South Africa Long Term Care Market Overview, 2031

Key Insights

• South Africa's long-term care market is shaped by a rapidly aging population and a policy framework that prioritizes community-based care over institutionalization. The population aged 60 years and older reached 6.6 million in 2025, representing 10.5% of the total population, up from 7.7% in 2002, and is projected to climb to 16.2% by 2050. According to Statistics South Africa's Mid-Year Population Estimates 2025, approximately 10.47% of the population is aged 60 years and older, with the Eastern Cape having the highest proportion of elderly residents.
• The Older Persons Act, 2006 (Act No. 13 of 2006) provides the legal framework for long-term care, with the explicit objective of shifting the emphasis from institutional care to community-based care to ensure that older persons remain in their homes and communities for as long as possible. The Act regulates the registration, establishment and management of residential facilities for older persons and provides for the combatting of elder abuse.
• The formal residential care sector remains small relative to the older population. According to data from the Department of Social Development, 27,623 older people, or 0.5% of the total older population, were living in 417 registered residential facilities as of 2023. The private sector operates over 1,000 long-term care facilities across South Africa, indicating a substantial non-state care infrastructure.
• The long-term care workforce faces persistent staffing shortages and skill-mix challenges. Research published in BMC Health Services Research found that South African long-term care facilities experience staff shortages due to the increasing number of older persons, a lack of qualified staff, and inflation-driven cost pressures. A study of staffing models in South African facilities found that fewer nurses were employed, resulting in an overuse of caregivers and an inadequate skill mix that neglected residents' acuity levels.
• The National Treasury has allocated increasing resources to social protection for older persons. The old age grant increased from R2,315 to R2,400 per month in the 2026/27 financial year, alongside increases to the disability grant, care dependency grant, and grant-in-aid. Social grants constitute the largest share of spending on social development, with allocations rising from R246.6 billion in 2025/26 to R276.5 billion in 2028/29, excluding the Social Relief of Distress grant.

Market Outlook

• According to the research report, "South Africa Long Term Care Market Overview, 2031," published by Bonafide Research, the South Africa Long Term Care Market is expected to reach a market size of more than USD 3.0 Billion by 2031. This growth is supported by accelerating demographic aging, the rising prevalence of chronic diseases and functional limitations among older persons, and the ongoing implementation of the Older Persons Act and its amendment legislation.
• South Africa's demographic trajectory is a primary driver of long-term care demand. The older population grew from 3.6 million in 2002 to 6.6 million in 2025, an increase of 3 million people over two decades. The share of older persons in the total population increased from 7.7% to 10.5% over the same period, and the United Nations forecasts that South Africa will join the "population ageing" club as early as 2030, with seniors accounting for 14% of the population by around 2060. Statistics South Africa data shows that old age dependency has increased due to better health outcomes, while child dependency is on the decline as fertility rates fall.
• The demand for formal long-term care services is expected to outpace the supply of registered facilities. Only 417 residential facilities were registered with the Department of Social Development, accommodating 27,623 older persons just 0.5% of the older population. The private sector has responded with over 1,000 long-term care facilities, but affordability remains a significant barrier for the majority of older South Africans. Community-based care models are being prioritized to reduce pressure on residential facilities.
• The home and community-based care sector is expected to expand in line with the Older Persons Act's policy orientation. The Act mandates a shift from institutional care to community-based care to enable older persons to remain in their homes for as long as possible. The Department of Social Development is implementing Community Based Care and Support Services (CBCSS) intended to cushion effects that might be harmful and affect older persons adversely.
• The Older Persons Amendment Act, 2025 (Act No. 01 of 2025), signed into law in November 2025, introduces significant new protections including the removal of older persons to temporary safe care without a court order in cases of immediate danger, and new provisions relating to the monitoring and evaluation of all services to older persons. These legislative changes are expected to strengthen the regulatory environment and improve quality standards across the sector.

Market Dynamics

Driver: Accelerated Demographic Aging and Policy Mandate for Community-Based Care South Africa is undergoing a steady demographic transition that is reshaping the long-term care landscape. The population aged 60 and older reached 6.6 million in 2025, representing 10.5% of the total population, up from 7.7% in 2002. The Eastern Cape has the highest proportion of elderly residents, reflecting provincial variations in age structure. Women outnumber men from ages 45 and above, and the older population is predominantly female. The Older Persons Act, 2006, mandates a shift from institutional care to community-based care, creating sustained demand for home-based and community-level services. The Act's objects include maintaining and promoting the status, well-being, safety and security of older persons, and maintaining and protecting their rights. This policy orientation, combined with demographic growth, creates demand across the full continuum of long-term care services, from independent living and community support to residential frail care.

Challenge: Workforce Shortages and Inadequate Skill Mix in Long-Term Care Facilities South Africa's long-term care market faces persistent workforce challenges that threaten the quality and sustainability of care provision. Long-term care facilities experience staff shortages due to the increasing number of older persons, a lack of qualified staff, and inflation rates causing price increases of services and goods. Research published in BMC Health Services Research found that South African long-term care facilities experience staff shortages with low staffing levels and an inappropriate skill mix. A study of staffing models in two South African long-term care facilities one private for-profit and one state-subsidised found that fewer nurses were employed, resulting in an overuse of caregivers as less qualified staff provided the bulk of resident care. The overreliance on caregivers contributes to an inadequate skill mix and results in the neglect of residents' acuity levels in care provision. Budget constraints and attempts to increase profits may result in facilities reducing nursing staff, favoring a lower-cost model of nurse categories. The South African staffing standards, outlined in the Regulations Regarding Older Persons, 2010, specify that Category 3 or frail residents must receive a minimum of 18 hours of care per week, Category 2 residents must receive a minimum of 9 hours of care per week, while Category 1 residents are deemed independent and receive no staff assistance. However, implementation of these standards faces barriers including inadequate nurse staffing levels, the unavailability of relief staff for nurses, facilities' neglect to provide in-service training, and an inadequate skill mix.

Trend: Strengthening of Regulatory Protections and Expansion of Community-Based Care Models A fundamental shift in long-term care policy and regulation is occurring in South Africa with the enactment of the Older Persons Amendment Act, 2025. Signed into law on November 3, 2025, and gazetted three days later, the Amendment Act introduces significant new protections for older persons. The Act permits the removal of an older person to temporary safe care without a court order if the person is in immediate danger, a landmark legislative advancement that will facilitate the movement of vulnerable older individuals into safe care. The Amendment Act also inserts new provisions relating to the monitoring and evaluation of all services to older persons. The Department of Social Development is implementing Community Based Care and Support Services (CBCSS) that are intended to cushion effects that might be harmful and affect older persons adversely. The Department continues to promote a 365-day approach to preventing elder abuse and raising awareness about the rights of older persons. The Western Cape Older Persons Care Alliance has recommended prioritizing community-based care and integrating early intervention strategies to reduce the pressure on long-term care facilities, while also calling for a long-term sustainable funding plan for care facilities and policy changes to simplify the Grant-in-Aid application process.

Policies

• The Older Persons Act, 2006 (Act No. 13 of 2006), is the cornerstone of South Africa's long-term care legal framework. The Act's objectives are to maintain and promote the status, well-being, safety and security of older persons; maintain and protect the rights of older persons; shift the emphasis from institutional care to community-based care; regulate the registration, establishment and management of services and residential facilities for older persons; and combat the abuse of older persons.
• The Older Persons Amendment Act, 2025 (Act No. 01 of 2025), signed on November 3, 2025, strengthens the protection mechanisms for older persons by introducing new definitions to improve interpretation, inserting new provisions relating to the monitoring and evaluation of all services to older persons, and permitting the removal of older persons to temporary safe care without a court order in cases of immediate danger.
• The Regulations Regarding Older Persons, 2010, prescribe staffing standards for long-term care facilities. Category 3 or frail residents must receive a minimum of 18 hours of care per week, Category 2 residents who are not frail but need staff assistance must receive a minimum of 9 hours of care per week, and Category 1 residents who are deemed independent receive no staff assistance.
• The Department of Social Development is implementing Community Based Care and Support Services (CBCSS) intended to cushion effects that might be harmful and affect older persons adversely. The Department continues to promote a 365-day approach to preventing elder abuse and raising awareness about the rights of older persons.
• The National Treasury allocates social grants to older persons through the South African Social Security Agency (SASSA). The old age grant increased to R2,400 per month in the 2026/27 financial year, with the grant-in-aid increasing to R580 per month. The old age grant for persons aged 75 years and above includes an additional payment. Social grants constitute the largest share of spending on social development, with allocations rising from R246.6 billion in 2025/26 to R276.5 billion in 2028/29.
• The National Treasury has introduced tightened controls to improve grant targeting and verification. By December 2025, the agency had checked the bank accounts of about six million clients and eight million credit bureau clients, flagging 291,581 grant beneficiaries for review. Adjustments were made for 8,599 disability and old-age grant recipients in accordance with eligibility criteria, and a further 34,661 grants were cancelled, generating expected savings of R170.7 million by the end of 2025/26.
• The Department of Social Development is engaging with municipal authorities to review and streamline regulatory requirements to ensure that long-term care facilities can continue to operate effectively and provide much-needed services to the elderly community.

Segment Analysis

South Africa Long-Term Care Market By Service Type • Home and Community-Based Care: Home and community-based care is the fastest-growing service segment in South Africa's long-term care market, driven by the Older Persons Act's policy mandate to shift emphasis from institutional care to community-based care. The Department of Social Development implements Community Based Care and Support Services (CBCSS) intended to cushion effects that might be harmful and affect older persons adversely. The Department promotes a 365-day approach to preventing elder abuse and raising awareness about the rights of older persons. The Western Cape Older Persons Care Alliance has recommended prioritizing community-based care and integrating early intervention strategies to reduce pressure on long-term care facilities. Home-based care includes personal care, nursing care, medication management, and support services delivered in the older person's home, enabling them to remain in their communities for as long as possible.
• Residential Care Facilities: The residential care sector comprises old age homes, frail care facilities, and nursing homes providing 24-hour care to older persons who are not physically or mentally fit to perform activities of daily living independently. Only 417 residential facilities were registered with the Department of Social Development as of 2023, accommodating 27,623 older persons just 0.5% of the total older population. The private sector operates over 1,000 long-term care facilities across South Africa. The Western Cape Department of Social Development registers frail care facilities where frail older persons are cared for on a 24-hour basis. All old age residential facilities, including private facilities, must be registered and adhere to norms and standards.
• Assisted Living Facilities: Assisted living represents a growing segment in South Africa's long-term care market, including retirement villages, retirement complexes, and independent living communities. Approximately 650 retirement complexes have been identified in South Africa either estates or sectional schemes that use terms like "retirement" in their marketing. Of the country's 5.45 million residential properties, approximately one-third is owned by people over the age of 60. The retirement housing market includes subsidised housing, non-retirement housing, and retirement complexes. The Cape Peninsula Organisation for the Aged (CPOA), for example, owns and operates 24 retirement facilities offering a full spectrum of services from independent living to specialised frail care in dedicated Care Centres.
• Hospice and Palliative Care: Hospice and palliative care services in South Africa are delivered across multiple settings, including homes, residential facilities, and dedicated hospice units. The Department of Social Development's Community Based Care and Support Services include palliative care components as part of comprehensive care for older persons. The Older Persons Amendment Act, 2025, strengthens protections for older persons in all care settings, including those receiving end-of-life care.
• Other Services: This segment includes adult day care, respite care, and community-based support services. The Older Persons Act provides for "respite care" as a service offered specifically to a frail older person and to a caregiver, aimed at the provision of temporary care and relief. The Department of Social Development is implementing Community Based Care and Support Services to cushion effects that might be harmful and affect older persons adversely. The Grant-in-Aid, increased to R580 per month in 2026/27, provides financial support to older persons requiring full-time care in their own homes.

South Africa Long-Term Care Market By Payer Type • Public: Public sources are a significant payer for long-term care services in South Africa, primarily through the National Treasury's social grant system administered by SASSA. The old age grant increased to R2,400 per month in the 2026/27 financial year, with the grant-in-aid increasing to R580 per month. Social grants constitute the largest share of spending on social development, with allocations rising from R246.6 billion in 2025/26 to R276.5 billion in 2028/29, excluding the Social Relief of Distress grant. The Department of Social Development registers and regulates residential facilities for older persons, with 417 facilities registered as of 2023. The Department is implementing Community Based Care and Support Services and promoting a 365-day approach to preventing elder abuse.
• Private: Private sources account for a substantial portion of long-term care spending in South Africa. The private sector operates over 1,000 long-term care facilities across the country. Private for-profit facilities exist alongside state-subsidised facilities, with research examining staffing implementation in both a private for-profit and a state-subsidised long-term care facility. Private retirement complexes and assisted living facilities operate predominantly on a private-pay model, with approximately 650 retirement complexes identified across the country. The private sector has responded to demand from higher-income older persons, though affordability remains a barrier for the majority of the older population.
• Out-of-Pocket: Out-of-pocket payments represent a significant component of long-term care spending in South Africa. The limited number of registered public residential facilities just 417 accommodating 27,623 older persons, or 0.5% of the older population means that families must either provide care themselves, rely on community-based services, or pay for private care. Private facilities charge fees that are beyond the reach of many older South Africans. The Grant-in-Aid, increased to R580 per month in 2026/27, provides limited financial assistance to older persons requiring full-time care in their own homes, but this amount is insufficient to cover the full cost of formal care services. The economic burden on families is substantial and growing as the older population increases and care costs rise.

South Africa Long-Term Care Market By Gender • Female residents account for a larger share of South Africa's older population, driven by higher life expectancy and the feminisation of aging. Statistics South Africa data shows that women outnumber men from ages 45 and above, with the older population being predominantly female. Approximately 51% of South Africa's total population is female, and this proportion increases with age. Women are more likely to live alone in old age, increasing their reliance on formal paid care services and community-based support. The caregiving workforce is predominantly female, with women bearing the majority of caregiving responsibilities in both formal and informal settings. The Department of Social Development is implementing targeted interventions to protect senior citizens, particularly women, from abuse in township communities.
• Male residents account for a smaller but growing share of South Africa's older population. The need for long-term care affects persons of all ages and is generally measured by limitations in an individual's ability to perform daily personal care activities. Men are more likely to need long-term care at younger ages due to disabilities and chronic conditions. As male life expectancy increases, the representation of men in the older adult cohort is gradually growing. The Department of Social Development's programs and services provide benefits to both male and female older persons without gender-based discrimination.

South Africa Long-Term Care Market Economics

• The cost of long-term care services varies significantly by service type, geographic location, and facility type. Public social grants provide a baseline of income support: the old age grant increased to R2,400 per month in the 2026/27 financial year, with an additional payment for persons aged 75 years and above, while the grant-in-aid increased to R580 per month. However, these grants are insufficient to cover the full cost of formal residential or home-based care services. Private long-term care facilities charge fees that are beyond the reach of many older South Africans, creating a substantial affordability gap.
• Public financing of long-term care is heavily weighted toward social grants rather than direct service provision. Social grants constitute the largest share of spending on social development, with allocations rising from R246.6 billion in 2025/26 to R276.5 billion in 2028/29, excluding the Social Relief of Distress grant. The Social Development function's overall budget will increase by approximately 4.2%, rising from R412.2 billion in 2025/26 to R466.4 billion in 2028/29. This supports poverty reduction by providing social grants, risk benefits through social insurance and welfare services.
• Staffing costs represent a significant operating expense for all long-term care providers. The sector faces persistent workforce shortages, with long-term care facilities experiencing staff shortages due to the increasing number of older persons, a lack of qualified staff, and inflation rates causing price increases of services and goods. Budget constraints and attempts to increase profits may result in facilities reducing nursing staff, favoring a lower-cost model of nurse categories. The overreliance on caregivers contributes to an inadequate skill mix and results in the neglect of residents' acuity levels in care provision.
• The economic value of community-based care relative to institutional care is a key policy consideration. The Older Persons Act mandates a shift from institutional care to community-based care to ensure that older persons remain in their homes within the community for as long as possible. The Western Cape Older Persons Care Alliance has recommended prioritizing community-based care and integrating early intervention strategies to reduce pressure on long-term care facilities, while also calling for a long-term sustainable funding plan for care facilities.


Considered in this report
• Historic Year: 2020
• Base year: 2025
• Estimated year: 2026
• Forecast year: 2031

Aspects covered in this report
• Long-term care Market with its value and forecast along with its segments
• Various drivers and challenges
• On-going trends and developments
• Top profiled companies
• Strategic recommendation

By Service Type
• Home Healthcare
• Nursing Care / Skilled Nursing Facilities: 
• Assisted Living Facilities
• Hospice & Palliative Care:
• Other Services

By Payer Type
• Public
• Private
• Out-of-Pocket

By Gender
• Male
• Female