A residential facility for older persons in the Western Cape this week recorded a Covid-19 related death, while a number of Covid-19 infections were reported at another facility in the province.
This has sparked fears that South Africa might see the kind of outbreaks that have claimed many lives in care homes for the elderly in other countries. The New York Times estimates that over 29 000 Covid-19 deaths have been linked to long-term care facilities in that country.
Dr Leon Geffen, a medical doctor and the Executive Director of SIFAR (Samson Institute for Ageing Research) says that due to the threat that Covid-19 infections pose to the older population, extra precautions must be taken to protect them. “We know that the Coronavirus (Disease) has a specific impact on the health and well-being of older people,” Geffen says. “We know that if Covid-19 gets into these facilities, older adults are very vulnerable to getting coronavirus and are at a high risk of dying from it.
Many facilities went into complete lockdown, at least a week before the official state lockdown,” he says. Some facilities in South Africa have already seen Covid-19 related deaths. On Tuesday, an old age home, Sen-Cit Resthaven in Strand, Western Cape, in a statement distributed on Facebook, confirmed the death of a resident who tested positive for Covid-19. At least one staff member was also infected.
“A nurse has tested positive (for Covid-19), but she has been in self-isolation for a number of days, and we believe that the resident who had been taken to hospital and subsequently died there, has tested positive also,” the statement read. A staff member confirmed the passing of the resident to Spotlight. The family of the deceased declined an interview.
This latest death follows reports of another resident in a facility in Vredehoek, Cape Town who also died from Covid-19 earlier this month. There are now reports of family members fearing for the safety of their older relatives after four other elderly residents and 11 staff members at the same facility tested positive for Covid-19.
What is government doing to keep older persons safe?
Geffen is also the head of a task team of representatives from various Residential Care Facilities and other organisations that work with the elderly in the Western Cape. The purpose of this task team is to find ways to deal with Covid-19 among older persons. “Communication from the Department of Social Development to funded facilities have been extremely limited,” Geffen says. “I’m talking about the funded facilities, the low socio-economic facilities, the facilities that the Department of Social Development has a particular responsibility to. From what I understand, having spoken to many of these facilities, they have received no communication from the Department of Social Development, other than a brief email of the 17th of March.”
The facility in the Strand where a resident died on Tuesday, is listed as a facility funded by the Department of Social Development (DSD) in the province. According to Joshua Chigome, spokesperson for the Western Cape MEC for Social Development, the department does "not operate or own any residential facilities for older persons, albeit that we provide a subsidy to 117 facilities across the province that is independent of government and managed by a Board.
"The Departments of Social Development and Health [in the] Western Cape, therefore, developed a detailed guideline to prevent and manage the coronavirus within residential facilities such as old age homes," Chigome said. It is not clear when these guidelines were developed and if it was in response to the latest developments. (Read department's response here.)
"This [guidelines] include all measures of control to be preventative as well as managing a person who is infected. This guideline is for residence and staff and provides guidance on all hygienic aspects within a residential facility." He said the guidelines are still being distributed to all the facilities and will provide more informative and stricter guidelines and protocols.
On a practical level, Chigome said, the two departments have a referral protocol in place and any old age home that reports an infection, will be assisted and supported. He said the Department of Health in the Western Cape have been "proactive by screening and testing Old Age Homes in specific hotspot areas – even if the Home did not request assistance".
Spotlight sent questions to the provincial Health Department but in its response, there is no mention of these guidelines. When approached for comment, spokesperson for the department, Mark van der Heever, said: “Guidelines [were made] available to all sectors on their role and it is for them to implement these safety measures”.
Van der Heever encouraged members of the public to report any business or institution not following the health guidelines in place to stop the spread of Covid-19. “Ultimately each sector, employer and institution should ensure the screening (and potential testing) of their own employees and clients – this includes old age homes through the support of Social Development,” van der Heever said. (Read the full response here.)
Chigome said the department cannot disclose any confidential information on any old age home that has positive cases. "It is the prerogative of the family of the older person, the older person themselves or the Board of the Home to disclose if they have Covid-19 positive cases. Staff at a home is also at liberty to disclose their own status voluntary." Chigome said all staff and residents from the facility in Strand have been screened and tested on Tuesday.
The national Departments of Social Development and Health did not respond to Spotlight’s questions.
Precautions and dilemmas
Geffen says most of these facilities are now adopting the same type of policies. This, he says, include screening of staff, residents being confined to facilities, and if they are allowed out, for them to be kept separate from residents who are not going out. “Any resident who has been hospitalised is quarantined. There has also been discussion on what measures should be put in place to protect staff,” Geffen says. Yet, some of these precautions pose a dilemma, Geffen says, as the movement of older people is now severely limited.
“We’re confronted with this problem where we’d like to protect people as much as possible from getting the coronavirus. However, part of that protection means that we are limiting their rights and ability to go out and participate in their normal daily activities,” he says. Health Sociologist and senior researcher at SIFAR, Dr Gabrielle Kelly, says in countries such as China and Italy it is evident that older people (those 60 and older) are more at risk for complications from Covid-19 infection.
“Older people are more at risk in terms of morbidity and mortality. They are more likely to become significantly sicker and be hospitalised or are much more likely to die from the virus,” she says.“So, it is very important to protect older people because it is such a highly contagious disease, and older people particularly in the South African context, might struggle to self-isolate.”
Delia Bulcraig, the Health manager at NOAH (Neighbourhood Old Age Homes), explained the precautions their organisation has taken to keep their residents safe. “In our (independent living) houses we’ve told them that they shouldn’t be going out more than once a week to do their essential shopping and it shouldn’t be for more than 45 minutes. Obviously, it can be challenging because there can be queues and stuff like that,” she said.
NOAH’s Assisted Living Facility has been in complete lockdown, with residents not being allowed to leave at all. Bulcraig says that the organisation has a zero-tolerance policy for anyone who does not stick to the rules. “We’ve (also) had talks with them about washing of hands, sanitising and wearing masks. NOAH has provided all its members with fabric masks and hand sanitisers.
”Visits from family members have also been suspended. Fortunately, says Bulcraig, most residents understand why this is necessary. “They have contact with their families via phones. If their families want to bring them stuff, they could drop it off but cannot come into the houses.”
Concerns for elderly in Western Cape Townships
Ishrene Davids is the general manager at the organisation Ikamva Labantu. She told Spotlight about the concerns they have for the elderly living in low-income communities outside of care facilities. “We talked among ourselves about how this whole world is going to look like during lockdown. And we understood that hunger is going to be the biggest problem. If people don’t eat then they can’t take their medication and their health will suffer,” she says.
“For them (elderly in township communities) it is very, very difficult. Our township communities are based on togetherness and kinship. So, the whole thing of physical distancing is foreign to them.”
Davids emphasises the impact of Covid-19 on poverty-stricken households.“It’s hard for them to look into the eyes of the children who ask for bread, and there isn’t any bread for them to give. It’s hard when their income (their grant) is the only income (in the household),” Davids says. “They worry about their children and the future for their children,” she added.
Among other concerns they have, Davids says, is being worried about whether their grants will be available, their access to medication and the possibility of abuse from within households. The DSD increased the old age pension with R250 for the next four months to mitigate the impact of Covid-19 on older persons. There are also special measures for pensioners and persons living with disabilities to get preference in collecting their grants at pay-points first on specific days.
Food parcels to vulnerable households and psycho-social support are the two other support services Minister of Social Development Lindiwe Zulu announced to lessen the burden on the already marginalised, including older persons. Kelly says older adults play a significant role in society that shouldn’t be underestimated. “Older people are big contributors to society as well. The old-age grants are a significant form of household support...they also play a role in caring for children and caring for the sick.
”In South Africa, Kelly says, the older population are at risk because of socio-economic factors, and bad health. “One of the big challenges is also poverty. Older people can be malnourished, they may not have good diets,” she says. “They are also (likely) to live in cramped conditions with lots of other people... There is also a strong correlation between being older and having chronic diseases of lifestyle, or generally just being frailer.”
'You miss the interaction with other people'
Maureen Phillips (74) is a resident at Grace Cottage in Woodstock, which is run by NOAH. It is one of NOAH’s communal homes that provide affordable housing for pensioners dependent on an old age grant from government.
“I’m a person who doesn’t sit indoors (much)… you miss the interaction with other people. That’s what we miss, because it is good to be among people,” Phillip tells Spotlight during a telephonic interview. The residents in the NOAH homes are living independently, are still active and can take care of themselves.
Another NOAH resident, Doreen Stoltenkant (73), explains that while she can stay in contact with her family, the lack of face-to-face interaction was getting to her. “That personal contact though is what you need. That’s really getting to everybody. Especially people my age, who have children and are always with them,” says Stoltenkant.
Stoltenkant, a resident of the Millicent Gunn house in Athlone where she has lived for the last eight years, recently had to celebrate her birthday under lockdown without family. “I was all alone, which was very, very sad. Usually, I spend it with my children, and it was not very nice being all alone here,” she says. “We are in constant contact; you know, we WhatsApp and we phone,” she says.
And while she is thankful for what she has, Stoltenkant is also experiencing some emotional dips because of lockdown. “I’m starting to feel very, very frustrated because I can’t go anywhere. It was fine in the beginning… But somehow for this week, I am feeling very dispirited,” she says. “It’s a very scary situation to be in because I’ve never and I don’t think any of us have ever, experienced this before.
”Stoltenkant and Phillips say they are anxious about the number of people they see not respecting health precautions like physical distancing and wearing a mask. “When you go to the shop… people just don’t care about the physical distancing or the masks,” says Stoltenkant.
“I keep myself busy with reading and filling in puzzles and word search and things like that, to keep my brain alive,” Phillips says. She says the residents in Grace Cottage, where she has lived for the last 12 years, are staying positive with the help of good music and good movies. “It’s only what you make of it… We here in Grace cottage, we’re jolly residents,” she says. “
We must look after the roof over our heads. We see so many people out there who don’t have a roof over their heads. I thank God that I have a roof over my head and am comfortably settled in here. We have a beautiful garden. When I can look out of my window, I’m looking straight at Table Mountain… what more do you need?” Phillips says. However, she admits that it is difficult to forget about Covid-19.“All these things they keep your mind off what’s happening. But (at the same time) you are aware of what’s happening,” she says.
A resident of the Thomas Gill house, Kathleen Barendse (68), says she is not letting lockdown keep her from living her life to the full. “I’m sitting here in my room now. I got up early this morning, went on with my chores. My responsibility is the kitchen. I do everything I can in the yard and everything,” she says. “I’m very active. I like dancing too. My husband was into disco when we were young… also karaoke. We love it. We only have one life to live, so we must live it.”
And after the lockdown?
If the lockdown was lifted tomorrow, Barendse would be happy to resume her weekly routine of volunteering with her husband, going to church and taking the train every day to see her grandson when he gets home from school. Barendse says that once she's allowed outside again, she will take her bag and go buy a bus ticket or get on a train and live her life to the full as she did before. “Positivity meisie (girl); we need to be positive,” she says. “That’s what life is all about. Keep your mind healthy, and then your body will also be healthy.”