Living to a ripe old age is appealing if you are healthy, have someone to take care of you, and have sufficient savings to ensure quality paid care. But if you are sick, dependent and poor, old age is simply a nightmare.
The situation can be even more dire for single women and widows.
Demands of filial piety often dictate that single women cut short their career to take care of their parents in old age.
Working mothers, more often than not, need to sacrifice their careers to take care of their children so that their husbands can freely pursue professional success.
Since women generally live longer than men, wives often find themselves looking after their elderly husbands until their last days. These women then suddenly find themselves alone, with no one to take care of them when they are old, infirm and in need of care.
In a previous era children may have stepped in, but times have changed. Weaker filial piety aside, financial and family pressure plus an increasingly mobile society make it difficult for offspring to be around to look after parents.
Preparations to ensure paid sources of care in old age are, therefore, necessary. But how?
Although Thailand’s universal health care system has lifted much of the burden of medical costs for the populace, expenses cannot be avoided when elderly patients are sent home, often bed-ridden or with limited mobility.
Currently, our various health care systems subsidise patients unequally. While patients with cancer or diabetes mellitus receive free medical care, those with dementia who need personal care must pay out of their own pockets.
Many elderly patients need to resort to nursing homes or private home care. Both are very costly. According to a survey by the Thailand Research Development Institute (TDRI), it costs about 230,000 baht per year to properly care for a bedridden patient, or about 120,000 baht per year for a house-bound elderly patient.
The costs of care for an elderly person from dependency to death are astronomical and often lead to family bankruptcy. Sadly, many drain their savings paying their elderly parents’ medical bills, leaving nothing for when they find themselves alone in old age.
Without family support, enough savings, or long-term insurance, an increasing number of elderly, poor Thais are dying alone and unnoticed.
Given the lack of systematic state support for elder care, long-term insurance may be the key to easing the financial burden as Thailand transitions to an ageing society.
The TDRI recently conducted a nationwide survey to gauge public willingness to pay for long-term care insurance that would cover help with daily activities such as bathing, brushing teeth, eating meals and toileting in old age.
The survey of 2,019 people aged between 25 and 60 in Bangkok and 10 other provinces offered respondents four options for four long-term care insurance.
The first option covered medical equipment and support such as wheelchairs, canes, air mattresses and adult diapers.
The second offered home visits from health personnel once or twice a month. The third gave access to a daycare centre where the elderly could meet friends and engage in social activities. The fourth option offered three levels of government support for home care – 0%, 25% or 50% of the total cost.
Respondents were asked which option or combination of options they would select, with premiums ranging between 300, 500, 1,000, 1,500 and 2,000 baht.
Responses were mainly limited to three preferences. The first group preferred a policy package covering medical equipment and support devices. The second group opted for government support for the cost of home care. The third group, meanwhile, chose a combination of medical equipment, support devices and government support for care costs.
As for the annual premium, respondents did not go for the cheapest 300-baht premium which gave the least protection.
In fact, according to a study conducted by the TDRI and the Puey Ungphakorn Institute for Economic Research, 86% of us are willing to pay an annual premium of between 500 and 2,000 baht for long-term care insurance. Of this number, 30% are willing to pay 500 baht per year for medical equipment, assistance devices and home visits. About 25% are willing to pay 2,000 baht for the benefits of all four attributes. The remainder are willing to pay 1,000 baht for moderate, not comprehensive coverage.
The study clearly shows there is a demand and need for long-term care insurance. The government should, therefore, consider offering such a scheme to the populace, to reduce financial burdens of elder-care as family help wanes and our society ages.
At present, the task of caring for elderly bedridden males mostly falls to their wives or daughters, while elderly women are usually looked after by their daughters. This is because care is traditionally delegated to women in the family.
Since more than 70% of female bed-ridden patients are widows, having long-term care insurance is, therefore, especially crucial for women.
As Thai society ages rapidly, the burdens and challenges are falling mainly on the shoulders of women, appointed as unpaid caregivers according to patriarchal tradition.
It is only fair that the government compensate women for their unpaid labour by offering them some form of security in old age. Long-term care insurance is one of the options. A society that exploits women’s labour without giving back is not a society we can be proud of.
Worawan Chandoevwit, PhD, is an Associate Professor at the Faculty of Economics, Khon Kaen University, and an adviser for the Thailand Development Research Institute. Policy analyses from the TDRI appear in the Bangkok Post on alternate Wednesdays.
First Published: Bangkok Post Wednesday, August 28, 2019