Abstract This action research aims to develop an integrated care to assess the current state of integrated care and to design a tailored integrated care model for homebound and bedridden elderly individuals in Pho Yai Subdistrict, Warin Chamrap District, Ubon Ratchathani Province, Thailand. The research consists of three main steps: (1) contextual factors, (2) developing the model based on the findings and relevant literature. Data from focus group discussions (n=18) and in-depth interviews (n =5), and (3) evaluating the model with a specific sample group (60 individuals) and analyzed using content analysis. Quantitative data were analyzed using descriptive statistics and paired-samples t-tests. Model development followed the PDCA (Plan–Do–Check–Act) quality improvement framework.

The results indicated a high level of care-related knowledge among participants (81.7%). Overall care development outcomes were rated at a high level (Mean = 201.41), with management performance showing the highest contribution (44.61%). The study proposes the PHOYAI Model, comprising P=Planning and Participation, H=Holistic Care, O=Organization, Y=Young-old Active Aging Program, A=Access and Audit, and I=Information and Communication. Implementation of the model significantly improved stakeholder knowledge and readiness (P < 0.001). Participant satisfaction with the model was also high (Mean = 201.41, SD = 11.92).

It is recommended that relevant agencies adopt the PHOYAI Model to ensure efficient and high-quality care, ultimately enhancing health outcomes and improving the quality of life.

Keywords: Model development, Homebound and bedridden elderly, Integrated care, Subdistrict health promotion hospital

Funding: The authors are grateful for the research funding provided by the College of Medicine and Public Heath, Ubon Ratchathani University, Thailand.

Citation:  Boonsang, A., Butsorn, A., Laosupap, K., and Saenruang, T. 2026. Development of an integrated care model for homebound and bedridden elderly in Pho Yai subdistrict, Warin Chamrap district, Ubon Ratchathani, Thailand. Natural and Life Sciences Communications. 25(3): e2026050.

Graphical Abstract:

INTRODUCTION

Population ageing is an unprecedented global demographic phenomenon with profound social, economic, and health implications. By the end of the Decade of Healthy Ageing (2021–2030), the number of people aged 60 years and older is projected to increase by 34%, rising from 1 billion in 2019 to 1.4 billion. By 2050, this population is expected to more than double to 2.1 billion, with the majority residing in developing countries (World Health Organization, 2020). In 2019, older adults were predominantly concentrated in eastern and south-eastern Asia, Europe and North America, and Central and South Asia, reflecting regional variations in ageing patterns.

Recent estimates indicate that in 2022, older persons accounted for approximately 16.8% of the global population, a proportion that will continue to increase significantly over the coming decades (United Nations, 2022). Thailand exemplifies this rapid demographic transition. According to the Department of Older Persons (2023), Thailand had approximately 13.2 million individuals aged 60 years or older, representing 20% of the total population, officially categorizing the country as a completely aged society. Projections suggest that this proportion will rise to 28% by 2033, marking Thailand’s transition into a super-aged society (Department of Older Persons, 2023).

The demographic structure of Thailand has shifted markedly over the past two to three decades, characterized by a rapid increase in the elderly population alongside a declining proportion of children. Life expectancy at birth has reached 71.9 years for males and 80.0 years for females (Institute for Population and Social Research, 2024). Although Thailand’s total population is projected to decline from 66 million in 2022 to 60 million by 2042, the number of older adults is expected to increase from 13 million to 19 million. Consequently, the proportion of individuals aged 60 years and above. According to the National Statistical Office, 20.2% of Thailand's total population falls within this age group. Furthermore, it is projected that within the next ten years, Thailand will transition into a super-aged society, with the elderly population expected to account for 28.0% of the total population (National Statistical Office, 2024).  And the proportion of older adults is projected to rise from 19% in 2022 to 31.4% in 2042 is projected to rise to 31.4% by 2042 (Department of Older Persons, 2023). This demographic shift underscores the urgent need for effective policies and interventions to support healthy ageing and address the challenges associated with an ageing society.

In Thailand, health problems that result in older adults becoming bedridden or homebound are predominantly associated with chronic diseases and increasing levels of dependency with advancing age. As physiological functions gradually decline and chronic conditions accumulate, older adults often lose the ability to perform activities of daily living independently, including mobility, bathing, and eating. This decline in functional capacity is largely attributable to multimorbidity, which is highly prevalent among bedridden older adults. Common conditions include stroke, hypertension, diabetes mellitus, and related complications, all of which contribute to physical frailty and prolonged dependence on others for daily care (ThaiHealth, 2023; Julabute and Kehaloon, 2025). Furthermore, studies focusing on homebound and bedridden older adults have identified additional physical health problems, such as dysphagia, mobility-related disabilities, and disorders of the excretory system. These conditions often lead to extended periods of bed confinement and increase the risk of secondary complications, including pressure ulcers and infections (Prayoonwong, 2022). Social and caregiving contexts also play a critical role in shaping health outcomes. Primary caregivers—most commonly family members—frequently experience substantial caregiving burdens due to the intensive and long-term nature of care, which can negatively affect the psychological well-being and quality of life of both caregivers and older adults (Julabute and Kehaloon, 2025). Evidence from studies conducted in several provinces of Thailand, including Kanchanaburi and Phang Nga, highlights the importance of comprehensive and integrated interventions, such as oral health care, physical rehabilitation, and community-linked service systems, in reducing dependency and enhancing the quality of life of bedridden older adults. The effectiveness of these interventions depends on sustained collaboration among families, healthcare providers, and community networks to ensure continuous and holistic care (Wanarak, 2021; Tantakul et al., 2022).

From the increasing number and proportion of elderly people in Thailand together with changes in the epidemiology of Illness of people from acute communicable diseases to chronic non-communicable diseases. Leads to disability that cannot be completely cured. Must receive continuous care services.

Meanwhile, the capacity of households to provide care for older adults has progressively declined due to significant demographic and social transformations. These include smaller household sizes, rural-to-urban migration of the working-age population, increased labor force participation among women, and a broader transition from rural to urban societies. Consequently, the old-age dependency ratio has worsened markedly. Whereas approximately 4.5 working-age individuals were available to support one older person in the past, this figure is projected to decline to only 2.5 within the next 14 years (National Economic and Social Development Board, 2024). As a result, the challenges associated with caring for dependent older adults and persons with disabilities have become increasingly visible. These challenges include a growing number of bedridden or homebound older adults lacking adequate caregivers, older persons with dementia experiencing neglect, and older adults living alone during daytime hours while family members work. Even in households with caregivers, the burden of care is substantial and may lead to social and economic disadvantages for caregivers, particularly following the death of the care recipient. At the same time, public health and social service systems remain limited, often providing fragmented and temporary support. Given the sharp rise in elderly health expenditures—from 60 billion baht in 2010 to 220 billion baht in 2022, equivalent to 2.8% of GDP—the establishment of a comprehensive long-term care (LTC) system has become essential to ensure continuous, dignified, and equitable care (National Health Security Office, 2016).

Pho Yai Subdistrict, Warin Chamrap District, Ubon Ratchathani Province, has a population of 8,299, consisting of 4,200 males (50.06%) and 4,099 females (49.39%). Older adults account for 1,143 individuals (13.77%), of whom 171 are classified as dependent and require continuous care. The subdistrict is supported by only eight elderly care workers, indicating limited caregiving capacity. Chronic non-communicable diseases are the predominant health problems, particularly affecting the elderly population. Caring for homebound and bedridden elderly individuals presents significant challenges, including functional limitations in daily activities, medication mismanagement, and mental health concerns among both patients and caregivers. In addition, elderly individuals are often left alone during the day, and home visit services remain insufficient, fragmented, and disease-specific rather than holistic. The absence of a standardized integrated care model further hinders effective and continuous elderly care (Pho Yai Subdistrict Health Promotion Hospital, 2023).

The literature indicates that effective care for bedridden patients requires multisectoral collaboration, including active participation from community network partners in care planning and implementation. Bedridden patient management is commonly guided by the Plan–Do–Check–Act (PDCA) quality management cycle, which emphasizes systematic planning, implementation, evaluation, and continuous improvement (The W. Edwards Deming Institute, 2023). However, health care for homebound and bedridden elderly individuals in Pho Yai Subdistrict remains inadequate due to the lack of an integrated care model. Consequently, this study aims to develop a comprehensive and collaborative home-based care model to improve access to equitable, high-quality care and enhance the quality of life of dependent elderly individuals.

MATERIALS AND METHODS

Study design, population, and samples

This study employs an action research approach utilizing a mixed-methods design, integrating both quantitative and qualitative research methodologies.

Population and Sample

The population comprised members of the Local Health Security Fund Committee, the Long-Term Care (LTC) Subcommittee, and other relevant stakeholders within the jurisdiction of Pho Yai Subdistrict Administrative Organization, Warin Chamrap District, Ubon Ratchathani Province.

The research samples were selected across three phases:

Phase 1: Situation analysis focused on examining the current situation of care for homebound and bedridden older adults in Pho Yai Subdistrict, Warin Chamrap District, Ubon Ratchathani Province. A total of 17 participants were involved. Of these, 5 key informants participated in in-depth interviews, consisting of one representative from each group: a district public health officer, a community hospital officer, the director of the Subdistrict Health Promoting Hospital, the Mayor of the Subdistrict Administrative Organization, and a village health volunteer. For the focus group discussions, a total of 12 participants were involved, comprising 6 members of the Local Health Security Fund Executive Committee and representatives from the Long-Term Care (LTC) Subcommittee, including community leaders, village health volunteers, care workers, representatives of older adults, and representatives of the general public, with one participants from each group.

Phase 2: Model development

Phase 2 focused on the development of an integrated care model for homebound and bedridden older adults in Pho Yai Subdistrict, Warin Chamrap District, Ubon Ratchathani Province. Data collection was conducted using focus group discussions and in-depth interviews.

For the focus group discussions, a total of 18 participants were involved, comprising six members of the Local Health Security Fund Executive Committee and representatives from the Long-Term Care (LTC) Subcommittee, including community leaders, village health volunteers, care workers, representatives of older adults, and representatives of the general public, with two participants from each group.

For the in-depth interviews, five participants were selected, consisting of one representative from each health-related partner network, namely: the director of the Subdistrict Health Promoting Hospital, the deputy chief executive officer of the Subdistrict Administrative Organization, a care worker (caregiver), a community leader, and a village health volunteer. 

Phase 3: Model implementation and evaluation

Phase 3 involved the implementation and pilot testing of the integrated care model for homebound and bedridden older adults. The sample used to evaluate the model consisted of 60 participants, and quantitative data were collected using a structured questionnaire.

The participants included nine members of the Local Health Security Fund Management Committee: one Mayor of the Subdistrict Administrative Organization (Chairperson of the Local Health Security Fund), one local expert, two members of the Local Administrative Organization Council, one Director of the Subdistrict Health Promoting Hospital, two village health volunteers, one representative of villages or communities selected by residents, and one Deputy Chief Executive Officer of the Subdistrict Administrative Organization (serving as a committee member and secretary of the fund).

In addition, eleven members of the Long-Term Care (LTC) Subcommittee participated. These comprised one Deputy Mayor of the Subdistrict Administrative Organization, two representatives of the Local Health Security Fund Committee, one Director of the Subdistrict Health Promoting Hospital, one district public health officer or representative, one long-term care manager in public health, two care workers (caregivers), one head of the Elderly Quality of Life Development Center, one Deputy Chief Executive Officer of the Subdistrict Administrative Organization (serving as a subcommittee member and secretary of the fund), and one community development officer.

Furthermore, forty stakeholders were included, consisting of care workers (caregivers), representatives of village health volunteers, community leaders, representatives of older adults, and representatives of the general public. These stakeholders were divided into five groups, with eight participants in each group. All participants were selected using purposive sampling.

Sampling method

A specific sample was selected using purposive sampling, and the research process is illustrated in the following flowchart.

Figure 1. Flowchart illustrating the research process.

Instrument of the study comprises three step as follows:

Step 1: Examine the context of long-term public health care for homebound and bedridden elderly individuals in Pho Yai Subdistrict, Warin Chamrap District, Ubon Ratchathani Province.

The researchers collected data using focus group discussions and in-depth interviews of stakeholder. The instrument used was included document recording forms a structured interview guides consisting of 11 questions. The data were analyzed using content analysis.

Step 2: Develop an integrated care model for homebound and bedridden elderly individuals.    

The integrated care model for homebound and bedridden elderly individuals was developed through the PDCA (Plan, Do, Check, Act) quality management process. Lessons learned and brainstorming sessions were organized in two rounds to refine the model. The researcher collected data by reviewing the research findings from Step 1, as well as studying additional relevant documents and research. A draft model was developed and presented to the Local Health Security Fund Management Committee, the Long-Term Care Subcommittee, and stakeholders, utilizing a participatory approach for feedback and further refinement. The tools used for data collection included focus group discussion questionnaires, in-depth interview questionnaires, copy forms, and observation record forms.

Step 3: Evaluation of the integrated care model for homebound and bedridden elderly individuals.

The data collection tool comprises three sections as follows:

Section 1: General information.

This section includes eight items related to respondents' demographic and professional background. These items cover gender, age, position, marital status, education level, income, work experience in providing care for homebound and bedridden patients, and prior training 

Section 2: Knowledge and understanding of caring for homebound and bedridden patients.

This section consists of a 25-item assessment measuring knowledge and understanding of patient care. Each question offers two response options: "Yes" or "No." Correct responses are awarded 1 point, while incorrect responses receive 0 points.

The interpretation of knowledge levels is categorized into three levels, based on classification criteria adapted from Chokthanasiri’s Taxonomy (Bloom, 1956).

                           Measurement Range  = Maximum score – Minimum score

                                                                       Number of level

                                                           =  (25-0)/3

                                                           =  8.33

                                                           =  9  

High level of knowledge (80–100%):  Scores ranging from 17 to 25 points.

Moderate level of knowledge (60–79%): Scores ranging from 9 to 16 points.

Needs improvement (0–59%): Scores ranging from 0 to 8 points.

Section 3: Caring for homebound and bedridden patients.

This section consists of 45 questions assessing various aspects of home-based care for bedridden patients. It includes the following components:

Readiness for Developing a Long-Term Care System for Homebound and Bedridden Elderly Patients. Personnel Aspect: 7 items, assessed using a five-point rating scale (most, very, moderate, little, least). Budget Aspect: 4 items. Equipment Aspect: 4 items. Management Aspect: 10 items.

Participation in Care Processes Decision-Making Participation: 5 items.   Operational Participation: 5 items. Participation in Receiving Benefits: 5 items. Participation in Monitoring and Evaluation: 5 items. Scoring System

Most Practice:         5 points

Very Practical:         4 points

Moderate Practice:   3 points

Limited Practice:      2 points

Minimal Practice:      1 point

The interpretation of practice results is categorized into three levels based on score groupings, following Best’s criteria (Best, 1997), as outlined below:

                         Measurement  range = Maximum score – Minimum score

                                                                  Number of Level

                                                        = (225-45)/3

                                                        = 60

High Level of Performance: Scores ranging from 165 to 225 points.

Moderate Level of Performance: Scores ranging from 104 to 164 points.

Low Level of Performance: Scores ranging from 45 to 105 points.

Section 3 of this tool is a five-level rating scale questionnaire consisting of 45 questions. It is designed to assess the integrated care model for homebound and bedridden elderly individuals. The results are evaluated by the research team.

Tool quality inspection

The researcher assessed the content validity of the instrument by having three experts evaluate its accuracy, language, and alignment with the research objectives. The content validity was measured using the Index of Item Objective Congruence (IOC), and it was determined that each question had an IOC score ranging from 0.67 to 1. For reliability assessment, the validated and revised questionnaire was administered to a sample group similar to the target population, consisting of 30 participants from Kham Nam Saep Subdistrict, Warin Chamrap District, Ubon Ratchathani Province. The reliability of the knowledge section was evaluated using Kuder-Richardson Formula 20 (KR-20), yielding a reliability coefficient of 0.73. Additionally, the reliability of the section on caregiving for bedridden patients at home was assessed using Cronbach's Alpha Coefficient, which resulted in a reliability score of 0.98.

Data collection

The data collection process was conducted in three steps, as follows:

Step 1: Contextual Study of Long-Term Public Health Care for Homebound and Bedridden Elderly in Pho Yai Subdistrict, Warin Chamrap District, Ubon Ratchathani Province.

The integrated analysis of the care model for homebound and bedridden elderly.

The researcher collected data through document analysis, utilizing a structured document recording form to study relevant literature and research. Data were analyzed using content analysis to identify key themes and insights.

Step 2: Development of an Integrated Care Model for Homebound and Bedridden Elderly.

The integrated care model for homebound and bedridden elderly individuals was developed using the PDCA quality management process (Plan, Do, Check, Act). Lessons learned from the initial stage were analyzed, and brainstorming sessions were conducted in two rounds to refine the model. The researcher collected data by reviewing findings from the first phase, examining relevant literature and additional research, and drafting a preliminary model. This draft was then presented to the Local Health Security Fund Management Committee, the Long-Term Care Subcommittee, and other key stakeholders through a participatory process.

Step 3: Evaluation of the Integrated Care Model for Homebound and Bedridden Elderly.

The model evaluation focused on four key aspects: appropriateness (propriety standard), accuracy, feasibility, and utility. The evaluation process was conducted as follows:

Qualitative Assessment: Data were collected through group discussions and in-depth interviews. The instruments used included document recording forms and structured interview guides. The collected data were analyzed using content analysis. Quantitative Assessment: A questionnaire was administered to evaluate the integrated care model for bedridden elderly individuals. The data were analyzed using statistical software, with descriptive statistics including mean and standard deviation.

Statistical analysis

Descriptive statistics

Descriptive statistics, including mean, standard deviation, median, and the 25th and 75^th percentiles, were used to summarize continuous variables such as age and income. Frequency distribution, presented as counts and percentages, was used to describe categorical variables, including gender, marital status, occupation, and educational level.

Inferential statistics

The paired t-test was used to compare differences in mean scores related to knowledge and understanding of caregiving for bedridden patients before and after the intervention.

Qualitative data analysis

Qualitative data were analyzed using content analysis to identify key themes and patterns.

Ethical consideration

The study was reviewed and approved by the Human Research Ethics Committee, Ubon Ratchathani University (UBU – REC – 67 /2566). with certification granted on June 12, 2023.  The authors affirmed that informed consent was acquired from all participants, who needed to give this consent before taking part in the research. 

RESULTS

The study results can be classified according to the stages of implementation as follows:

The situation analysis stage focused on identifying problems

The situation analysis stage focused on identifying problems and obstacles in caring for homebound and bedridden older adults in order to develop a care model. Data on the local situation were obtained, including information on the care of homebound and bedridden older adults. A total of five participants took part in in-depth interviews and a focus group discussion involving 12 participants. Data from stakeholders involved in the care of homebound and bedridden older adults of Pho Yai Subdistrict Administrative Organization revealed that the problems and obstacles in caring for homebound and bedridden older adults. Detailed information on the informants included:  Elderly individuals lack someone to care for them, Lack of budget and resource integration, Increasing number of elderly individuals, Insufficient number of caregivers, Lack of medical equipment and supplies, Lack of support in social, economic, and environmental dimensions and Inadequate holistic care.

Table 1. Example coding for subcategories, categories, and themes.

Results of the model development

Through the process of developing a care model for homebound and bedridden elderly individuals—using brainstorming sessions, focus group discussions, and in-depth interviews with key stakeholders—the PHOYAI Model ("Pho Yai Does Not Abandon Each Other") was established. This model comprises six key elements, as illustrated in Figure 2.

Figure 2. Model of care for homebound and bedridden elderly (Pho Yai does not abandon each other).

P&P = (Planning and Participation) refers to joint planning, where the fund management committee and relevant stakeholders regularly engage in collaborative decision-making. This process includes shared ideation, collective implementation, participation in evaluation, and mutual benefits.

H = (Holistic Care) emphasizes an integrated approach to care that addresses all dimensions of well-being, including physical, mental, intellectual, and spiritual aspects (Detthippornpong et al., 2021).

O = (Organizing with Clear Responsibility) signifies the presence of a designated responsible agency with a well-defined understanding of its roles and responsibilities.

Y = (Young-Old Active Aging Program) refers to initiatives aimed at promoting the well-being of elderly individuals through health promotion activities and other interventions designed to enhance their overall health and vitality (Terathongkum and Kittipimpanon, 2023).

A = (Access & Audit) ensures that elderly care models are equally accessible to all individuals and subject to systematic auditing for transparency and quality assurance.

I & C = (Information & Communication) highlights the importance of accurate, clear, and timely dissemination of information regarding bedridden patients, including budget allocation for their care. It also emphasizes the establishment of efficient communication channels among network administrators to ensure prompt and effective coordination.

Results of the implementation of the developed model

The results obtained from implementing the developed model with the study sample are presented as follows.

Personal information

The majority of the sample were female (62.7%), with a median age of 55.35 years. The largest proportion of participants (35.0%) were village health volunteers (VHVs). Most respondents (75.0%) were married. Regarding education level, 43.3% had completed primary education, while an equal proportion (43.3%) had completed secondary education.

The median family income was 5,000 baht, with a minimum income of 1,000 baht and a maximum of 7,600 baht. The median work experience related to caring for bedridden elderly individuals was three years, with some participants having no experience and others having up to three years of experience. Additionally, 48.3% of the participants had received training on caring for homebound and bedridden elderly individuals.

Average score of knowledge and understanding regarding health care for the elderly who are homebound and bedridden. Before and after the development of the health care model for elderly people homebound and bedridden in the area of Pho Yai Subdistrict, Warin Chamrap District, Ubon Ratchathani Province. The sample group that has the most knowledge and understanding about health care for homebound and bedridden elderly is the target group that receives budget allocation from the Long Term Care (LTC) Elderly Dependent Care Fund, which is people. Thai, everyone, every right that is homebound and bedridden. Elderly people who are dependent It is only the elderly who cannot move their bodies and cannot help themselves. If an elderly person experiences regular constipation, caregivers should administer laxatives daily to prevent stomach discomfort. Dull, tight, or heavy chest pain—especially in the center of the chest or on the left side near the heart, radiating to the elbow or arm—is a symptom of coronary artery disease. In such cases, immediate medical attention is required.

Elderly individuals are also at high risk for chronic conditions such as diabetes, hypertension, and stroke. In addition to consuming three main meals, which may be reduced in portion size, they should eat small, nutritious snacks between meals to ensure adequate nutritional intake. The principles of medication administration for the elderly include ensuring the right disease, the right patient, the right time, the right method, and the right dosage. Furthermore, elderly individuals are more susceptible to depression. Training in deep breathing exercises can effectively reduce stress levels (Wungrath et al., 2022). Regarding knowledge of health care for homebound and bedridden elderly individuals, the least correctly answered question pertained to their right to receive care based on an individualized care plan.

As appropriate, necessary materials such as disposable adult diapers, ready-made nutritional supplements, and calcium supplements should be included in the individual care plan Nutritional interventions play a crucial role in elderly care, particularly for managing chronic conditions such as diabetes (Terathongkum and Kittipimpanon, 2023). These provisions must be allocated within the budget and approved by the Subcommittee of the Elderly Long-Term Care Fund (LTC), with an approval rate of 91.7%. Physical exercise programs, including simple arm movements, have been shown to improve metabolic control and nutritional status in elderly populations with chronic diseases. Communication strategies and health education approaches significantly impact care outcomes for homebound elderly individuals.

Additionally, elderly individuals—defined as those aged 65 years and older—have the right to receive welfare, public amenities, and appropriate government assistance with dignity. If an elderly person has difficulty hearing or is hard of hearing, it is recommended to speak loudly and clearly to enhance their ability to understand, with a reported adherence rate of 93.3%.

Average knowledge level of the sample group before and after the experiment in the area of Pho Yai Subdistrict Administrative Organization, Warin Chamrap District, Ubon Ratchathani Province.

The average knowledge level of the sample group improved significantly following the implementation of an integrated care model for homebound and bedridden elderly individuals. After the intervention, all participants demonstrated a good level of knowledge, accounting for 100.00% (Table 2).

Table 2. Number and percentage of knowledge levels before and after the experiment  (n = 60).

Summary of research findings

This study examined the conditions of care for homebound and bedridden elderly individuals in Pho Yai Subdistrict. The key findings are as follows:  1) Knowledge of Caregiving – The survey assessing knowledge and understanding of caregiving for homebound and bedridden elderly individuals revealed that, overall, the participants' knowledge significantly improved following the implementation of the care model (P-value < 0.001). 2) Caregiving Practices – The study found that caregiving practices for homebound and bedridden patients were at a high level and had significantly improved after the development of the care model (P-value < 0.001). 3) Readiness for Long-Term Care System Development – In terms of readiness for developing a long-term care system for homebound and bedridden elderly individuals, the most frequently implemented aspect was management (44.61%), followed by personnel (32.73%). Regarding participation in various aspects, the highest level of practice was observed in benefit reception (22.01%), followed by monitoring and evaluation (21.93%).

Results of the evaluation of the care model for homebound and bedridden elderly individuals in Pho Yai Subdistrict, Warin Chamrap District, Ubon Ratchathani Province, developed by the researcher, demonstrated that the model is appropriate, accurate, feasible, and highly beneficial. A comparative analysis of the mean differences in practice scores related to the care model for homebound and bedridden elderly individuals was conducted. The model comprised eight key areas: personnel, budget, materials and equipment, management, decision-making, operational aspects, benefit reception, and monitoring and evaluation. The findings indicated that post-implementation performance and evaluation scores were significantly higher than pre-implementation scores, with statistical significance at the 0.05 level. Specifically, after the model was developed, the sample group's average increase in knowledge about funding was 6.86 points higher than before implementation (95% CI = 6.35–7.37). Additionally, the mean difference in the overall care score for bedridden patients increased by 51.55 points (95% CI = 45.66–57.43).

For each aspect, the results are as follows:

The mean difference in personnel readiness scores increased by 5.66 points (95% CI = 4.66–7.59).

The mean difference in budget readiness scores increased by 4.88 points (95% CI = 3.87–5.89).

The mean difference in equipment readiness scores increased by 3.93 points (95% CI = 2.96–4.89).

The mean difference in management readiness scores increased by 13.31 points (95% CI = 11.69–14.93).

The mean difference in participation scores increased by 13.31 points.

The mean difference in decision-making scores increased by 6.10 points (95% CI = 5.31–6.88).

The mean difference in action participation scores increased by 6.10 points (95% CI = 5.36–6.83).

The mean difference in participation scores related to benefit reception increased by 6.36 points (95% CI = 5.58–7.14).

The mean difference in participation scores related to monitoring and evaluation increased by 4.72 points (95% CI = 3.85–5.57). (Table 3) 

Table 3. Comparison of mean differences in knowledge and understanding scores regarding the care of homebound and bedridden elderly patients before and after the intervention (n = 60).

DISCUSSION

The purpose of this action research was to assess the current context of integrated care and to develop a tailored integrated care model for homebound and bedridden older adults in Pho Yai Subdistrict, Thailand. The findings indicate that the study aim was achieved, as evidenced by significant improvements in caregiver knowledge, care management performance, and stakeholder satisfaction following implementation of the PHOYAI Model. The results of the situational study on the process of obtaining the model showed that: Data on the local situation were obtained, including information on the care of homebound and bedridden older adults. A total of five participants took part in in-depth interviews and a focus group discussion involving 12 participants. Data from stakeholders involved in the care of homebound and bedridden older adults of Pho Yai Subdistrict Administrative Organization revealed that the problems and obstacles in caring for homebound and bedridden older adults. Detailed information on the informants, included:  Elderly individuals lack someone to care for them, Lack of budget and resource integration, Increasing number of elderly individuals, Insufficient number of caregivers, Lack of medical equipment and supplies, Lack of support in social, economic, and environmental dimensions and Inadequate holistic care.  Thus, this aligns with a study revealed that, prior to the development of the system, there was no clear framework for long-term health care services. Caregivers lacked standardized work guidelines, community recognition, and confidence in their roles. However, after the system was developed, a structured service organization process was established, comprising six key steps: (1) appointing a working group, (2) developing a collaborative work plan, (3) screening and registering new elderly individuals, (4) planning individualized elderly care, (5) organizing forums for knowledge exchange, and (6) evaluating care outcomes. These improvements contributed to a more effective and structured long-term care system for the elderly. The provision of long-term public health care services for dependent elderly individuals in the community has involved both relatives and elderly participants in the project. Overall satisfaction with the system’s development was reported at the highest level, aligning with the findings of (Suanruang et al., 2018).

The findings of this study indicate that participants demonstrated knowledge and understanding of caregiving for homebound and bedridden elderly individuals at a consistently high level, with 100% achieving a good level of comprehension. The average post-intervention knowledge score was significantly higher than the pre-experiment score, with statistical significance at P < 0.05 (X= 24.41, SD = 0.88, 95% CI = 11.69–14.93), suggesting that the model effectively enhanced competencies in caring for homebound and bedridden older adults. This improvement may be attributed to the structured application of the PDCA quality management process, which emphasized participatory planning, community-based implementation, and systematic evaluation. Similar findings have been reported in prior studies demonstrating that capacity-building interventions combined with continuous care planning contribute to improved caregiving outcomes and service readiness (Boonlert, 2016; Aung et al., 2022).

The PHOYAI Model integrates six key components—Planning and Participation, Holistic Care, Organization, Young-old Active Aging Program, Access and Audit, and Information and Communication—which collectively address fragmentation in service delivery and promote continuity of care. The highest post-intervention scores observed in the management domain suggest that clearly defined organizational structures and coordinated multidisciplinary collaboration played a critical role in enhancing care effectiveness. These findings are consistent with previous research emphasizing the importance of organized service systems, clear role delineation, and community network engagement in long-term care models for dependent older adults (Sriphuwong et al., 2020; Rattanaphan, 2021).

High levels of stakeholder satisfaction further support the feasibility and acceptability of the PHOYAI Model within the local context. Active participation by community networks, local administrative organizations, and health professionals contributed to shared ownership of the care process and strengthened the sustainability of the model. Develop participation among all relevant stakeholders in elderly healthcare, including ministries, departments, divisions, agencies, and organizations outside the Ministry of Public Health. There should be coordinated collaboration at the national level (Suthamchai et al., 2017).

As a result, self-care among older adults should be continuously encouraged and promoted by families, healthcare teams, and elderly community groups. Participation and group processes have contributed to significant positive changes among members, particularly in enhancing their experiences and practices related to self-care. (Dullyakeit, 2020). In addition, the PHOYAI Model is consistent with national aging and long-term care policy frameworks in Thailand, which emphasize decentralized service delivery, community participation, and integrated care systems (Jitapunkul and Wivatvanit, 2008). The model for caring for these six elements was developed based on a comprehensive review of literature, concepts, and theories conducted by researchers. This model aims to enhance the care of bedridden elderly individuals through collaboration with the Local Health Security Fund Committee, the LTC Fund Subcommittee, and local stakeholders. The process involved generating knowledge through activities that incorporated engaging and informative content (Detthippornpong et al., 2021). The development of the care model for homebound and bedridden elderly individuals was carried out through practical training, group discussions, and in-depth interviews. The primary objective was to establish an integrated care model that fosters awareness and understanding of homebound and bedridden elderly care. This process also emphasized preparation and active participation in the development of the care model. Following the implementation of the model, an evaluation was conducted, revealing significant differences in outcomes between the experimental and control groups (Wongpimoln and Pholputta, 2025).

In summary, this study demonstrates that the PHOYAI Model provides an effective and contextually appropriate framework for integrated care delivery for homebound and bedridden older adults. By strengthening caregiver capacity, enhancing care management processes, and fostering community participation, the model has the potential to improve care quality and quality of life for dependent older adults. Future research should examine the long-term outcomes and scalability of the model across diverse community settings.

CONCLUSION

This research provides compelling evidence that the PHOYAI Model represents a highly effective intervention for improving the conditions of care for homebound and bedridden elderly individuals in Pho Yai Subdistrict. By systematically addressing knowledge deficits, enhancing caregiving practices, bolstering readiness for long-term care, and fostering genuine community participation, the model has created a more supportive and comprehensive care environment. The findings offer a valuable blueprint for other communities facing similar challenges in caring for their aging populations, emphasizing the importance of integrated, community-driven, and holistically-oriented approaches to elderly care. The PHOYAI Model stands as a testament to the power of localized, evidence-based interventions in improving the lives of the most vulnerable members of society.

ACKNOWLEDGEMENTS

The authors thank the Pho Yai Subdistrict Health Promoting Hospital for facilities places to implementation research.

AUTHOR CONTRIBUTIONS

Arun Boonsang: Conceptualization (Lead), Methodology (Lead), Formal Analysis (Lead), Validation (Lead), Resource (Equal), Writing – Original Draft (Lead), Writing – Review & Editing (Equal), Investigation (Equal), Supervision (Lead), Project Administration (Lead); Aree  Butsorn: Data Curation (Equal), Formal Analysis (Equal), Writing – Original Draft (Equal), Writing – Review & Editing (Equal), Investigation (Equal); Kitti Laosupap: Data Curation (Equal), Formal Analysis (Equal), Writing – Original Draft (Equal), Writing – Review & Editing (Equal), Investigation (Equal); Thitima Saenruang: Data Curation (Equal), Formal Analysis (Equal), Writing – Original Draft (Equal), Writing – Review & Editing (Equal), Investigation (Supportive).

CONFLICT OF INTEREST

The authors declare that they hold no competing interests.

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