of intensifying research debate on ageing in SSA, and evidence of:
−Substantial prevalence of NCD, functional impairment high level of care need (on a par with ‘North’)
−Rapid social change: urbanization, globalization
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Emerging research focus on long-term care for older persons in SSA
• Informal care
−Pathways to care
−Care arrangements, patterns, content
−Adequacy of care
− Impacts on caregiver and recipient
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Emerging research focus on long-term care for older persons in SSA
• Formal care (institutional, community-, home-based)
−Contexts of, pathways to care
−Well-being of care-recipients
−Practice focused: toward improving quality
• Mainly in SA (only SSA country with substantial, long established formal care sector)
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REALITIES OF LONG-TERM CARE
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Family care: patterns, arrangements
• Long-term care overwhelmingly provided by families:
−Close kin, mainly women
−Substantial share of carers are old themselves
−Role of young grandchildren
• Rationales:
− Long-term reciprocity
−Exchange (incl. for material benefit)
−Necessity (lack of alternative), beneficence
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Family care: adequacy
Substantial unmet need and care inadequacies esp. in contexts of poverty:
• Large % lacks a carer (20% Nigeria; KZN, South Africa)
• Severely compromised care quality:
−Family carers lack skills, financial resources, time
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“Mama is not recovering well from the stroke. I know that there are ways of rubbing mama’s affected areas on her body that can improve her condition, but I don’t know how to do it and I don’t have the money to take her to the hospital for them to do it there”
“The care I give mama is not fully adequate. But I cannot devote all my time to her. I also have my life to live. If I don’t look after my shop how can I make progress in life?...”
“Mama needs more attention than I can give. I take care of my little children, myself and my husband… By the time I do all my household chores and I am tired, there is little or no strength in me to clean mama’s room thoroughly” (Voices of carers, Nigeria)
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Family care: impacts
• On carer:
−Stress, lost economic opportunities, sense of entrapment
• On care recipient:
−Basic care needs not met
− Loss of dignity
−Compromised autonomy and independence
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“….When she is at her shop I do not have company. And I might need help with going to the toilet but…I have to endure the situation until she comes back. Sometimes I would have started urinating on myself before I get help to go to the toilet” (Care-recipient, Nigeria)
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“Look at me, I have always been a clean person, but look at the filthy surrounding in which I sit and sleep. Can you perceive the odour of urine? It’s because my daughter-in-law last washed the bed sheets a few days ago. This makes me feel very bad” (Care-recipient, Nigeria)
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“It is when it is convenient for her that she does things for me... My niece determines too many things about me..In my own house I cannot determine what I eat. I feel sad because decisions on my food and on when I have my bath are taken for me. Even when I can have my meal is determined by others” (Care-recipient, Nigeria)
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Family care inadequacies and detrimental impacts
• Arise within contexts of:
– Low, insecure incomes– Low education, lack of access to information and training– Inadequate housing– Lack/high costs of basic amenities (water, electricity,
sanitation)– Poor, costly basic services (transport, health, education)
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Formal care: patterns, arrangements
• Clearly emerging need/demand for formal care services
• Considerable ‘organic’ expansion of such services:
−Private for profit: emerging ‘industry’ (home based/residential)
−Charitable (institutional or community based)
−E.g.Kenya: 16 residential facilities (most founded post 2000)
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Formal care: adequacy
• Strong indications of compromised care quality in residential care facilities:
−Poor infrastructure−Poor amenities (sanitation, water, electricity, transport)− Lack of relevant care skills, expertise among staff− Limited number of personnel− Lack of essential supplies (nutrition, diapers)
• Above all: lack of coordination and regulatory oversight
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DOMINANT POLICY DISCOURSES
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Long-term care in SSA policy frameworks and debate
• Recent growth in:−Number of national, regional policy frameworks on ageing−Policy and public debate
• Care seen as ‘family issue’ and responsibility• Key concerns:−Encouraging, supporting families to (re-) embrace their
‘traditional’ care role in the face of social change −Discouraging formal, esp. institutional care provision
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Long-term care in SSA policy frameworks and debate
“We [should] delete the idea of establishing residential homes [for the elderly]. That is ‘un-African’ and it goes against our culture..”(Senate debate March 2014, Kenya)
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Long-term care in SSA policy frameworks and debate
• AU Plan of Action on Ageing urges Member States to:
−Enact legal provisions that promote and strengthen the role of family and community in the care of older people
− Learn from traditional family values and norms to inform legislation about…care of older persons
−Discourage the institutionalization of older people and retain the cultural respect for older people
• Echoed in national ageing policies (exception SA)
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Long-term care in SSA policy frameworks and debate
Major gaps:
• No recognition of present realities of care:
−Scope, gravity of inadequacies and detrimental impacts on family care-recipients and –givers
−Real, growing need/demand for, and growth of, formal care services
−Apparent inadequacies in formal care provision
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HUMAN RIGHTSIMPLICATIONS
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Four key implications
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1. Human rights violations
• Present informal and formal long-term care arrangements in SSA, esp. in contexts of poverty and broad capacity gaps, entail violations of a spectrum of older people’s rights:
−To dignity
−To independent living and autonomy
−To self-fulfillment
−To participation
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2. Lacking recognition of long-term care as human rights issue in SSA policy discourse
• Dominant policy frameworks/debate do not recognise long-term care as a rights issue that State has obligation to address
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3. Circumscribed stipulations on long-term care in SSA human rights frameworks
• Extant national (e.g. Constitutions) and regional (Draft AU Protocol) human rights instruments do address care – but only in circumscribed terms
• Do not capture:
−Plurality of rights to be safeguarded in relation to care at family and formal levels
−Explicit need for State oversight and regulation
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“The state shall take measures to ensure the rights of older persons are recognised to… receive reasonable care and assistance from their families and the State “(Article 57; Constitution of Kenya)
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State Parties shall:
• ‘Identify, promote and strengthen traditional support systems...to enhance the ability of families and communities to care for older family members’
• ‘Enact or review legislation that ensures that residential care is optional for older persons’
• ‘Ensure older persons in residential care facilities are provided with care that meets national minimum standards’
(Draft AU Protocol on the Rights of Older Persons in Africa, articles 11, 12)
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4. Need for long-term care element in new legal international instrument
• Need for explicit element on older persons’ rights in relation to long-term care as part of new legal international instrument, to:
−Augment, complement extant national and regional human rights instruments in SSA
−Help promote recognition of care as rights issue in SSA policy frameworks and debates
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4. Need for long-term care element in new legal international instrument
• AU Member States, in their Africa Common Position on the Rights of Older Persons (2013) explicitly call for the development of a new legal international instrument
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THANK YOU