By Ifeanyi Ugwuadu
he DNA of all living things, among which the human species ranks the most highly developed, stipulates birth, growth and death. The transitions are what we describe as childhood, adolescence, youth, and adulthood. Within the same transition of adulthood, there are various transitions leading to old age. Generally, 70 years is adopted worldwide as the beginning of old age or the first phase of senior citizenship.
In the world of insurance, 65 years is the cutoff for the inception of either whole-life or term insurance. The reason for this may lie in the distant past’s mortality data but could also present current dataset realities that predict high death risk within Age 65 and above. This population is put at about 2.9% of the entire population in Nigeria.
Childhood and old age present families and societies with dependency realities that are normal but require policies to deal with these stages of existence at the national level. The medical practice had already established specialties in these fields called paediatrics and geriatrics. In between the two categories, there is the normal growth period prescribed for human beings.
The common denominator for both the beginning of life on earth and its ending is caregiving – the child needs to be given care, protection, love and steadying hands so it can learn to stand on its feet and grow. The same applies to the elderly, they too require the same measure of care but for the attainment of a different goal – the release of the aged body through death. These two important poles of existence on earth are very important and require appropriate strengthening of laws that safeguard their rights.
Constitutional provision for the elderly
The rights of the elderly or the Nigerian senior citizen class are grounded in the 1999 Constitution under Section (2) (d) as amended which mandates the State to provide adequate social services to improve the quality of life of the elderly. Towards the pursuit of this objective, the federal government enacted the National Senior Citizens Act of 2017 to cater for the needs of people 70 years and above. The real work to consolidate a planned programme for the elderly could only begin in 2021 after the inauguration of the National Senior Citizens Centre. A 12-person Board with a Director-General as the CEO has since taken off the affairs of national implementation of a policy that ought to have begun and institutionalized a long time ago. Here we are looking at about 9.4 million people or 2.9% of Nigeria’s population.
For the records, the National Senior Citizens Centre Act signed into law in 2017 by President Muhammadu Buhari adopted a framework of “community-based prototype systems” to cater for the needs of the elderly. Accompanying the Act is a National Policy on Ageing aimed at protecting the rights of older persons.
In its inaugural declaration, the government stated; “while taking steps to reduce poverty and ensure inclusiveness of most Nigerians, this administration has recognized the special needs of older persons as active agents of societal development. It is in this connection that the government made conscious efforts to establish the Centre to develop and implement productive activities, social protection and work schemes for senior citizens to improve the quality of life of the elderly and ensure a sense of security and a general feeling of health and worthiness extended to them.” This statement captures the nobility of the intentions but walking the talk is often herculean for our governments.
As stated, Nigeria’s senior age population is the smallest in the age distribution. The country is predominantly a young one with a median age of about 18. However, in the gender category of seniors, there are more females than males. Ageing and its associated challenges are global issues where 12.5% of the global population is 60 years and above. Nigeria is only beginning now to confront the accumulated socio-economic hardships, absolute poverty, poor health facilities and lack of access to education that are now endemic and which afflict our vulnerable ageing population.
In Nigeria, post-Covid figures show that as of July 2020, there are nearly 1.7 million elderly people across the 36 States and Federal Capital Territory as contained in the National Social Register of Poor and Vulnerable Households data. While 48% of this total number are males, 52% are females.
The major vulnerabilities of this population are exposure to declining health conditions, poor financial status and inadequate or lack of basic care. Out of this number, the Federal Ministry of Humanitarian Affairs, Disaster Management and Social Development where the senior citizens centre is domiciled, claims it “mined 200,748 elderly persons nationwide from the National Social Register” to distribute benefits from the Federal Government’s Covid-19 Cash Transfer Programme.
Medical insurance for seniors
Typically, insurance for seniors is program-based – that is, specialized healthcare is offered as extensions where pre-existing conditions are taken into consideration. In the United States, it comes under Medicaid or Medicare. In Nigeria, a few insurance companies and HMOs offer insurance to seniors with the same assumptions of pre-existing illnesses. Pre-existing conditions refer mostly to diseases existing before insurance is bought.
Ironically, the Nigerian government adopted a system not backed by financial prudence but instead opted for the community-based approach that could falter and fail along the way. The long list of the 12-member board does not have any insurer to advise the government on the sustainable options for the medical care of seniors. However, if the community type is based on the basic National Health Insurance Scheme, then it is important to expose the plan so that families can assess what is provided for in the baseline medical care and what they need to purchase as additional medical insurance for the families and the aged parents.
Instrumentality of medical insurance, educative caregiving for older people
It is wrong to envisage an older person as someone with illnesses, needing only to be cared for, protected and possibly pampered because as we often say, “he has paid his dues.” The general view many people have about growing old is wrong and has framed a wrong picture through which we view the elderly as disadvantaged people. Aside the preponderance of various health conditions which are common at this stage in life and under which many of the elderly suffer from, they are an active population but only in a more tempered form.
Whereas appropriate and adequate medical insurance for the ageing population is essential, caregiving must combine this with a sound national policy that enhances their outlook on life. The most important consideration for this class of seniors when their medical needs are fully taken care of, is to design a program where they can remain actively engaged until death comes. Such programs should not be physical exercises only but a deliberate plan to mine their experiences through communicative activities.
For instance, those inclined to teach may continue to strengthen their skills by teaching those of their peers who did not acquire the same. They may also be deployed, at least monthly, to public schools to teach real classroom students under a special program. Through this type of exchange, the one teaching is constantly learning while the other older student has a sense of doing something new. In the same vein, younger students may receive impactful teaching borne out of the experience. Their knowledge will be richer for it. That is just one aspect. The constant requirement to study and prepare teaching aids, and course outlines will keep the mind busy and focused. For all other disciplines, similar programs can be designed. Dementia, inertia and boredom will take a long walk from seniors if this proposal is properly articulated and implemented. To be effective, this proposed program may start at age 65 and be preparatory to 70.
The major weakness of caregiving as offered by specialized homes is not being able to recreate the home of the elderly when they eventually need to be moved to a caregiving home. The natural environment will include work settings, rest, play and recreation.
Environment for Caregiving
Most caregiving homes in the country are neither homes nor caregiving. The prerequisites for the ecosystem natural to this state and stage of life hardly exist. Many of them have been set up as charities while others were established with a sense of profit. These objectives are not altogether wrong but the attitude of society and those individuals working in the environment tend to portray these elderly ones as people on awaiting death list. As such, an environment of despondency and ill health is formed and ascribes to an unhealthy state of living.
The National Senior Citizens Centre’s policy framework for ageing should embrace a holistic approach that first establishes a requirement for the enrolment of seniors into health insurance schemes, medical insurance and programs for active spiritual and bodily activities. Thereafter, initiate a template for older people’s homes where the natural environment is the essential landscape among other standards to be demanded from those setting up and organisations already running caregiving. Just as children need nature to grow firmly, the elderly need the same for reflective engagement with the beginning of their lives. There must be a minimum standard for caregivers and the homes they operate.
National Senior Citizens Centre
Insurance is necessarily not a priority of our national policies but it must be integrated, in this instance, into the policy for ageing. Incidentally, NSCC has a ready-made National Social Register (NSR) where significant data already exists to approach health insurance organisations. The States’ governments should also be persuaded to enact similar laws to cater for the elderly. It must be healthy first before rations of money or other essentials. Enrollment into the national health insurance scheme should be the first step, followed by specialized medical insurance that covers pre-existing conditions. The NSCC should now seize the moment and create an environment for our seniors to thrive. Then, families and organisations catering for the elderly will follow suit.