Recognizing What You Have: Lessons from Elder Care in ThailandSociety
Negative Views of Care Facilities
If you ask people in Thailand about care options for older citizens of their country, they often have a hard time answering. In Japan, facilities and institutions like elder-care homes and nursing insurance come to mind, but neither of these is common in Thailand. Even trains do not have priority seating for elderly passengers. Older people are supported not by facilities and institutions but by families and communities. Indeed, many Thai people say that if they were to put their aged parents in a care facility, they would be criticized by those around them as ungrateful and cruel.
In Bangkok, local and international private enterprises and individuals have recently opened a number of elder-care facilities, targeting an extremely limited subset of the wealthy class. Such enterprises are under no obligation to register as care facilities with the government. So long as they offer no medical care, they can be operated as hotels or serviced apartments. As a result, the exact number of facilities in this category is unknown, but more than 100 within the city limits alone advertise themselves as elder-care facilities.
Meanwhile, Thailand has 12 care facilities under the supervision of the central government. These centers, which are not restricted to older residents, are managed with a strong awareness of their mission to care for those who are financially disadvantaged and without families to turn to. This negative image of a “last resort for the unfortunate” may partly explain the views that Thai people hold of care facilities in general.
The Reality of Thailand’s Public Care Facilities
The oldest of Thailand’s publicly operated care facilities is the Ban Bang Khae Social Welfare Development Center for Older Persons, opened on the outskirts of Bangkok in 1953. It has bungalows and private units available for a price, but no fee is charged for the shared dormitories. Its facilities are divided according to the level of independence of their residents; the building for residents with severe dementia is a grim, imposing structure reminiscent of a prison.
The facility can house roughly 200 people, and has been at maximum capacity for some years now. According to the staff, there are constant altercations between paying residents over privacy. Indeed, I was struck by the tension in the air when I visited.
Life in Thailand is steeped in Buddhist culture, and donations are an everyday practice among people hoping to accumulate merit for a favorable rebirth. The government does provide some of the operational budget for these facilities, but the majority of their funding comes from donations. Goods are donated from around the country as well. During my visit, I saw diapers and other daily necessities piled high in the entranceway. External benefactors also support a diverse range of other activities.
Thammapakorn Social Welfare Development Center for Older Persons, located in the northern city of Chiang Mai, is a completely fee-free facility that accepts only residents who are both impoverished and have no family or community support network whatsoever. Clothing, food, and medical care are all provided by the facility. There are no private rooms. The wing for those needing medical care is attended 24 hours per day by specialist staff with university degrees.
Older residents in good health do as much for themselves as possible, in addition to playing a role in the operation of the center. The premises are kept clean and hygienic, the staff are friendly and cheerful, and the relaxed expressions of the residents suggest that they spend their time in fulfilling ways.
Learning from Thailand to Recognize What We Have
Japan has expended a great deal of time and resources to establish its nursing insurance system and elder-care facilities, which have no real parallel in Thailand. While Japan’s generous institutions do open up new possibilities for the elderly Japanese making use of them, I wonder if they have also caused the Japanese people to forget the values they once shared with Thailand, which prompted families and communities to care for their older members.
When the aging of Thailand comes up in assistance or research contexts, the discussion tends to center on issues to be resolved and institutions that are lacking. But perhaps asking first what Thailand does have, rather than beginning the discussion by identifying what it doesn’t, could bring a different world into view.