Social Return on Investment of Long-Term Care for Dependent Older Persons: A Case Study of Sa-Ard Subdistrict, Namphong, Khon Kaen

Abstract

Background and Rationale: Thailand becomes an ageing society. The Thai government officially implemented long-term care (LTC) for dependent older persons in 2016. Sa-ard subdistrict of Namphong, Khon Kaen, has provided an LTC service program by the family care team and the LTC center since August 2017. However, the impacts of this program, particularly social impact, have not been reported. This study aimed to determine social return on investment (SROI) of the LTC program for dependent older persons in this setting. Methodology: A mixed-methods approach was used to collect data on outcomes, program impacts, and costs of the LTC program for dependent older persons (37 people with the Barthel index of activity of daily living (ADL) ≤ 11 points) in the fiscal year 2018. We conducted a questionnaire survey among 74 program beneficiaries (dependent older persons and family caregivers) and focus group inter­views among 49 program stakeholders (dependent older persons, family caregivers, family care team members, trained caregivers, and community and local government representatives). Secondary data were gathered from reports, records, and databases of the hospital, the local government, and the LTC center. SROI was calculated and sensitivity analysis was performed. Results: Outcomes of LTC program delivered better conditions (walkability or doing usual activities by themselves) to the dependent older person group, more relaxation/leisure time and saving costs from going to hospitals to family caregivers, happiness in helping other people to the family care teams and trained caregivers, and the healthy community. Of the total 37 dependent older persons, after participating in the LTC program their ADL increased signifi­cantly on average 3.9 ± 5.2 points (p < 0.001) and 73% had better outcomes. The older persons valued their better outcomes at a median of 708,432 baht (Q1-Q3 = 699,216 - 2,000,000). For a one-year invest­ment of LTC program of 2,138,704 baht and its benefit of 15,853,919 baht, the SROI ratio of this program was 7.4 with a range of sensitivity analysis values between 1.3 and 20.5. Conclusion: This study indicat­ed that the LTC program for older persons could effectively improve their outcomes and provide values to stakeholders and society. The LTC program provided social return higher than investment. Therefore, the LTC program should be promoted and expanded to other settings.