Questions/Answers

The transformation to ageing society has a great impact on national development and national economic growth in the long run, in terms of budget provision, economy, and the citizens’ quality of life, as a whole. Nowadays, the government spends large budgets for elderly care, such as elderly welfare and health care allowance which has risen every year due to the larger population of the elderly. According to the Thailand Development Research Institute’s report, supported by the Thai Health Promotion Foundation, showed that Thailand’s health care expenditure had increased rapidly. It was predicted that the expenditure in the next 15 years, according to the Organization for Economic Co-operation and Development’s (OECD) framework, will be approximately 4.8 – 6.3 hundred billion THB. Moreover, other factors in the ageing society will push the expenditure up to 1.4 – 1.8 trillion THB. The Department of Health’s mission is cooperative and sustainable health system development and governance aiming at “The locals are healthy. The health care officers are happy. The health care system is sustainable.” Therefore, this System Development for Long Term Care in Community through 3C’s Innovation (Care Manager, Caregiver, and Care Plan) was carried out, in order to make “The Smiley Siam” for all Thais.

The main criterion was integrative cooperation in planning, developing, and carrying out the innovation. The procedures started from designing and running the first care manager curriculum in Thailand, developing and using a caregiver curriculum, pushing the curriculum as a national agenda, developing a long-term care database system, and developing an online care plan for a smooth, steady and short flow of the processes, and for greater cooperation between organizations, so that health care service system for the elderly and dependent persons is entrusted, accessible, and continuous.

The Department of Health has pushed and driven long-term elderly care in community through 3C’s Innovation to be a crucial policy formulating a strategy plan for integrative works with partnership networks under the 3S’s Strategy, that was 1) Social (Family and community as a strong institution), 2) Strong Health (The elderly have good health.), and 3) Security (The welfare system and support services with quality standards access). The strategy does support the achievement of the third goal of the 2030 Agenda—Good Health and Well-being.

According to the implement of the System Development for Long-term Care in Community through 3C’s Innovation (Care Manager, Caregiver, and Care Plan), 7,001,490 elderly people throughout Thailand were given health evaluation and screening. 6,769,607 (96.69%) of them were social-bound elderly; 188,979 (2.70%) of them were home-bound elderly; and 42,604 (0.61%) of them were bed-bound elderly. Regarding the Health Data Center, Ministry of Health’s data recorded on 4 April 2018, 187,890 dependent elderly people received continuing home health care following an individual care plan had better health. 1,952 bed-bound elderly became home-bound, and 7,412 home-bound ones became social-bound. 4,797 (66.1%) out of 7,255 subdistricts in Thailand met the criteria of standard long term care. Thus, the System Development for Long Term Care in Community through 3C’s Innovation (Care Manager, Caregiver, and Care Plan) is an innovation that builds up values and honor in humanity, allows accessible health care and well-being for the elderly, deducts expenses for the citizens, societies, and government, and supports the national stability and prosperity sustainably, as it was stated in the Thailand 4.0 Development Plan.

The Long Term Care in Community through 3C’s Innovation aimed at minimizing the crowd in hospitals, reducing wait time to receive treatment, increasing opportunities for inclusive and equal medical service system by changing wards to home health care in community, transforming chief nurses into Care Managers who take care of the elderly at home or in community based on the Care Plan with cooperation from the elderly’s family and community, having volunteer Caregivers who were trained to master elderly care skills following the Care Plan and were assigned by the Care Manager regarding the Thailand’s Elderly Rights and Benefits Package.

Systematic development allowed the officials to study elderly care systems in various countries. The systematic development also reflected the strength of Thai society that values the elderly and reciprocates to parents and senior relatives. As a result, the elderly care system was purely based on Thai culture. The Thailand’s Care Manager Curriculum (70 hours) was applied from the Japan’s Manager Curriculum (44 hours). However, the Caregiver curriculum was formulated by the Department of Health, Ministry of Public Health; and the online Care Plan was Thailand’s initiation.

The transfer and processes were begun from training Care Managers. The first pilot batch of Teacher A operated in 100 areas in 2015. Later in 2016, training were arranged to build Teacher A in every regional health office in every district. There were also regional and national meetings held for experience and learning exchanges. To spread out the knowledge and operations of this innovative project to the ASEAN nations, national seminars and ASEAN regional seminars on long-term care were held; besides, organizations from many countries, such as China, Japan, and Vietnam, took field trips to Thailand to learn the project.

This 3C’s long term care innovation has been accepted by the locals and in societies, as it became one of the government’s precedent policies. The government provided financial and personnel development supports for the project. Care Managers and Caregivers were produced more for thorough care for home-bound and bed-bound elderly throughout Thailand. Personnel in organizations related to the Ministry of Public Health, local administration offices, local networks, as well as the locals also took part. In addition, the government supports the Care Plan budget through the NHSO and develops personnel’s proficiency to long-term care data base and related skills.

1) Communities are crucial for making sustainable impacts on the use of 3C’s long term care innovation. Caregivers are younger generations in the elderly’s communities who will take parts in taking care of the elderly, giving knowledge about the project to raise awareness, calling their neighbors to participate, and administrating elderly care funds. 2) In policy level, MOU’s with the Ministry of Interior, and the Ministry of Social Development and Social Security were signed; while, the Ministry of Health and the Ministry of Education are in charge of the elderly care in communities where there are committees in regions and provinces. 3) Regarding the role assignment, Care Managers in the operating areas work with multidisciplinary team. Care Managers evaluate and screen the elderly, collect information of the elderly who need the proactive cares, make Care Plan for individual elderly, arrange Care Conference to coordinate with their partners following the Team Building Plan, administrate and conduct Caregivers’ operations, and evaluate the operation plan and outcomes for further development. However, for sustainability, the attempt was to push this long term care treatment as a right and welfare for all elderly.

Yes

This long term care through 3C’s innovation project has been followed and evaluated by the government continuously. It was assigned to be followed-up and supervised by the DoH, MoPH, and related organizations, such as the Budget Bureau, the State Audit Office of Thailand, National Legislative Assembly, and civil society organizations. The Bureau of Elderly Health has to report the operations and progress of the project to the government monthly, as well as every three, six, nine, and twelve months. The results are evaluated, analyzed, and synthesized to improve, and develop the quality of the services and to revise the policy.

Major indicators were 1) number of the elderly accessible for, or utilizing the long term care through 3C’s innovation 2) number of trained Care Mangers 3) number of trained Caregivers 4) number of the elderly receiving the health care following the individual care plan. 5) this project is also one of main indicator under “Integration to Create Equality to Support Ageing Society” of Thai government.

According to the previous operations, 187,890 dependent elderly, both home-bound and bed-bound, utilized the innovation. 12,279 Care Mangers passed the training; and 74,833 Caregivers passed the training. Moreover, 187,890 elderly people received the health care based on the Care Plan, and all of them had better health. In details, 1,952 bed-bound elderly became home-bound, and 7,412 home-bound elderly became social-bound.

The System Development for Long Term Care in Community through 3C’s Innovation was carried out with different types of the elderly in different places and with different health care needs. The major stakeholder is the elderly and their families who agreed to get the service following the individual care plan performed by volunteer caregivers who are paid only a little by the government. Care Managers are mostly government officials working for subdistrict health promoting hospitals, community hospitals, and family doctor teams. They all work cooperatively with multidisciplinary team from local administration organizations, houses, temples, schools, religious organizations, local elderly clubs, subdistrict health fund committees, district health boards, provincial public health offices, the NHSO, also Maejo University that developed the long-term care data base, and other networks taking parts in works for the improvement of the elderly’s well-being.

1) Integrative actions are fundamental for sustainable operation development. Care Managers support, develop, coordinate, and allocate resources to make the most of them. 2) Caregivers’ work is still voluntary that is a limitation. To improve, there should be formal and informal caregivers. Payment system which is in the form of time bank, considered to be more suitable, must also be improved. 3) The 3C’s innovation database and Care Plan technology should be developed for accessibility to reduce burden on report, which gives them encouragement to work and allows much time for them to take care of the elderly more effectively.