INSTITUTIONAL CARE PROVISIONS FOR THE ELDERLY IN SOUTHWESTERN NIGERIA

Abstract

The upsurge in the number of the elderly, owing to the weakened traditional family system and younger generation’s socio-economic quest, has brought about increase in the provisions of institutional care facilities, where elderly are catered for, in southwestern Nigeria. This trend, as against the African belief system, raises concern about the acceptability, quality and cost of care and capacities of such provisions. Previous studies have focused largely on different aspects of their needs such as nutrition, social security, life satisfaction, indigenous welfare and retirement challenges of the elderly with little attention paid to the increase in institutional care provisions. This study, therefore, was designed to investigate institutional care provisions for the elderly in southwestern Nigeria in order to determine the motive, patronage, capacity, costs, care process, legal framework and predicting factors of its utilisation. The study was premised on Activity, Ecological and Family Support theories, while the survey design was adopted. The three states (Lagos, Oyo and Ogun) with high numbers of institutional care facilities were purposively selected, while the 20 care facilities in the states were enumerated. Two hundred and sixty-four residents and outpatients with relatively fair cognitive ability and capacity to give consent were purposively selected. The instruments used were Institutional Care Provisions Questionnaire (r=0.74) and Institutional Care Facilities Inventory (r=0.73). Focus group discussions were held with the elderly, in-depth interviews with the professionals, and key-informant interviews were held with the family caregivers. Quantitative data were subjected to frequency counts, descriptive statistics and Logistic regression at 0.05 significant level, while qualitative data were content analysed. Age of the elderly was 69.50±4.20 years with 32.0% as residents and 68.0% as outpatients, while 58.4% were female. Elderly who were married or co-habiting were 11.0% and constituted the outpatients. Private individuals motivated by profit-making owned 90.0% of the facilities, while patronage was based on personal conviction and individual’s need. Most of the facilities (75.0%) were not built-on-purpose but converted to care facilities with structural deficiencies, while their existing capacities were: staff-resident ratio: 1:5.1; resident-room ratio: 1:8.3; resident-toilet ratio: 1:10.3 and less than 45.0% had call-bell facility. Average utilisation costs were: private - ₦100,000 and public - ₦50,000 for residence without medical expenses. Social, demographic and health status jointly predicted the use of the facilities (X2=35.40; Nagelkerke R2=0.33); accounting for 33.0% of its variance. Age (β=0.15), gender (β=1.95), marital status (β=0.99), functional disability (β=.09), cognitive disability (β=-.053) and depression (β=.17) relatively predicted facilities usage, while income, education and childlessness did not. Care process involved routinised, individualised and flexible patterns which accommodated the socio-cultural needs of residents. While there was no legal framework to specify minimum standard for residential care, there was an observed increase in the disposition and acceptability of the use of the facilities. Geriatric institutional care provisions in southwestern Nigeria are increasingly becoming popular and acceptable with facilities’ deficit and higher user fees without legal framework to specify minimum standard in southwestern Nigeria. Therefore, there is the need for basic minimum requirements for provision of residential care facilities.