National experiences from Thailand
regarding long-term care of older persons
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
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.
14
12
10
8
13.2
6
9.5
4
2
7.4
4.6
4.9
5.5
0
Source: The National Population and Housing Census, National Statistical Office, quoted in TGRI (2012), The Situation of Thai Elderly 2011.
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.
35.0
30.0
25.1
25.0
25.9
26.6
27.2
27.9
28.5
29.1
29.6
30.2
15.0
13.2
10.0
9.1
13.7
9.3
14.2
9.6
14.7
9.9
15.3
15.9
10.2 10.6
16.5
11.0
17.1
11.5
17.8
12.0
18.4
12.5
19.1
13.0
19.8
13.5
20.5
14.1
21.3
14.7
15.2
22.8
15.8
16.5
17.1
17.8
18.4
19.1
19.8
20.5
21.2
31.7
32.1
65 up
23.6
20.0
31.2
60 up
24.3
22.0
30.7
21.8
22.5
23.0
23.6
24.1
24.6
25.0
5.0
0.0
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
Source: National Economic and Social Development Board (NESDB), Population Projection in Thailand: 2010-2040
Population Ageing in Thailand:
Fertility Decline (TFR) after 1970s
6
5
4.9
4
2.7
3
2.0
2
1.7
1.6
1.5
1
0
-
-
-
-
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
85.0
80.1
80.8
81.9
81.3
79.3
80.0
77.6
77.7
78.4
74.9
75.0
73.4
74.7
75.3
72.6
72.4
71.6
70.9
69.9
70.0
74.1
69.9
70.6
68.9
67.7
Male
65.6
65.0
63.8
Female
63.8
60.0
58.0
55.0
/2040
50.0
-
-
-
-
Source: TGRI (2012), The Situation of Thai Elderly 2011 and
National Economic and Social Development Board , Population Projection in Thailand: 2010-2040
Population Aging in Thailand:
The number and proportion of the oldest old population (80 and above) will be increasing.
25,000.0
20,000.0
15,000.0
10,000.0
5,000.0
0.0
-
-
-
-
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 (%)
55.1
57.5
52.7
43.7
60-69
70-79
80 up
Total
32.2
29.1
33.6
37.2
12.7
13.4
13.8
19.1
100.0
100.0
100.0
100.0
Data Source: National Economic and Social Development Board , Population Projection in Thailand: 2010-2040.
9
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
The number and proportion of
the oldest old population (80 and above)
will be increasing.
+ Increase of life expectancy
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
4.2
4.1
Female
More frail elderly live longer?
Source: The 2007 and 2011 Survey of the Older
Population in Thailand by NSO, quoted in TGRI (2012), The
Situation of Thai Elderly 2011.
2
Current Situation of Elderly Care in
Thailand: Family Care and Policy
The Government Stance on Elderly Policy
The 2nd National Plan on the Elderly (2002-2021) 1st revised of 2009
Who are the older population’s caregivers?
(Data Source: The 2011 Survey of the Older Population in Thailand by NSO)
60%
52%
50%
40%
30%
20%
36%
35%
37%
26%
19%
13%
10%
5%
0%
Source: Figure 6.9 in John Knodel, Vipan Prachuabmoh and Napaporn Chayovan (2013)
6%
3%
Who is the older population’s main caregiver?
(Data Source: The 2011 Survey of the Older Population in Thailand by NSO)
All
Married
Not Married
Main Providers of
Assistance with Daily
Living Activities
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
Nakhonpathom
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
National
Health
Security
Office
Tambon
Administrative
Organization,
Municipality
Tambon
Health
Fund
•
•
•
•
•
•
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
Integrated Communitybased LTC
Protecting
Promoting
Supporting
Active Aging
Self-reliance Elderly
Not drop to
Protecting
Promoting
Supporting
Elderly with disability
Health development program for the elderly
G1-benefit group
Elderly, Family
Community
leaders/
members
G2-Authority group
Sub-district
Administration
Organization
G3-Med group
Health
Center/
volunteers
G4-Contributors
Elderly Club
Health volunteer
Religious, school,
NGOs
Gap between Existing Elderly Care Support Systems
Communitybased 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 National Plan on the Elderly
(2002-2021) 1st revised of 2009
The 2nd Evaluation 2007-2011
Half Way of the 2nd Plan
Level of Success of the Plan
Strategy (No. of Index)
Accomplishment (%)
51.0%
Overall
Strategy on readiness preparation of the
people for their quality ageing
28.6%
53.3%
Strategy on the elderly promotion and
development
Strategy on the social safeguards for the
elderly
Strategy on management of developing
the national comprehensive system for
undertakings and developing the
personnel for the elderly involving
missions
Strategy on processing, upgrading and
disseminating knowledge on the elderly
and the national monitoring of
implementation of NPE
33.3%
85.7%
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.
2.5 R&D research support for future policy recommendation
Role of
2.6 Promotion and development of home nurse
National
2.7 Development of Human resource on LTC
Government on
LTC
(cont.)
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!