Worawet Suwanrada, Ph.D.

Dean of College of Population Studies and Associate Professor of Economics Chulalongkorn University

Regional Expert Consultation on Long-term Care of Older Persons

9-10 December 2014

ESCAP, Bangkok

National experiences from Thailand regarding long-term care of older persons

Outline of Presentation

1. Population Aging in Thailand: Situation and Trends

2. Current Situation of Elderly Care in Thailand: Family Care and Policy

3. Community-based Integrated Approach for Older Person’s Long Term Care

4. Progression of Elderly Care Policy from the Perspective of the 2nd National Plan on the Elderly’s the 2nd Monitoring and Evaluation

5. Challenges of Long Term Care System in Thailand

1

Population Aging in Thailand:

Situation and Trends

Population Aging in Thailand: Increase of the older population (aged 60+) through last 50 years.

4.6 4.95.5

7.4

9.5

13.2

0

2

4

6

8

10

12

14

Source: The National Population and Housing Census, National Statistical Office, quoted in TGRI (2012), The Situation of Thai Elderly 2011.

13.213.7

14.214.7

15.315.9

16.517.1

17.818.4

19.119.8

20.521.3

22.022.8

23.624.3

25.125.9

26.627.2

27.928.5

29.129.6

30.230.7

31.231.7

32.1

9.1 9.3 9.6 9.9 10.2 10.611.0

11.512.0

12.513.0

13.514.1

14.715.2

15.816.5

17.117.8

18.419.1

19.820.5

21.221.8

22.523.0

23.624.1

24.625.0

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040

60 up

65 up

Population Aging in Thailand: The proportion of the older population aged 60 and over (or 65 and over) will increase

from now 13% (9%) to 32% (25%) in next three decades.

Source: National Economic and Social Development Board (NESDB), Population Projection in Thailand: 2010-2040

Population Ageing in Thailand: Fertility Decline (TFR) after 1970s

4.9

2.7

2.01.7 1.6 1.5

0

1

2

3

4

5

6

- - - -

Source: TGRI (2012), The Situation of Thai Elderly 2011 and National Economic and Social Development Board , Population Projection in Thailand: 2010-2040

Population Ageing in Thailand: Increase of Life Expectancy at Birth

58.0

63.8

65.6

67.7

69.9 69.970.6

71.6

72.673.4

74.174.7

75.3

63.8

68.9

70.9

72.4

74.9

77.6 77.778.4

79.380.1

80.881.3

81.9

50.0

55.0

60.0

65.0

70.0

75.0

80.0

85.0

- - - -

Male

Female

Source: TGRI (2012), The Situation of Thai Elderly 2011 and National Economic and Social Development Board , Population Projection in Thailand: 2010-2040

/2040

Population Aging in Thailand: The number and proportion of the oldest old population (80 and above) will be increasing.

0.0

5,000.0

10,000.0

15,000.0

20,000.0

25,000.0

- - - - 80 up

Source: National Economic and Social Development Board (NESDB), Population Projection in Thailand: 2010-2040.

Distribution of the Older Persons by Age in 2010, 2020, 2030, 2040

Age Group 2010 2020 2030 2040

Number of Older Persons

Age of 60 and over 8,407,965 12,621,655 17,578,929 20,519,373

Age 0f 70 and over 3,778,297 5,366,052 8,318,501 11,560,886

Age of 80 and over 1,070,178 1,689,474 2,420,579 3,921,450

Proportion of the Older Persons by Age (%)

60-69 55.1 57.5 52.7 43.7

70-79 32.2 29.1 33.6 37.2

80 up 12.7 13.4 13.8 19.1

Total 100.0 100.0 100.0 100.0

9 Data Source: National Economic and Social Development Board , Population Projection in Thailand: 2010-2040.

Functional Limitations of the Elderly In 2011, among total older population (60+), the proportion of the elderly

with functional limitations in daily living is 3.7%.

Survey Year 2007 2011

Total 3.8 3.7

Age 60-64 1.4 1.4

65-69 2.4 2.0

70-74 3.7 2.6

75-79 4.6 4.8

80 up 14.9 15.4

Sex Male 3.2 3.0

Female 4.2 4.1 Source: The 2007 and 2011 Survey of the Older Population in Thailand by NSO, quoted in TGRI (2012), The Situation of Thai Elderly 2011.

The number and proportion of the oldest old population (80 and above)

will be increasing. + Increase of life expectancy

More frail elderly live longer?

2

Current Situation of Elderly Care in Thailand: Family Care and Policy

The 2nd National Plan on the Elderly (2002-2021) 1st revised of 2009

The Government Stance on Elderly Policy

Who are the older population’s caregivers? (Data Source: The 2011 Survey of the Older Population in Thailand by NSO)

26%

36%

52%

35% 37%

19%

13%

5% 6% 3%

0%

10%

20%

30%

40%

50%

60%

Source: Figure 6.9 in John Knodel, Vipan Prachuabmoh and Napaporn Chayovan (2013)

Who is the older population’s main caregiver? (Data Source: The 2011 Survey of the Older Population in Thailand by NSO)

Main Providers of Assistance with Daily

Living Activities

All Married Not Married

Total Men Woman Total Men Woman Total Men Woman

spouse 18.1 32.4 9.0 33.5 42.0 22.8 - - -

child or child in law 66.2 54.9 73.4 57.1 50.1 66.1 76.8 71.3 78.1

other relative 12.5 8.5 15.1 7.3 6.0 8.9 18.7 16.9 19.1

paid carer 2.8 3.8 2.2 1.8 1.7 1.9 4.1 10.9 2.5

other 0.4 0.4 0.4 0.3 0.2 0.4 0.4 0.8 0.4

total 100 100 100 100 100 100 100 100 100

Source: Table 6.4 in John Knodel, Vipan Prachuabmoh and Napaporn Chayovan (2013)

Elderly Care Services Market: Employing Caregiver (unit: Baht per month)

Note: Household Average Income at National Level in 2011 = 23,236 Baht/month (NSO, SES)

Qualification of

Caregiver

Functional limitations of the cared elderly

Nakhon- pathom

Chiangmai Songkhla Bangkok

With certificate Somewhat independent 8,000 + 7,500-8,000 10,500 6,000-10,500

Somewhat dependent 9,000 + 8,000 11,000 6,000-12,000

Dependent 10,000 + 8,000 12,000 6,000-15,000

Without certificate but having experiences in

care giving

Somewhat independent 8,000 7,500-8,000 10,500 7,000-10,500

Somewhat dependent 9,000 7,500-8,000 11,000 7,500-12,000

Dependent 10,000 7,500-8,000 12,000 7,500-15,000

Without experiences but trained by center

Somewhat independent 8,000 7,000-7,500 9,000 6,400-12,000

Somewhat dependent 9,000 7,000-8,000 9,500 6,800-12,000

Dependent 10,000 7,000-8,000 10,500 8,000-12,000

Source: Suwanrada W., Sasat S. and S. Kamruangrit (2009), Financing Long Term Care Services for the Elderly in the Bangkok Metropolitan Administration, Research Report submitted to Foundation of Thai Gerontology Research and Development Institute (TGRI) and Thai Health Promotion Foundation. And Suwanrada W., Chalermwong D., Damjuti W., Kamruangrit S. and J. Boonma (2010), Long Term Care System for Old-age Security Promotion, Research Report submitted to Office of the Welfare Promotion Protection and Empowerment of Vulnerable Groups, Ministry of Social Development and Human Security.

Elderly Care and Government Support

Individual Income Tax Incentive Parental Care Expenses Deduction Parents’ Health Insurance Expenses Deduction

Provision of Care Services National Government Managed Public Elderly Home (12) Local Government Managed Public Elderly Home (13) Elderly Home Care Volunteer (MOSDHS, from 2002) Sub-district Health-promoting Hospital and Village Health

Volunteer Home Health Care for the Elderly (Home Visit and Care) Various Long Term Care Pilot Projects

Senior Citizens Club: Friends-help-friends project

Another Financing Scheme for LTC Services Tambon (Sub-district) Health Fund: started in the beginning of 2006,

strengthened 2009, expand to whole country in 2011

Tambon Health Fund

National Health

Security Office

Tambon Administrative Organization,

Municipality

Community

• To promote community health • To promote well-being of people and

community based on the cooperation among citizens, local authorities and public health authorities

• To decentralize authority to local authorities under the civic participation and academic support from other organizations.

• Community Health Information, Strategy Map, Community Health Plan

• Community care for the elderly, the disability, the chronic patients

• Preventive care: diabetes, high blood pressure, TB, AIDS

• Health behavior adjustment • Cooperation with other relating heath

organizations for provision of community health care services

3

Community-based Integrated Approach for Older Person’s

Long Term Care

College of Population Studies (2014)

granted by The Toyota Foundation

Active Aging

Self-reliance Elderly

Elderly with disability

Health development program for the elderly

Not drop to

G3-Med group Health Center/

volunteers

G2-Authority group Sub-district

Administration Organization

G4-Contributors Elderly Club

Health volunteer Religious, school,

NGOs

G1-benefit group Elderly, Family

Community leaders/ members

Protecting

Promoting

Supporting

Protecting

Promoting

Supporting

Integrated Community-based LTC

Gap between Existing Elderly Care Support Systems

Community-based Care

4

Progression of Elderly Care Policy from the Perspective of the 2nd National

Plan on the Elderly’s the 2nd Monitoring and Evaluation

The 2nd National Plan on the Elderly (2002-2021)

The 1st Evaluation 2002-2006

Plan Revision

The 2nd Evaluation 2007-2011

Half Way of the 2nd Plan

The 2nd National Plan on the Elderly (2002-2021) 1st revised of 2009

Level of Success of the Plan Strategy (No. of Index) Accomplishment (%)

Overall 51.0%

Strategy on readiness preparation of the people for their quality ageing

28.6%

Strategy on the elderly promotion and development

53.3%

Strategy on the social safeguards for the elderly

33.3%

Strategy on management of developing the national comprehensive system for undertakings and developing the personnel for the elderly involving missions

85.7%

Strategy on processing, upgrading and disseminating knowledge on the elderly and the national monitoring of implementation of NPE

100.0%

Elderly Care Related Index Target Actual Pass or Not?

Index 9 proportions of the elderly clubs which usually hold activities in the previous year (at least once a quarter or 4 times a year)

70% 51.1% Not passed

Index 10 proportions of communities** that have the elderly clubs

continuously increasing increasing Passed

Index 11 proportions of the elderly population who are members of the elderly clubs and participate in activities of the clubs in the previous 3 Months

25% 23.7% Not Passed

Index 13 proportions of budgets LAOs/ BMA/ Pattaya City Administration spend for the elderly or for the elderly involving activities

10% 0.2%-9,4% Not Passed

Elderly Care Related Index Target Actual Pass/Fail

Index 22 proportions of the elderly persons who live in houses in the enabling and friendly environment*

5% 2% Not Pass

Index 26 proportions of the elderly persons with disabilities who are visited at home once a month

80% 38.7% Not Pass

Index 27 proportions of the elderly persons who access annual health examination

70% 56.7% Not Pass

Index 29 proportions of elderly persons with mobility impairment who receive Wheelchairs

25% 7.9% Not Pass

Index 30 proportions of the elderly persons who live with their families

More than 90% 90.9% Pass

Target Actual Pass/Fail

Index 31 numbers of their caregivers educated on caring (knowledge of nutrition, troubleshooting in case of their acute illness) proportionally to numbers of caregivers for the elderly persons who are unable to participate in activities outside their home.

60% 25.3% Not Pass

Index 38 proportions of sub-districts which render the following services (covering 1. a service that supports long-term care; 2. a nursing system*; 3. treatments for significant chronic diseases such as hypertension, diabetes and cerebro-vascular disease; 4. community-based volunteers; 5. support their caregivers to access knowledge and skill in the elderly care.

50% 60% Pass

Index 39 proportions of the local authority (provincial administration organizations, municipalities, sub-district administration organizations, BMA, Pattaya City Administration) which allocate their budgets and/or run activities for the elderly

95% 96%-100% Pass

Index 46 proportions of the local authority (provincial administration organizations, municipalities, BMA, Pattaya City Administration) which have their yearly plan of action on the elderly

30% 87.3%-100% Pass

5

Challenges of Long Term Care System in Thailand

Long Term Care Action Plan I

National Elderly Committee approved the Action Plan for Promotion of Elderly Long Term Care Issue proposed in the 5th Meeting of 2010 on November, 18

Action Plan: 2011-2013

Moved forward by three Working Groups under the Elderly Long Term Care Issue Promotion Subcommittee.

1. Working Group for Home, Community and Institutional Care Promotion

2. Working Group for Caregivers

3. Working Group for Action Plan Evaluation

Long Term Care Action Plan II

Issues Sub-issues

1. Promotion and support the LTC by local authorities

1.1 Promotion of the level of care assessment process for local authorities

1.2 Family care support services (counselling, temporary care services, day care service, care devices centre)

1.3 Training course for all types of caregivers

1.4 Promotion of social value of caregiver

2.

Role of National Government on LTC

2.1 Setting definition, criteria and assessment procedure of the elderly who needs care.

2.2 Standard setting for operation and personnel issues of care providers

2.3 Establishing day care centre or temporary care centre

2.4 Information centre elderly who needs care (evaluated by local Government)

Long Term Care Action Plan III

Issues Sub-issues

2.

Role of National Government on LTC

(cont.)

2.5 R&D research support for future policy recommendation

2.6 Promotion and development of home nurse

2.7 Development of Human resource on LTC

3.

Financial

and Fiscal Support

3.1 Financial support to the family with the elderly who needs long term care.

3.2 Providing tax incentive scheme for private or NPO type nursing home

3.3 Financial support for the house maintenance or reform for LTC purpose.

Challenges towards Future of LTC

Sustainability of Community-based Care System

Diversification of Elderly Care Services

Private and Voluntary Sectors in Elderly Care Services Market Elderly Care and Urbanization Manpower for Elderly Care (Numbers and Knowledge)

Increase of Government Budget

Financing Methods

Role of Local Authorities on Elderly Care

Fragmented Governmental Bodies (Health, Social Affairs, Interior)

Administrative Unit of Long-term Care?

THANK YOU FOR YOUR ATTENTION

Q&A and discussion time!