Rural Ageing in South Africa: Distance, Infrastructure and Access to Care

For an older person living in rural South Africa, the practical meaning of care can be determined by distance. A clinic may require a long journey. A social worker may cover communities spread across a large geographic area. Adult children may be working in Gauteng, Cape Town or another economic centre. A neighbour or relative may therefore become the person who notices deteriorating mobility, collects medication, prepares meals or responds when something goes wrong.

Rural ageing is consequently about much more than whether formal services exist. It concerns the infrastructure connecting an older person to those services and the capacity surrounding them between professional contacts. Within the South Africa Ageing, Long-Term Care & Community Support Knowledge Hub, rurality deserves separate analysis because it changes the economics, workforce requirements and practical organisation of long-term support.

South Africa’s Older Persons Act 13 of 2006 provides an important foundation. Its emphasis includes creating an enabling and supportive environment and promoting community-based care so that older people can remain within their communities for as long as possible. That direction is particularly significant outside major urban centres, where institutional expansion alone could never provide a realistic response to population ageing.

The challenge is translating that principle into dependable local capacity. Rural communities are diverse, and neither poverty nor limited services should be assumed simply because an area is rural. Yet national evidence shows substantial rural-urban differences in poverty, while the geography of South Africa makes physical access an unavoidable part of service design.

The stronger rural model is therefore not an urban care system delivered over longer distances. It is a different operational architecture built around proximity, outreach, family sustainability, community capability and reliable connections to professional support.

Rural ageing is becoming a larger planning question

South Africa’s older population has grown substantially. The proportion of people aged 60 and over increased nationally from 7.7% in 2002 to 10.5% in 2025, and every province experienced growth in its older population over that period.

The provincial pattern matters. In 2025 the Eastern Cape had the highest proportion of older people in its population, while the Western Cape also had a relatively high share. Other provinces combine significant rural territories with different demographic profiles and patterns of internal migration.

National averages can therefore conceal the places where ageing intersects most strongly with rurality, poverty and limited infrastructure.

This is particularly important because demographic ageing is not synonymous with dependency. Many rural older people remain economically, socially and practically active. They contribute to households, care for grandchildren, participate in community life and sometimes provide financial stability through pension or grant income.

Planning that treats older populations only as recipients of care misses this contribution. Equally, policy that assumes active older people will remain independent without appropriate infrastructure risks overlooking the gradual changes that can turn manageable frailty into substantial dependency.

The central planning question is therefore functional: what enables an older person to continue doing what matters to them despite changes in mobility, health, cognition or family circumstances?

That directs attention towards transport, housing, nutrition, primary healthcare, rehabilitation, community networks, accessible information and reliable home support alongside conventional long-term care services.

Poverty and rurality interact without being the same problem

Rural poverty remains substantially higher than urban poverty in South Africa. Recent national poverty analysis found that poverty among people aged 65 and over had fallen significantly over time but remained considerably higher in rural than urban areas.

This is an important achievement and an important warning at the same time. Social protection has reduced older-age poverty, yet location continues to influence economic vulnerability.

The Older Person’s Grant provides crucial income security for eligible people and can stabilise whole households. In rural communities, however, the purchasing power of income depends partly on what can actually be purchased locally.

Money for transport is useful only where suitable transport exists. Money towards home support has limited effect where no organised service reaches the community. A mobile phone can improve communication but cannot replace physical assistance with bathing, mobility or meal preparation.

This distinction means that rural long-term care policy needs to examine both household resources and service availability.

A useful equity assessment asks:

• whether older people can reach essential services without disproportionate cost or physical difficulty;
• whether community and home-based support covers dispersed settlements;
• whether families can sustain caring roles without severe financial consequences;
• whether professional advice can reach local caregivers when needs become more complex;
• whether emergencies and deterioration can be identified early; and
• whether rural people have realistic choices rather than nominal entitlements.

This connects rural ageing directly with wider work on health inequalities, prevention and early intervention. Preventive support is valuable precisely because the consequences of deterioration can be harder to reverse when the next level of care is distant.

Distance changes the economics of community care

Community-based care is central to South Africa’s policy framework for older people. Registered community-based care and support services are intended to enable people to receive assistance close to home, while home-based care provides support where a frail older person lives.

The model is especially relevant to rural communities, but rural delivery has costs that activity counts can obscure.

A caregiver working in a dense urban neighbourhood may reach several people within a relatively small area. In a rural district, travelling between households can consume a substantial part of the working day. Fuel, vehicle maintenance, road conditions and weather become operational variables.

Travel time is therefore not an administrative inefficiency. It is part of the cost of equitable provision.

If funding or performance expectations assume that every worker can complete the same number of visits regardless of geography, rural services can be placed at a structural disadvantage. Organisations may respond by shortening visits, reducing coverage or concentrating support around accessible settlements.

Each response can improve apparent productivity while reducing actual accessibility.

Rural service planning therefore needs a more sophisticated understanding of capacity. The relevant denominator is not simply staff hours divided by service users. It includes the time required to connect geographically dispersed people safely and reliably.

Scenario modelling can help make these trade-offs visible. The Digital Twin Scenario Modeller offers organisations a practical framework for testing how changes in demand, workforce and capacity might affect service stability. It is not calibrated to South African rural policy, but the underlying method is relevant: geographic assumptions should be tested rather than treated as fixed background conditions.

Operational scenario: one caregiver, five villages and a changing caseload

A registered community-based organisation supports older people across five villages in a predominantly rural district. One caregiver has an established route covering households where older people need different levels of assistance. Some require welfare checks and help with meals; others need more intensive personal support.

Over several months, two people on the route become frailer. One begins falling and needs more time with mobility and personal care. Another develops cognitive changes and can no longer reliably manage medication.

The organisation faces a capacity problem. Increasing time with these two people reduces the number of other visits possible. Recruiting another caregiver would help, but funding and transport are constrained. Simply maintaining the original visit schedule would preserve activity numbers while ignoring the changed level of need.

A stronger operational response re-stratifies the caseload. The organisation identifies which visits require a trained caregiver, which preventive contacts could be supported through a service centre or community network, and where health or social work input is needed. Travel patterns are redesigned so that professional time is concentrated where it adds most value.

Crucially, management reports the change in dependency alongside the reduction in visit capacity. The provincial funding relationship can then see that lower activity is not automatically lower performance: the service is supporting more complex need across the same geography.

The scenario illustrates why rural care requires measures of workload and outcomes, not only numbers of contacts.

Transport is part of the care pathway

Transport is frequently treated as an external issue, separate from health or social care. For rural older people, that distinction is often artificial.

Accessing a clinic, collecting medication, attending rehabilitation, completing an assessment or visiting a family member in residential care may all depend on transport. Physical frailty can make ordinary public transport difficult even where a route exists.

A missed appointment may therefore reflect transport failure rather than disengagement.

This changes how services should interpret behaviour. Repeated non-attendance should trigger curiosity about accessibility rather than an assumption that the person has chosen not to participate. The same applies when families delay seeking assistance until needs become severe.

Transport also influences discharge from hospital. An older person may be clinically ready to leave an inpatient setting while the home environment, journey, medication arrangements and follow-up support remain uncertain. Rural distance increases the consequences of getting this transition wrong because returning rapidly to hospital may itself be difficult.

The relevant principle from hospital discharge and step-down support for older people is continuity: discharge should be understood as a transfer of responsibility and support, not merely physical departure from a hospital.

Primary healthcare and social support meet in the household

South Africa formally distinguishes health services from social development services, but older people experience their needs together.

An older person with diabetes, arthritis and declining mobility may need medication and clinical monitoring through the health system while simultaneously needing assistance with meals, bathing, transport and household activities. A family caregiver may become responsible for coordinating all of these tasks without belonging formally to either system.

In rural settings, the overlap becomes especially important because every additional journey creates cost.

South Africa’s primary healthcare model includes community-oriented and outreach approaches, and community health workers can provide an important connection between households and health services. Social development structures, social workers and community-based organisations provide a different but complementary set of supports.

The opportunity lies in better connection rather than assuming that organisational integration is required everywhere.

A community health worker who notices that an older person is no longer managing meals needs a clear route for raising a social support concern. A community caregiver who observes breathlessness, confusion or deterioration needs to know when and how to connect with health services.

Good rural integration therefore depends partly on practical interfaces: referral routes, communication, role clarity and feedback.

These are familiar principles within multi-agency working, but they need adaptation to the institutions and distances of the South African setting.

Migration changes the meaning of family availability

Family care remains fundamental to later life across South Africa, but rural family structures have been shaped by migration and employment patterns.

Adult children may live in metropolitan areas while parents remain in their home communities. Financial support can flow back to the household even when physical care cannot. Grandparents may also continue to play significant roles in raising grandchildren.

This produces a more complex picture than the simple assumption that an older person either “has family” or “has no family”.

A daughter living in Johannesburg may pay for groceries, speak to her mother daily and return during periods of illness, but she cannot provide everyday assistance with bathing. A nearby niece may provide practical care without having the financial resources to purchase additional support. A neighbour may be the person physically present in an emergency.

Assessment therefore needs to understand the real care network rather than recording family membership as a binary variable.

This also matters for consent and communication. With the older person’s agreement, distant relatives may need to participate by telephone or digitally in planning discussions. Services should not automatically treat the geographically closest relative as the only meaningful family partner.

Strong family partnership and carer support recognises contribution without transferring unlimited responsibility to relatives.

Migration also creates a strategic workforce issue. The same economic forces that draw younger family members away from rural communities can make recruitment into formal rural care roles difficult. Demography, informal care and workforce planning therefore interact rather than operating as separate policy questions.

Operational scenario: the family is connected but 700 kilometres away

An 82-year-old widow lives in the Eastern Cape in the community where she has spent most of her adult life. Her two adult children work in Gauteng. They send money regularly, telephone frequently and visit when possible. She strongly prefers to remain at home.

Following a minor stroke, her mobility deteriorates. A neighbour initially helps with shopping, while one daughter travels home for several weeks. The family can contribute financially, but identifying reliable ongoing support locally proves difficult.

The operational question is not whether her children are willing to help. They are. It is how their financial and emotional contribution can be combined with local physical support.

A sustainable plan might involve registered community-based care, primary healthcare follow-up, mobility support and a named local contact, with the daughters included in reviews where the older woman wants this. Escalation points are agreed so that new falls, confusion, missed medication or inability to prepare food trigger reassessment rather than relying on the next family visit.

Technology helps maintain communication, but it does not become the care plan. Video calls cannot assist with transfers or inspect a difficult pathway outside the home.

If the arrangement becomes unstable repeatedly, that information should reach the organisation responsible for coordinating support. Recurrent family travel from another province is itself evidence that local capacity may be insufficient.

The older woman’s wish to remain at home can then be treated as a legitimate outcome requiring infrastructure, rather than as an expectation that distant relatives somehow provide the missing service.

Rural workforce strategy needs more than additional posts

Workforce distribution is one of the defining challenges of rural care. Creating funded posts does not guarantee that suitably skilled people will be available to fill them or remain in them.

Professional workers may face large caseloads and significant travel. Community-based organisations need caregivers who understand local languages, culture and geography. Supervisors may oversee staff operating remotely across wide areas.

Recruitment strategies therefore need to consider where workers come from, how they are trained and what enables them to remain.

Developing people from local communities can strengthen continuity and trust. It can also create employment in areas with limited labour-market opportunities. But localisation should not become a rationale for lower standards or unsupported roles.

South African government requirements for registered home-based caregivers include appropriate training, while registered community-based services are expected to operate within national norms and standards. Competence therefore needs to accompany proximity.

The stronger workforce model combines:

• locally accessible training and career development;
• clear role boundaries and escalation arrangements;
• effective supervision despite geographic dispersion;
• reasonable travel and workload expectations;
• connections to health, social work and specialist expertise; and
• workforce data that distinguishes rural vacancies and turnover from national totals.

This is where workforce planning becomes a service-access issue rather than simply an employment function.

The Predictive Workforce Risk Module can help organisations structure analysis of turnover, vacancies and continuity pressures. In South Africa it would require locally appropriate data and assumptions, but its core principle is relevant: workforce instability should be detected before it becomes a gap in care.

Housing can determine whether community care is viable

Remaining at home is often discussed as though the home itself were neutral. It is not.

Housing conditions influence whether an older person with declining mobility can continue living safely. Steps, uneven ground, inaccessible toilets, limited water supply or unreliable electricity can increase dependency and caregiver workload.

A small adaptation may sometimes preserve independence more effectively than adding another recurring care visit. A rail, improved lighting, accessible washing arrangements or suitable mobility equipment can change what the person can do independently.

Yet access to adaptations and assistive equipment is not uniform. Rural households may face additional difficulties obtaining assessment, installation, maintenance or replacement.

This makes housing part of long-term care infrastructure.

The same applies to the immediate environment. An older person may be able to walk independently inside the home while an uneven route outside prevents participation in community life. Functional independence should therefore be assessed in the context in which the person actually lives.

The principle of equipment, assistive technology and home adaptations is relevant beyond disability services: environmental changes can reduce avoidable dependence while preserving dignity and autonomy.

Service centres can be anchors, but only if people can reach them

South Africa’s community-based approach includes service centres operated by registered non-profit organisations. These can provide meals, activities, information, social participation and other forms of support that strengthen wellbeing and reduce isolation.

In rural areas, such centres can become important community infrastructure.

Their value extends beyond the activities delivered inside the building. A well-connected centre can identify changes in an older person’s functioning, provide information to families, connect people to services and create a focal point for outreach.

But the accessibility question remains.

If a service centre is located in one settlement while its intended population is dispersed across a large area, attendance may depend on transport or family assistance. The people most at risk of isolation may be least able to attend.

A hub-and-outreach approach can therefore be more effective than expecting every older person to travel to one location. Activities can be combined with home visits, mobile outreach or partnerships with other community facilities.

This illustrates a broader principle of rural service design: infrastructure should create reach rather than merely create buildings.

Technology should extend reach, not withdraw human support

Digital technology can reduce some of the disadvantages created by distance. Remote consultations can connect rural professionals to specialist expertise. Electronic information sharing can reduce duplication. Mobile communication can support families living elsewhere. Digital scheduling can improve travel routes for dispersed care teams.

There is also potential for remote monitoring and assistive technologies to support some older people at home.

These possibilities need realistic boundaries.

Connectivity varies. Devices and mobile data cost money. Electricity reliability matters. Older people have different levels of digital confidence, sensory ability and preference. Technology can also create privacy and surveillance concerns when monitoring enters a person’s home.

Most importantly, digital access does not equal physical care capacity.

An alert that somebody has fallen is useful only if there is an effective response. A remote clinical opinion can support decision-making but cannot provide personal care. Digital scheduling may improve caregiver productivity but cannot eliminate the distances between households.

Rural digital strategy should therefore ask what problem the technology is solving and what human system sits behind it.

Organisations considering such developments can use the Digital Transformation Readiness Assessment to structure questions around infrastructure, workforce adoption, governance and resilience. It should be adapted to local circumstances rather than treated as a South African compliance framework.

Equally important is digital inclusion. A service that becomes easier for connected households but harder for people without devices has redistributed access rather than universally improved it.

Operational scenario: telehealth solves the consultation, not the journey after it

An older man in a rural part of KwaZulu-Natal has several long-term conditions and increasing difficulty walking. A remote consultation allows a clinician to review his symptoms without requiring an initial long journey.

The digital contact works well. His daughter helps with the phone, and the clinician identifies a need for further assessment and a change in treatment.

The apparent success reveals the next problem. Medication has to be obtained, mobility needs further assessment and the family is concerned about the steps outside the home. None of these needs is resolved by the video consultation itself.

A mature digital pathway therefore connects the remote encounter with local action. Information is communicated to the appropriate primary healthcare service, the family understands what happens next and concerns about mobility are routed towards relevant rehabilitation or support services.

If digital consultation data repeatedly show that patients in the same locality cannot complete recommended follow-up because of transport or service availability, the information becomes valuable planning intelligence.

The lesson is not that telehealth is unsuitable for rural South Africa. It can be particularly valuable there. The lesson is that digital access should shorten a pathway rather than merely move its bottleneck. Technology delivers equity only when the actions generated by the technology remain achievable.

Safeguarding looks different when services are distant

Rural community life can provide strong informal protection. Neighbours may notice absence, faith communities may know who is isolated and extended families may maintain close relationships.

Informal visibility, however, should not be confused with formal safeguarding capacity.

Older people can experience physical, emotional, sexual and financial abuse, neglect and exploitation in any setting. Geographic isolation can make disclosure and intervention more difficult, particularly where the person depends on the alleged abuser for transport, money or personal care.

Professional contact may be infrequent. Confidential opportunities to disclose concerns may be limited. Community relationships can also make privacy complicated where everyone knows one another.

The Older Persons Act establishes protections against abuse and creates duties within the wider safeguarding framework. Operationally, rural safeguarding requires routes that remain usable despite distance.

Workers need to know how to escalate concerns, who can respond and what happens when immediate protection is necessary. Services should also recognise patterns rather than waiting for one dramatic incident. Repeated missed medication, unexplained injuries, sudden financial difficulties or a caregiver preventing private conversations can require further exploration.

Good safeguarding incident response and escalation depends on speed, clarity and coordination. In a remote area, planning also needs to account for the practical time required for somebody to reach the person.

Operational scenario: an isolated safeguarding concern becomes a system test

A community caregiver notices that an older woman who normally attends a local service has stopped coming. During a home visit, the caregiver finds her withdrawn and observes that food supplies are low despite the woman receiving regular income. A relative who has recently moved into the household answers most questions for her.

The caregiver cannot determine from one visit whether abuse is occurring. Dismissing the situation would be unsafe, but confronting the relative without a plan could also increase risk.

The concern is recorded and escalated through the organisation’s safeguarding arrangements. A social worker is contacted, and the older woman is given an opportunity to speak privately. Her wishes, immediate safety, financial circumstances and dependence on the relative are explored rather than assuming that removal from the household is automatically the preferred response.

The geographic context matters. Alternative accommodation is not immediately nearby, and the woman does not want to leave her community unless necessary. Protection planning therefore has to combine statutory safeguarding responsibilities with practical local options.

At governance level, the organisation reviews how long the escalation took and whether staff knew whom to contact. If similar delays recur across remote communities, the issue becomes more than one safeguarding case. It indicates that the response pathway itself needs strengthening.

Rural safeguarding is therefore both a person-centred protection process and a test of whether formal systems can reach people when informal arrangements become unsafe.

Quality assurance has to see beyond the service office

Registration and national norms and standards provide essential foundations for community-based services. Government guidance states that registered community-based care and support services are monitored and evaluated for continuing compliance.

In dispersed services, however, quality is experienced largely away from organisational premises.

The relevant questions concern whether visits occur as planned, whether workers have the right skills, whether changing needs are recognised, whether records support continuity and whether people receiving care feel safe and respected.

Supervision is also more difficult when workers spend much of their time independently across large geographic areas. Managers need sufficient visibility without creating an administrative burden that removes workers from direct support.

Digital records and mobile systems can help, but governance should focus on meaningful evidence rather than electronic activity for its own sake.

A small rural service may benefit from tracking a focused set of indicators: missed visits, unfilled shifts, travel disruption, incidents, safeguarding concerns, hospital admissions, changing dependency, complaints and workforce turnover.

Approaches to quality data and performance metrics are valuable when the information leads to decisions rather than simply accumulating reports.

The Quality Dashboard Builder can help organisations structure this kind of oversight. In a South African rural context, locally meaningful indicators would need to reflect travel, access and community outcomes alongside conventional quality measures.

Provincial planning needs to see rural capacity as a network

Responsibility for implementing social development services is distributed across national and provincial structures, with non-profit organisations playing a major delivery role. Rural capacity therefore cannot be understood by examining one organisation at a time.

A district may have a residential facility, several community organisations, primary healthcare services, community health workers, social workers, rehabilitation professionals and informal community networks. The strategic question is whether these components function as a usable network for older people.

Mapping can reveal gaps that service counts alone conceal.

A province may know how many funded organisations it has without knowing whether their combined catchment areas leave particular communities effectively uncovered. It may know how many caregivers are employed without understanding how travel affects available care hours.

Demographic information should therefore be combined with service location, workforce, travel and utilisation data.

That creates a more useful basis for decisions about new funding, outreach, transport support, workforce development and partnership arrangements.

It also strengthens accountability. If a rural district repeatedly produces delayed assessments, avoidable hospital use or family breakdown because support cannot reach households, the pattern should be visible above the individual case level.

The purpose of governance is not to eliminate every operational difficulty. It is to ensure that recurring difficulties become information capable of changing the system.

Climate and infrastructure resilience will increasingly matter

Rural care systems are exposed to wider infrastructure risks. Extreme weather, flooding, heat, road disruption, electricity interruptions and water insecurity can affect older people directly and interrupt the services supporting them.

Older people with frailty, disability or chronic illness may be particularly vulnerable when transport routes become unusable or medication and equipment depend on reliable infrastructure.

This creates a growing requirement to connect long-term care with continuity planning.

Community organisations need to understand which people would be most at risk during disruption, how staff would maintain contact and which alternative arrangements are realistic. Provincial and local emergency structures also need visibility of populations who may require additional assistance.

The principle of risk assessment and scenario planning is especially relevant because resilience is easier to build before disruption than during it.

This does not mean every rural care service needs a complex emergency infrastructure. It means foreseeable dependencies should be understood: roads, vehicles, mobile networks, power, water, medication supply and the availability of family or neighbours.

Climate resilience will increasingly become part of ageing policy because independence depends partly on the resilience of the environment around the person.

The future lies in distributed capability rather than institutional concentration

South Africa’s policy emphasis on supporting older people within their communities provides an important foundation for rural ageing. The demographic trajectory makes implementation increasingly significant.

Expanding residential capacity may be necessary in some areas, particularly for people requiring continuous care, but institutions cannot become the default solution to geographic disadvantage.

A sustainable rural architecture is more likely to combine community-based services, primary healthcare, rehabilitation, social work, trained caregivers, family support, service centres, outreach and selective use of technology.

The exact configuration will differ between provinces and communities.

What matters is that responsibilities connect. An older person should not have to understand administrative boundaries between health and social development in order to obtain help. A family should know where to raise concerns. A community worker should have access to professional advice. Provincial leaders should be able to see where demand is outgrowing local capacity.

Future models could make greater use of digital coordination, mobile specialist input and data-led service planning. These are credible directions rather than substitutes for investment in physical services and people.

The Older Persons Amendment Act 1 of 2025 also points towards stronger monitoring, evaluation and implementation within the legislative framework. As of September 2026, its commencement remains subject to proclamation, so its enacted reforms should not be confused with provisions already operational under the principal Act.

The strategic opportunity is to use stronger oversight not merely to identify non-compliance but to understand where geography itself is producing recurring service risk.

International learning from South Africa’s rural care challenge

Rural ageing is not unique to South Africa. Countries with large territories, dispersed populations or significant internal migration face similar questions about how to provide support without concentrating all specialist capacity in cities.

South Africa’s circumstances are nevertheless distinctive. Its rural care challenge sits within substantial socioeconomic inequality, a strong social-grant system, provincial delivery responsibilities, significant non-profit provision and extensive family and community support.

These institutions cannot simply be transplanted elsewhere.

The transferable lesson lies instead in treating distance as a design variable.

Uniform service models can produce unequal access when population density, transport and workforce availability differ substantially. Rural equity may require different staffing assumptions, more outreach, stronger community capability and greater tolerance for delivery models that appear less productive when measured only by contacts per worker.

A second lesson concerns informal care. Strong community networks are assets, but they should increase the effectiveness of formal support rather than justify its absence.

Finally, digital technology is most useful when it connects scarce expertise with local capability. A remote specialist linked to a competent local worker can extend reach. A remote specialist without any local response capacity simply identifies needs from further away.

The model is shaped by South Africa’s own institutions, but these principles have wider relevance wherever older people risk receiving less support simply because they live further from it.

Conclusion

Rural ageing in South Africa brings together demographic change, poverty, migration, transport, workforce distribution and community resilience. The Older Persons Act provides a clear direction towards enabling older people to remain within their homes and communities, but achieving that ambition across dispersed areas requires more than formally available programmes.

The strongest rural systems will treat geography as part of care design. Travel time must be recognised in capacity planning. Families need support rather than assumptions about unlimited availability. Community caregivers require training, supervision and routes to professional expertise. Health and social development services need practical interfaces around the older person, while technology should extend human capability rather than replace it.

Provincial governance has an equally important role. Service counts need to be supplemented by evidence about coverage, travel, unmet need, workforce stability and outcomes. Where the same communities repeatedly struggle to obtain support, that pattern should influence resource and service decisions.

South Africa’s rural communities already contain substantial social assets: families, neighbours, community organisations and older people themselves. Sustainable policy should build around those strengths without exploiting them. As the population ages, the decisive question will be whether community-based care becomes genuinely reachable across geography. Rural residence should shape how support is organised; it should not determine whether an older person can obtain meaningful support at all.