“We were a little boat in the ocean and the waves were crashing”.  South African long-term care facilities during the COVID-19 pandemic

Co-Authors: Leon Geffen and Gabby Kelly.

Until recently, there were relatively few long-term care facilities (LTCFs) in low and middle-income countries. But since the turn of the century, there has been a rapid increase and South Africa contained at least 1,150 LTCFs at the start of the pandemic (Mahomedy, 2021).

With colleagues from Mexico and Brazil, we received funding to develop emergency strategies to assist government agencies supporting LTCFs face the pandemic. Among other things, we looked at government engagement with LTCFs and different coping strategies adopted over time. We found that the limited capacity of government departments to support LTCFs dated back to years before the pandemic, when many LTCFs were not officially registered, or even known about. As in other countries, there was confusion between government health departments and those focussed on social services about their respective roles and responsibilities.

Our analysis is ongoing, but we would like to share a limited snapshot of the situation in South Africa, where the two government agencies with lead responsibility for LTCFs are the Department of Social Development (DSD) and the Department of Health (DoH). We do this by simply presenting a small selection of broadly typical comments made by some of the LTCF managers interviewed in late 2021

Relations between LTCFs and government agencies before COVID-19

We didn’t get help from DSD to register. They were prescriptive and attacking – the feeling was ‘us and them’. They tried to catch us out but didn’t walk alongside us. “Do it now. Comply or we’ll take away your licence.”

They want us to implement these wonderful plans but don’t provide the resources… It feels like we are being set up to fail. We have to replace vinyl concertina doors –they’ve been here for 55 yrs. Because they are bigger than a normal door for wheelchairs it will cost R12,700 per door and I need to replace 40.

The biggest problem is DoH and DSD have different rules – so who do you follow?

During the pandemic

I can’t give DSD a pat on the shoulder – now and again they sent a protocol or a letter.

There has been more connection with DSD. They had to send us information and didn’t leave us in the lurch…  At least I’ve learnt a few names and know who to call.

I think the biggest challenge with DSD and DoH is that you don’t know who to contact. There is no list that says “if you have this problem, phone that person.” They know exactly who’s who, but we don’t.

DSD wasn’t great but it is better now. I have a personal relationship with the DSD rep and she responds to my calls.

Final comments

This is a blog, not a research paper. As such, we leave it to the readers to draw their own interpretations from this very limited selection of comments. Your interpretations may include the extent to which the issues presented here resonate with the experiences of LTCFs in other countries.

For those interested, a full analytical paper is due to be published in the Journal of Long-Term Care later in the year, and others are in the pipeline.

This blog draws on a study funded by the UK Research and Innovation award GCRF_NF407 – Emergency strategies for mitigating the effects of COVID-19 in care homes in low and middle-income countries.

Authors

Peter Lloyd-Sherlock, Northumbria University, UK.

Leon Geffen, Samson Institute For Ageing Research, South Africa.

Gabrielle Kelly, independent researcher, South Africa

Reference

Malherbe K. (2021).  Assessing the Protection of Older Persons’ Access to Social Services in South Africa during the COVID-19 Pandemic. Speculum Juris 35(2): 118-133.