Caged beds and barred cells expose Thailand’s elderly care crisis
After years spent locked inside a caged bed at a nursing home, a 63-year-old mother’s cries for help have finally reached Thai society, triggering an investigation that has uncovered a crisis in elderly-care.
Earlier this month, the mother, identified only as Pat, accused her son of dumping her at a nursing home in Kanchanaburi’s Tha Muang district by falsely claiming she was mentally ill and required specialised care. Pat has filed police complaints against both her son and Sothornchai Nursing Home.
“I decided to speak up because I don’t want this to happen to anyone else,” the distraught woman told media.
An unregulated reality
Pat’s story is far from unique; numerous seniors have recounted similar experiences. After she blew the whistle, authorities ordered inspections at nursing homes nationwide, uncovering illegally modified caged beds and barred cells at a string of other facilities.
Under the 2016 Health Establishment Act, nursing homes must be licensed and regularly inspected by the Department of Health Service Support (DHSS).
Official figures show that only 1,200 licensed nursing homes exist nationwide – just a small fraction of the nearly 4,000 facilities currently operating across Thailand, according to a recent survey by the Senior Health Service and Trade Association and the Foundation of Thai Gerontology Research and Development Institute.
The survey reveals that almost 70% of elderly-care facilities are unlicensed, leaving them exempt from safety, hygiene and staffing inspections.
Worse still, holding a licence is no guarantee of quality.
“We found that the quality of service at licensed facilities deteriorated significantly after the initial inspection and approval,” said DHSS chief Dr Phuwadet Surakhot.
Sothornchai Nursing Home had passed its inspection and been granted a licence to care for a maximum of 50 residents. The DHSS had no red flags against the facility until Pat’s complaint triggered a raid by officials.
They discovered the nursing home had expanded its capacity to 129 beds – more than double its legal limit – and broadened its scope of care to cover psychiatric patients and drug addicts. Along with caged beds, authorities found barred cells, locked and surrounded by barbed wire.
Photo credit: Central Investigation Bureau
Cost barrier and state shortfall
The shocking state of many nursing homes has sparked accusations that the government lacks an effective policy to support the country’s fast-growing aged population.
Thailand officially became an “aged society” in 2023 when the number of citizens aged 60 and above surpassed 13.2 million or 20% of the population. That figure has since grown to 14.2 million, putting the nation on track for “super-aged” status (28% aged 60 or more) by 2029.
This demographic crisis is piling the burden on both the care system and individual households, with about 170,000 elderly citizens now bedridden and more than 800,000 struggling with dementia.
As a result, calls are growing for policies to relieve the strain.
“The elderly population needs dedicated long-term care,” said Admiral Dr Ittiporn Kanacharoen, secretary-general of the Medical Council.
However, the current system simply pushes the burden of care on to families, according to Ekkapop Sittiwantana, MP for the opposition People’s Party.
While state-run nursing homes offer government-subsidised rates of between 3,000 and 8,000 baht per month, places are limited and waiting lists are often very long.
Meanwhile, a quick survey reveals that private nursing homes charge between 25,000 and 45,000 baht per month, which covers rent and meals but not medical or other needs.
Given that the average monthly income for most Thai households ranges between 25,000 and 35,000 baht, placing a dependent relative in a private facility is financially out of reach for the majority. Premium nursing homes charge more, with prices ranging from 50,000 to 120,000 baht per month.
Small or unlicensed nursing homes are far more affordable, at between 12,000 and 22,000 baht per month. However, lower fees often means lower quality and safety. Sothornchai Nursing Home, for instance, had slashed its nurse-to-resident ratio and failed to provide enough toilets, with many residents forced to use buckets instead.
Meanwhile, the Foundation for Consumers (FFC) reports that many nursing homes accept patients with Alzheimer’s disease or palliative care needs despite lacking medical specialists qualified to care for them. Instead, they often rely on low-paid migrant workers who lack the mandated 420 hours of caregiver training.
“When patients suffer serious problems like infected bedsores or choking on food, these centres simply attribute the problems to underlying health conditions and deny all responsibility,” said Tanat Thammisakul, head of consumer rights protection at the FFC.
Proposed reforms
Opposition MP Ekkapop, who serves as vice chair of the House Committee on Public Health, is pushing for a dedicated National Long-Term Care Fund backed by contributions from working adults.
“The existing system can only provide home visits at best due to limited funds.”
He said the opposition was poised to table a systemic plan for the fast-ageing population in Parliament, adding that the Human Security and Social Development Ministry did not have the capacity to manage logistics for rapid demographic change.
“We need a separate organisation to plan ahead and draw up solutions before the problem gets out of hand.”
He proposed that local administrative bodies play a bigger role in purchasing and providing long-term care. The regulatory framework could also be revamped to introduce tiered standards and co-payment that would open doors to more affordable licensed long-term care.
The MP said the current standards set for licensed nursing homes are so high that they have become unaffordable for most Thais. Hence, families end up relying on unlicensed facilities.
The Foundation for Consumers urged the creation of a regulatory watchdog, along with a compensation fund for victims of substandard care.
“State-run elderly daycare centres should also be introduced to curb the dependence on expensive private services and uphold the dignity of the elderly, who should be able to stay safely in their own neighbourhood instead of being moved elsewhere,” Tanat said.
Photo credit: Central Investigation Bureau