Project – The Challenges of Caring for Older Adults Without Adequate Family Support: A Study of Selected Elderly Care Facilities in Enugu State

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Ageing is a natural and multidimensional process that involves changes in physical capacity, health, psychological functioning, social relationships and economic circumstances. As people grow older, some experience reductions in functional capacity and may require assistance with activities of daily living, healthcare, mobility, nutrition and social participation. The World Health Organization (WHO, 2024) explains that long-term care encompasses health and social care interventions that enable older people with significant declines in capacity to maintain well-being, dignity and functional ability. The need for such care is becoming increasingly important because longer life expectancy is accompanied by a greater number of people living with chronic conditions and limitations that may require continuing support. Consequently, caring for older adults requires attention not only to medical needs but also to emotional, social, environmental and practical needs.

Family support has traditionally constituted an important source of care for older adults, particularly in low- and middle-income countries where formal long-term-care systems remain limited. Family members may provide food, accommodation, financial assistance, transportation, medication support, companionship and help with personal activities. In Nigeria, Akanji, Ogunniyi and Baiyewu (2002) observed that nuclear and extended family members traditionally provide care for older persons at home, while changes in household structures and economic migration may affect the availability of such support. More recently, Ebimgbo, Chukwu and Okoye (2021) found that Nigerian older adults continue to depend considerably on family networks, although the forms and levels of support received can differ. This continuing reliance on families means that older adults without adequate family assistance may face particular difficulties in meeting their care needs.

The absence or inadequacy of family support can create substantial challenges for older adults because many care needs become more complex with advancing age. Older people living with difficulties in mobility, chronic illness, visual impairment or reduced capacity may require assistance that cannot easily be provided through occasional visits or financial contributions alone. A Nigerian study by Olawale et al. (2024) found that unmet needs in activities of daily living were common among older adults experiencing functional difficulties, with family and household structures significantly associated with levels of unmet need. The study further found that older people living with non-family members had greater unmet needs, whereas larger family size was associated with fewer unmet needs. These findings illustrate the importance of reliable social and family networks in supporting older adults who experience functional limitations.

Caring for older adults without adequate family support can also place substantial demands on formal care providers and caregivers. Long-term care may involve assistance with personal hygiene, feeding, medication, mobility, health monitoring, emotional support and social activities. WHO (2024) notes that, where formal long-term-care systems are weak or unavailable, the costs and responsibilities of care can shift disproportionately to families and informal caregivers. The organisation further identifies the development of an appropriately trained workforce, support for caregivers and quality assurance as important components of sustainable long-term-care systems. Thus, elderly care facilities that accommodate older adults who cannot depend adequately on family members must address complex needs while operating within available human, financial and infrastructural resources.

The social and emotional well-being of older adults is another important dimension of care. Older people may experience loneliness, social isolation, reduced participation in community activities and changes in relationships following retirement, bereavement, disability or migration of family members. WHO (2025) identifies social isolation and loneliness as important determinants of health and reports that social connections are essential to mental and physical well-being and quality of life. Where family members are absent or unable to provide regular companionship, elderly care facilities may become important sources of social interaction, emotional support and meaningful engagement. Consequently, effective care should go beyond meeting basic physical needs and should create opportunities for older adults to maintain dignity, autonomy, relationships and participation.

The Nigerian context presents particular challenges because family-based care remains culturally significant while social and economic changes are altering traditional patterns of intergenerational support. Ebimgbo et al. (2021), in a qualitative study of older adults and family carers in south-east Nigeria, reported differences in the forms of support available to older men and women and emphasised the importance of understanding family support in the development of inclusive social policies. In addition, recent research on elder caregiving in Nigeria has highlighted changing household and caregiving patterns and the continuing support needs associated with caring for older adults. These changes suggest that formal care facilities may become increasingly relevant for older persons who lack adequate family support, although institutional care must be appropriately organised and culturally responsive.

Enugu State provides a particularly relevant setting for examining the challenges associated with caring for older adults without adequate family support. Recent research specifically examining family caregivers’ experiences in Enugu State found that caregivers encountered difficulties associated with older adults’ age and health status, as well as financial and educational limitations among caregivers. The study also reported that caregivers used different coping strategies and highlighted a need for assistance in managing care for older adults. These findings demonstrate that the provision of care can involve significant demands even when family members remain involved. Where family support is absent or inadequate, these demands may become more pronounced for elderly care facilities responsible for meeting the daily needs of older residents. Therefore, investigating selected elderly care facilities in Enugu State can provide useful evidence about the practical, financial, health, emotional, staffing and social challenges associated with caring for older adults who lack adequate family support.

1.2 Statement of the Problem

The increasing need for support in later life presents a significant challenge for older adults who do not have adequate family assistance. Although family members traditionally provide much of the care required by older Nigerians, changes in family structures, migration, economic pressures and other social circumstances may reduce the availability of such support. Akanji et al. (2002) noted that changes in household arrangements and economic migration could affect traditional family-based care, while WHO (2024) explains that declining availability of informal caregivers increases the importance of formal long-term-care systems. Consequently, older adults without reliable family support may depend increasingly on elderly care facilities for assistance with healthcare, personal care, nutrition, mobility and social well-being.

A major problem is the complexity of meeting the physical and healthcare needs of older adults who may have multiple and continuing care requirements. Some older persons may require assistance with bathing, feeding, movement, medication, medical appointments and other activities of daily living. Evidence from Nigeria indicates that unmet care needs remain a concern among older adults with functional difficulties, particularly where family support is limited. Olawale et al. (2024) found substantial levels of unmet needs among older adults with difficulties in activities of daily living and identified household and family structures as important factors. These circumstances create additional responsibilities for elderly care facilities, which may need to provide services that would otherwise have been shared among family members.

Another problem concerns the financial, human-resource and emotional demands placed on those responsible for caring for older adults. Caring for older persons can require continuous attention, trained personnel, appropriate facilities, medical supplies, food, transportation and other resources. Recent research involving caregivers in Enugu State reported challenges associated with older adults’ health and age, caregivers’ financial capacity and educational background, and indicated a need for additional assistance in care management. WHO (2024) similarly identifies sustainable financing, an appropriately trained workforce and caregiver support as important components of effective long-term-care systems. These concerns raise questions about how elderly care facilities in Enugu State manage their responsibilities when residents have limited or no adequate family support.

There is also a need to understand the social and emotional consequences of inadequate family involvement and the capacity of elderly care facilities to respond to them. Older adults may require companionship, communication, emotional reassurance and opportunities for meaningful social participation in addition to physical care. WHO (2025) identifies social isolation and loneliness as significant concerns for older people’s health and well-being, while research in south-east Nigeria demonstrates the continuing importance of family support to the welfare of older adults. However, there remains a need for context-specific evidence concerning the actual challenges experienced by facilities caring for older adults without adequate family support in Enugu State. This study therefore focuses on selected elderly care facilities in Enugu State to examine the challenges they encounter in providing appropriate and comprehensive care to older adults who lack sufficient family assistance.

1.3 Purpose of the Study

The main purpose of this study is to examine the challenges of caring for older adults without adequate family support in selected elderly care facilities in Enugu State.

The specific objectives are to:

1. Identify the major challenges faced by elderly care facilities in providing care for older adults without adequate family support in Enugu State.
2. Examine the physical and healthcare needs of older adults without adequate family support in the selected elderly care facilities.
3. Assess the social and emotional challenges experienced by older adults without adequate family support in the selected elderly care facilities.
4. Examine the strategies and support mechanisms used by elderly care facilities to manage the challenges of caring for older adults without adequate family support.

1.4 Research Questions

The following research questions will guide the study:

1. What are the major challenges faced by elderly care facilities in providing care for older adults without adequate family support in Enugu State?
2. What are the major physical and healthcare needs of older adults without adequate family support in the selected elderly care facilities?
3. What social and emotional challenges are experienced by older adults without adequate family support in the selected elderly care facilities?
4. What strategies and support mechanisms are used by elderly care facilities to manage the challenges of caring for older adults without adequate family support?

1.5 Research Hypothesis

The following null hypothesis will be tested at the 0.05 level of significance:

H₀: There is no statistically significant relationship between the adequacy of family support and the challenges of caring for older adults in selected elderly care facilities in Enugu State.

1.6 Significance of the Study

The study may be significant to older adults because it will draw attention to the physical, healthcare, social and emotional needs of elderly persons who lack adequate family support. The findings may help highlight areas in which care services can be improved to promote dignity, safety, independence and quality of life.

The study may also benefit elderly care facilities and their administrators by identifying practical challenges associated with caring for residents without adequate family assistance. The findings may help administrators understand areas requiring improvement in staffing, caregiving procedures, health services, social activities, nutrition, infrastructure and family engagement.

The study may be useful to social workers because social work practice is relevant to assessment, advocacy, counselling, family intervention, care coordination and support for vulnerable older adults. Evidence from the study may assist social workers in developing approaches that address both the individual needs of older persons and the wider family and community factors affecting their care.

The study may be beneficial to families and caregivers by increasing awareness of the continuing importance of family involvement in the lives of older adults. It may demonstrate that family support can involve more than financial assistance and may include communication, companionship, emotional support, participation in healthcare decisions and regular contact.

The findings may also be useful to government agencies and policymakers responsible for health, social welfare and ageing-related programmes. The study may provide context-specific information that can contribute to discussions concerning long-term care, caregiver support, standards for elderly care facilities and services for older persons without adequate family support.

Finally, the study may contribute to academic research in social work, sociology, gerontology, community development and related disciplines. It may provide a basis for further research into ageing, family support, institutional care, caregiver burden and the development of sustainable long-term-care systems in Nigeria.

1.7 Scope of the Study

The study is focused on the challenges of caring for older adults without adequate family support in selected elderly care facilities in Enugu State.

The content scope covers four major areas: challenges faced by elderly care facilities; physical and healthcare needs of older adults; social and emotional challenges associated with inadequate family support; and strategies and support mechanisms used by elderly care facilities to address these challenges.

The geographical scope is limited to selected elderly care facilities in Enugu State, Nigeria. The specific facilities selected for the study will be identified in the methodology chapter.

The population scope will comprise relevant categories of respondents connected with the selected elderly care facilities, such as older adults/residents and caregivers or care staff, depending on the final sampling design adopted for the research.

1.8 Operational Definition of Terms

Older Adults: Persons who have reached an advanced stage of adulthood and require consideration of age-related physical, psychological, social or healthcare needs. For this study, the term refers to older persons receiving or requiring care in the selected facilities.

Family Support: The emotional, social, financial, material and practical assistance provided by relatives or family members to an older adult.

Adequate Family Support: A level of family involvement considered sufficient to meet or substantially contribute to an older adult’s reasonable emotional, social, financial and care needs.

Inadequate Family Support: Insufficient, irregular or absent family involvement in meeting an older adult’s physical, emotional, social, financial or healthcare needs.

Elderly Care Facility: A residential or organised care establishment that provides accommodation, supervision, healthcare assistance, personal care, nutrition, social support or other services to older adults.

Caregiving: The provision of practical, physical, emotional, social or healthcare-related assistance to an older adult who requires support.

Long-Term Care: A range of health and social care services provided over an extended period to people whose capacity to perform everyday activities has declined and who require continuing support.

Caregiver: A person who provides regular assistance, supervision or support to an older adult. The term may refer to a family caregiver or a paid/formal caregiver working in an elderly care facility.

Social Well-being: The ability of an older adult to maintain meaningful relationships, participate in social activities and experience a sense of belonging and connection with others.

Emotional Well-being: The state in which an older adult is able to experience emotional security, meaningful interpersonal relationships, dignity and appropriate psychological support.

Care Challenges: The difficulties encountered by caregivers or elderly care facilities in meeting the physical, healthcare, financial, emotional, social and other needs of older adults.

Project – The Challenges of Caring for Older Adults Without Adequate Family Support: A Study of Selected Elderly Care Facilities in Enugu State