Exploring end-of-life care during reintegration from the perspectives of correctional social workers and caregivers providing after-care services to elderly parolees released on medical parole in eThekwini Metropolitan Municipality.

Abstract

Legislation that governs the medical release of offenders in South Africa remains a contentious issue, particularly concerning the reintegration and end-of-life care of elderly parolees. Despite the growing discourse on end-of-life care, there is a critical gap in understanding the lived experiences of elderly parolees and the challenges faced by their caregivers. Guided by Caregiver Dynamics Theory and Ecosystems Theory, this study adopted a qualitative phenomenological approach to explore how end-of-life care is experienced during reintegration from the perspectives of family caregivers and correctional social workers. Participants were selected through purposive sampling, and data were generated using in- depth semi-structured interviews. The sample comprised 15 caregivers and six (n=6) correctional social workers (who were responsible for delivering social work programmes to parolees). All ethical standards including informed consent, confidentiality, voluntary participation, and sensitivity to participant vulnerability were strictly observed. The data were analysed using thematic content analysis, allowing for an in-depth interpretation of experiential meanings. Based on the interview guide, the researcher was able to gather data which revealed that reintegration is hindered by inadequate institutional care, limited caregiver support, insufficient training, and weak community linkages. The study identifies systemic failures, including the lack of specialised end-of-life care services within correctional frameworks, leading to increased physical confinement, isolation, and emotional distress for elderly parolees. Spiritual practices emerged as an essential coping mechanism, yet they remain an underutilised resource. Family caregivers reported experiencing compassion fatigue, ambiguous loss, and difficulty balancing caregiving responsibilities with personal wellbeing. The absence of training on medication management and polypharmacy further complicated caregiving, leading to ineffective medical support. Many caregivers expressed feelings of resentment and regret, exacerbated by their emotional and physical burdens. Conversely, prior experience in caring for relatives that are now deceased enabled some caregivers to better navigate the demands of end-of-life care, highlighting the role of experiential learning in improving caregiving outcomes. Correctional social workers were found to be largely ill-equipped to support elderly parolees, with findings indicating a lack of structured aftercare programmes. This deficiency resulted in the exclusion of ill elderly parolees from essential reintegration services, straining family relationships and diminishing the effectiveness of reintegration efforts. Furthermore, inadequate collaboration between custodial and non-custodial correctional social workers severely compromised service delivery, undermining the quality of end-of-life care for elderly parolees. This study underscores significant deficiencies in training, policy, and resource allocation within the correctional system, emphasizing the urgent need for policy reform and targeted advocacy. The findings call for a comprehensive approach that includes specialised training for caregivers and social workers, improved interdepartmental collaboration, and enhanced institutional support for elderly parolees in end-of-life care. Recommendations are directed at policymakers, programme coordinators, correctional social workers, and managers within the Department of Correctional Services to ensure effective reintegration and dignified end-of-life care for elderly parolees.