1. LTC POLICY DESIGN Definition of Long-term care The term ‘long-term care services” refers to the organization and delivery of a broad range of services and assistance to people who are limited in their ability to function independently on a daily ….. The term ‘disability’ is used as an umbrella term covering any or all of the following components: impairment, activity limitation and participation restriction. This usage was endorsed in the International Classification. On the basis of the responses from OECD and EU countries, we recommend that the definition of the boundary between LTHC and LTSC should be based on types of services received (ADL/IADL distinction)3. This recommendation maintains the status quo of the current guidelines under the JHAQ.

2. LTC POLICY DESIGN IV.21 DEFINITION OF THE POLICY RISK DEFINITION SCOPE OF THE POLICY OBJECTIVES BENEFICIARIES PACKAGE OF SERVICES STAKE HOLDERS IMPACT ASSESMENT IV.22 IMPLEMENTATION OF THE POLICY FINANCE SCHEME ORGANISATIONAL MODEL HUMAN RESSOURCES DEVELOPMENT STANDARDS AND CONTROL GOVERNANCE

3. LONG TERM CARE POLICY FOR ELDERLY IN THAILAND DEFINITION OF THE POLICY  Global objectives: Non-definition or uncertainity of the aims suitable to cover the identified needs and the environemental features  Conceptual frame:LTC social or health as it is in Thailande facing the needs of the beneficiaries and actors  Beneficiaries, old people in various situations defined through their needs of care  Stakeholders, Policy makers, institutions, formal and informal  Fundation: funded, private insurance, public systems, copayment, taxe fundation or social funds are all facing the rapid growth of the expenditures through the solvabisation of needs, rules to allocates the means,  Governance: What is the suitable level and the role of each

4. LONG TERM CARE POLICY FOR ELDERLY IN THAILAND IMPLENTATION OF THE POLICY  Organisation: Centralised, decentralised, professional, association, are all facing the lake of coordination with overlaping between systems and multiplication of people who are in charge to help the elderly. Professionalisation enhance the risk of decreasing the place of informal and family help,  Human resources:The harrassement of helpers (work injuries and psychological deseases), Need of a strong training policy to support HR competency from one to the other to realise a suitable support (volunteers/care givers – nursing home/ health care institutions),  Evaluation process: ratio to access the results?  Standards and quality to deliver services  Help the helpers, prevention of autonomy lost, improvement of housing, enhancement of social relation and cognitive entertainement,  LTC in the comprehensive organisation for care

5. LTC RISK DEFINITION LONG TERM HEALTH CARE LONG TERM INTERMEDIATE CARE LONG TERM SOCIAL CARE INDEPENDANTHELPED DEPENDANT PHYSIOLOGICAL DECREASE LOST OF AUTONOMYDEMENTIA/ ALZHEIMER AGE 6580

6. LTC POLICY DESIGN SCOPE OF THE POLICY SERVICES BENEFIT CALCULATION CASH/KIND MEANS TESTED/PERCENTAGE LUMPSUM/ COPAYMENT/BASKET JURIDICAL FRAME CATEGORIES OF BENEFICIARIES UNIVERSAL TERRITORIAL/PORTABLE PERMANENT/LIMITED IN TIME CONCEPTUAL FRAME/ORGANIZATION STAKE HOLDERS PUBLIC /PRIVATE SERVICE(S) CENTRALISED/DECENTRALISED ADMINISTRATED/ DELEGATED ECONOMICAL FRAME FUNDING: CONTRIBUTION/TAXATION FUNDED/P.A.G/INSURANCE/RISK.P OOL SCOPE OF LTC SCHEME

7. CONCEPTUAL FRAME ORGANISATION ADMINISTRATIVE ORGANIZATION. Responsibility for Administration generally rests with semiautonomous institutions or funds. These agencies are usually subject to general supervision by a ministry or government department but otherwise are largely self governing, STAKE HOLDERS Policy makers Implementing agencies Organizations Health care system Social care system Intermediate care system

8. JURIDICAL FRAME (AISS) COVERAGE: In principle, universal systems cover the entire population for the contingencies of social risk. Five types of programs: Old age, disability, and survivors; Sickness and maternity; Work injury; Unemployment; and Family allowances. QUALIFYING CONDITIONS. OLD AGE Qualifying to receive an old age benefit is attainment of a specified pensionable age completion of a specified period of contributions or covered employment. DISABILITY. Under most programs, provisions for disability benefits for persons who are permanently disabled as the result of non-occupational causes are very similar to those for the aged. HEALTH Generally, a person becoming ill must be gainfully employed, incapacitated for work, and not receiving regular wages or sick-leave payments from the employer to be eligible for cash sickness benefits.

9. BENEFITS CALCULATION OLD AGE BENEFITS The old-age benefit in most countries is a wage-related, periodic payment. Some countries pay a universal fixed amount that bears no relationship to any prior earnings DISABILITY BENEFITS (means tested) 50 percent of the benefit, may be paid to those who need help on a daily basis. Partial disability benefits, if payable, are usually reduced, according to a fixed scale. The system may also provide rehabilitation training HEALTH BENEFIT cash sickness benefits, which are paid when shortterm illnesses prevent work, and health care benefits,are provided in the form of medical, hospital, and pharmaceutical benefits LONG TERM CARE

10. ECONOMICAL FRAME SOURCE OF FUNDS. OLD AGE The financing of benefits for oldage,disability, can come from three possible sources: A percentage of covered wages or salaries paid by the worker, A percentage of covered payroll paid by the employer, A government contribution D HEALTH INSURANCE More commonly, however, employees and employers contribute directly to a separate program that includes both health care and cash benefits for sickness LONG TERM CARE

11. LTC POLICY OBJECTIVES The soft aging To maintain autonomy To develop LTC activity and economy To integrate for efficiency the LTC components

12. SITUATIONAL ANALYSIS CountryTotal populati (millions ) Perce nta 65 or older Depend ency ratio Life expectan at birth (years) M Life expectan at birth (years)W Statutory pensiona ble Age M Statutory pensiona ble Age W GDP per capita (US$) China1,341.38.238.272.175.660556,828 Hong-Kong7,112,732.080.286.465 43.229 Japan126.522.756.480.187.165 32,418 Singapore5.0869.035.978.983.755 50,633 South Korea48.18311.138.177.384.060 27,100 Vietnam87.86.042.173.477.460552953 Thailand69.18.941.771.177.855 7,995

13. Nursing Home Volunteer Home Care Difficulties of ADL & IADL of OP Cost of Care Community based care Institutional care Continuum of Care Day Care Paid Home Care Short Stay Home for he Aged Source: HelpAge Korea

14. EXISTING FRAME FOR LTC POLICY NATIONAL PLANS FOR OLDER PERSON  1 st National Plan 1982-2001 Focused on health, education, social and income security, social and cultural participation, social welfare services  2 nd National Plan 2002 2021, Revised 2010 ENACTMENT TO PROMOTE ELDERLY WELFARE  1999 Declaration of Thailand older person’s  2003 National Commission for the Elderly  2003 Act on older person’s  2007/2011 National Framework on preparing for ageing society NESBD

15. EXISTING FRAME FOR LT HEALTH CARE POLICY REGULATION 1990 Universal free health care for older persons Section 52 of the Constitution (1997) states that “ All Thai people have an equal right to access the quality health services…” Universal Health Coverage (UHC) reforms introduced in 2001 with small co-payment at Baht 30 (equivalent to 1 USD) ELDERLY HEALTH CARE & SERVICES Community-based Care by NGOs & CBO & the Local Administrative Organizations s e.g. Home visit by health personnel and volunteers (in 2009 =1,007,274) Health Volunteers i.e. home visits, data collection, basic health assessment (under supervision of Community Health Centers) Temples and Elders Clubs are actively engaged in health promotion through selfcare and physical exercises and education prevention

16. LONG TERM CARE POLICY FOR ELDERLY IN THAILAND

17. OOLD PEOPLE ASSOCIATION NET WORK

18. LONG TERM CARE POLICY FOR ELDERLY IN THAILAND