Home Away From Home: The Emerging Forms Of Aged Care In The Urban Centres Of The Greater Accra Region Of Ghana

ABSTRACT Globally, population ageing is occurring at a period when the extended family support system which has been a safe haven for the Ghanaian aged is fast eroding as a result of the impact of social change. The increasingly failing domiciliary eldercare is making way for residential non-domiciliary eldercare in the urban centres of Accra. This study is a contribution to the growing literature on aged care in Ghana with a focus on the activities of residential aged care facilities and how the phenomenon is being rationalized by families patronising them. The objectives for this study were as follows: first, to identify the different types of systems of care currently available in the urban centres established to meet the care needs of the elderly people; second, to explore the kinds of activities of care provided by the residential aged care facilities to the elderly who access them; third, to describe the circumstances under which the aged are admitted into the residential aged care facilities; fourth, to find out how the elderly accessing these facilities make sense of the decisions made to delegate their care to residential aged care facilities; and finally, to examine how the family members of the elderly accessing the non-domiciliary systems of care evaluate the decision they have made to delegate the care of their aged persons to a formal institution. This study adopted a qualitative mixed methods approach. Fifteen elderly persons at two residential aged care facilities comprising of twelve females and three males were purposively selected and interviewed. Other key informants were six family members of the residents, two administrators, two facility operators, and six caregivers making a total of thirty-one interviews. In addition, observational notes were made of 57 field visits. The data was analysed using thematic network approach. Two types of care are available to the elderly in urban Accra. They are care within their usual dwelling places and care out of home. Eldercare out of home consist of non-residential nd residential aged care facilities. The residential aged care facilities are owned by individuals who have lived and worked abroad. The residential aged care facilities employ not more than six caregivers at any given time with majority of them being females. There are two types of caregivers at the facilities; trained caregivers who deliver direct acts of caring and untrained caregivers who act as support staff. The facilities operate a 24-hour service, seven days a week for the residents. They also operate an 8-hour routine five days a week for elderly persons accessing the facilities for recreational purposes. Between two to four elderly people share a room depending on the size. The daily activities of care mostly performed for the elderly are intimate and non-intimate technical, medical, and emotional care. The bulk of activities of care for the elderly is performed in the morning. Material care is provided by the family members of the elderly to ensure their continued support at the facility. The circumstances under which the elderly are admitted at the residential aged care facilities are varied but largely boils down to the elderly persons’ need for long-term technical and medical care, which cannot be sustained within the domiciliary context. The elderly persons had been admitted after they had suffered from complications associated with their chronic diseases. The four major medical conditions at the facilities were hypertension, stroke, diabetes and dementia. Majority of the elderly agreed to access the residential aged care facilities based on the negative circumstances they were facing accessing domiciliary care. Four mothers who were providing childcare to their grandchildren prior to their illness rejected the decision. The relationship that existed between them and their children has been characterized by generalised reciprocity whereby as parents, they looked after their children with expectations that their actions would generate gratitude and an open-ended, diffuse obligation for the children to return the gesture someday. However, when parents serve as caregivers for grandchildren, they then expect their gesture to be reciprocated in a balanced way. When the favour is not returned, it is viewed resentfully as negative reciprocity. Accessing the residential aged care facilities is associated with a sense of abandonment at three specific points: when the elderly were initially informed about the decision made, arrival at the facility and lastly when the elderly do not get visits or phone calls from family members. The presence and the availability of the facilities favour the career oriented middle aged adults who are responsible for addressing the care needs of their elderly persons. They end up enjoying a balanced life and the relative peace of mind needed, knowing that their elderly person’s achievement of activities of daily living (ADL) is not dependent on their physical presence to provide hands-on care or supervise the care provided for them. The benefits of accessing these facilities, comes at a cost which some are not able to sustain over a very long period, thereby withdrawing their elderly persons from the facilities. For those who can afford the costs, however, the traditional notions of care-giving are now replaced with care-managing and both parents and adult children are largely satisfied with this care arrangement. The study therefore recommends that the state prepares a document regarding the nature and basic tenets of an eldercare institution to guide the design of private initiatives. The Department of Social Welfare should assess the operations of these facilities periodically to ensure that they operate per the stipulated rules of engagement. It should also champion the cause of public education and the acceptance of residential aged care facilities in Ghana. The Government of Ghana should set up public residential aged care facilities for families who require out of home care for their elderly persons but cannot afford cost of private residential aged care facilities currently available in urban Accra.