1. Responding to ageing: Workshop to Exchange International Experience Ha Noi, 25-26 September 2013 Hanoi Melia Hotel D. Wesumperuma, HelpAge International Community care in lower income and middle income Asia

2. Spectrum: countries and responses are diverse and at different levels of development/experience Countries with more advanced CC approaches and structures Paid home care (public) Paid HC (private services) Community day care centres Short stay centres Cash for care Public nursing homes Structured and regulated private sector residence: independent living to nursing What initiatives are there in those countries moving to middle ground What are the experiences and lessons in this move? In Vietnam? In Thailand? In China? In Indonesia? In the Philippines? Countries moving to middle ground Countries: traditional forms dominant Family primarily A few old age homes or faith based institutions Very basic emergency services for indigent Hospitals Volunteer-based HC (e.g. ROK-ASEAN) Small largely unregulated, expensive private sector residential or paid services

3. Community based initiatives in countries moving to middle ground Several pilot projects are being run for home- and community-based care programmes. Ministry of Social Development and Human Security’s Elderly Home Caregiver is a community volunteer pilot programme implemented by Local Administration Agency with community leaders. In 2011, 40,000 trained volunteers in 63 provinces Ministry of Health’s Old Age Care Program encompasses community- based senior centres, the Elderly Fund and health clubs for older people. Ministry of Health launched in 2005 the Home Health Care (HHC) project to provide community-based health services to older people through local hospitals. In 2007 the two Ministries jointly commenced the Community-based Integrated Healthcare and Social Welfare Services for older people to develop an integrated model with support from JICA. Initially piloted in 4 provinces, the model is now extended to 6 other provinces. CSO pilot: Volunteer Home Care RoK-ASEAN by FOPDEV CSO pilot: SCCT’s “Peer help Peer” THAILAND: Started pilots and gradual progression thereafter

4. Thailand (2) Steps towards Long Term Care scheme Thailand is now in the process of designing and building a LTC system for the elderly. A Scoping Study recommends to design and establish a long term social care insurance system including cost for home-based care for all ages financial assistance for informal caregivers establishment of more elderly care centers implementation of volunteer-based home care programme involving non-government agencies and the private sector, scaling up by local authorities of the community-volunteer caregiver for older people programme initiated by the Ministry of Social Development and Human Security

5. Indonesia (1) Community-based care model (Pusaka) Volunteer-led community service Target: Disadvantaged older people, the majority widows or other vulnerable women Funding: Mostly private but with government subsidy Care givers: Community volunteers Implementation: By local community groups and NGOs with oversight by local government Services: Meals 3-5x/week, some social/exercise activities, support accessing Health Post for the Elderly Scale: 110 in Jakarta only (50-60 people per Pusaka) Challenges: Community leadership/solidarity, limited coverage and services

6. Indonesia (2) Cash Assistance for Older Persons (ASLUT) Social assistance cash benefit ($20/month) Target: Poor older people who are neglected and/or bedridden (priority: age 70+) Selection: Local government using criteria Coverage: 26,500 of est 1.8m poor and neglected Costs: Assistance to older people was 0.3% of total social assistance budget (2010, World Bank) Challenges: Very limited coverage, arbitrary access, favouritism, inclusion/exclusion errors

7. Regional volunteer-based model: Republic of Korea-ASEAN approach Target countries: All 10 ASEAN countries Administration: Generally government guidance or funding of care delivery by NGOs or faith-based groups Location of service provision: The older person’s home Frequency of services: At least once a week Service providers: Unpaid, locally trained community volunteers Types of services: (1) Befriending and companionship, (2) help with ADL/IADL (cleaning, cooking, personal care, escorting to shops, doctors, social events) Scale: About 20,000 older people in the region

8. Challenges and lessons (1) Balance between family care and care provided by non- family members  Family care is the bedrock of care in all societies. Other care schemes need to be presented clearly as complementary to family-based care.  Volunteerism by older people themselves could increase their own well-being and contribute to the expansion of services. Balance between care delivered by state, civil society and private sector (for non-family care)  ROK-ASEAN and other models have demonstrated how government can encourage and support care delivered through civil society groups.  The strong and growing network of older people’s groups in the region could help expand care.  The private sector can be supported to address the needs especially in urban or more affluent areas.

9. Challenges and lessons (2) Balance between institutional or community & home care  Community-based care models also reinforce the social networks that older people and their carers need  Community-based care models should make good use of existing structures and institutions, including older people’s groups and community centres Balance provision of cash vs provision of services  Cash transfers can be useful, but are difficult to target and may be counterproductive if not well designed  European and other countries have lessons of experience Balance between health and social care  Mental health and emotional challenges of older people are stigmatised and poorly understood  A neglected care-related need of older people in the region is social support and companionship  Countries such as the UK have found it challenging to reintegrate social and health care after splitting them

10. Challenges: Resources (human and financial) Fiscal costs of meeting expanding demand A cost-benefit analysis of community-based care models could help to make the case for further public investment Trained human resources Training and support for caregivers to promote consistency and quality Establishing carer support groups based at local community centres

11. Costs increase up the continuum

12. The path ahead There is no blueprint in care for MICs. Governments need to support and share replicable practice & policy. Some suggestions for the path ahead: Place priority on community based care Ensure coverage for the most urgent cases Integrate social care and health care Foster and regulate the growing private market

13. Thank you