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| An elderly woman participates in an arts and craft session at a nursing home. Courtesy of National Health Insurance Service |
By Lee Hyo-jin
Everyone gets old. And as people age, they are more likely to suffer from various medical conditions and diseases, leaving them in need of care and assistance in their daily lives.
But the question is, who will provide care and who will foot the bill?
Caregiving for seniors has traditionally been perceived as a duty of their family members. Sons and daughters were responsible for the care ― both physically and economically ― of their elderly parents.
But this outdated system has faced challenges in modern society. Unlike the past when extended families lived under one roof, family ties are loosening, with more and more elderly people living alone.
As a result, the enhancement of public care services for the elderly population has become a priority for Korea, a country which is predicted to become a "super-aged society" by 2026, where one-fifth of the total population is aged 65 and older.
Against this backdrop, the National Health Insurance Service (NHIS) launched what is called the Long-Term Care (LTC) Insurance scheme in 2008 aiming to shift elderly care away from the family-dominated system to an insurance-based one.
All Korean nationals are eligible for LTC insurance, which offers a comprehensive caregiving system to elderly people who are unable to perform daily activities on their own.
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| Elderly women participate in a physical activity session at a senior care center. Courtesy of National Health Insurance Service |
The insurance program differs from others provided by the NHIS by covering services provided by nursing facilities, while other types of insurance cover services provided by hospitals, clinics and pharmacies.
The LTC insurance scheme is a mandatory form of social insurance, which aims to enhance the quality of life of the elderly population who are experiencing difficulties due to old age or geriatric diseases.
To apply for NHIS approval, an LTC subscriber must qualify under several criteria: the subscriber must be aged 65 or older; or aged under 65 with an age-related disease, such as dementia, Parkinson's disease or cerebrovascular disease.
An applicant who is deemed incapable of carrying out daily activities alone for a period of six months or longer is eligible for LTC services.
After the subscriber applies for NHIS approval, an official at the agency will pay a visit to the applicant for a detailed assessment.
Based on the assessment results and the endorsement of a doctor, a rating board at the agency will then determine the level of care that is appropriate for the individual, ranging from nursing-home residence, day and night care, to welfare visits at home to help with day-to-day tasks such as bathing, cooking and eating.
Under the insurance scheme, the NHIS pays for 85 percent of home-living benefit expenses, and 80 percent of facility care benefit expenses, within the monthly limit which may differ depending on the level of care.
Over 900,000 Koreans benefit from LTC in 2021
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| Elderly people play Yut-nori, a traditional Korean board game, during Lunar New Year. Courtesy of National Health Insurance Service |
Although the Long-Term Care Insurance scheme has a relatively short history compared to other NHIS services, its coverage has consistently expanded to reach tens and thousands of Koreans.
According to NHIS data, over 857,000 applicants were granted approval for LTC services in 2020, up from some 286,000 people in 2009. Of the people who were approved in 2020, over 712,000, or 83 percent, received benefits.
According to a survey conducted last October among 2,500 beneficiaries, 91 percent said they were satisfied with the services which include short-term accommodation at facilities, bathing services and community residence for the elderly.
The comprehensive care model has not only improved the quality of life of senior citizens and lowered the care burden placed upon their family members, but it has also spurred the development of the elderly care industry and contributed to increased employment in the sector.
In 2020, the number of home-living institutions across the nation reached 19,621 following a steady increase from 15,063 in 2017, 15,970 in 2018 and 19,410 in 2019.
The number of live-in LTC institutions has also shown a steady increase to reach 5,763 in 2020, more than tripling from 1,700 in 2008.
Public geriatric care facilities serve as test beds
The provision of long-term care services has expanded to the private sector, but this has also resulted in problems such as poor safety management at private facilities and excessive competition in the market.
Therefore, the national health insurance company has been operating two geriatric care facilities each located in Seoul and the southern resort island of Jeju, to develop a standard model for long-term care services.
These two state-run care facilities enable the agency to make regular assessments of benefit expenses, serving as test beds where it can perform various pilot projects on senior welfare.
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| Seoul Long-term Care Center located in Gangnam District / Courtesy of National Health Insurance Service |
Seoul Long-term Care Center, which opened in November 2014, is located in Gangnam District.
Accommodating up to 150 elderly residents, the center provides customized care according to the health conditions of each resident, while setting up a standardized work manual for all caregivers working there.
Seven pilot projects are underway at the center, including the establishment of a cost analysis system, development of home care services, operation of a personalized health care system, short-term accommodation, improvement of benefit management, along with strengthened health management for the elderly living at home.
Seogwipo Long-term Care Center in Jeju was established in June 2020, in cooperation with the Seogwipo City Government, aiming to promote a state-level care system specifically for dementia patients.
NHIS seeks to enhance quantity and quality of service
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| Elderly people at a nursing home enjoy indoor camping activities, as outdoor activities were limited due to the COVID-19 pandemic. Courtesy of National Health Insurance Service |
NHIS hopes to come up with improved measures to better accommodate the needs of an aging population, as the agency views that social demand for long-term care serivces is increasing due to Korea's rapidly aging society and changing family structure.
"In particular, there is a rising need for 'local community residential support,' as elderly people prefer to live in their own houses rather than being admitted to nursing homes," said an official at the NHIS.
The agency plans to introduce a so-called "care-mix" scheme, which is an integration of home care services including healthcare, day and night care, bathing and nursing.
"In addition, we are considering the launch of an at-home medical system through which the beneficiaries can receive medical services at home and not at hospitals or facilities. We will also continue to promote community-based care models in cooperation with local governments," said the official.
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