Nigerians with the means are increasingly entrusting their elderly relatives in the hands of professional caregivers in assisted-living facilities, otherwise known as old people’s homes. This is amid rising acknowledgement that busy children cannot by themselves give the adequate healthcare and close monitoring that ageing requires.
Geriatric care management focuses on planning and coordination of care for the elderly and others with physical or mental weaknesses to meet their long-term care needs, improve their quality of life, and maintain their independence for as long as possible. This is because ageing often comes with vulnerability.
Except in extremely difficult situations, Nigerians before now hardly transferred the care of their aged to public residential care centres. Such act was adjudged to be devoid of love for parents or relatives as it was thought to be akin to utter abandonment of these relatives to complete strangers in strange environments, exposing them to risks of ill treatment.
But all that is changing. As is the practice in the west where senior citizens are placed on a supportive social structure, there has been a noticeable shift in Nigerians’ attitude towards patronising old people’s home. But apathy still persists, said Agboola Dabiri, Lagos State commissioner for Youth and Social Development.
“We must try and change the thinking of our people for more private players to invest in it. In places like South Africa, Canada and the US, people save towards it so that at the age of 60, they go there,” Dabiri said.
“People don’t have time for their old parents and we don’t want to leave them to the mercy of domestic helps. The next remedy is to bring them to the old people’s home where you have various activities for them and specialised people that take care of them. There’s nothing bad about that,” he said.
BusinessDay checks showed a number of old people’s homes have sprung up in major cities across Nigeria, though only a few of the available centres possess the capacity to deliver near excellent quality care.
Lagos has the highest number of homes for the elderly, with over eight registered homes, followed by Ibadan (Oyo) and Edo State, where pockets of them exist.
In Lagos, these homes distributed across Yaba, Ikorodu, Lekki, Ogudu, Mushin, among others, are largely private sector-led initiatives. They include, prominently, Rockgardens Homes and Winiseph Care Home, with bills running into over N1 million yearly.
Lagos State government, which regulates the homes, has established only one in 40 years. The home, nestled on Lancaster Road, Sabo, Yaba, currently looks after 80 people under the watch of 15 medical experts and social workers. There has been an approval to build three new ones at Epe and Ikorodu at the moment, Dabiri told BusinessDay.
The Yaba Home officially sets 60 years as the minimum benchmark and will accept people with conditions such as stroke, blindness, amputation, deafness and even high blood pressure.
But it will neither consider those with severe life-threatening conditions nor anyone who has, at least, a relative residing in Lagos.
Dabiri, who admitted that the quality of care was yet to be perfected, said the home depends a lot on manpower to support the elders where it should install structures that encourage independence.
It’s the reverse at Rockgardens Homes, the largest private home for the elderly by facility in the state. Rockgardens runs a multidisciplinary geriatric care approach that encourages the elderly to be as independent as possible. It uses clinical support system with physiotherapy, healthy nutrition, pampering, karaoke and music therapy to rehabilitate elders, helping them to regain lost functions.
Rockgardens has a maximum capacity of about 45 persons but it currently services only 30 old persons, the oldest among them being 93-year-old Saliu.
Saliu and his peers are categorised into three: independent, semi-independent and very-dependent. The independent are those who can still do a lot of things without assistance, while the independent are those who are bed-bound and can’t move at all and need 100 percent assistance.
The aged at Rockgardens are roofed under 13 bungalow blocks of 52 flats, two residents to each two-bedroom flat. The bulk of these cheerful elders who get excited at the sight of a new visiting face are from settings where families have tight schedules, where children live abroad or where children are leaving the country briefly on vacation. While some are on permanent stay, others are in for retirement.
When Rockgardens started in 2016, only two families believed in them. But its client base grew from two to 18 in 2017, over 20 in 2018 and 30 so far in 2019.
“For some people, they are still in that old school of thought. The awareness is growing and people are beginning to appreciate and embrace the issue of a nursing home in families,” Eda Aitalegbe, the facility manager, said when BusinessDay visited.
Speaking on the Rockgardens model, the UK-trained public health expert said the home, first of all, assesses the individual before he or she is admitted.
“We have two residents to a flat; all rooms en-suite. The flat is furnished with set of chairs, dining set, TV and bed. They get three square meals and in between snacks. The doctor comes in to see them twice a week. Three nurses are on duty daily. Nurses check their blood pressure, prompt medication, bath, medication,” Aitalegbe said.
In Rockgardens’ experience, no family enrolled their old one and absconded, said Adesina Adewale, the medical team leader.
But this care isn’t cheap. It ranges from N100,000 to N150,000 on a monthly basis, depending on categories. This translates to a minimum of N1.2 million annually. There are other additional costs in cases such as dementia or where need for physiotherapy, diapers and others arise.
There are also charity homes for the elderly, such as Holy Family Home for the Elderly, Regina Mundi Catholic Church, which currently cares for 14 old people, including 61-year-old Taiwo Gabriel. But the home is space-constrained as it can only take 14 people at a time. If the health challenges of these 14 elders do not lead to death, for instance, no other older adult can be enrolled into the facility as long as they live.
Since inception, the 30-year-old home has cared for over 200 residents of various categories. Amongst them were those abandoned by families, those with irreconcilable and intractable family problems, those brought in by families for professional care and others picked up around the town. Occasionally, home-bound elders are visited in their homes as part of its work.
But the sustainably of the home worries the owners as it relies on goodwill donations to get things done.
In-home specialised services rising
For families who still feel uneasy about keeping old relatives in public homes, specialised in-home health services have become an option, BusinessDay findings show. This implies families who don’t want to explore old people’s homes option can access the care of a professional nurse, for instance, right in their homes.
In-home health service takes professional services to the doorsteps of the old, looking into what happens to frail elders who struggle with conditions such as dementia, mobility challenge, stroke, arthritis, post-operation complications or terminal illnesses requiring palliative and hospice care. Upon demand and permission, nurses can live with them.
Wellcare Home Medicals Limited is one of the few in Nigeria broadening the options of care available to old people.
Chinwe Essien, nursing supervisor at Wellcare Home Medicals Limited, told BusinessDay that people need a lot of support when they have their loved ones at these stages of life.
“It is not something they can do all by themselves. No matter how learned they are, when that stage of life comes knocking, they get blank,” Essien said.
Cost disqualifies most
Despite this growth in opportunities, it appears the majority of Nigerians who struggle with poverty lack the capacity to afford these professional services when the strength to wait on long queues in public hospitals wanes.
Generally in Nigeria, investment in social care for elderly citizens has not been considered important enough to be institutionalised. This is despite a constitutional recommendation in Section 16, sub-section 2(d), that “suitable and adequate shelter and suitable and adequate food, reasonable national minimum living wage, old age care and pensions and unemployment, sick benefits and welfare of the disabled are provided for all citizens”.
The health expenditure of Africa’s most populous country represents an inconsequential 4.6 percent of the total gross domestic product (GDP), according to available records.
Of the 3.7 percent of the GDP that Nigeria spent on health in 2014, only 0.9 percent was government funded, according to the World Health Organisation Global Health Expenditure database.
Millions of old Nigerians in the age class of President Muhammadu Buhari, who has just returned from one of his regular medical trips to London, do not have the luxury of accessing high standard of care like he does.
On the list 191 member countries that the WHO assessed in 2017 on the basis of overall health level, distribution in population, responsiveness and distribution of finance, Nigeria ranked 187th, extremely far off from France, Italy, San Marino or Malta, among others.
TEMITAYO AYETOTO
