Creating Caregivers: Hill Tribes Fill Lowlands Care Gap

A System for Cultivating Caregivers

The poorer inhabitants of the mountainous areas around Chiang Mai include many isolated older residents. Lacking family or other support system, they can find it difficult to visit hospitals in the lowland areas. The Foundation for Older Persons’ Development (FOPDEV), a Thai NGO based in Chiang Mai primarily serving older people, is working to cultivate caregivers who can offer care in these areas at no cost to recipients.

FOPDEV’s training program for caregivers begins with a three-month course at Chiang Mai University’s Faculty of Nursing, followed by an additional three months of practical experience at a hospital or elder-care facility in the city. Program participants who complete this half-year program are recognized as caregivers. FOPDEV offers loans to cover all costs during the training period, including food and accommodation.

Once trained, caregivers are dispatched by FOPDEV on weekdays to care for wealthy older people in the cities, who pay for this service. On weekends, caregivers provide free care to the poorer residents of the mountainous areas that are FOPDEV’s base. They also work to share information needed for elder care more widely throughout these communities.

In this revolutionary approach, the system harnesses the significant demand for home care among wealthy older people in urban areas, using the fees they pay to fund the training of further caregivers and the provision of free care to poorer recipients. However, within the city of Chiang Mai there are no applicants for this funded caregiver development course. This is in large part because of the negative image of “caregiver” as an occupation.

There are many resort-style care facilities in Chiang Mai targeting foreigners and wealthy Thais. Pictured here is Dok Kaew Gardens, which is run by a Christian organization and has several Japanese and other foreign residents.

Leaving Lowland Work to the Hill Tribes

Entrance to a temple in Chiang Mai, where Mon children in traditional dress earn money by posing for photographs with tourists.

An expanding labor market following recent years of economic development has given Thailand’s workers an increasingly diverse range of employment options. Fields like construction and domestic work are increasingly viewed as “work that Thais don’t do” and left to migrant workers from Myanmar, Cambodia, and other nearby countries. The hurdles are particularly high for care work, which is poorly paid despite the challenging tasks it involves, such as the need to handle human waste. Recognizing this, FOPDEV has aimed its caregiver cultivation program, intended to remedy this lack of trained carers, squarely at hill tribes. The program allows members of these impoverished communities—which have few educational or employment opportunities—to study care skills, establish a source of income once their student loans are repaid, and find work. Meanwhile, it also ensures that the poor older people FOPDEV aims to help can receive care for free. The arrangement, as FOPDEV puts it, is win-win.

However, the rate of attrition is high. Of the 20 students who enrolled in the course in its first year, 4 dropped out halfway through, 4 found work at elder-care facilities and hospitals, and 5 changed careers, opting for more lucrative work at privately owned automotive and other businesses. Is work that the lowland Thais do not want to perform being forced on the “unfortunate hill tribes”?

“Therapist,” a kind of carer who works in a hospital or government-run care facility, is a specialized profession requiring a university degree, so the barriers to entry are high. On the other hand, anyone who completes a few days of training run by a private organization can become a caregiver. In some cases, the difference can even be unclear between a caregiver and a maid. Spurred by increasing demand, the Thai government has plans to standardize the  “caregiver”qualifications and establish it as a professional occupation. Whether it takes root as a recognized profession that Thai people can hold with pride will greatly depend on how this framework is constructed.

The Issues and Implications of Aging Asian Population Project (Global Frontier Fund, Sasakawa Peace Foundation)