In Botswana, growing old rarely means entering a care home. It means staying put in a family yard, often without running water, steady food, or reliable help. A new national study, Family Caregiving of Older Persons in Botswana, paints a stark picture of an elder-care system that exists almost entirely out of sight and largely without state support. In the absence of subsidised residential care, families – mostly women – shoulder the burden alone.
‘Caregivers have to do more with less support,’ the authors write, warning that family-based elder care is ‘increasingly fragile’ as resources dry up and kin networks thin. Based on in-depth interviews with 80 older people and their caregivers across four communities, the report concludes that Botswana’s care system rests almost entirely on unpaid family labour, mostly carried by women, in conditions of severe scarcity.
There is no state-subsidised residential care in Botswana. Nearly all older people are cared for at home, often by an adult daughter who has returned after divorce, unemployment or bereavement. In many households, that daughter is the only dependable caregiver left.
‘As a daughter, it was automatic that I must be the one taking care of her,’ one woman told researchers. ‘I consider this my home; she is my parent’.
But love does not pay for water, food or transport. Nearly half of older-person households reported eating fewer meals than they needed, while many lacked running water or proper sanitation. Caregiving often means hauling water, managing incontinence without supplies, and walking long distances to clinics.
The Old Age Pension, long a pillar of Botswana’s social protection system, offers some relief. But even after a recent increase, it remains insufficient for households juggling food insecurity, medical costs and multigenerational unemployment. Access to disability grants and home-based care services remains strikingly low, the report found.
The emotional toll is just as severe. Caregivers described exhaustion, isolation and unresolved grief linked to decades of AIDS-related deaths. ‘Families are no longer united,’ one caregiver said bluntly. ‘They can come to check up, but they don’t take care of her in any way’.
The report was authored by Professor Elena Moore of the University of Cape Town, alongside Dolly Mogomotsi Ntseane and Gwen Lesetedi of the University of Botswana, with Vayda Megannon and Zeenat Samodien, also affiliated with the University of Cape Town’s Family Caregiving Programme for Older Persons in Southern Africa.
The report recommends government to ‘Review access and eligibility for the disability grant,’ since only 7% of older persons currently receive the disability cash. It also states that there is need to ‘Improve food security in older-person households’ and for the government to ‘expand existing food assistance programmes and review the destitute food coupon system to ensure it reaches all eligible older persons.’ The researchers also urge ‘government departments, working with the Department of Water Affairs,’ to introduce ‘water subsidies or targeted relief for older-person households, prioritising those with limited income or caregiving responsibilities.’
As Botswana finalises a long-awaited Older Persons Act, the report poses a stark question: can the country continue to rely on family care alone in the face of rising food insecurity, water shortages and economic strain? Without stronger state support, the authors warn, the system may soon collapse, behind the walls of family yards where care has long been assumed, but never guaranteed.