What We Need to Solve the Urgent Crisis of and How to Develop Sustainable Long Term Care in Thailand: Policy Makers’ Perspectives

Background

Thailand is experiencing one of the most rapid demographic transitions in Asia. The country’s growing ageing population — characterised by increased longevity and the rising prevalence of chronic diseases and disability — has created an urgent demand for comprehensive long-term care (LTC) systems. By 2040, projections indicate a substantial increase in the proportion of elderly citizens requiring sustained care services.

The Thai government has recognised this challenge and begun implementing pilot programmes, including community-based care initiatives and a trial LTC budget introduced in the fiscal year 2016. However, significant gaps remain between policy intentions and the development of a sustainable, equitable, and comprehensive LTC delivery system. This study set out to explore the perspectives of senior policy makers on the most urgent challenges facing Thailand’s LTC system and to develop a feasible ten-year framework for sustainable LTC development.

Study Design and Methods

The researchers employed a qualitative approach using in-depth interviews with 11 policy makers — eight male and three female — who held positions relevant to elderly care and LTC policy in Thailand. Interview transcripts were analysed using NVivo 8 qualitative data analysis software. Two independent investigators developed thematic codes from a subset of transcripts, ensuring analytical rigour. The study received ethical approval (Certificate of Approval number 031/2015), and interviews were translated from Thai to English by a bilingual researcher.

Six Urgent Issues Identified

The analysis revealed six issues that policy makers considered urgent and requiring immediate solutions. First, a pronounced care services imbalance existed between urban and rural areas, with metropolitan regions receiving disproportionate resources while rural communities lacked basic elderly care infrastructure. Second, poor management of existing LTC programmes resulted in fragmented services and duplicated efforts across government agencies.

Third, the skill search challenge reflected difficulties in identifying and training workers with appropriate competencies for elderly care — a field requiring both technical health skills and interpersonal caregiving abilities. Fourth, health workforce scarcity was identified as perhaps the most acute crisis, with insufficient numbers of trained caregivers, nurses, and geriatric specialists to meet growing demand.

Fifth, regulatory gaps meant that LTC providers operated without standardised quality assurance frameworks or accountability mechanisms. Sixth, information system problems hampered the ability of government agencies to track elderly care needs, monitor service delivery, and evaluate programme outcomes at the national level.

Proposed Ten-Year Framework

Policy makers proposed a comprehensive framework addressing financing, workforce development, community integration, and system governance. The framework emphasised moving beyond a purely medical model of elderly care toward one that addressed social, psychological, and spiritual needs — reflecting the recognition that Thailand’s LTC system must fulfil more than basic physiological requirements.

Key recommendations included integrating LTC into Universal Health Coverage, developing community-based care models that leverage existing social structures (including the roles of Buddhist temples and local volunteers), establishing standardised training curricula for care workers, and creating a national information system for elderly care needs assessment and service tracking. The framework also addressed sustainable financing mechanisms, including the potential for social insurance contributions dedicated to LTC.

Implications for Southeast Asian Countries

Thailand’s experience holds significant lessons for other Southeast Asian nations facing similar demographic transitions, including Malaysia, Vietnam, and Indonesia. The study highlights that LTC system development requires not only financial investment but also institutional capacity building, workforce planning, and cultural adaptation. The traditional reliance on family-based care, while culturally valued, is becoming increasingly unsustainable as family sizes shrink and women — who have historically borne the primary caregiving burden — enter the formal workforce in greater numbers.

Limitations

The study’s qualitative design, while providing rich policy insights, limits generalisability. The sample was restricted to policy makers, and the perspectives of care recipients, family caregivers, and frontline workers were not captured. Additionally, the rapid pace of policy change in Thailand means that some of the specific recommendations may have been overtaken by subsequent policy developments.

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