Aged care in Thailand: Challenge and opportunity

In Thailand the elderly are traditionally kept in the bosom of the family, often actively involved in household chores or family businesses, right up until the time of death. While there are now more exceptions to this rule as families disperse for education or employment, it still remains common practice. This, combined with limited public sector funding, have meant that Thailand has yet to develop the system of elder care facilities found in most western countries. The facilities that are current available are mainly limited to designated aged care wards in a few of the hospitals.

Now introduce into this picture the many thousands of expats choosing to retire in Thailand. One reason for this growing trend is a recognition that they can no longer afford to maintain an adequate standard of living in the West in their golden years. Another factor is that retirees today are more well-travelled and savvy than any generation before them. Many of these folks rely on pensions from foreign governments, whilst others have personal savings or investments. Almost all have been hard-hit in recent years by a combination of inflation, adverse movements in the value of foreign currencies, and the Global Financial Crisis.

It is no revelation that as people age they require an increasing amount of medical intervention – and assistance generally. As expat numbers grow this is beginning to have a noticeable impact on already-stretched Thai public health services. For example it has been reported that the clinic that services Bangkok’s international airport is now facing budget over-runs as a result of treating foreign patients who subsequently claim to have inadequate funds to pay their bills. There have also been reports of similar situations occurring in areas of Thailand popular with expats.

Most older expats enter and remain in Thailand on the basis of a ‘retirement visa’. These are granted, and extended annually, on the basis of a number of conditions. One of these is that a minimum balance of 800,000 Thai baht (about $26,000) is maintained in a Thai bank account. But this mandatory nest egg can be quickly eroded in the event of a major health crisis. Similar financial crisis can also occur when elderly persons, sometimes with diminishing mental capacity, are scammed or simply spend their money unwisely. In some cases those responsible are unqualified female ‘personal assistants’ who have been provided with PIN numbers to enable them to shop for food and household items.

Frequently unable to speak the language, and without access to family and old friends, or the sort of government safety nets found in a western country, old people can very quickly find themselves in a dark place if and when things begin to unravel. Help is often then sought from honorary consuls or embassy officials, but who have limited resources on hand to support or repatriate old, sick and/or penniless citizens.

What can the Thai government do about this? Well some possible responses might be increased visa fees, imposing maximum age limits, mandatory health insurance for expats, and increasing the thresholds for minimum cash holdings and/or annual income. These are not ideal solutions and will adversely affect many expats in order to help safeguard the Thai public purse from a minority. Still some action seems inevitable, and it’s hard to see what else might be done given the resources currently available.

What can expats themselves do to be part of the solution, rather than part of the problem?

  • Prepare a financial plan and a personal budget, and be careful with your cash
  • Prepare a Will, an Enduring Power of Attorney, and maintain adequate health insurance
  • Register your name and contact details with your embassy
  • Have a contingency plan in place for when you can no longer manage on your own – which might well include returning to your country of origin
  • If you employ a personal carer then ensure they are qualified and undertake whatever checks you can concerning their character and bona fides.

One further step, only now becoming a viable alternative, is to enter a specialized aged care facility.  For the reasons set out earlier, these remain few and far between.  In fact the author is unaware of any integrated three stage aged care facilities operating in Thailand (i.e. independent living + hostel + nursing home). Foreign entrepreneurs have entered the market but appear to be only interested, thus far, in developing small blocks or clusters of independent living units.  One of the few existing facilities for people requiring a higher level of care (that is not merely a hospital ward) is ‘Dok Kaew Gardens’ in Chiang Mai (see www.mckeanhosp.org/mckean-rehabilittation-center).

One would sincerely hope, and it would seem likely given current demographic trends, that further quality aged-care facilities will come on stream in Thailand in the very near future – catering for Thais and foreigners alike.

This article is also available at http://issuu.com/austcham/docs/advance_october_2011?e=2062779/2987225 (see page 6). A slightly amended earlier version appeared in the June 2011 edition of MelbThai magazine.

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Two articles on aged care in Thailand written by other authors can be found at http://www.chiangmainews.com/ecmn/viewfa.php?id=1937 (September 2007) and
www.chiangmainews.com/ecmn/viewfa.php?id=4046 (May 2014)

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