Who cares for older persons in South Africa? A socio-political analysis of family caregiving of older persons

This article examines who provides care to older persons in South Africa and with what consequences. In contexts where public provision for long-term care remains limited, families are widely positioned as the primary providers of support. Drawing on an in-depth qualitative study conducted in seven communities across three South African provinces, the article analyses interviews with caregivers from caregiving dyads comprising older persons receiving care (n = 96) and their primary caregivers (n = 103). The findings show that family caregiving is not the outcome of free choice or cultural preference but is produced through structural conditions that constrain who is available to care and under what circumstances. Care is organised across distance through migration and relocation; accumulates over time through the legacies of HIV/AIDS, mortality and unemployment; is physically embodied in caregiving by individuals who are themselves ageing, unwell or exhausted; and is economically consequential, frequently requiring caregivers, most often women, to withdraw from paid employment and forego future opportunities. These dynamics are conceptualised as a form of familialism by default, in which responsibility for care is implicitly shifted onto families in the absence of adequate public provision. By making visible the everyday arrangements, negotiations and costs of family caregiving, the findings underscore the limits of policy regimes that assume the availability of family care without support and point to the need for sustained investment in community-based and long-term care systems that recognise and support caregivers.