As soon as I set foot inside Suansawan Care Resort for the elderly in northern Thailand, I was immediately struck by its spacious, sylvan and tranquil surroundings. Set in Maerim valley, 20 km away from the Lanna province of Chiang Mai, this retirement facility is owned and managed by 66 years old British businessman Peter Brown and his Thai wife. Opened in 2013, it won the Most Outstanding Care Resort of the world award in 2016. In an exclusive and candid interview with CNS (Citizen News Service), Peter narrated the incident that motivated him to open this care home for the elderly.
His mother, Joyce Brown, had been living in a nursing home in London for 5 years, where the care kept diminishing to the point when there were just 4 carers for 40 people. Once when Peter went to meet her, he found her very sick-almost dying-in her room, without anyone of the care facility staff knowing about it. When a visibly upset Peter questioned them, they said that every morning they would call her and ask her how she was, and she would say she was fine. So they believed her, without ever checking if she was telling the truth or was just being polite. Even though her meals were being returned untouched for the past 5 days, no one seemed to be bothered. The lame excuse given to Peter was that the person who delivered the meals was not a carer, only a delivery person. “So basically, there was no culture of care in that care home. Unfortunately, what people need is care, and what care needs is carers. So if you do not have enough carers you cannot give care, if you do not give care you cannot improve people’s lives.”
Peter then looked for other care homes for his mother but could not find anything better. At that time, he was already running a 4-star tourist resort on this property since 2007. So in 2013 he and his wife converted a part of that tourist resort into a care facility for the elderly (including those with dementia and Alzheimer) and brought his mother (now 94 years old) to live here with the other guests.
Joyce is now one of the residents with dementia at the facility. Unlike other places, they are not kept in locked wards but in a ‘memory care’ zone where they have the freedom to move around. Peter ensures that there is a carer for a guest with dementia, just a few metres away, 24 hours a day. When the guest wants to go for a walking the resort’s garden, the carer goes alongside. Guests go shopping once a week - that means one carer goes with one guest. If there are not enough carers, one cannot give that sort of personalised service.
The other residents live in independent villas, each of which is fully alarmed to the central care station. Basic health checks, like measuring blood pressure, are done daily, with carers taking residents for periodical medical appointments to the city. Meal times are flexible. Says Peter: “They can eat when they want, what they want, in their room or outside. We believe that even in their old age people should be able to enjoy a quality life, and retain their independent freedom of choice, within physical and medical limitations. Guests here are not treated like a child, but like normal adult human beings”.
The facility currently houses 25 residents between ages 63 and 97 years: 70% of them being females. Most of them come from the USA, and the rest are from UK, Canada, Australia, France and Hong Kong. 12 of the guests are in some stage of dementia. Guests stay here on a one-year renewable retirement visa which Peter helps to organise for them. The all-inclusive monthly cost runs from Thai Baht 47,000, depending upon the level of care required and the room-type chosen. But, as Peter says, it is not only about costs, it is also about care levels - while it is much cheaper here than in the US or UK, care level is also very high here.
“When I started this facility, neither did I have any experience of running such an enterprise, nor could I find any existing model that I could copy and replicate. So, I thought what would my mother like, and what would she not like. My mother had said to me - do not ever put me in a nursing home. People go to a nursing home to die miserably. Let me die happily in my own bed. I also felt that when I am old and infirm I would not want to live in boarding school-like environment where others dictate and force their will upon me. I would not like to be a child again.”
The biggest USP of this care home is the high staff-to-resident ratio. There are 29 Thai carers, including two degree-qualified nurses, for these 25 residents. Add to this, Peter’s philosophy regarding elderly-care, and you have a perfect recipe to add cheer to the twilight years.
“Providing sufficient 'care' whilst maintaining individual dignity is our key philosophy. My carers know that maintaining the dignity and personal freedom of the guests is very important. Our guests live their own lives as much as possible - they choose when to eat, what to eat, where to eat, when to go to sleep, what activities to do, what not to do, etc. In most nursing home type care places around the world the guests virtually live in a prison like atmosphere.”
People with dementia are often aggressive and depressed, perhaps due to frustration for being treated like children. “So here we try to take away that frustration from them, give them a dignified life, give them choices. I have guests in stage-6 of Alzheimer’s disease. But they still go shopping, they still make their own decisions - whether to buy something or not, whether to go out and have lunch or sit in a coffee shop.”
“People with dementia are not stupid - they just suffer from memory problems," says Peter. "One has to learn how to adapt to the actions of a dementia patient. They might seem to act like a child, but should not be treated like a child. Adequate provision of care levels coupled with a healthy lifestyle and diet can improve their condition tremendously.”
High blood pressure and diabetes are two major health problems of the guests, which, in most cases, are controlled through proper diet and physical exercise- an important part of the guests’ routine here. But to make elderly people exercise is not easy. Recalls Peter, “We had a guest in her 80’s who came here from the USA in stage 6 of Alzheimer’s. She had not walked for 7 months, and had not talked for 2 months. Within 2 months of her stay here she could walk 200 metres. Once she started walking, she started talking. It just took 4 days’ efforts, sans any medication, to make her take the 1st step with the help of two carers. But then there was no looking back for her. She made continuous progress - walking to the bathroom, then till the front door, then past the terrace. And now she enjoys walking and talking when she wants to. Her son says she is stubborn, but I say that she is free willed. When you reach 75, you do have the right to be free willed - you have the right to exercise your choice on what you want or do not want to do.”
Peter has many other success stories to share: “I have been pleasantly surprised to see what one can achieve by helping people with care. One gentleman, who came from USA, was on 24 hour care for one whole year in this place—one carer with him throughout day. But last year he moved to an independent living unit. He still needs care but he lives independently. And it is not because his health has got any better, but because he has learnt to live with his disease and also because we respect his decisions. I have also dared to comply with his request to let him manage his shopping expenses, with astounding success. It is not about right or wrong decisions; it is about giving one the freedom to make choices. So elderly people can do much more than what others think.”
Peter still runs his tourist-resort alongside, but its size is diminishing and the care home size is increasing. He had earlier thought of closing the resort when he broke even in December 2016. But then he decided against it because the resort is very popular with the care home guests. It creates a different ambience for them and they feel happy seeing and meeting younger people and children from different countries. It gives them the feel that they are not segregated.
“We do have a huge place here, but I do not want to increase the number of guests beyond a certain point. If the number is too big, care will not be that personalised. As of now I know the minute by minute medical problem of each of my guests. It is the care and the philosophy within the care that is important.”
Peter candidly admits that he is not running this care home for altruistic reasons, but because it gives him pleasure to see people benefit from what he does. “I am passionate about looking after the elderly and I believe in people. Elderly people can do a lot more if we just give them a little bit of support.”
Between 2015 and 2030, the number of older persons worldwide is set to increase by 56% - from 901 million to more than 1.4 billion - thus making care for the elderly is a huge problem which must not be neglected anymore. Although there is a growing market for elderly care homes, but it may not be prudent to make it a business. A profit driven model cannot run a good caring facility that focuses to improve the quality of life of senior citizens, rightly believes Peter.
The elderly do need care, but they also want to live their own lives and do not want to be a burden. People’s independence, and their freedom of choices are important and must be respected, irrespective of their age. Only then can countries fulfill their pledge to step into a sustainable future leaving no one behind.
(Shobha Shukla is the Managing Editor of CNS (Citizen News Service) and has consistently written on health and gender justice, ageing and care of the elderly related issues. Follow her on Twitter @Shobha1Shukla or visit www.citizen-news.org)