What can we conclude then from this lengthy discussion of ageing in South Africa? The data is starting to tell an important story. While the attention of policymakers is focused on the issues of our youth and unemployment, demographic changes – specifically increasing longevity and urban migration – are placing an increasing strain on our assumptions that a culture of reciprocity will mean that families will take care of their elders. The title of one study on this phenomenon says it all: Who will take care of the caregivers? What will happen in the absence of a policy focus? The biggest issues lie not with ‘who’ and ‘how’ but rather with ‘what funding’ and ‘if funding exists, who ensures that it is properly administered?’
Potentially the answer may lie with the private sector, or with a hybrid for-profit/notfor- profit model. Probably one of the most successful models for funding long-term care solutions for both those who can pay and those who can’t is the Rand Aid Association, a non-profit organisation that addresses the needs of both older people who can pay for long-term care facilities and those who can’t. Two elements of the Rand Aid model make it stand out:
- It uses a portion of its profits from the sale of life rights retirement accommodation to fund the development and management of long-term care solutions for the aged in need, and men suffering from substance abuse. It in turn provides all the administrative and management support for both sets of solutions.
- It was the first long-term care facility in South Africa to adopt The Eden Alternative. This is a transformative model of care that advocates person-directed solutions of care as opposed to the conventional practice where the institution dictates the daily routines for an individual (see The Eden Alternative below).
Getting creative
If we really want to start thinking creatively here, then perhaps it’s time that South Africans consider a model that has already been put to good use in both Japan and Germany. Both countries experience a double whammy when it comes to providing longterm care to their ageing population. Not only are medical care and caregiving expensive, but there is a serious shortage in locally sourced caregivers. The answer for many lies in a transnational care model. For the Japanese, the Philippines plays a key role. Any number of nursing homes have been set up by Japanese and Filipino businesses to take advantage of low medical care costs, the availability of English-speaking health professionals, and an attractive setting with a desirable climate. This is simply another variation of ‘medical tourism’, a phenomenon that has already proven to be an important foreign revenue generator for South Africa.
While this certainly challenges the notion that older people would prefer to stay near their loved ones, or are unwilling to make such drastic changes late in life, in European and North American contexts, finding lower-cost alternatives for retirement is making this a ‘must-consider’ option.
Could retirement tourism work in South Africa?
Consider what the implications could be for South Africa if such a model became more fully developed:
- Policymakers could make the licensing and visa facilitation conditional on the model supporting the funding and coadministration of a residential model for local indigent elders.
- This would in turn provide a further source of funding and development for much-needed frail care centres for low-income South Africans.
- Training of caregivers for both facilities would be paid for and facilitated by the long-term care facility operator.
- Caregiving training and employment could be extended to currently unemployed people.
- A life rights model of residential ownership would ensure that all property ownership would remain in South African hands.
- The model would provide an attractive source of foreign revenue for South Africa.
- A franchisable model would provide another ideal opportunity to develop a niched SMME business.
What makes this model particularly attractive is that it builds on aspects of strength for South Africa:
- Our private medical care and caregiving capabilities are recognised as world-class.
- We have a large population of unemployed people who need training in skills that can’t easily be automated – ensuring sustainable job prospects. Caregiving as envisaged by such models as Eden Alternative requires high levels of compassion and emotional intelligence (EQ), something that is difficult to automate.
- The costs of such a service would be approximately a tenth of what would be available in Europe or North America.
It could work!
The Eden Alternative – a radically different approach to long-term care
The Eden Alternative is an international not-for-profit organisation dedicated to transforming care environments into habitats for human beings that promote quality of life for all involved. The brochure on The Eden Alternative uses the term ‘culture change’ to describe how the initiative is transforming our notions of long-term care globally.
Their care model advocates a shift from institutional models of care to person-directed values and practices that put the person first. This means it focuses on the unique needs, preferences and desires of each individual. Decisions and actions for care reflect the choices of the people receiving care, as opposed to standard routines designed to suit the care-giving institution. For The Eden Alternative, self-determination and purposeful living are at the heart of quality ageing. That means preserving choice, dignity and respect throughout an individual’s life is paramount. As a living environment, The Eden Alternative recognises how life-enhancing a steady flow of exposure to youth, animals, plants, the outdoors and a rich and diverse daily life can be for the elderly.
But where The Eden Alternative has had its greatest impact is in the training of the carer. The Eden Alternative model for caregiving training infuses a much-needed sense of purpose into the caregiver’s function. Here, caregivers are provided with the skills and tools to add real value to their patients’ lives. This training can be applied to caregivers servicing people in a retirement residence, the community or their homes. This makes it a model that is ideally suited to caregiver training in South Africa.
WHY WE NEED TO START PAYING ATTENTION – NOW!
Perhaps the most chilling cautionary around the issue of ageing in a world that is making extraordinary medical studies is the one Gratton and Scott pose to governments, echoed in Yuval Noah Harari’s book, Homo Deus. All of these authors see health inequality as being the biggest challenge of longevity.
For Gratton and Scott, the problem is as follows:
“Life expectancy gains are not spread equally across the population and an ever-widening gap between rich and poor is developing within countries. It is also clear that many of the options we explore to make the most of a 100-year life are most easily available to those with professional or technical backgrounds with high income. A long life requires resources, skills, flexibility, self-knowledge, planning and respectful employers. The danger is that the gift of a long life will only be open to those with the income and education to construct the changes and transitions required14.”
For Harari, inequality of health could be an even greater disruptor to social order than financial equality. Here we return to our discussion of the Fourth Industrial Revolution and remember that, in addition to robotics and artificial intelligence, this revolution incorporates biotechnological advances. Harari paints a fairly realistic picture of a future where we have so mastered the art of body-part replacement and genetic re-engineering that amortality (not quite immortality) is within reach. He argues, though, that if only the wealthiest had access to these developments, we could well see the emergence of what he terms ‘biological castes’. There would be a segment of the population that could afford upgraded bodies and access to unprecedented creativity and skill enhancements and then there would be the rest of humanity. It’s a concept that might seem extreme to contemplate – but is it entirely outside the realm of possibility?
What it does suggest is that we start paying close attention to how health, ageing and caregiving play out in South Africa, lest this climate of inequality increase further.
