In Ivory Coast, the difficult care of seniors

Nestled in a sleepy alley in Bingerville, an outlying district of Abidjan, the building exudes tranquility

In Ivory Coast, the difficult care of seniors

Nestled in a sleepy alley in Bingerville, an outlying district of Abidjan, the building exudes tranquility. This is precisely its vocation: opened in July 2023, the Rest Home welcomes convalescent elderly people who have become dependent and whose entourage is no longer able to care for them. The private establishment has seven rooms and as many residents. A first in Ivory Coast, where care for the elderly is generally provided by families, but where changing lifestyles are disrupting traditional balances.

Rather than a retirement home, “we are a place of convalescence, of transition”, corrects Arlette Monney, refusing the comparison with accommodation establishments for dependent elderly people (Ehpad) in France. “People live here in community,” insists the co-manager. They stay a day, two weeks, three months, recover and then return home. Stays are “à la carte”, as are the levels of support, which vary according to needs.

Jean-Pierre is here for a month, maybe more. Time to get back on your feet after a stroke. With his calm face turned towards the television in the living room, the sixty-year-old occupies one of the seven bedrooms in the house. Her meals are prepared by a nutritionist before being served by one of the six nursing assistants who assist her on a daily basis. For a full board including a few outings and visits from a geriatrician and a psychologist if necessary, the family pays 750,000 CFA francs for one month (1,143 euros), the equivalent of ten times the Ivorian minimum wage.

Demographic change

By listing all the services included and the associated costs, Arlette Monney attempts to put these prices into perspective, while its structure is regularly attacked on social networks, suspected of doing business on the backs of seniors and mistreating them. Accusations fueled by the scandalous practices revealed in France with the Orpea affair in 2022. The managers of the rest home defend themselves by ensuring that they are, for the moment, “more volunteer work than a lucrative activity”. “We do not receive any aid from the State,” emphasizes Andrée Zougo, its co-founder. If you are not an NGO, we will not give you the means. »

In 2021, the Ivorian government launched a financial and medical aid program for some 200,000 vulnerable seniors. An “Age Friendly Center” has even emerged in Abidjan, which offers medical care to those most in need. Two years ago, the State created universal health coverage (CMU). This contributory system, financed by policyholders to the tune of 1,000 CFA francs per month, partially covers consultations, hospitalization costs and certain medications when available. In 2022, only 12% of the population was covered according to the National Health Insurance Fund (Cnam).

“Great efforts have been made, but the social protection system remains truly embryonic and insufficient for the elderly, who often need extensive treatment,” underlines demographer Rosine Mosso. The number of Ivorians over 60, currently estimated at 1.2 million, could triple by 2050. With the decline in the birth rate (4.4 children per woman in 2020, compared to 5.8 it twenty years ago) and a slightly increasing life expectancy (57 years), the country is undergoing a demographic change. But for now, “Africa has not anticipated the issue of old age,” observes Andrée Zougo.

“Perceived as witches”

The problem is as much economic as it is sociocultural. The question of caring for seniors is linked to the evolution of the family structure, while the mononuclear household replaces the intergenerational model, to the detriment of the elderly. In the countryside, they rely more and more on assistance from the neighborhood. In the city, “they live more and more alone,” notes the demographer. Their children do not always have the time, means or energy to take care of them.

“A senior I know was recently hospitalized. All his children are abroad except one of his daughters. And it’s very complicated for her to take sole responsibility for her father,” reports Félix Taubin, member of the Help Elders association. The example is not isolated and concerns more and more families, torn between filial duty and new ways of life. Sometimes the situation goes beyond simple negligence. During home visits, Arlette Monney has already discovered bedridden parents “abandoned, lacking affection and sometimes mistreated”. Some of them are stigmatized, “perceived as witches because of their advanced age,” she laments.

However, the creation of retirement homes still arouses reluctance in the country. Many still think that support structures like the Maison pour tous undermine the family model. A distrust that does not discourage Andrée Zougo. In addition to the Bingerville center, it plans to build others “in each commune of Abidjan and in the five largest cities in the country”.