Contributing to the growth diamond through the development of a long- term care system in Thailand Valerie Schmitt & Viennarat Chuangwiwat, ILO Bangkok Siem Reap, 30 May 2013

“We must all accept the inevitability of ageing; what we do not have to, and must not, accept is that old age brings with it lesser access to, and enjoyment of, the full range of human rights.” Statement by the UN High Commissioner for Human Rights, Navi Pillay, International Day of Older Persons (1 October 2010)

What is long-term care ?

Source: EU LTC Policy

Thailand becomes an ageing society

Source: UNDESA Low fertility rates (1.6 in 2010) Increased life expectancy Older people 13% in 2013 to 30% in 2050 Thailand: an ageing society

Existing Social Protection for Older Persons and Challenges

Pension Existing SchemesChallenges Non-contributory -Civil servants -Universal basic social pension (older persons’ monthly allowance) - Cover only 4 % of total old age population - Benefit less than poverty line Contributory -Social security mandatory for formal sector (Section 33,39) -Social security volunatry for informal sector (section 40) - Government pension fund for civil servants and GO’s employees -Provident Fund (private only) -National Savings Fund (not yet implement) - Cover 25.64% of working age; not portable - Cover 58.33% of informal workers; only lump sum pension - Only lump sum pension - Voluntary, hence low coverage - If implemented after all, still very low monthly pension

Health Care and Services Universal Health Coverage (UHC) covers only institutional care and LTC is not included Unavailability of transportation and absence of carers are barriers for older persons to access to the universal health care at the health centres LTC and rehabilitative care are not yet available through the state system while the private nursing homes and home-care by paid carers are increasing in response to the increasing demand. Efforts in developing LTC by GOs, NGOs, civil society organizations, UNFPA, JICA are fragmented and many are the pilot projects and model development – none has been scaled-up. To date, formal LTC system in Thailand has not been decided

Initiatives on LTC in Thailand

Multi-disciplinary services required for comprehensive LTC Medical Doctors Lab Technicians Nurse Dentists Social Workers Physical Therapists Nutritionists Pharmacists Socio- Health Care Community Health Promotion Hospital Community- based Organisations (CBO) Adult Day Service (ADS) Programs Case managers/ geriatric care managers Home Health Care (HHC)/ Home Care Emergency response systems Home chore services Home visit/ Companion services Meals programmes Respite Care Senior Centers Transportation services Transitional Care/ Intermediate Care

Means: meeting, telephone, web-based data/info sharing, skype Refer Link System

Multi-disciplinary Professional Team Physical Care

Spiritual care in hospital

21 / 7 / 5217 Home Ward

21 / 7 / 5218 Home visit by health volunteers

Rehabilitation Centre at Buddhist temple services provided by trained volunteers

Training of volunteers

21 / 7 / 5221 Training for carers on elderly care, traditional medicine, healing massage

21 / 7 / 5222 Home Health Care and Home Visit (psycho-social support) Home Health Care by Health Professionals Home care by volunteers Recommendations on older person-friendly home improvement

Home health care team

Institution LTC at private nursing home

UNJT-SP & RTG Joint Efforts in LTC  In line with UNPAF and 11 th NESDP ( ) priority, UNJT-SP led by ILO supports the development of a comprehensive LTC system in Thailand  Taking participatory approach with support from GIP SPSI/France and in collaboration with HISRO & stakeholders  Adaptive to demographic and social changes  Taking stock of existing systems and the potentials to design a comprehensive LTC system that fits with the country’s context and the sustainability

Expected Outcomes Combined sets of services to bring: Single window service Create new jobs/new services Reduce burden from the family Reduce opportunity loss and maintain economic productivity Improved quality of services and right protection Enable appropriate supply to match with the increasing demand in LTC

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