2020 HAPI 2nd Prize Winner
Community involvement is critical in supporting healthy aging and improving the ability of older people to age in place. The role of community care is even more vital in countries such as Thailand, which do not have long-term care insurance and where many people do not have a pension to draw on to support themselves as they age. A key aspect of successful community-based care models is ensuring that they meet the specific needs of the community they serve and that they are integrated with other services to ensure that no one is left behind. In Thailand, developing integrated and comprehensive care for older people is particularly challenging because while care for bedridden patients is typically handled by the central government, community programs for active older adults are run at the municipal level. This not only creates a disconnect, but it also leaves out services for frail older people.
The local government in Bueng Yitho, a municipality situated about 20 kilometers outside of Bangkok, noticed that the services they were offering at their medical and rehabilitation center and their community center were underutilized and were not meeting residents’ needs. In 2013, the municipality worked with the Faculty of Social Administration at Thammasat University to carry out a survey, which found that older residents there needed someplace to go each day and they needed more activities. They have also worked with Nogezaka Glocal (Japanese NGO) and Yugawara Municipality to learn from Japanese models of community-based care. As a result, they have developed an innovative program that emphasizes community engagement to create an integrated cycle of services to better meet the needs of a wider range of their residents.
The first step was the establishment of three Quality of Life Development Centers for older persons. A small membership fee is required to encourage a greater sense of ownership and engagement and to help sustain the programs. Activities include everything from dance classes and aquatic exercise to computer lessons and karaoke, and the municipality works with the members to recruit teachers and trainers. Promoting healthier behaviors and self-management of health are a major objective, and the more than 2,000 members of the centers have shown positive outcomes to date in terms of improved self-awareness and health behaviors. In 2018, this program came to be known as the STRONG Program, with STRONG standing for Socialization, Treatment, Recreation, Opportunity, Nutrition, and Group.
The results of the programs were monitored, and feedback was used to adjust the types of services offered. The target audience was broadened as well, and the members at the centers began taking a more active role. The STRONG Program encourages residents to participate in the planning, implementation, and monitoring of STRONG programs. In other words, it went from a top-down to a bottom-up approach to providing these services, or what they refer to as “dynamic value co-creation.” As Mr.Rungsarn Nuntakawong, Mayor of Bueng Yitho, points out,“People in the community know that STRONG belongs to them. They own the services and I think that is where the STRONG program gives people motivation—the motivation to take care of themselves, to take care of others, and to take care of our own community.”
This is accomplished through community surveys, brainstorming sessions, and the creation of a community committee that brings together representatives from elderly clubs, the municipality, and volunteers working on the programs.
In 2019, a day care and day service center was added to assist older persons who do not have caregivers at home. The caregivers working there are active older persons who have participated in the STRONG Program, some of whom are volunteers in the community, and they serve as role models who encourage others to get involved. The services there combine rehabilitation and other activities to improve users’ ability to carry out daily activities. Furthermore, a fourth Quality of Life Development Center was also established in the same building as the day care and day service. Another aspect of the innovation is the creation of the donation-based Bed Side Loving and Caring Foundation, which provides home care and medical devices for older adults who have become bedridden, helping to improve their quality of life. This foundation is managed by a committee that involves both the community and the municipality.
By integrating care services and targeting a comprehensive range of older people, the STRONG program has seen significant successes for program participants. As one member explains, “My life has changed. STRONG gives me a stronger and healthier life, both physically and mentally. Because I have a good quality of life, I want to share more with others and to give them more opportunities to live a better life, like I do”. There has been a steady rise in program membership and a marked increase in the number of people accessing day care and other day services, demonstrating that the program is now better meeting the needs of the community. It has become a model that people are looking to both within Thailand and overseas as well. The Mayor himself hopes that “in the future people will learn to give more, care more for others, and do more for our society.”
KEYS TO SUCCESS
- Integrated approach to services for older people that provides a continuum of care for those with a wide range of different needs
- Bottom-up community approach that has taken input from the community to ensure their participation and investment in the program
- Partnerships at both the local and international level with academics, other municipalities, and NGOs