Dr Kanapon Phumratprapin, chief executive officer and founder, sees that as a success and the opportunity for expansion is bright, given the increasing number of elderly people in Thailand and the Asian culture in which children are the last resort for their ageing parents.

“Hospitals are designed for curative treatments, not the seriously-ill elderly. Being in a hospital also entails huge expenditure. Home care should be the right answer for elderly individuals who need long-term care [for non-communicable diseases],” he said, as he joined a seminar organised by the Thailand Development Research Institute (TDRI) last week.

Home care for the elderly is trending, said the 33-year-old physician of Bangkok Hospital’s Longevity Centre.

In the US, there are fewer new hospitals due to the high operating costs, which reduces the possibility for palliative care at such institutions. If there is any such hospital care, the cost is steep, with doctor visits and data collection being the alternative, Kanapon added.

Research by the Public Health Ministry’s International Health Policy Programme showed that out of a total of 387,970 deaths in Thailand in 2005 and 2006, more than half were among those aged over 60.

Half of those elderly people died at home, incurring health expenditure of between Bt10,646 and Bt231,167 in the last year of their lives.

Kanapon got a vote of confidence from Srivieng Pairojkul, a lecturer at Khon Kaen University’s Faculty of Medicine and president of the Thai Palliative Care Society.

At the TDRI seminar, she said the quality of life of the elderly would definitely be better if they could be cared for at home, where they wanted to be.

While the survival rate is higher for this group, health expenditure is also reduced, she added.

At hospitals, Srivieng said, the service could not as things stand be any better than it is, given that Thailand had very few specialists – doctors and nurses – in the field of palliative care or specialised medical care for people with serious illness. Notably, palliative care is not included in most medical curricula, and there is no specialised training centre, she pointed out.

Health at Home, which currently provides its service in the Bangkok area, has enlisted 119 caregivers in its system. They are on call from patients through a mobile app, which won funding under the DTAC Accelerate programme for start-ups. They earn Bt15,000-Bt25,000 a month, or Bt600-Bt900 per shift.

Only those with experience are enlisted, and they are also given half a day’s training and have to pass a test supervised by Bangkok Intercare School.

Kanapon acknowledged that what they were doing was indeed a tough job. In Thailand, there is little differentiation between caregivers and housemaids.

Moreover, these workers have no apparent career path. Once a patient under their care dies after years of service, they are unlikely to gain above-market-rate pay from a new client despite the experience they have acquired, he said.

Building portfolios for them is therefore necessary.

In his focus now is to have these caregivers key in daily health data concerning their charges, which can be shown to the patients’ doctors during house calls.

The wider use of healthcare wearables will relieve the caregivers from this task in the future, he said.

Data on healthcare-related expenses of the patients is also being collected. With this, he plans to work with life-insurance companies, which want to reduce healthcare claims resulting from hospitalisation.

Moreover, once the data is ready, he will also consider expanding the service to the provinces.

“The data collection should be completed by the end of this year. I want solid data in my hands before making the next move,” he said.

Fund proposal welcomed

He also welcomed the TDRI proposal to create a fund for elderly care.

Such a fund would be governed by a body overseeing the standard of service providers, among others.

“Having a standard is favourable for the industry, in order to provide a level playing field for newcomers. Nevertheless, this should not be allowed to lead to too much regulation,” he stressed. “Palliative care at home is a favourable choice for Thailand. Some elderly patients are now taken care of in hospital intensive-care units. If they can be attended to at home, the beds would be free for needy patients and this could reduce the country’s overall healthcare cost,” he explained.