[Special reportage- part III] Nursing home workers toil for pennies, patients suffer

Posted on : 2013-05-19 20:34 KST Modified on : 2019-10-19 20:29 KST
Nursing homes are always out to cut costs, meaning staff work and patients live in poor conditions
 the day after this photo was taken.
the day after this photo was taken.

By Lee Jung-gook, staff reporter

It was on a sofa in the corner of the room after lunch when I first met Kim (not his real name) while volunteering at a nursing home. After finishing the morning diaper, meal and cleaning care, I was resting on the sofa when Kim approached me. His eyes marveling at a new face, he initiated conversation by asking me, “Why did you come here?”

We came to discuss the reality of workers at the nursing home. Kim has worked at the nursing home for about six months. He arrives at work at 7am and leaves for home around five. Being in his 50s, Kim avoids talking about his personal life. He only half-heartedly answered the question, “Did you come here after you lost your last job?” by evasively saying, “Yeah…”

Most nurses find nursing home jobs online or through personal contacts. Kim was introduced to this nursing home by an acquaintance. He is paid for eight hours of work a day, five days a week and earns about 1.3 million won (US$1,167) a month. After deductions for insurance, his take-home pay is less than that. After finding out about the frequent holiday work hours, I asked, “Is the holiday pay good?” Kim answered after stalling, “The extra-pay system is weird”. He clearly didn’t know the exact wage system.

Kim doesn’t know much about the system of the nursing home he works at. I asked him what work the director used to do, or what the relationship between the nursing home management was, but Kim only said, “I don’t know”. He didn’t seem very interested.

Kim had no skills for nursing when he started. “I had a lot of trouble in the beginning, especially when they asked me to change the diapers of elderly women. Even if they are old, they are still women. The smell also was bad. As a man, it was difficult to bathe the elderly women. But now I am used to the work so it’s okay. If you can’t get used to those kinds of things, it’s a really hard job”.

He thinks that the situation isn’t much different for the other nurses. “Other nurses have the same problem with the diaper care process. Some of them end up quitting after a few days. It’s physically stressful, so it’s not for everyone.”

“Are you trying to become a nurse?”, Kim asked me. “That’s very admirable for a young man” he said with a grin.

Kim seems to not have any sense of pride in the work he does. “The job description says nurse, but actually it’s just chores. It’s like being a janitor, cleaning and doing other menial tasks”. Besides taking care of the patients, the nurses have to do other ‘chores’ that aren’t supposed to be their job. One of the tasks the nurses ordered me to do was to clean the nursing home. I had to use a vacuum cleaner and a mop to clean the floors.

On Apr. 11, after the bathing care, I had to clean the tiles of the bathroom. After cleaning the whole floor of a 3 pyeong (9.9m2) bathing room with kitchen cleaners and metal scrubbing brushes, my back ached.

These jobs are normally done by the nurses. But the extra chores don’t end here. In the morning, the nurses have to help with administrative services by writing up different documents about payment, patients’ excretion and changing the patients’ sleeping positions.

The nurses are not given breaks. As the conversation developed, Kim said, “How about a coffee?” while walking towards the end of the hallway of building B. On the way, I saw an elderly man laid down on his bed with his hands cuffed. Kim said, “I know there are concerns about human rights violations. But we have no choice. We are human, too. If the elderly man suffering from dementia hits us and grabs us, we have no alternative [but to tie him up like that]”. At the corner of the hallway was a 1 pyeong (3.3m2) room. A female nurse was crouching on the floor resting on a small chair normally used in public bathhouses.

Resting in a room smaller than 1 pyeong (3.3m2)

After washing a cup, Kim made coffee for me. Team leader Park of building A and Team leader Seo of building B also came into the room. “I like sitting on the floor” said Park while he sat on the floor without a chair. I asked why the lounge was so small. A nurse answered, “This is still the most comfortable room” while laughing. The small room was shoulder-to-shoulder crowded.

Han turned his gaze to Park’s new slippers. “They look good. They must be expensive. Mine cost only 7,000 won (US$6.29) at E-Mart”. Park showed his slippers saying, “If your slippers are comfortable, then it will help your legs. I bought these at a department store and will be paying for them for three months”. For the nurses who practically stand all day while working, they talked about slippers even during their break.

The next topic was about the ‘accident’ that happened in the morning. After excretion, an elderly man dirtied his bed and sheets, which then needed to be cleaned by the nurses. “Don’t even mention it. It was a hard task” said Kim while shaking his head. Han replied by saying, “It must have been troublesome”.

The topic of the conversation changed to talking to annual paid vacation. Han said, “I’m not sure what the system is for vacation”. While rubbing his sore shoulder, Seo answered, mentioning all the relevant laws. Of the twenty minutes they spent talking, most of the nurses talked about their working conditions, and indirectly spoke about their dissatisfaction.

In the 2010 Korean Public & Social Service Worker’s Union’s actual-condition survey, 81.8% answered, ‘there is no time to rest’. In the 2010 Korea Care Workers Association’s actual-condition survey, 54% of nurses in nursing homes said that the dining room was a patient room, while 33% said there were no place to eat. meaning that in addition to having no rest time, workers also had no place to eat or relax.

One nurse per fifteen patients

On the door of the supply room in building A, the workers’ schedule is posted. The weekly group consists of five nurses and the schedule shows what type of work the nurses have to do. One nurse is appointed to work all five days of the week while the rest work every other day. Every nurse’s work time is different. Nurses that are required to come to work every day arrive at nine in the morning and leave at six. One nurse that works every other day arrives at 7:30 in the morning and leaves at 7:30 in the evening, a twelve-hour workday. All 22 nurses are shown in the nursing home’s status board. The hourly wage is normally 7,000 won (US$6.29). Once fees for insurance are deducted, their earnings are equal to South Korea’s minimum wage (hourly wage 4860 won (US$4.37) according to 2012) according to the Korea Care Workers Association.

In each building, normally five workers are assigned on weekdays, but most of the time only three people work. If one person takes the day off then only two workers work in each building. On the April schedule, nine days of the month in building A are taken care of by only two nurses. Since there are 29 patients in building A, one nurse has to take care for about 15 patients. But the nurses not only take care of the patients, they also have to clean and help with administrative services. In the afternoon, many nurses in the nursing home can be often seen writing documents in the hospital rooms or physical therapy rooms. During this time, ‘care’ for the patients is lacking.

I observed the nurses working harder than I had imagined. South Korea lacks a system for elderly welfare. The elderly suffer due to this lack. A nurse in Seoul said, “Normally, one nurse takes care of more than ten patients. In this situation, it is hard for the nurse to act as a companion and provide high quality care”. The current law stipulates that if the facility has more than 10 patients, then there should be one nurse for every 2.5 patients. But this doesn’t mean that the nurse takes care of 2.5 patients. The nursing home just has to hire according to regulations, but the hired nurses follow a day/night schedule that is different for each person, dividing up the work. It is therefore virtually impossible for the nurses to take care of 2.5 people. In the morning of Apr. 11, Han was changing the diapers of patients in building B by himself. It’s a task that is hard for two people, but Han can do it well alone. As I offered my help, Han rejoiced. I asked, “If they hire more people, wouldn’t the work be easier?” Han replied with a sigh, “Definitely. But that won’t happen…”

Expense cuts everywhere; the elderly pay the price

The main profit for nursing homes is the insurance pay provided by the National Health Insurance Service (NHIC) according to the number of patients currently admitted. For the nursing homes, to maximize profit, cutting expenses or increasing the number of patients is the answer. NHIC spokesperson said, “Some nursing homes personnel or rehabilitation program expenses in order to avoid deficits,” Because increasing the number of patients is impossible, it’s easier to cut expenses.

In this process, the people who suffer the most are the nurses and the elderly that are under their care. The superintendent has the authority to decide the nurses’ wages. The government sets no guidelines on wages.

Apart from personnel expenses, expense cuts from the nursing homes are also seen in other areas. For example, although there are water coolers in the nursing homes, there are no paper cups. This is not because the nursing home is trying to save the environment, but trying to save money. I asked a nurse, “Do you have any paper cups?” He replied with a sigh, “We don’t have paper cups”.

On Apr. 9, I was cleaning the dust in between the floor mats in front of the bathroom. The floor mat got dirty easily and the dust in between the crevices was hard to remove. The only way to clean the mat was to hit it with a metal stick, use tape or a vacuum cleaner. Even if the mat was cleaned often, it became dirty again soon. I asked, “I think you should buy a new mat that doesn’t become dirty”. A kitchen worker passing by answered, “They will never buy a new one. It was hard to get a new one” while shaking his head. It is the elderly patients who have to walk on this dirty mat.

But compared to these minor costs, the definite answer to cuts is personnel expenses. In 2011, the NHIC interviewed 2,694 nurses. In the operation condition report, 68.8% of respondents said their monthly wage was less than 1 million won (US$899), and only 24.6% had been in their jobs for more than two years. According to the Korean Women Workers Association’s ‘nurse labor human rights survey’, the average work hour of a nurse was about 53 hours and the average amount of patients per nurse was 9.7 in the day and 16.5 in the night. Wages are low and unstable, and the labor intensity is high.

Because the society kept bringing up problems of the rights of nurses, last July, the National Human Rights Commission of the Republic of Korea recommended ‘improvement of labor human rights of nurses’. At least starting from March 2013, a 100,000 won (US$89.92) treatment improvement fee will be provided to nurses by the NHIC.

Consequently, the poor service now seen in nursing homes is caused by the country funding private facilities for welfare, the nursing homes cutting expenses, and the nurses having to work long hours for low wages.

The last part of a three part seriesTranslated by Kim Kyung-min, Hankyoreh English intern

Please direct questions or comments to [english@hani.co.kr]

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