The Hopes of Older Folk (2): Practical suggestions for the State, Communities and Businesses

Story: Woraphong Wechamaleenonda

Thai society has begun to anticipate and prepare for its transition into a super-aged society. The healthcare and human resource management sectors of the government are in the process of implementing new measures in response to demographic changes. However, our entry into a super-aged society will bring sweeping changes to society that require structural adjustments beyond the purview of the government. Every facet of society will

Following the morning’s discussion of conceptual frameworks around demographic ageing, the conference moved on to the topic of structural adjustments that need to be made in the public, private and civil sectors based on research findings, policy proposals and organizational changes.

Preparations Within the State and Local Communities

The three overarching concerns of Thai seniors are the deterioration of their physical health, becoming unable to care for themselves and burdening family and friends, says Assistant Professor Dr. Duangjai Lorthanawit in her introduction to “A Model of Long-Term Care of the Elderly For Individuals, Families and Senior Services.” In her survey of research on Thailand’s senior population over the last decade, she found a number of studies with suggestions for social and caregiving infrastructure for the elderly, which can be divided into the following four categories:

(1) Friendly and accessible public spaces. Seniors should have spaces other than food courts and malls where they can meet and spend time with each other.  (2) A range of services for the elderly that support their physical, social and spiritual well-being, and (3) economic security. (4) There should be educational programs that enable seniors to keep up with changes in society. 

These models give rise to interesting practical applications, such as local fresh markets, so people don’t have to go to stores for groceries, and community-based care centres for the elderly that are located close to home. They also advocate for holistic healthcare systems and the development of tambon health promoting hospitals into recovery centres for elderly patients after receiving hospital treatment, where they can be cared for until they are well enough to go home. Additionally, they suggest raising the retirement age and reforming employment policy, while also underscoring the role of universities in empowering elderly students to become the driving force of Thailand’s economy and society.  

Next, Prof. Dr. Nalinee Tantuwanit’s synthesis of research into elderly care systems at the family, community and regional levels over the last decade, reveals that social attitudes rooted in filial piety largely place caregiving responsibility on families. However, the many limitations of the family unit, without the support of other institutions, leave seniors with inadequate care. For one, the primary caregiver in a family is typically the eldest daughter, who is often the least skilled and educated member of the family. Unemployed, she stays home and looks after the other family members. However, the majority of these women lack the necessary skills and knowledge to provide effective care for their senior relatives, and may have their own health conditions that need additional care. Therefore, the whole community– volunteers, networks of relatives and neighbors — must mobilize in support of elderly members, as well as social institutions and organisations such as temples and schools. We can even work towards the integration of virtual communities in caregiving systems. That being said, regional care infrastructure such as health promoting hospitals and subdistrict administrative organisations (SAOs) have the most potential in improving the circumstances of the elderly. 

Furthermore, the studies recommend that family caregivers, who are unable to work because of their responsibilities, should be given financial support so that they have the means to be independent. Research should also be conducted into the mechanics of virtual communities and possible ways of integrating them into existing networks of knowledge, especially in healthcare. 

Most importantly, there must be a shift in cultural attitudes that pressure the elderly to be self-reliant, and brand them as burdens to society if they aren’t, towards a recognition of their right to receive public welfare with dignity. 

After surveying 1,424 studies on Thailand’s senior population between 2008-2018, Assistant Professor Narit Nisomboon found that the majority were medical research preoccupied with treatment methods, disease prevention and healthcare professionals. On the other hand, research into mental health, ways of preparing for death, medical emergencies and caregiving systems in different types of communities, as well as studies that look at the relationship of support systems to society, lived environments and businesses, were scarce, and should be given greater emphasis moving forwards. 

Next, Associate Professor Narumol Nirathorn presented her research on Thailand’s informal labor sector in the context of an ageing society. She chose to focus on motorcycle taxi drivers between the ages of 45-60, because they are a large population of informal workers, and conducted her analysis on three areas: health, financial stability, and social and economic participation. Though theirs is a considerably dangerous line of work, she found most of the drivers without healthcare arrangements and, in particular, preventative care — few of the drivers surveyed get health checkups. 

However, the network of motorcycle drivers possesses a unique economic and social property, which is that the movement of motorcyclists across the urban grid acts as a conduit for the circulation of information to other motorcyclists throughout the city. It therefore has great potential for certain kinds of mobilization and collective preparation. Most importantly, motorcycle taxi drivers typically earn more than other sectors of the informal economy. Most of them, therefore, aren’t interested in switching to another line of work. 

With respect to their financial responsibilities, the majority of motorcycle taxi drivers have close to ties to their home communities in the provinces. They see themselves returning home, and prefer to save their money in their community’s investment funds. 

Professor Nirathorn concludes that there should be a greater emphasis on health checkups, as well as increased awareness and enforcement of safety regulations in the motorcycle taxi driver network. We should also have a greater appreciation for the role motorcycle taxi drivers play in shoring up the financial strength and stability of communities. 

Preparations in the Private Sector 

The section on preparations in the private sector began with Prof. Dr. Surat Teerakapiban’s lecture titled “Embracing Risk in Old Age”. He explains that the traditional notion of working until one is 60 years old and living off of a retirement fund for the next 20 years until one passes away at 80 is incompatible with our current context, as studies show that an growing number of people will live to be a hundred. Solely relying on one’s own savings in old age will be insufficient in the future.

Some of the reasons why older people tend to be risk-averse are: (1) They feel like they don’t have much time left to live, so learning and making investments feel like fruitless endeavors. (2) Too much statistical information becomes overwhelming for seniors. (3) They are tend to be more concerned for their loved ones than themselves, (4) They gravitate towards the familiar; for example, they would be more inclined to lend money to an acquaintance than a stranger. With these tendencies in mind, merely providing investment advice for elderly people will not be enough to change their perspectives and habits so that they are more independent and willing to take risks. They must have an understanding of how that advice will be generative and beneficial for them, such as encouraging elderly clients to make investments that will directly benefit organisations they care about, or loved ones. These approaches can transfigure their risk averse behavior into an embrace of a moderate amount of risk. 

Next, Dr. Arunee Tanvisut presented her analysis of “The Thai Senior Market”, positioning it as a compelling emerging market. Ederly consumers tend to invest in healthcare, have strong purchasing power and a lot of leisure time, and are more inclined to reward themselves after many years spent supporting others. While organizing exhibitions on healthcare services and products throughout 2016-2018, Dr. Arunee Tanvisut found that the senior market had grown from 3 billion baht to 17 billion baht, and will continue to expand at a rapid pace. 

Senior marketing concepts tend to divide elderly consumers into three groups — younger seniors (60-69), middle aged (70-79), and old (80-89) — that each have different consumption patterns. Eight months worth of data collection by Dr. Tanvisut’s research team shows that goods and services for senior citizens can be categorised into eight distinct groups: healthcare foods, products with senior-oriented designs such as pads for elderly women, residences such as houses and condominiums specifically designed for elderly lifestyles, health insurance, will-writing services, delivery services for seniors such as Go Momma, banking and financial service packages for elderly clients, travel infrastructure, and last but not least, care homes for seniors who are no longer able to take care of themselves.

Other than producing products that are safe, high quality, suitable and intuitive to use, Dr. Arunee Tanvisut proposes that an important goal for the growing senior market in Thailand is to set its sights on international, as well as domestic, consumer bases. 

Startups and the Thai Healthcare Industry

The conference concluded with Prof. Dr. Nopadol Rompho’s presentation of his research paper titled “An Analysis of Startups and the Healthcare Industry in Thailand”. Observing that the growth of ageing societies globally has been the driving force of technological innovation and the expansion of healthcare technology, he asks whether Thailand could become the vanguard of senior care by spearheading these two vectors of technological change. 

After interviewing 14 healthtech startups about the senior healthcare industry, he found that while there is a diverse range of manufacturers, there are only two main consumer models: B2B (Business-to-Business), which supplies products to hospitals and and senior care centres, and B2C (Business-to-Consumer) which directly engage with elderly consumers. He also found that trends in the healthcare startup industry can be categorised into four main themes:

(1) As elderly consumers become more familiar with simple technology, it becomes easier for them to access healthcare technology. (2) New AI technology can complete tasks, such as reading x-ray films, in place of healthcare personnel, allowing doctors to spend more time with patients. (3) The analysis of large datasets, known as Big Data, can predict health-risk behaviors and possible preventive measures. (4) Seniors are living longer, which has produced a large job market of senior workers over 60 years old. 

These trends have generated a spectrum of innovation and opportunity for healthcare startups: 

(1) Activities for senior citizens. Seniors are no longer expected to care for their grandchildren at home, and want to go out to meet their peers. Many startups are trying to encourage seniors to socialize with one another through the formation of senior clubs and other activities. 

(2) Financial services. Many seniors are unaccustomed to saving money. Therefore, financial services for senior citizens promises to be a huge industry in the future. 

(3) Hard and soft technologies. Technology become more affordable with technological advancements, and are increasingly being incorporated into healthcare.  

(4) Preventative and Mobile Healthcare. Healthcare providers should invest in preventative screening and medical house calls, instead of expecting senior patients to spend all day at a hospital in order to see a doctor and pick up their medicine. Some startups have proposed blood testing services for senior patients at their homes, which will eliminate the need for seniors to travel to the hospital for their blood test after going without food and water. 

(5) Alternative Reality and Virtual Reality Technology. In the future, patients and doctors may no longer meet in person, but on virtual reality platforms. This has the potential to improve senior citizens’ access to healthcare and allow doctors to advise their patients more easily.  

At present, though, there is still a significant gap between startup activity, available technology and healthcare needs, which are: 

  1. Mobile services such as at-home blood tests lack the number of personnel needed to meet the demand for home-based services
  2. Seniors struggle to access and navigate the latest technologies (devices should have user-friendly design).
  3. The person purchasing the product often isn’t the one using it. For example, a son may buy a gps-fitted watch for their father with alzheimers. However, their father may become frustrated with the product, or misplace it. It is important to account for what each party’s needs are. 

In order to bridge some of these gaps, Dr. Nopadol put forward a few interesting policy suggestions.

  1. Telemedicine systems will allow for medicine deliveries through the postal service, though there are some concerns over dispensing errors. However, regulatory structures can be developed to solve them, since the implementation of telemedicine will improve the safety and comfort of senior patients on the whole. 
  2. Complicated and outdated legislation that is prohibitive to the growth of healthcare startups should be amended. 
  3. The government should collect and compile information on Thailand’s senior population into a centralized database, which businesses can access and use to develop their products. At present, each startup conducts its own research, which is a much more complicated and costly system.
  4. Antiquated laws that have not kept up with global and technological changes should be fixed.
  5. There should be measures that incentivize the growth of a robust healthcare startup industry, such as tax incentives.

In conclusion, rapid technological progress has alleviated the apprehension of Thai society towards a future shadowed in uncertainty. If we can weave technological innovation into the future of Thai society, and encourage the public sector and private startups to enhance our current healthcare system, we will, without a doubt, find a way to adapt to our ageing society.