By the end of this year, the population of elderly people in Nigeria is expected to reach about 11.5 million, and approximately 25.5 million by 2050. This ageing population, combined with shifting family structures, existential challenges, and the ongoing migration of healthcare workers, is quietly but steadily driving growth in the elderly care economy, which holds immense potential for job creation and investment. Though largely unregulated, expensive, and inaccessible to many low-income families, IJEOMA NWANOSIKE reports that, given the projected elderly population by 2050, Nigeria?s care economy presents both a critical challenge and a significant economic opportunity.

Benue State-born Mrs. Elizabeth Onah was doing well as a local food processor. The money she earned from her fufu processing business increased the family?s income and allowed her to support her husband meaningfully with household expenses.

After building a loyal customer base in her Egunla Estate, Arigbajo, Ogun State, residence?thanks to her consistency and product quality?many were left astonished when Mrs. Onah suddenly stepped away from it all, left her children in her husband?s care, and moved to Lagos for a new role, returning home only once a month.

It did not take long before neighbours discovered that she had taken up a job as a live-in caregiver for an older woman in Lagos, whose children live abroad.

While the exact terms of her new employment remain private, many in her community believe that for her to walk away from a profitable business and, more significantly, leave her young children behind, the job must offer not just better pay but also a level of stability she found hard to ignore.

Onah?s story is one of many emerging across Nigeria, where an increasing number of people, especially women, are taking up caregiving jobs without formal training. Though the idea of entrusting one?s ageing parents to non-relatives remains culturally sensitive and is even frowned upon in many Nigerian communities, The Guardian investigation reveals a quiet but steady shift is underway.

In another corner of this growing industry is Madam Anuoluwapo James, who has been working as a full-time caregiver for elderly people for the last three years.

With only a modest level of education and no formal training or background in healthcare, James might seem an unlikely candidate for the role. Yet, her dedication and natural compassion have both earned her a solid reputation in her new calling.

For two of the three years, she cared diligently for an older woman, committing herself fully to the role. But that job came to an abrupt end when her client?s children relocated their mother abroad. Within weeks, Madam James secured another caregiving role in Abeokuta, Ogun State, where she has been working ever since.

Although still underappreciated, caregiving?once viewed as a job reserved for those seeking opportunities abroad?is now quietly gaining ground in Nigeria, providing many with steady sources of income sufficient to support their families and maintain a modest but stable livelihood.

In part, that is the reason that 32-year-old Nurse Titi?s dream of relocating abroad for better opportunities is still pulsating.

As a registered nurse working long shifts at a private hospital in Lagos, she found herself trapped in what she described as a cycle of burnout and underpayment, barely earning enough to cover her yearly house rent and transportation fare.

?Until I switched gear not long ago, I was earning peanuts. It felt like modern-day slavery,? she summarized her sojourn.

Like many Nigerian healthcare workers, Titi?s sights are set on countries such as England, the United States, and Canada, where nurses are better compensated and more respected. But the high cost of travelling, examinations, and proof of funds are some of the reasons that have stopped her from taking the leap.

Veering off from nursing began slowly for Nurse Titi when an unexpected opportunity crossed her path. On her days off, Titi began assisting an elderly relative with basic daily care. Soon, word spread, and she found herself caring part-time for two older women whose children lived abroad.

In just a month, she tripled her hospital salary. Hence, what began as a side hustle to fund her migration plans soon took a different turn.

Even though the increased workload?hospital shifts at night and caregiving by day?remained intense, Titi said that the emotional and financial rewards from her caregiving work have imbued her with a renewed sense of purpose.

?I still think about travelling, but for the first time in a long while, I?m not desperate. I?m starting to believe that I can build something right here,? she admitted.

Titi?s closely guarded plans mirror a national trend as the country grapples with a mass exodus of trained health professionals, who are leaving in droves for better-paying jobs in the UK, US, Canada, and even some African countries.

It is this trend that has compelled the Nigerian Association of Resident Doctors (NARD) and other healthcare bodies to continually raise the alarm regarding the tens of thousands of nurses and doctors who have migrated abroad, dealing a debilitating blow to the country?s health sector.

According to the UK?s Nursing and Midwifery Council, over 14,800 Nigerian-trained nurses and midwives have migrated to the UK in the last five years. Between April and September 2024 alone, 1,159 more health workers joined the UK register, as poor pay and harsh working conditions at home continue to drive them abroad.

THE term geriatric refers to individuals aged 65 and above. While geriatric care focuses on the medical treatment and well-being of older adults, gerontology is the broader, multidisciplinary study of ageing, encompassing biological, psychological, and social aspects.

According to the World Health Organisation (WHO), ageing is the result of the gradual accumulation of various types of molecular and cellular damage over time. This process leads to a progressive decline in both physical and mental capabilities, an increased vulnerability to diseases, and, eventually, death. However, these changes do not follow a strict or uniform pattern and are only loosely linked to a person?s chronological age.

Ageing is also recognised globally as a major driver of non-communicable diseases, the absence of affordable health care services and health insurance coverage for the Nigerian elderly, therefore complicates matters for them and the society.

In addition to the biological aspects, numerous socioeconomic challenges impact ageing populations. Issues such as poverty, income inequality, and limited access to social support can severely limit families? ability to provide adequate care for elderly members.

Experts highlight that the financial burden of specialised care is especially overwhelming for low-income households, which struggle to afford essential services like healthcare, proper nutrition, housing, and emotional support.

While geriatric service requires a multidisciplinary team (MDT) approach, often consisting of a clinician (geriatrician) and other healthcare workers with training in older adult care such as nurses, physiotherapist, pharmacist, medical social worker, occupational therapist, and nutritionist, a report in the Journal of Global Medicine titled: ?Current Status and the Future Trajectory of Geriatric Services in Nigeria,? by Ogugua Osi-Ogbu, noted that of the approximately 35,000 doctors practicing in Nigeria, less than 20 are formally trained as geriatricians. With a population of roughly 15 million older people, the country has a patient-to-doctor ratio of 750,000.

However, beyond these staggering numbers and the urgency of addressing the mass staff shortage in care facilities, many, including experts, have been calling on the government to establish robust public policies and social security systems to support elderly citizens.

That said, in a country where many healthcare professionals feel forced to leave to live well, practitioners like Nurse Titi may have found an alternative: staying and still thriving.

Beyond scenarios mentioned above, shedding light on the untapped potential of Nigeria?s care economy, the brain drain, while damaging to hospitals and clinics, has indirectly created a vacuum and an opportunity in home and community-based gerontology care.

Though largely informal and overlooked, the care economy, particularly gerontology, is steadily becoming a safety net for families who can afford it. Quietly expanding beyond the spotlight of national policy and public discourse, this sector holds immense untapped potential as it rises to meet the needs of a changing society.

At the heart of this emerging industry is a demographic shift ? Nigeria?s ageing population. While the country remains largely youthful, marginally increasing life expectancy and attendant steady rise in the number of elderly citizens is leading to an increase in demand for specialized care services like never before.

Age statistics by the World Bank?s collection of development indicators in 2023 showed that the percentage of the population aged 65 and above in Nigeria was 3.0282 per cent, indicating that about 6.77 million of the population were 65 and above.

The United Nations projected that this scenario would result in a significant rise in the number of older adults, reaching 11.5 million by 2025 and approximately 25.5 million by 2050.

According to experts, this growth is expected to create even greater demand for specialized care. While this demographic shift is not only transforming healthcare priorities, it is also opening up a promising frontier for investors and entrepreneurs looking to tap into the emerging care economy.

Leading the charge for elderly care in Nigeria is the private sector, which has stepped in robustly, employing innovative, tailored care models that cater to this growing demography. Interestingly, what makes the care economy especially appealing is the diversity of services that are now available to meet varying levels of elderly needs.

Substituting informal family caregiving with improved, complex services

FROM basic companionship and daily living assistance to more intensive services, such as palliative and dementia care, the industry has expanded to offer comprehensive support. These services are provided by a range of professionals, including nursing assistants, care aides, and executive caregivers, each playing a role in ensuring quality of life for ageing clients. This variety reflects a maturing industry that is adapting to the complex health and emotional needs of its clientele.

Compounding this need, however, is a dramatic shift in family structures. The era of large, closely-knit extended families is gradually giving way to nuclear living arrangements, urban migration, and transnational families.

Recently, many families have opted for professional help rather than relying solely on informal family caregiving. This change in cultural and social attitudes toward ageing care is further fueling demand, thereby making the sector a magnet for smart investment.

But while these services are rapidly gaining popularity among Nigerian families, they are often considered expensive and unaffordable for low-income families.

A market survey by The Guardian showed that the cost of these services ranges between N200,000 and N500,000 per month. These prices vary based on the type of care required, the patient?s condition, and whether the service is provided at home or in a residential setting.

Despite the cost, families are increasingly opting for these services as a more reliable and organised option for care.

Experts view the industry as a significant avenue for entrepreneurial growth, with the potential to transform and strengthen the healthcare sector through increased private investment and innovative solutions that aim to close existing gaps and meet the rising demand for care.

Recognising the need to streamline services for the proper care of the elderly, the federal government has recently established at least 40 desks for senior citizen care across 40 different Ministries, Departments, and Agencies.

The spread of the desk in the 40 MDAs is because no single agency can address the needs of care for aged persons.

According to Dr. Emem Omokaro, Director-General of the National Senior Citizens Centre (NSCC), the government has developed a Care Quality Assurance System for the country, featuring a national benchmark and minimum standard for accrediting care settings.

?No one person, no single ministry can handle ageing alone because what they do is different statutorily. NSCC has dug deep to understand different mandates of relevant agencies, and we went on a very high-level advocacy, meeting with technical partners. I want to say that NSCC now has 40 ageing desks in 40 Ministries, Departments, and Agencies. Of those partnerships, we ensured that there was a Memorandum of Understanding??

However, despite the existence of the National Policy Guidelines for Geriatric Social Care and Standard Operating Procedures, the industry remains a developing one without a skilled workforce.

That notwithstanding, the federal government is focusing attention on training and capacity enhancement, particularly with the establishment of minimum benchmarks and standards for accrediting care facilities. Appropriate government agencies are also collaborating with the National Assembly to pass regulations and laws that ensure compliance in this field.

Omokaro further explained that the absence of comprehensive policies and structured frameworks has contributed to inconsistencies in service delivery and a general lack of standardization in elderly care across the country. ?But we have developed policy guidelines and benchmarks. We are just waiting for the official handover to begin a nationwide upgrade. We are planning a system that includes e-wallets tied to ID cards for older people, which will give them access to social programmes and potential subsidies,? she revealed.

While also acknowledging that the number of geriatricians in Nigeria remains critically low, the NSCC DG downplayed the concern by noting that other nations, such as Canada, rely on a multidisciplinary approach.

?In Canada, they train family physicians, physiotherapists, and nutritionists with a bias in geriatrics instead of producing many geriatricians. That?s the model we are adopting.?

In a bid to expand the workforce, Omokaro called on retired nurses to join the geriatric care sector by upgrading their skills through certification programmes, revealing that the organization has developed a new model for training certified caregivers, including recruiting and retraining retired nurses.

?We are training and certifying caregivers, some of whom are retired nurses. It?s part of our broader effort to build a competent workforce to support Nigeria?s ageing population,? she said.

Even though Omokaro claimed that the centre has one of the smallest budgets among federal agencies, which is grossly inadequate for the scale of work being done, the centre has begun setting up a Geriatric Social Care Sector Skills Council, and is working toward developing a web portal to register all certified caregivers and training institutions nationwide.

One major milestone, she said, is the formalization of geriatric social care as a professional field in Nigeria. In partnership with the National Board for Technical Education (NBTE), caregiving has now been classified as a skill within the Nigerian Skills Qualification Framework. ?Before now, anyone could claim to be a caregiver. But today, we have a national curriculum and a five-level certification system to ensure competence,? she said.

Slow response in standardizing geriatric care prone to exploitation, abuse

Without a doubt, the slow response in standardizing the process of geriatric care in the country has opened doors for quacks to open care homes without having proper training or expertise.

That is why stakeholders, such as Dr. Olutoyin Akande-Ajala, Managing Director and Founder of JBS Gerontology Centre and JBS Medicare Services, are concerned about the underdeveloped regulatory environment governing elderly care services.

She stated that, despite recent progress, the system remains largely unregulated and lacks the structure necessary to ensure quality care, stressing that the sub-sector is in a state similar to how hospitals once operated in Nigeria, when anyone, regardless of qualification, could set up a health facility with little to no oversight.

While acknowledging that, until recently, individuals could open care agencies and send out untrained caregivers with little or no accountability, Akande-Ajala noted, however, that this is becoming increasingly difficult as regulatory mechanisms are being introduced to assess training standards and monitor service delivery.

The geriatrician also expressed frustration that the government has not made enough efforts to support elderly care services, noting that about 80 per cent of the patients seen at the JBS Gerontology Centre, including those from underprivileged backgrounds, have dementia.

?Healthcare is not affordable for all, and the government has not done enough to provide incentives or financial support for elderly care providers. We rely on private funding and donations to support the underprivileged elderly through our foundation, but it?s not enough. ?When I first arrived in Nigeria in 2018, I was shocked by the high number of dementia cases. I used to think it was a condition primarily seen in Western countries, but I quickly learned that dementia is a major health issue here as well. Dementia is incredibly common in Nigeria, especially among elderly people,? she said.

Akande-Ajala noted that while the demand for geriatric care is high, it is mostly unaffordable for most Nigerians and largely beyond the reach of many families. Consequently, older adults in such situations often face a reduced quality of life, suffering from neglect, poor health outcomes, and social isolation because their families cannot meet their needs.

According to Akande-Ajala, many senior citizens in Nigeria experience challenges like arthritis, vision impairment, hearing loss, and cognitive disorders, particularly stroke and dementia, which have become alarmingly common.

Absence of traditional support systems renders Nigerian oldies vulnerable

According to Dr. Chiemezie Atama, the Founding Executive Director of the Equity Watch Initiative, the country?s healthcare situation for the elderly is a ?very complex issue? marked by a clash between traditional caregiving practices and emerging but underdeveloped modern approaches.

?In the past, the care for older adults was primarily the responsibility of their children, grandchildren, and wider family networks. They provided food, water, firewood, and emotional support. These elderly persons were revered, and communities had informal mechanisms to support them,? Atama, a social gerontologist at the University of Nigeria, Nsukka, explained.

However, these traditional structures are rapidly disintegrating due to economic pressures, urban migration, modernization, and the growing influence of individualistic values. ?The communal care structure is weakening. People are leaving rural communities, and family members who once formed the backbone of elderly care are now absent,? she said.

Atama pointed out that the breakdown of traditional support systems has led to a rise in elderly neglect, social isolation, financial insecurity, and poor access to healthcare. She also emphasised the often-overlooked emotional and psychological needs of elderly Nigerians, many of whom face loneliness, anxiety, and a loss of self-worth.

Neglecting these needs, she warned, could lead to increased mental health issues. ?Social isolation can lead to anxiety and depression. Many older adults have no one to talk to and no one to share their experiences with. We must establish community-oriented spaces for companionship and interaction. Sadly, some of these policies have remained in draft form for years. Why propose a policy if it won?t be implemented? That non-implementation is just as damaging as not having a policy at all,? she said.

Atama expressed concern over how shifting cultural values are influencing the treatment of older adults.

?Traditionally, age was associated with wisdom and respect. Elders played important roles in family and community decision-making. However, societal attitudes are changing today. There is a growing lack of reverence for the elderly, especially in urban areas. The absence of intentional programmes aimed at promoting positive attitudes towards ageing is a concern; there are no sensitization efforts, no workshops to reorient the public about care for the elderly. As a result, younger people, who are more tech-savvy and often wealthier, tend to be prioritized in society. In Nigeria, where money usually dictates outcomes, those not in economic or policy-making positions are often overlooked. Since the traditional society is no longer what it used to be, and the extended family model is somewhat thinning out, Atama said what is needed now is the adoption of mechanisms based on today?s realities.

Specifically, she emphasised the need for the adoption of ?context-specific, culturally sensitive mechanisms to care for our ageing population. We cannot continue ignoring the realities of our society. We must act, through policy, through programmes, and a renewed cultural commitment to our elderly.?

Care industry a ?huge, untapped market? with limited uptake

FOR the General Manager and Director of Operations, Caring Habitat Hospital, Adebowale Ojekale, the care industry is ?a huge, untapped market? with the capacity to significantly impact the healthcare sector and the economy.

He noted that although there is a vast market potential for the economy, uptake has been limited due to public fears surrounding abuse, lack of qualified personnel, and competence of caregivers. ?Some people have either seen or heard about negative experiences, which understandably makes them shy away from using these services,? he noted.

While the market has not yet reached its full potential in terms of uptake, Ojekale said the sector is expanding with new players entering the industry. He also emphasised the importance of the government?s involvement, not only through regulation, but also by creating enabling environments for business sustainability, such as favourable economic policies and infrastructural support.

He called for the government?s action to help the sector thrive, noting that without such support, maintaining quality services could become increasingly difficult.

?Compared to overseas, receiving quality care here is significantly more affordable. Services abroad could cost as much as $15,000 per month, while in Nigeria, similar services cost far less, often below $5,000,? he revealed.

He maintained that with proper support, the Nigerian care industry could become a model for affordable and high-quality gerontology care in Africa. ?Whether we like it or not, people will grow old, and they will need care. The market is there. What we need now is awareness, trust, and strategic collaboration to meet that growing need,? he explained. (The Guardian)

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