In the first of a series delving into the work of people often overlooked, Life follows a caregiver at a home for the elderly, hearing her thoughts on a country verging on becoming an ageing society, and what actions need to be taken to ensure the aged are not forgotten.
Kridkamol Pangsri encourages a 65-year-old resident to finish her physiotherapy session.
5.30am
Kridkamol Pangsri, 51, has been a registered nurse for more than 30 years. She no longer requires an alarm clock to wake her up in the morning. Although she has just finished her midnight shift at a public hospital in a neighbourhood in Prachin Buri province, Kridkamol does not mind rising so early.
Kridkamol is the founder and manager of Tharawadee Home for the Elderly, which serves both as her home and second workplace. Her first job in the morning is to bathe the elderly residents, a few of whom bawl and struggle in protest against their baths. It is only the break of dawn, but Kridkamol has already broken a sweat.
"Our job is simply to take care of someone else's parents and elderly relatives," says the 51-year-old registered nurse.
"Here we do not provide medical treatments or cures. We just take care of them so their children who might have full-time jobs somewhere have nothing to worry about."
6am
There are currently 18 elderly residents at Tharawadee Home. After they have been bathed, it is time for Kridkamol to check their blood pressure. Four nursing aids patiently attend each resident. Kridkamol considers her nursing home small in size. The larger homes, she says, should be able to the needs of up to 80 residents.
After the assistants put the blood pressure machine back in storage, it's time to welcome additional colleagues who have arrived to help with the day's work. Altogether there are 12 nursing aids.
As defined by the World Health Organization (WHO), an elderly or senior citizen is someone older than 60 years of age. According to current figures from the Ministry of Public Health, there are approximately 9.4 million elderly people in Thailand, accounting for 14.5% of the total population. This percentage is rising.
7.30-8.30am
One of the busiest hours of the day — breakfast time. Kridkamol and some of the nurse aids assist the generally healthy elderly as they eat. Those who are bedridden are fed via tubes.
According to Kridkamol, there are around 100 registered private homes for the elderly in Thailand, and approximately 100 non-registered. Only seven public nursing homes are operated under the Ministry of Social Development and Human Security, including the famous Banbangkhae Social Welfare Development Centre for Older Persons in Bangkok. The other six are located in Chon Buri, Chiang Mai, Yala, Ayutthaya, Phuket and Buri Ram.
Nonetheless, the number of nursing homes is not enough for the country's ageing population.
"Taking care of the elderly requires not just physical but also mental energy," says Kridkamol.
"You also need to have fundamental medical know-how. For example, you need to know, to a certain extent, early warning signs of diseases, when medication needs to be adjusted, how to administer liquid diets through a feeding tube, how to suction phlegm and so forth.
"This is one of the reasons why people decide to leave this job to us professionals instead of doing it themselves at home — they are afraid they will do these things incorrectly, which can be detrimental to the health of their loved ones."
No elder wants to be left here, but many understand why they have been.
9am
Monthly fees at Tharawadee Home range from 15,000-25,000 baht, depending on the needs of each resident. Those who are bedridden, for instance, pay more than those who are healthy. This price includes four meals a day, laundry, physiotherapy sessions and massages by certified masseurs.
10am
"Lift your left leg, uncle, on the count of three," says one of the nurse aids to Uncle Boonma*, as she moves his body to prevent bed sores.
In Thailand, there are an estimated 1 million bedridden elderly people, according to the Ministry of Public Health. By 2025, Thailand is expected to have fully transitioned into what is considered by the United Nations as an "ageing society". Countries with elderly persons constituting more than 10% of the total population, according to the UN, are considered on the verge of becoming ageing societies. If that number rises to 20%, a nation is an ageing society.
Despite a national budget of 39 million baht from the Ministry of Public Health earmarked this year for the improvement of the livelihood of the elderly, Kridkamol believes that Thailand is not ready to become an ageing society.
"Support from the government is definitely not sufficient," she says. "We have the senior pension [which starts from 600 baht a month per person for people aged over 60], but in terms of facilities and other social welfare, there is a lot of room for improvement. Take public nursing homes, for instance. What the country has now cannot meet the demands of the rising number of elderly people. This is not happening just in Thailand, but in many other countries around the globe."
12pm
Lunch is served, but some residents do not want to eat. Living apart from their family is emotionally tough on them, but many understand the reasons they stay at Tharawadee. There is often no one available to look after them at home. Young people have to work, not forgetting they lack the skills to properly nurse and care for elderly people.
"We Thais have been taught and instil a sense of gratitude toward our parents and ancestors," Kridkamol says. "Therefore people believe sending your parents to a nursing home is like abandoning them, and it is an unacceptably ungrateful act. Attitudes like this needs to be changed. How are you abandoning them, when you are paying for them to live here?"
1-2pm
"I haven't had lunch at all," 65-year-old Lim* tells Kridkamol. Lim has mild dementia. She was sent to Tharawadee Home only a few weeks ago, because her relatives had hit a dead end in attempting to care for her.
In a 2009 study by the International Health Policy Programme, 85% of elderly Thais are self-reliant. The rest depend on assistance from others.
The four most commonly found chronic diseases and ailments among the elderly are high blood pressure, diabetes, obesity and degenerative joints.
"Disease certainly comes with ageing, and this definitely has to become the country's financial burden," says Kridkamol. "To improve the quality of life of elderly people, the government needs to assist them with more and better access to public health services."
4.30pm
Dinner today is Thai-style mackerel salad and deep-fried pork balls. The pork balls are made by residents who are still capable of preparing food. Cooking sessions are arranged as part of the nursing home's leisure activities, along with karaoke, merit making and Buddhist prayer sessions.
6pm
Nurse aids attend the residents once more for evening blood pressure checks. There are not usually many visitors on weekdays, but on weekends family members often arrive, with some spending all day with their relatives.
Aside from the lack of facilities and inadequate social welfare for elderly Thais, Kridkamol sees the widening gap between those of working age and senior age as another problem facing the country. Due to continual medical advancement and improving technology, people are living longer.
"So at the end of the day, the government has to step in to create a balance, otherwise more elderly people mean more burden on the working population," she says.
8pm
Another body rotation for bedridden patients.
10pm
Kridkamol is about to leave for her night shift at the hospital in Prachin Buri. At Tharawadee Home, a few nurse aids are placed on standby and finish rotating the bodies of the bedridden patients. The rest are finished for the day.
2am
Only one nurse assistant is assigned to the late-night shift, and performs the day's final inspection. After that, it's lights out.
* Names have been changed.
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