Development of Comprehensive Long-term Care System in Thailand RESTITUTION Technical Meeting on the System Design on 26 March 2013, at the Amari Watergate Hotel

LTC RISK DEFINITION SKOPE PROPOSED DURING THE SEMINAR LONG TERM HEALTH CARE LONG TERM INTERMEDIATE CARE LONG TERM SOCIAL CARE INDEPENDANT HELPED DEPENDANT PHYSIOLOGICAL DECREASE LOST OF AUTONOMY DEMENTIA/ ALZHEIMER AGE 60 65 80

JURIDICAL FRAME AND BENEFICIARIES FEATURES OF THE SYSTEM, QUALIFYING CONDITIONS LTC BENEFIT A) UNIVERSAL (in term of economic status) B) MEANS TESTED (TARGETED) CRITERIA FOR ELIGIBILITY A) DISABILITY LEVEL, Health status certified by doctor ex Severs – lower level of care/needs B) AGE 60 years and above C) INCOME LEVEL regardless to the economic status, all dependant of 60 and above.

BENEFIT AND BENEFICIARIES DIRECT OR FINAL BENEFICIARIES   ALLOWANCE right PROVIDERS OR INDIRECT BENEFICIARIES ALLOWANCE payment OPS, DEPENDANT ELDERLY Depandency allowance FAMILY RESPITE care RESPITE allowance CARERS ORGANISATIONS AND SERVICES PROVIDERS

CONCEPTUAL FRAME ORGANISATION. National level To define policy in the field of : - Finances, -HR -KM -R&D -STD -ICT for LTC Laws and regulation Regional level Assessment of LTC Needs Technical back stoping Capacity building M&E Planification of services   Provincial level Area based Control regulation and quality and finances Payments Capacity Building Local authorities Implementation (care management) Coordination of providers Feed back to the National (Futur purchasers) Data base for LTC Bottom Up

STAKE HOLDERS RUN BY GOVERNMENT Old People : self assisted Family GO/private support system, Home visits by volunteers, older person association (friends to friends) Local administration office Nursing Home, paid care givers (HHC) Respite care funded by LOA and community health promotion center , OPA Community based Referal system in cooperation with comminuty and district hospital and Hot Line Community Health Center for primary care District hospital Secondary care: - Training informal careers and volunteers - Sub-system intermediate care (post acute care)(over 45 days they are in LTC) Provincial for Tertiary , high level of care specialist care, R&D Day care center (Thai context..)

PRIVATE STAKE HOLDERS PRIVATE STAKE HOLDERS PROFITABLE Need regulation and law to complete and standardise the nursing home services, care givers, NON PROFITABLE B.1 Service provider face bas organisation (bhudism, NGO, charity Old person, club) B.2 Part pf the official services agreed could receive the reimbursement Consider including qualified private nursing home to serve as part of the service system (agreement and control) OTHER STAKE HOLDERS INSTRUMENTAL SUPPORT (for the case of IADL) Funds needed for instrumental as governement ; institution others

DEVELOPMENTOF COMPREHENSIVE LONG-TERM CARE SYSTEM SERVICES THIS CHAPTER OF THE POLICY DESIGN SHOULD BE DEVELOPPED IN ACCORDANCE WITH THE PREVIOUS DIAGRAM OF THE LTC SKOPE : Social care, intermediate care and health care

HR SUPPORT A-PROFESSIONAL 1 Medical Doctors (lack of geriatric specialists at the national level) 2 Managers - Care managers Evaluateur for assessment of needs 3 Specialists : They should have a degree level Gerontology, Anthropology Medico sociologist 4 Physicians 5 Ergotherapists 6 Nurses, 6.b Assistant nurses 7 Psychologists 8 Nutritionists, 9 Dentists 10 SocialWorkers B-SKILLED PERSONNEL (certificate) 1 Assistant therapists 2 Assistant nurses (one year training- not yet approve from the Nurses Council) 3 Trained care givers 420 hours training 70 Hours plus expérice (MOL, MOI, MOPH, MSDHS,Private company at the moment thetraining course reference of MOPH curriculum not in action ; Need to regularise and quality control for HR System) C-OTHER CATEGORIES LOW SKILL Volunteers (MOPH, MSDHS, in charge of the volunteers) recommend to train them to upgrade their capacity Family members (need support after regular assessment of their needs)  

OTHER PRINCIPLE COLLECTED IN OUR MEETINGS AND FIELD VISITS

OUR FUTUR INVESTIGATIONS To design the suitable costing model and link with the selected policy To develop the description of services and standards To prepare the main processus to be able to fulfill the requirement of shaping a IT To develop the HR policy and Capacity Building To reinforce the coordination for a shared view of the LTC policy Selected on thes featutres the moste suitable scenario To prepare recomendations for implementation