LeadingAge Magazine · July-August 2019 • Volume 09 • Number 04

Care for older adults does not occur in a geographic vacuum, so although the issues that providers in the United States face may not be exactly the same as those in other countries, there is still much to be learned from colleagues around the globe.

The Global Ageing Network connects providers and researchers from around the world in order to share information and collaborate with one another. In this spirit of teamwork, we interviewed a few aged-care leaders abroad—most of them Global Ageing Network board members—to get an idea of the services they provide and what the aging care landscape looks like in their countries.

Femada Shamam, CEO at The Association For The Aged (TAFTA) in South Africa

LeadingAge: What does your organization do? Who do you serve and what services do you offer?

Shamam photo
Femada Shamam

Femada Shamam: The Association For The Aged is a nonprofit organization operating in Durban. The organization was started by a group of volunteers in 1958, who were driven by the purpose of making dignity, growth, and a meaningful life for all elders a realistic prospect. The organization currently supports elders both in the community as well as within its 14 [communities], which house 1,900 people.

The basket of services includes accommodation at all levels (independent and assisted living, as well as long-term care), access to social work services, community clubs and wellness centers, aging in place services (meals on wheels, home-based care, maintenance, and other “fix-it” services), educational and awareness programs, and lobbying and advocacy activities.

LeadingAge: How does your organization fit into the aging care system that exists in your country?

Femada Shamam: Aging care services in South Africa are provided by a number of players including the state, nonprofit organizations, and faith-based organizations, as well as community-based organizations. The state provides subsidization for some services aimed at supporting the most vulnerable and indigent elders in the community. The framework for the provision of services is provided by the Older Persons Act 13/2006, which came into effect in 2010. The Act is rights-based and is aligned to the priority directions as per the Madrid International Plan of Action.

In addition to these priority directions, South Africa included a fourth priority, namely the protection of older persons, to provide the legal framework to address the issue of elder abuse.

There are currently 413 state-subsidized facilities in South Africa. The government subsidy varies from province to province. The subsidy does not cover the total cost of care, and in some cases, the state subsidy only accounts for 25% of the total cost of care. The shortfall is generally covered by the nonprofit organizations receiving the subsidy through their individual fundraising initiatives.

The governmental framework promotes preventive and early-intervention services, which are community-based; however, the resources to give effect to these community-based services remain scarce.

LeadingAge: What are the best aspects of the care and services for the aging in your country?

Femada Shamam: Limited and scarce resources have provided fertile ground for the establishment of community-based resources to support elders in the space where they live. There is a strong sense of community involvement and this ties in with local practices, such as “ubuntu,” which roughly translates into “I am because we are.” In addition, other cultural practices support taking care of those most vulnerable, including older persons.

South Africa is one of the few countries on the continent that makes available to older people a state grant. The grant is means-tested and is generally described as a poverty alleviation initiative due to its primary focus being on those who are most economically disadvantaged.

LeadingAge: How would you like care and services for the aging to improve?

Femada Shamam: South Africa needs to move beyond policy towards ensuring the resources are available to deliver on the mandates. There has to be the political will to take forward the aging agenda. Improvements in care and services would include conscientizing [Editor: "to make somebody/yourself aware of important social or political issues."] a number of stakeholders on the roles they can play in supporting elders.

My vision is to live in a society supportive of elders where networks, services, and [communities] are available, accessible, and affordable to all elders—enabling them to live their best lives, […] of dignity, purpose, and growth irrespective of loss of abilities as they age. I see a society that compensates for these losses in a way that maintains the elders as active, contributing members of society.

Margaret Van Zyl Chapman, director of strategic partnerships for the South African Care Forum

LeadingAge: What does your organization do? Who do you serve and what services do you offer?

Van Zyl Chapman photo
Margaret Van Zyl Chapman

Margaret Van Zyl Chapman: I founded and am currently the chairperson of the South African Care Forum. It is a nonprofit company supporting the care [field] in South Africa. I support organizations serving the needs of older people and people living with disabilities, both in residential care and in the community.

Our vision is to raise the voice for the care [field] and grow a reputation for excellence and best practice. Our key objectives include lobbying and influencing policy, being a clearinghouse for information, raising awareness on aging and care issues, strengthening networking and developing partnerships, and learning and development. We want to inspire, focus on quality, and encourage engagement.

LeadingAge: What are the best aspects of the care and services for the aging in your country?

Margaret Van Zyl Chapman: The best aspect is the amazing care sector that responds to need among older people as best it can. There is huge generosity of spirit, and many committed, dedicated care staff. More services are available to those who are in a position to pay. Many faith-based organizations render aged care services to the poorest of the poor. Issues to be faced include the financial plight of older people, need for donor support, and funding and resource mobilization. South Africa is a very ageist society—felt particularly in the workplace—so there is a need for health literacy and a focus on health and aging.

LeadingAge: How would you like care and services for the aging to improve?

Margaret Van Zyl Chapman: I would like to see services to the poorest of the poor expanded and for the government to acknowledge older people’s contributions to society and repay them with good care in their old age.

My dream is to see a gym in every care home across South Africa.

Richard Semanda, executive director of the Geriatric Respite Care Foundation Uganda

LeadingAge: What does your organization do? Who do you serve and what services do you offer?

Semanda photo
Richard Semanda

Richard Semanda: Geriatric Respite Care Foundation Uganda (GRCF-U) was founded in 2011. It is a national, non-government, membership organization with offices in Kampala, but operating countrywide. GRCF-U promotes decent health lifestyles to older persons in the communities of Uganda to live a dignified life. The services we provide include family support care, palliative care, health education, primary health care, and medical routine checkups by our caregivers.

GRCF-U focuses on older men and women only, and in addition to promoting health care, we carry out training and advocacy, promoting proper nutrition of older persons and their grandchildren, counseling, and networking.

LeadingAge: How are the care and services for the aging organized in your country?

Richard Semanda: Care for older persons is not well-organized as the government of Uganda has not invested much in it due to lack of expertise, poverty, and the negative attitudes of all people, especially the policymakers—which leads to this special interest group’s recognition going slow, hence the plans for care also move slowly. However, when there is urgent need of care for heart attack or stroke, decisions are made on an emergency basis.

LeadingAge: How would you like care and services for the aging to improve?

Richard Semanda: I think information sharing with various stakeholders and active participation of older persons could be of help in the development agenda, as it would emphasize and change the negative attitudes and stereotypes that older persons are a burden, useless, disasters, mindless, sexless, worthless, spent forces, powerless, ugly, evil, [that] they are all alike, and that aging is a disease.

Furthermore, there is need of integration of aging issues and care in the education curriculum to create awareness as we are towards a society of all ages.

LeadingAge: What are the greatest challenges you face in providing services to the aging?

Richard Semanda: The Uganda Population and Housing Census results of 2014 had a total population of 34,856,813 and the population of older persons 60 years and above was 3,700,000—the majority of whom live in the countryside with few social services and scattered health centers to meet their health challenges and needs—but the aging group is experiencing negative attitudes and ageism.

Many older persons are living in very difficult circumstances due to lack of support of their families. The HIV and AIDS epidemic and the general high level of poverty had obviously contributed to the breakdown of our support system in the country, yet older persons continue to bear the burden of caring for many orphans because 2.1 million, or 13.7%, of the children who would normally have been raised by their parents are cared for by older persons. As they struggle with these orphans, many older persons suffer from a range of untreated chronic diseases, which can be permanently disabling. Also, 64.5% of our older persons have at least 1 form of disability.

Uganda is also witnessing a rapid rise in cases of non-communicable diseases and mental health [issues], particularly dementia, and families are frustrated as they don’t know what to do with their beloved living with dementia. Drugs for old-age-related diseases are expensive and are not readily available. Access to health facilities is difficult for many older persons and the attitude of health workers towards them, and long queues, discourage many from seeking treatment.

Also, Uganda has not even a single geriatrician or geriatric ward. We do not have a single program specifically targeting older persons in dealing with the HIV and AIDS scourge. In fact, a doctor is quoted as famously saying, “Why waste scanty resources on a group that is about to die off anyway?”

Vincenzo Paolino, of Almacasa in Switzerland

LeadingAge: What does your organization do? Who do you serve and what services do you offer?

Vincenzo Paolino

Vincenzo Paolino: Almacasa offers services that [older adults] need and what their relatives wish for: on-site, nearby, everyday support and care. Our [communities] are also suited to people with dementia and in both options, long-term stay arrangements and temporary relief are available. The application and relocation processes are easy and uncomplicated. Living in an Almacasa care home is an option for all people with middle- and high-care needs, including palliative care, irrespective of income or wealth.

We focus on enabling our residents to lead a normal everyday life in a familiar environment, despite physical and cognitive changes. Cooking all meals for up to 10 residents per group gives a structured day similar to what most residents lived before. A typical Almacasa-site has 3 such groups. Our care homes include a private area for each resident, carefully furnished, communal spaces, and a well-tended garden or terraces. Pets can be brought along. Visitors are always welcome, and we are especially happy about children’s visits.

LeadingAge: How are the care and services for the aging organized in your country?

Vincenzo Paolino: Switzerland has a population of 8.2 million and consists of 26 Cantons. Following the subsidiarity principle (and therefore not far from the U.S. system) every Canton and every municipality has its own "government," health system, and financial responsibility.

Every municipality has to take care of its own aging population. In the past, smaller villages built large nursing homes together—usually using the hospital paradigm as guidance. This seems to change now. More and more people hesitate to enter big institutions, leaving their social and emotional space and security. They want to be near friends and familiar environments.

LeadingAge: How would you like care and services for the aging to improve?

Vincenzo Paolino: I think the key is to offer more affordable options to older adults in terms of housing, care, and social activities. Apartments should be built generally following universal design to make life easier and safer.

Care needs should be addressed in ways that empower people to stay as engaged as possible. The big building with a sign on the roof claiming "I am a nursing home," in my view, will more and more belong to the past. We need small-scale living environments offering highly skilled staff that supports residents and relatives emotionally through a challenging time in their life. Staff has to be supported by easy-to-use devices and aids. We need "high-tech" and "high-touch."

We also should work together to create an atmosphere of acceptance and inclusion concerning sexual orientation and gender identity because this helps all residents to be who they are and to live a full life.

Kenya McCullum is a writer who lives in San Francisco, CA.