Safeguarding Older Adults in Ghana: Preventing Abuse, Neglect and Financial Harm in Later Life

An older person does not need to live in a formal care service to experience a safeguarding risk. Harm may develop in the home, around property or money, during illness, through dependency on another person, or because somebody who needs assistance is gradually left without adequate care. The person causing harm may be a relative, neighbour, caregiver, service worker or somebody who has deliberately targeted the older person because of vulnerability.

Ghana’s National Ageing Policy establishes dignity, security and freedom from exploitation, discrimination and abuse as important principles for later life. Across the wider Ghana Ageing, Long-Term Care & Community Support Knowledge Hub, those principles connect directly with the country’s developing approach to family care, community support, healthcare, social protection and long-term care. As more people live into older age, safeguarding needs to develop alongside those systems rather than remain a response used only after serious harm has occurred.

The challenge is particularly complex because protection and autonomy can pull in different directions. Older people may depend financially or physically on relatives they love. They may choose arrangements professionals consider risky. They may be reluctant to report mistreatment if doing so could threaten housing, relationships or daily support. Strong safeguarding therefore cannot be reduced to removing risk. It requires the ability to recognise harm, hear the older person, coordinate an appropriate response and address the conditions that allow abuse or neglect to continue.

Safeguarding begins with recognising the full range of harm

Abuse of older people can include physical, psychological, sexual and financial abuse, neglect, abandonment and serious loss of dignity. In practice, these categories frequently overlap.

An older woman whose pension is controlled by a relative may also be prevented from buying medicines. A man dependent on another person for mobility may experience intimidation because he cannot easily leave the household. Somebody with cognitive impairment may be persuaded to transfer money or property without understanding what is happening. An exhausted family caregiver may begin leaving an increasingly dependent relative without adequate food, hygiene or supervision.

Safeguarding systems therefore need to look beyond dramatic incidents.

Changes in behaviour, unexplained injuries, recurring hunger, deteriorating living conditions, unusual financial transactions, missing medicines, fearfulness around a particular person or repeated failure to attend healthcare appointments may all justify further enquiry. None automatically proves abuse, but each can provide information that should not be dismissed simply because the older person lives with family.

The wider principle of understanding different forms of abuse is important because narrow definitions create blind spots. Financial harm, coercion and neglect can be as consequential as visible physical violence.

Recognition also requires cultural sensitivity without cultural exemption. Family relationships, inheritance practices, community authority and beliefs about ageing differ between households and regions. Those differences should shape how concerns are understood and discussed, but they should not make serious harm acceptable.

Ghana already has a rights foundation, but protection depends on implementation

Ghana’s National Ageing Policy, “Ageing with Security and Dignity”, places human rights, security, participation and protection from exploitation and abuse within the national policy framework for older people. That provides an important foundation, but a policy commitment is not the same as a comprehensive operational adult-protection system.

Safeguarding in practice crosses several parts of Ghana’s institutional architecture. The Ministry of Gender, Children and Social Protection and Department of Social Welfare have responsibilities relevant to vulnerable adults and social welfare. Ghana Health Service and healthcare providers may encounter injuries, neglect, mental distress or unexplained deterioration. The Ghana Police Service and justice system become relevant where conduct may be criminal. Metropolitan, Municipal and District Assemblies influence local social services and community structures. Financial institutions may identify suspicious transactions. Community, faith and civil society organisations may be the first to hear that something is wrong.

The central governance problem is therefore not simply identifying another organisation to add to the pathway. It is determining what happens after concern arises.

A workable system needs clarity about who receives information, who assesses immediate danger, how healthcare and social circumstances are considered together, when police or legal intervention is appropriate and how the older person remains involved.

Organisations considering comparable questions of responsibility and escalation can use the Governance Maturity Assessment to structure thinking about accountability and oversight. It is not a Ghanaian safeguarding standard, but it illustrates the governance principle: shared responsibility should not become responsibility that disappears between institutions.

Financial exploitation can remain hidden behind ordinary family arrangements

Money within families rarely moves through neat administrative boundaries. Adult children may pay bills for parents. Older people may support grandchildren. Relatives abroad may send remittances. One household member may collect income or make purchases for somebody whose mobility is limited.

These arrangements can be entirely consensual and supportive. They can also create opportunities for exploitation.

An older person may have money withheld, be pressured into transferring assets, lose control of a pension or benefit, or be persuaded to sign documents they do not understand. A relative may justify taking money by saying that the family is entitled to it. Where property values increase or inheritance is disputed, pressure can become particularly significant.

Financial abuse is difficult to address because dependence may run in both directions. An older person may rely on a son for transport while the son relies on the parent’s income. Challenging the financial arrangement could therefore threaten the older person’s practical support.

The response needs to establish more than whether money has moved. It needs to understand consent, control, benefit and consequence.

Does the older person know what is happening? Do they agree? Are they able to access their own money? Are essential needs being met? Has somebody used threats or deception? Has control changed after illness or cognitive decline?

Those questions are consistent with person-centred safeguarding: protection should begin with the person’s experience rather than treating every unusual family financial arrangement as automatically abusive.

A pension collected by someone else can become a safeguarding issue

Consider a 78-year-old widow living in a town outside Kumasi. Arthritis makes travelling difficult, so her nephew increasingly handles errands and financial transactions. The arrangement initially works well. Over time, however, she tells a community health worker that she frequently has no money for food or transport to appointments despite receiving regular income.

The simplest response would be to confront the nephew. That could also leave the woman without the person currently buying food and arranging transport.

A stronger response begins privately with her. What does she believe should happen to her money? How much control does she retain? Is she afraid of the nephew? Are other relatives available? Does she need assistance accessing financial services independently? Are there concerns about her cognition or ability to understand transactions?

If evidence suggests theft, coercion or other unlawful behaviour, the matter may require escalation beyond social support. But the safeguarding response should simultaneously consider the practical consequences of intervention. If the nephew stops visiting tomorrow, who will obtain food and medicines?

This is why financial safeguarding cannot operate separately from care planning. Protection that removes an abusive arrangement without replacing the legitimate support embedded within it can create another form of risk.

If similar cases repeatedly involve older people surrendering financial control because mobility prevents independent access, the local lesson is broader still. Accessible banking, trusted payment mechanisms, transport and digital support become part of prevention rather than merely conveniences.

Property, inheritance and housing security can determine whether an older person is safe

Safeguarding in Ghana also intersects with land, housing and inheritance. The National Ageing Policy has long recognised that older people can experience housing insecurity and property disputes, with older women facing particular vulnerabilities following the death of a spouse.

The consequences extend beyond ownership.

An older person who fears being removed from a home may tolerate mistreatment by relatives. A widow may experience pressure over property while simultaneously depending on the same extended family for food, transport or care. A dispute may therefore involve legal rights, economic security, emotional abuse and practical dependency at the same time.

Responses need to distinguish genuine family disagreement from coercion, fraud or abuse. Access to appropriate legal assistance can be important, but legal resolution alone may not address the person’s support needs.

This is also where prevention matters. Clear information, accessible legal processes and stronger awareness of older people’s rights can reduce opportunities for exploitation before dependency becomes acute.

The principle connects with safeguarding and human rights in later life. Safety should not be defined only as freedom from immediate injury. Security of home, possessions, decision-making and relationships can all influence whether an older person can live with dignity.

Neglect is not always deliberate, but its consequences still matter

Neglect can arise through intentional abandonment, but it can also emerge gradually when the level of care required exceeds what a household can provide.

An older man becomes less mobile. His wife initially helps him wash and dress. He then develops continence difficulties and begins falling. Their adult children provide money but live elsewhere. His wife becomes exhausted and starts leaving some tasks undone.

The resulting poor hygiene, dehydration or missed medicines may meet the practical definition of serious neglect even though his wife has no intention of harming him.

This distinction matters to the response.

Punitive intervention directed at an overwhelmed caregiver may make the situation worse. The immediate question is whether the older person is safe; the next is why adequate care is not being provided.

Where lack of knowledge, caregiver illness, poverty or absence of services is contributing to harm, the safeguarding plan should address those causes. Training, equipment, respite, rehabilitation or paid assistance may be more protective than simply instructing the family to provide better care.

Intent remains relevant where deliberate cruelty, exploitation or abandonment is suspected, but safeguarding should be capable of responding to both malicious and non-malicious pathways into harm.

This is why prevention and early intervention are integral to safeguarding. Families who receive support before exhaustion becomes extreme are less likely to reach the point where basic care collapses.

Healthcare services can see risks that remain invisible elsewhere

Health professionals occupy an important position because older people may attend healthcare services even when they have little contact with social welfare structures.

Repeated injuries, untreated wounds, dehydration, poor medication management, anxiety or delayed presentation can all raise questions about the person’s circumstances. A clinician may also observe interactions between an older person and accompanying relative that suggest fear, control or difficulty speaking freely.

None of these observations should automatically be interpreted as abuse. Older people can bruise easily, falls are common and poverty can produce poor living conditions without another person intentionally causing harm.

The operational requirement is professional curiosity combined with proportionate escalation.

Healthcare staff need enough knowledge to recognise possible harm, speak with the person appropriately and know what to do when concern remains. That is particularly important where cognitive impairment, communication difficulty or disability makes disclosure harder.

Safeguarding information also needs to follow the person across transitions. If a hospital identifies concerns but the information disappears when somebody returns home, the protective value of recognition is lost.

Information sharing must nevertheless remain proportionate. Sensitive allegations should not circulate through communities merely because several organisations are involved. Privacy, consent and immediate safety all need consideration.

The wider discipline of responsible safeguarding information sharing therefore matters as Ghana develops stronger coordination between healthcare, social welfare and community support.

Cognitive impairment changes risk but should not erase autonomy

Dementia and other forms of cognitive impairment can increase vulnerability to exploitation, neglect and coercion. They can also create a danger that everybody begins speaking about an older person rather than with them.

A diagnosis or memory problem does not automatically mean that somebody cannot make any decisions.

An older person may understand daily spending but struggle with a complex property transaction. They may be able to express clearly whom they trust even if they cannot recall every recent event. Their ability may fluctuate with illness, fatigue or distress.

Safeguarding therefore requires careful attention to the particular decision rather than a blanket assumption that family members should take control.

This is especially important where the person alleged to be causing harm is also the person presenting themselves as the older adult’s spokesperson.

Communication should be adapted where necessary. Conversations may need more time, familiar language, reduced distraction or support from somebody independent of the alleged source of harm.

The aim is not to create an imported legal test where Ghanaian law and procedure differ. It is to preserve a rights-based operational principle: dependency should not automatically extinguish voice.

Where organisations need to examine how autonomy and risk can coexist, the Positive Risk-Taking Planner provides a generic framework for structuring those questions. It does not determine Ghanaian legal capacity or safeguarding decisions, but it can help separate genuine protection from unnecessary restriction.

Safeguarding can become harder when harmful beliefs surround ageing

Older people do not experience abuse outside their cultural and social environment. Ageism, stigma and harmful accusations can affect how communities interpret illness, dementia, unusual behaviour, poverty or dependency.

In some circumstances, an older person may be ostracised, threatened or displaced following accusations connected with supernatural beliefs. Older women can face particular exposure where age, widowhood, poverty and gender inequality intersect.

A safeguarding response cannot simply dismiss deeply held community beliefs and expect the risk to disappear. Nor can cultural sensitivity justify threats, violence, dispossession or degrading treatment.

Effective prevention requires work at community level: challenging harmful age-related stereotypes, increasing understanding of dementia and mental or physical illness, engaging trusted community and faith leaders, and ensuring that older people know where they can seek help.

This is an area where cultural identity and person-centred support need to operate together. Respecting culture means understanding the person’s social world and sources of identity. It does not require accepting practices that remove their rights or safety.

Community education is therefore not separate from safeguarding infrastructure. Where stigma contributes to harm, changing the environment around the person can be as important as responding to individual incidents.

A rural safeguarding concern may require coordination rather than a single referral

Imagine a 74-year-old woman in a rural community whose behaviour has changed following the death of her husband. She sometimes appears confused and has begun wandering outside at night. Some neighbours interpret her behaviour through harmful beliefs, and hostility towards her increases.

A niece who lives nearby is worried but has limited resources. The nearest health services are some distance away and the woman has not received a full assessment.

Treating this only as a community dispute would miss possible health needs. Treating it only as a medical problem would miss the immediate social risk.

A coordinated response could involve healthcare assessment to understand cognitive or physical causes, social welfare involvement where protection or practical support is required, engagement with trusted local figures to reduce hostility and family discussion about sustainable support. If threats or violence have occurred, appropriate law-enforcement involvement may also be necessary.

The woman herself should remain central. She may want to stay in her community, and relocation should not become the automatic safeguarding response simply because it is administratively easier.

If the immediate risk can be reduced while support around her improves, remaining at home may be possible. If danger persists, temporary alternative arrangements may be required.

The case demonstrates why multi-agency safeguarding matters. No single participant can address cognition, community hostility, practical care, possible criminal behaviour and the person’s living arrangements simultaneously.

Formal care services create a different set of safeguarding responsibilities

As Ghana’s paid home-support and residential-care sectors develop, safeguarding responsibilities increasingly extend beyond families.

Paid services introduce professional power into people’s homes and daily lives. Workers may assist with personal care, mobility, medicines, food or money. Residential settings may control routines, visitors and access to the wider community. These arrangements can provide essential support, but they also create opportunities for neglect, exploitation, restrictive practice or institutional cultures that diminish dignity.

Quality assurance therefore needs to examine more than whether a service exists.

Providers should be able to demonstrate how workers are selected, trained and supervised; how concerns are reported; how complaints are handled; how incidents are reviewed; and how people receiving support can speak without fear of retaliation.

Where a worker handles money, clear financial controls become particularly important. Where a service supports people with cognitive impairment, staff competence in communication, distress and rights matters. Where workers operate alone in private homes, supervision and escalation need to compensate for reduced direct oversight.

These are developing questions within Ghana’s broader long-term care architecture rather than evidence of one uniform national regulatory model. The key principle is that expansion of formal care should be accompanied by proportionate assurance.

Providers and system partners can use the Quality Dashboard Builder to consider how incidents, complaints, workforce indicators and outcomes can be viewed together. It does not replace Ghanaian requirements, but it demonstrates how safeguarding becomes stronger when warning signals are connected rather than reviewed separately.

Workforce competence determines whether policies reach the person

Safeguarding depends heavily on the judgement of people closest to the situation.

A community health worker may need to decide whether poor hygiene reflects poverty, self-neglect, caregiver difficulty or deliberate neglect. A social welfare officer may need to explore financial control without destabilising essential family support. A care worker may hear an older person disclose abuse and need to know how to respond without promising secrecy that cannot safely be maintained.

Training therefore needs to develop judgement rather than only awareness of categories.

Relevant capabilities include recognising indicators of abuse, communicating privately with older people, documenting concerns accurately, understanding confidentiality, responding to immediate danger, knowing escalation routes and avoiding discriminatory assumptions about age or disability.

Supervision matters equally. Workers facing ambiguous family situations need access to advice. Otherwise difficult decisions can become individualised, inconsistent and defensive.

This has implications for Ghana’s wider workforce assurance. As community and long-term care services grow, safeguarding competence should develop alongside technical care skills rather than being treated as a specialist subject relevant only after serious incidents.

Workforce wellbeing also matters. Poorly supported, exhausted or insecure workers can find it harder to maintain safe practice. Strong safeguarding cultures therefore depend partly on employment conditions, supervision and leadership as well as formal procedures.

Digital systems can prevent exploitation and create new forms of harm

Digitalisation changes safeguarding rather than simply improving it.

Electronic payments can reduce the need for somebody else to handle cash. Mobile communication can help relatives maintain contact with an older person living elsewhere. Digital records can improve continuity when several services are involved. Remote technology may support people who live alone.

But digital systems can also create vulnerability.

An older person may disclose a mobile money PIN to somebody assisting them and gradually lose financial control. Fraudsters may exploit unfamiliarity with digital services. Family members may use devices or monitoring technology in ways that intrude on privacy. An older person without digital skills may become dependent on another person for access to benefits, banking or information.

Digital safeguarding therefore needs to consider control as well as access.

A useful question is whether technology increases the older person’s independence or merely transfers dependence from one mechanism to another.

Organisations considering technology-enabled services can use the Digital Transformation Readiness Assessment to structure questions about governance, workforce readiness and digital risk. It is not a Ghana-specific cybersecurity or safeguarding standard, but the underlying discipline is relevant: technology should be implemented with privacy, access and human consequences considered from the outset.

Good safeguarding needs a pathway from concern to outcome

Awareness campaigns are valuable only if somebody who recognises abuse can reach an effective response.

A mature safeguarding pathway does not necessarily require Ghana to reproduce another country’s institutional model. It does require several functions to connect.

• Older people, families and communities need accessible ways to raise concerns.
• Frontline workers need to recognise possible harm and understand where concerns should go.
• Immediate safety needs to be distinguished from issues requiring longer assessment.
• Healthcare, social welfare, justice and community responses need to connect when the circumstances cross institutional boundaries.
• The older person’s wishes, communication needs and practical dependencies need to influence decisions.
• Recurring patterns should reach decision-makers so that prevention and service design improve.

The final point is frequently neglected.

If several older people experience financial exploitation through the same service, repeated incidents should trigger scrutiny of that service. If neglect repeatedly follows hospital discharge because families receive inadequate preparation, the discharge pathway needs attention. If property disputes repeatedly expose widows to displacement, policy and legal-access questions arise beyond individual cases.

Safeguarding becomes a system-improvement function when individual experience changes the conditions that produced the risk.

Measuring safeguarding requires more than counting reports

An increase in reported concerns does not automatically mean that abuse has increased. It may indicate that awareness and confidence in reporting have improved. Conversely, a district recording few concerns may have low incidence or simply limited mechanisms for recognition.

Performance measures therefore need interpretation.

Useful evidence can include the type of concern, where it arose, whether immediate protection was required, the time taken to respond, whether the older person was heard, what support followed and whether similar harm recurred.

Complaints, healthcare data, community intelligence and provider incidents may each reveal different parts of the picture.

Data also need demographic context. Gender, disability, cognitive impairment, living arrangements, rurality and economic circumstances may influence vulnerability and access to protection. Better evidence can help Ghana understand where prevention should be targeted without labelling whole groups as inherently vulnerable.

The wider practice of using quality data and performance evidence is therefore directly relevant. Safeguarding information should help leaders ask why patterns exist rather than simply demonstrate that cases have been processed.

Older people and families should also influence how success is defined. Closure of a case is an administrative event; restoration of safety, control and confidence is an outcome.

Prevention requires stronger everyday support around older people

Safeguarding cannot be separated from the wider condition of Ghana’s long-term care system.

Isolation increases dependence. Inadequate caregiver support can contribute to neglect. Poverty can make people vulnerable to financial pressure. Limited dementia understanding can intensify stigma. Weak formal care options can leave an older person dependent on a harmful relationship because no practical alternative exists.

Some of the strongest safeguarding interventions are therefore not labelled safeguarding at all.

Reliable community healthcare, caregiver respite, accessible transport, social protection, rehabilitation, trustworthy home support, age-friendly communities, legal assistance and opportunities for social participation can all reduce vulnerability.

This does not remove the need for robust responses when deliberate abuse occurs. It creates an environment in which fewer people become trapped in unsafe arrangements.

Ghana’s demographic transition makes that preventive perspective increasingly important. As the number of older people rises, safeguarding cannot depend on exceptional intervention around a small number of highly visible cases. Protection needs to become part of the ordinary design of health, social welfare, financial and long-term care systems.

International learning should focus on functions rather than imported institutions

Countries with more developed adult-protection systems often use dedicated safeguarding agencies, statutory reporting arrangements, multidisciplinary teams or specialist financial-protection mechanisms. Those structures reflect particular legal systems, public-service capacity and long-term care markets.

They cannot simply be transplanted into Ghana.

The more transferable lessons concern functions. People need somewhere accessible to disclose harm. Professionals need clear routes for escalation. Different sectors need mechanisms to work together. Financial exploitation requires attention alongside physical abuse. Caregiver stress should be addressed before it becomes harmful. Formal care services require oversight. Data from incidents should influence prevention.

Ghana can build those functions through institutions and community structures appropriate to its own administrative and cultural context.

There is also an international lesson in the other direction. Systems with highly formalised safeguarding arrangements can become overly procedural, measuring referrals and meetings while losing sight of the person’s desired outcome. Ghana’s strong family and community relationships underline the importance of understanding safeguarding within the person’s actual social network.

The objective is neither maximum bureaucracy nor maximum informality. It is protection that is accessible, proportionate, accountable and capable of preserving relationships where they are safe while intervening decisively where they are not.

Conclusion

Safeguarding older adults in Ghana will become increasingly important as population ageing, chronic illness and longer periods of dependency change the circumstances in which people live and receive support. The National Ageing Policy already establishes a clear principle: older people should live with dignity and security and be free from exploitation, discrimination and abuse. The next challenge is ensuring that this principle can be recognised in everyday practice.

That requires a broader understanding of harm. Physical abuse matters, but so do financial exploitation, coercion, neglect, property insecurity, harmful beliefs and the gradual loss of control that can accompany dependency. Effective responses need to connect healthcare, social welfare, justice, financial services, community organisations and emerging long-term care services without allowing responsibility to disappear between them.

Protection must also remain person-centred. Family relationships should not be treated as automatically safe or automatically suspect. Cognitive impairment should not erase voice. Intervention should address the practical support an older person may lose when a harmful relationship changes. Stronger caregiver support, community services and economic security can prevent some risks before they become safeguarding incidents.

The strongest future direction is therefore both protective and preventive. Ghana can develop clearer pathways for recognising and responding to harm while building everyday services that reduce isolation and unsafe dependency. Safeguarding will be strongest when national commitments are visible in local decisions and when success is measured not by the number of cases closed, but by whether older people retain safety, dignity, control and meaningful participation in their own lives.