Care services for older people ‘chronically’ underfunded in SA

“A society that does not value its older people denies its roots and endangers its future. Let us strive to enhance their capacity to support themselves for as long as possible, and, when they cannot do so anymore, to care for them.” – Nelson Mandela

A research report, led by Professor Elena Moore from the University of Cape Town’s (UCT) Department of Sociology, finds that more can and should be done to support older persons in South Africa. Professor Moore is the lead of the Family Caregiving of Older Persons in Southern Africa programme.

In their latest study, Moore and Dr Gabrielle Kelly, the deputy director at the Samson Institute for Ageing Research, delve into how well the country cares for older people. The findings reveal that spending on this sector of society remains severely underfunded. Moore said spending on older persons has largely been focused on the Older Persons Grant, which provides monthly financial assistance to eligible citizens. This, she said, has overshadowed the lack of government spending on residential care and community-based services. And with the number of older persons increasing in the country (from 3.4 million in 2006 to 5.6 million in 2022), additional support is needed.

Moore and Dr Kelly’s most recent report is titled “Funding Elder Care Provision in South Africa: A Focus on Community Care Spending” and forms part of the Family Caregiving of Older Persons in Southern Africa programme. The programme aims to provide a better understanding of the meaning of family care for older people in Southern Africa.

“ Care services for older people are chronically underfunded, and, in its absence, family caregivers carry the full responsibility of providing care for elderly loved ones”

“Our research shows that spending on care service provision over time has not kept up with the increased number of older persons who need support. In addition, state spending across the country – especially spending on care provision services for our elderly – is uneven and is limited in reach,” Moore said.

Gaps with community care

What is elder care provision? Moore explained that it involves multiple ways older persons can access support. It prioritises community-based care to help older persons remain in their homes and being cared for there and is executed in partnership with community-based non-profit organisations (NPOs). Services range from government-subsidised meals to wellness clubs and full-time private nursing for those who are unable to care for themselves. However, Moore said state funding is not prioritising this level of care, despite having a clear policy on ageing. This policy, she explained, stipulates that elderly people should remain in their homes and communities and cared for there as they grow old.

“Care services for older people are chronically underfunded, and, in its absence, family caregivers carry the full responsibility of providing care for elderly loved ones, which adds to the physical and emotional toll that comes with this enormous responsibility.”

Moore said their research found that about 1.4 million older persons need community-based care.

Yet they receive very little of it because NPOs that provide these services are not adequately funded. Currently, community-based care only reaches 2% of older persons and provincial expenditure per older person grant beneficiary has dropped from approximately R535 in 2006 and 2007 to R398 in 2024 and 2025. This represents a decline of around 26%.

“Funding at both national and provincial levels has not been linked to inflation either and it has neither changed to meet the increasing number of older persons in the country,” she explained.

Provincial spending snapshot

Moore said Gauteng has recorded the highest number of older persons (approximately 1.4 million); followed by KwaZulu-Natal (KZN), with roughly 940 000 older people. In the Western Cape and Eastern Cape, the older person population sits at 770 000 in both provinces. Yet, she noted large disparities with funding allocation per province when it comes to elder care. She said the Gauteng Provincial Government spends approximately R377 million on NPO subsidies per year. In the Western Cape, the total NPO spend sits at R259.5 million, which is far higher than KZN (R181 552 000), where the population is also much larger than the Western Cape.

Sadly, she noted, spatial inequality also plays a role with accessing community-based care services. Therefore, Moore advised that careful consideration be given to where service centres are located and the number of older persons they can reach. Moore said Gauteng recorded 231 service centres that only support a fraction of its older population (20 616); the Western Cape logged 199 service centres that support 17 029 older persons. Provinces like the Eastern Cape with higher rural populations recorded more service centres (480), yet they serve fewer older people.

“The provincial budget is being allocated to the very poor and the very frail, rather than older persons who may have high care needs.”

That’s not all. Moore said the number of care homes per province is also unbalanced. The Western Cape has 125 care homes, which provide residential care services to 4 993 people. On the other hand, despite having the largest population of older people, Gauteng and KZN only have 73 and 37 care homes respectively. These facilities service approximately 2 940 and 2 538 older people respectively. Interestingly, she added, only the Northern Cape and North West allocate spending on home-based care (professional or personal support delivered in the older person’s own home rather than a care facility) from their total Department of Social Development budget.

“From this research, we see that the provincial budget is being allocated to the very poor and the very frail, rather than older persons who may have high care needs, but who are not eligible for a bed in assisted living or frail care facilities. What this means is that the provincial budget is skewed in favour of residential care home costs, which means there are fewer resources left for community-based services,” Moore said.

Recommendations for review

Considering the increase of older persons in the country, Moore said the financing and structure of state funding, as well as the care services the state has committed to provide must be reviewed closely. The bottom line, she added, is that NPOs need additional funding.

“We are deeply concerned with the decrease in funding at provincial level. The South African government should address the underfunding of older person care, especially the underfunding of community-based care urgently. This will dramatically improve quality of life for older persons, as well as for their caregivers,” she said.

“The current structures of community support are not recognising and responding to many older persons’ needs and their vulnerabilities.”

She also advised that the increase in funding with community-based NPO care be channelled towards home-based and respite care. This will ensure that the elderly receive the care they need and family caregivers can access a break from caring for their loved ones.

“At this stage, committing to a review of the structure of support to NPOs that can provide an added level of support at community level is vital. The current structures of community support are not recognising and responding to many older persons’ needs and their vulnerabilities. This means we are failing this vulnerable sector – and that is a grave concern,” Moore concluded.