The Impact of Covid-19 on Long-term Care Facilities in South Africa, with a specific focus on Dementia Care

Alice Ashwell, Roxanne Jacobs, Sumaiyah Docrat and Marguerite Schneider (STRiDE South Africa)

The full report (including initial survey findings) is available here:

Key findings:

  • Provision of long-term care for older people in South Africa reflects the inequalities of the society in general. Most older people are cared for at home by unpaid family members, most of whom are female.
  • Most public sector long-term care facilities (LTCFs) are run by non-governmental and faith-based organisations. These are generally underfunded and there are not enough to meet the demand. There are no public-sector dementia-specific facilities. Private sector facilities are expensive and not accessible to the majority of the population. Many private LTCFs provide dementia care, and some are dementia-specific facilities.
  • The Covid-19 pandemic has highlighted issues in elder- and dementia care that need to be addressed. For example, older persons appear to be less of a priority for government than children, youth, women, and people with disabilities; no nationally representative data on dementia exist; and there is still no accredited training and registration system for caregivers.
  • While many LTCFs went into lockdown before this was formally announced, in most provinces the response from the relevant government departments was delayed and inadequate, including for: detailed protocols and guidelines for coping with the pandemic; provision of personal protective equipment (PPE) and emergency funding; and monitoring of and reporting on infections, recoveries and deaths. Delays in obtaining test results of up to 14 days from public sector laboratories made testing unfeasible.
  • Most LTCFs responded quickly and effectively to the need for infection control, developing their own policies and procedures to deal with the virus.
  • While most of the focus in LTCFs has been on infection control, dealing with the emotional and mental health toll of Covid-19 and the ongoing hard lockdown needs urgent attention.
  • Some LTCFs have shown great creativity and compassion in enabling safe contact with loved ones and creating as normal an environment and routine as possible under trying conditions. This has included special responses to people living with dementia, for whom physical distancing and the wearing of masks can be impractical and disturbing.
  • Despite the relatively low levels of mortality from the virus, the constant focus on infections and deaths has contributed to high levels of fear and anxiety, as well as to the stigmatising of people who have tested positive for the virus. This has led to staffing issues in some LTCFs.
  • The financial impact of Covid-19 on LTCFs has been extreme, due to increased costs, reduced income and community support, and inadequate emergency funding from government.
  • In South Africa, the rapid response of LTCFs to the Covid-19 outbreak greatly delayed infections and deaths; however, as infections increase in the community and lockdown restrictions are gradually lifted, more infections and deaths are now being experienced.
  • South Africa must turn the Covid-19 crisis into an opportunity to prioritise and strengthen elder- and dementia care.

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