Comprehensive community care system to allow elderly Koreans to live in their homes by 2025

Posted on : 2018-11-21 16:58 KST Modified on : 2019-10-19 20:29 KST
Program created in response to S. Korea becoming “super-aged society”
Senior citizens enjoy a game a community residence for the elderly in Seongnam
Senior citizens enjoy a game a community residence for the elderly in Seongnam

Work is underway on a system of caregiving that would enable elderly Koreans to spend their healthy years in their homes instead of in nursing homes and assisted living facilities. In 2026, South Korea is expected to become a “super-aged society,” in which the elderly (those aged 65 and above) make up one out of every five people in the total population. This will inevitably create a greater demand for elderly care. As of 2016, there are 498,000 elderly people at nursing homes and assisted living facilities.

There are a number of serious social issues related to this. Nursing homes often provide an excuse for hiding old people out of sight; the cost of elderly care has been spiraling; and older people prefer to spend their twilight years in their homes, even if their mobility is impaired.

South Korea’s Ministry of Health and Welfare (MOHW) responded by announcing on Nov. 20 that it will be laying the foundation for comprehensive community care to provide the elderly with residential, medical, nursing and care services in their homes and neighborhoods by 2025, shortly before Korea becomes a super-aged society. Starting next June, 12 local government bodies will be taking the first step by launching two-year trial programs.

Community care refers to a social service policy of providing support so that the elderly and those with disabilities can enjoy services customized to their individual needs without leaving their homes and to be a part of their communities. Such services are provided by local governments in countries such as the UK and Japan.

 Gyeonggi Province. Between 2019 and 2022
Gyeonggi Province. Between 2019 and 2022

Expanding residential infrastructure tailored to the elderly

First, the government is planning to greatly expand the residential infrastructure that is tailored to the elderly. Between 2019 and 2022, it will be building 40,000 additional units of public rental housing customized for the elderly that are in close proximity to facilities that provide health care and other care services. These housing units will be equipped with motion sensors and apparatus to automatically shut off the gas. The government will also be increasing the links between 140,000 permanent rental apartments, which house many elderly individuals, and social welfare centers.

A program will also be launched to provide home repairs for 270,000 households. This project will involve installing slip-resistant flooring and safety railing in bathrooms in the homes of the elderly, who have trouble using the bathroom and taking baths. Last year, the medical cost of treating fractures caused by elderly people falling down amounted to 1.3 trillion won (US$1.15 billion).

Next year, a program will be launched to send doctors on house calls. At the moment, a health visitation service that sends nurses to check on old people’s chronic diseases and lifestyles is only being provided to 1.1 million households (1.25 individuals), most of them in the low-income bracket. The government is planning to expand this program more than threefold by 2025, to 3.46 million households (around 3.9 million individuals).

The program will be available to elderly individuals who have been released from long hospital stays and to those who live alone. One variable here is pushback from the Korean Medical Association, which has been demanding a guarantee of appropriate compensation. By 2022, “resident health centers” will also be built in all cities, counties and districts and social welfare teams installed in “local connection offices” at 2,000 hospitals to connect discharged patients with caregiving services in the area.

11% of elderly population to receive care via long-term insurance by 2025

In addition, the percentage of the total elderly population who are receiving care through long-term care insurance will be increased from 8% (580,000) to over 11% (around 1.2 million) by 2025. There is a push to use long-term care insurance to fund the removal of door sills that impede mobility and “hospital taxis” that could transport people from their homes to hospitals. There are also plans to develop new services that can be enjoyed at home, such as food delivery and check-ups on general wellbeing.

There will also be “community care councils” representing both the private and public sectors, in recognition of the fact that these services will be provided by a mixture of private hospitals and public social welfare centers. The government is planning to increase the number of government employees working in social welfare by 155,000 through 2022.

The Health Ministry is working on the outline of basic legislation for comprehensive community care, which it hopes to submit in 2022, after experimenting with a variety of models for community care through these trial programs. It will also be submitting plans for other kinds of community care, first for children and later for people with disabilities, in the first half of next year.

But there are still many hurdles that must be cleared before community care can be properly implemented. The Ministry of Health and Welfare has emphasized that these are policies that local governments will plan and implement on their own, after the central government provides a legal and institutional basis.

Question of allocating financial responsibility

“Local government bodies don’t have clear authority or responsibility. Since the fact is that the majority of caregiving services in Korea are in the for-profit private sector, this might lead to little more than a long list of various services,” said Kim Yun, a professor at the Seoul National University College of Medicine.

These thoughts were echoed by Lim Jong-han, a professor at the School of Medicine at Inha University and president of the Korean Association for Community Care and Medical Care.

“Establishing community care will require expanding participation by local residents and decentralizing power so that local governments can play an active role on a larger scale,” Lim said.

Another open question is how the financial burden will be divided between long-term care insurance, medical insurance and local government bodies.

The 8 billion won (US$7.08 million) allocated in the budget bill for next year that awaits review by the National Assembly would only give 600 million won (US$530,649) to 12 local government bodies. The Health Ministry said that analyzing the total services needed to provide universal community care and estimating the funding required are matters to be dealt with later, while promising to commission studies that will review these questions in-depth.

Some adjustments will probably also be needed for the specifics of the government’s plans.

“Before we can move forward with house calls by doctors and nurses and rehabilitation by physical therapists, long-term care insurance and health insurance will have to be reorganized to support this,” said Im Jong-han.

“The fact of the matter is that bedridden elderly individuals with grade-one long-term care insurance are only able to receive four hours a day of service at home, which forces them to go to facilities that provide 24-hour care. The long-term care insurance system needs to be transformed into a system that guarantees elderly citizens’ quality of life,” said Kim Bo-yeong, a professor at Yeungnam University.

In other countries, it took decades for such a system to take root. As community care takes its first steps, the road ahead is likely to be a long one.

By Hwang Ye-rang and Park Hyun-jung, staff reporters

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

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