This qualitative study used participatory observation and reflexive thematic analysis of three sessions at the 2025 Regional Policy Dialogue involving 107 policymakers, academics, civil-society actors and providers. It identified institutional fragmentation that converts life-course disadvantage into unequal access, communities absorbing formal-care shortfalls, and the need to redistribute voice while coordinating responsibility across levels. Costs were described as falling disproportionately on women and rural or low-income older people. The findings interpret one dialogue; they are neither population-representative estimates nor a policy-effectiveness test.
Key findings
- The first theme linked fragmented institutions and governance levels with the conversion of accumulated life-course disadvantage into unequal long-term-care access.
- The second showed families and communities compensating for formal-service gaps, while warning that community capacity should not displace public responsibility.
- The third argued that equity requires both stronger voice for older people and carers and coordinated responsibility across local, national and regional levels.
- Women and rural or low-income older people were described as bearing disproportionate costs, making equity outcomes essential alongside service counts.
- National coordination hubs are an author-developed proposal extending dialogue themes, not evidence of unanimous participant endorsement or demonstrated effectiveness.
Why this matters globally
ASEAN-Plus Three societies are ageing under diverse welfare, workforce and financing arrangements. A life-course framework connects long-term care with SDGs 3 and 10 and exposes gendered and income-related burdens hidden by reliance on families. The propositions can guide cross-country policy questions, but require operational indicators, budgets, accountability and evaluated pilots measuring access, quality, carer burden and fiscal sustainability.
Thai researcher contribution
Chulalongkorn University's College of Population Studies and the ASEAN Centre for Active Ageing and Innovation within Thailand's Department of Medical Services connected population research, care systems and regional policy dialogue. Thai institutions thereby served as a knowledge-synthesis base for comparing welfare regimes and foregrounding equity for older people, carers and communities across ASEAN-Plus Three.
Limitations to consider
Evidence comes from one regional policy dialogue. The 107 convened participants were not a random sample of populations, service users or care workers in each country. Participatory observation and reflexive thematic analysis depend on researcher positioning and interpretation; the study provides no statistical country comparisons, coverage estimates or post-policy outcomes. National coordination hubs therefore remain an institutional hypothesis, not a proven solution.
Verify the original sources
Australasian Journal on AgeingAustralasian Journal on Ageing (Wiley)↗DOI: 10.1111/ajag.70237