Abstract
Thailand becomes ageing society. The Thai government officially implemented long-term care (LTC) for dependent elderly in 2016. Sa-ard sub-district of Namphong, Khon Kean has provided LTC services program by family care team and LTC center since August 2017. However, impacts of this program particularly social impact have not been assessed. This study aimed to examine the impacts of dependent elderly care program by the family care team, Nampong district, Khon Kaen province. Specific objectives include; describing elderly care delivery, examining program outcomes, and social return on investment (SROI), exploring opinions and recommendations to improve the program in the future. A mixed-method was used: both quantitative and qualitative. The Sa-ad sub-district's primary care cluster (PCC) was a study setting, where the dependent elderly care program is well established and managed by the local council and the community. Quantitative data include: clinical outcomes and cost due to geriatric care provided by the program; cost of the program delivery from provider’s perspective; impacts on social cost from elderly and caregivers’ perspectives. We compared clinical, humanistic and economic outcomes using the data of Nong-Kung sub-district where no program was provided. Qualitative data include: documentary review of the program delivery; stakeholder’s interviews and focus groups to investigate the social impacts of the program; stakeholder interviews to identify recommendations for future development. Findings are as follow: The dependent elderly care program by family care team (the program) Sa-ad sub-district has the dependent elderly care program, which is collaboratively managed by the community hospital and the local council. Sa-ad sub-district has great potential in providing an integrated day care and home care services program. The family care team, composed of a family doctor and other health professionals, provides a home visit to home-bound patients every week. There is a day care center (or called LTOP) located at the community center. Here, a community nurse is acting as a care manager and some trained care givers assisting in elderly care daily service. A Japanese organization, JICA also supports this program. Dependent elderly patients are divided into three groups: social-bound, home-bound, and bedridden. Two options of the care plan are possible: home-care or walk-in center, for each individual depending on the patient’s conditions. Moreover, the community involves running this service by raising funding to advocate the elderly and dependent people to get jobs and thus earn money. Program outcomes Outcomes of the dependent elderly care program were evaluated by three methods: first, comparing clinical outcomes of elderly living in Sa-ad sub-district – the program group and Nong-Kung sub-district – the comparison group. The pre-program data collection time was during May 1, 2016 – July 31, 2017, and the post-program was during August 1, 2017 – October 31, 2018. The comparison within the program group shows a significant improvement in increasing Barthel ADL from 6.78±3.20 to 10.68±6.08 (p<0.01), indicating the program can promote elderly independence. No difference was observed in clinical outcomes, quality of life, and healthcare cost, compared between the program and the control groups. The multivariate regression analysis reiterates no difference between groups. Being in aging health conditions similarly affects the elderly themselves and their care givers in a low to moderate level. Social return on investment of the program The social return on investment (SROI) analysis was performed for a one-year time frame. The dependent elderly care program impacted multiple stakeholders such as older people, care givers, staff, community residents, relevant organizations, and society. However, changes in health and independent status were the program highlight. The monetary value impacted by this program was 15,853,919 Baht, proposed by 37 patients. The program was invested by 2,138,704 Baht. Therefore, the program's SROI ratio equates to 7.4 which means every one Baht of program investment can return 7.4 Baht to society. In sensitivity analysis, SROI ratios ranged between 2.9 and 20.5. Willingness-to-Participation and Willingness-to-Pay for the program General population survey revealed proportion of willingness to participation in the program (92.06%), willingness to pay for the program (91.35%) and average wiliness to pay for one service at 443.12 ± 427.416 Baht (median 300 Baht). From this willingness to participation and willingness to pay information, there would be pooling money to the LTC fund around 3 million bath per sub-district. Opinions and recommendations to the program development Opinions toward the dependent elderly care program were drawn from various stakeholders; patients, care providers, the general public, relevant organizations, and stakeholders. All had prioritized the importance of elderly health, mainly the bedridden group. The program set up in the Sa-ad sub-district has been seen as the best model and should be shared with other localities. However, several points have been raised that still needs further work: 1. Long term support to the day care center and care givers should be discussed. 2. Local authorities or other relevant organization should guarantee that appropriate welfare and safety during work hours are provided for care givers. 3. Financials and other resources should be sought to support this program. In conclusion, this study indicates that the dependent elderly care program directly impacts the elderly and care givers, which is valuable to society. The program has 7.4 times the return to the investment. Therefore, it should be supported continuously and expanded to other areas.
