South Africa
The vast majority of older persons in South Africa require financial support and care.
This support comes primarily from the State through social grants and some care
services. In 2025, just over 4 million older persons receive the Older Persons Grant
(OPG), and just over half a million (536,000) receive the Grant-in-Aid. Care service
provision, however, is very limited: just over 100,000 older persons benefit from
residential care and service centres, out of a total older population of 5.6 million.
At a time when the number of older persons are increasing and older persons are
living longer in poor health, i.e. when the care need is increasing, our findings show
that state support for care services has reduced. The Funding Elder Care in South
Africa Report shows that, over the last two decades, the low level of state spending
on programmes, policy development, and transfers to NPOs that provide residential
and community-based care services. In reality, there is very little funding for direct
“care provision.” In fact, by 2023, we calculated that state funding for community-
level care had decreased by 13% since 2007/08. Moreover, spending on service
provision and policy development has not kept pace with the growing demand for
support, as the number of older persons increases. We showed that state spending is
also highly uneven: provinces with more residential care homes or community-based
services require, and often do not receive, greater financing. Rural areas are most
disadvantaged.
The Older Persons, Care Needs & Social Grants in South Africa Report shows that
OPG remains the main source of survival for low-income older persons. Beneficiaries
are predominantly black (80%), women (70%), rural/farm-based (60%), and widowed
or never married (60%). For most, the OPG is used to meet only the most basic needs;
very few older persons can use it to enhance dignity or functional ability. The decline
in provincial funding for care services, alongside systemic failures in service delivery,
means that household income (most often the OPG) becomes the only way to meet
care needs.
If we take a look at one household in Khayelitsha (Site C), Cape Town, we find five
members: four adults and one child. The household income is made up of two Older
Persons Grants (OPGs) and one Child Support Grant (CSG). Within this household, one
older person requires full-time care following a stroke. She is partially blind and lives
with Parkinson’s disease. Her husband, aged 74, is her primary caregiver. He describes
the daily struggle of managing food costs despite the two OPGs:
“The challenges that I face devastate me, they also impact my health, this is not my normal
weight I was bigger than this, as I mentioned we survive with this grant from government.
My wife illness causes her to eat in an abnormal way, the grant we get from government do
everything in the household then we run out of food, when she gets ill again, we are out of
food…. I’m doing everything because I am fighting for my wife's health, this is destroying me”.
On the surface, this household may appear to be coping, with income balancing
against expenditure. But the caregiver’s account reveals the reality: the family
manages only by underspending on food. The food bill stands at R1,935 per month,
almost the entire value of one OPG (R2,080). Yet, according to the Household
Affordability Index, the basic cost of nutritious food for a household of this size
should be R4,459. This means the family is underspending on food by more than 50
percent.
The second OPG is stretched thin, as funeral policies, electricity, and transport absorb
nearly a third of it. These are all essential expenses that cannot be cut. The CSG is
allocated to the child’s needs, such as school transport and lunchboxes, and does not
cover food outside of school meals.
The 74-year-old caregiver is tasked with balancing the household budget. When
funds run out, often before month-end, he is forced to borrow from neighbours or
loan sharks, trapping the family in a cycle of debt and repayment that drives them
deeper into poverty. While the OPG provides a vital income stream, it is clearly
insufficient to meet the combined demands of care, food, and household needs.
Based on the experiences of 103 caregivers and 96 older persons across 100 family
units in seven sites in the Western Cape, Eastern Cape, and KwaZulu-Natal, we
document the costs of family care for older persons. We found that many households
are under severe financial strain, forcing both older persons and their caregivers to go
without food or essential items. The findings from the Family Caregiving of Older
Persons in South Africa Report show that many OPG beneficiaries live in a cycle of
debt, borrowing to make ends meet and paying for the cost of borrowing the next
month.
Our calculations, drawing on national income datasets and family interviews, confirm
that OPG households are experiencing acute financial pressure, especially in rural
areas. Under-spending on critical items such as food, hygiene products and transport
(to attend clinic visits) directly undermines wellbeing. Food which is vital to health, is
often the first item sacrificed when money runs short, driving many older persons into
debt. As a result, large numbers of older persons are left without food, transport, or
hygiene products, further compromising their dignity and quality of life.
A further form of state support is The Grant-in-Aid, which is available to OPG
recipients who are “in need of regular assistance,” and it is meant to support older
persons’ right to independent living by covering care costs. However, our findings
show that uptake is low due to both administrative and conceptual barriers. Older
persons living with a disability must navigate at least five different government or
private institutions to collect the required documentation. The cost of applying
amounts to at least R600 (rising to R1,400 in informal settlements and over R2,000 in
rural areas), plus an estimated 35 hours of waiting and preparation. For many, the lack
of money, time, and capability severely compromises their right to assistance, and
transport and hygiene products costs must often be paid out of pocket.
Policy Recommendations:
1. Rebalance spending: ring-fence a portion of fiscal resources to expand
community-based care and prioritise provinces with highest unmet need.
2. Simplify and subsidise Grant in Aid access: streamline documentation, reduce
institutional barriers, and waive or subsidise application costs involved in return
visits.
3. Invest in family care support: direct small cash top-ups or voucher schemes for
households providing care (food, transport, hygiene), and fund community respite
and training programmes to reduce caregiver time costs.
4. Targeted rural interventions: mobile clinics, subsidised transport, and investment in
community service centres where the majority of older persons live.
5. Increase transfers to NPOs delivering community services and invest in
monitoring, workforce development and standards to scale quality care.