Seniors blur line between comfort, medical care

As the number of older people who suffer from dementia and other chronic diseases such as diabetes continues to increase in Korea, so too has demand for nursing home facilities and hospitals.

But some elders and their families often make a dangerous shift between hospitals and nursing homes without proper guidance. With the implementation of the long-term care act for the aged, those who are registered in a nursing hospital cannot be covered by insurance, while residents of nursing facilities are entitled to coverage.

Nursing hospitals are geared toward treating seniors with acute diseases and have doctors available, while various nursing facilities - sanatoriums, nursing homes and care centers for the aged - tend to those with chronic diseases such as Alzheimer’s.

Thanks to state insurance, nursing facilities usually charge approximately 430,000 won ($422) to 490,000 won per month, while hospitals specializing in care for the elderly generally cost between 700,000 won and 1 million won.

One 75-year-old woman who was diagnosed with Parkinson’s disease, for instance, stayed at a nursing hospital in Ansan, Gyeonggi, for six months until her family decided to move her to a nursing facility. Hospital staff tried to persuade the family to let the woman, surnamed Choo, continue her treatment in the hospital, but her relatives were insistent and eventually moved her to a nursing home. “We warned that the services at such facilities wouldn’t be enough for the type of treatment Ms. Choo needed,” said a hospital employee who refused to be named. “But the family insisted that it would be too costly. About 80 percent of those who move to other facilities have the same reasons.”

By contrast, some elders who don’t suffer from serious diseases sometimes prefer to stay in nursing hospitals because they can be attended to by doctors on a regular basis.

A 67-year-old woman in the beginning stages of dementia chose to go to a medical center for the elderly in South Chungcheong for that reason.

“There are nurses in the facilities, but not enough doctors,” said the woman, who only gave her family name Park.

The demand for such institutes for the elderly is expected to grow as the number of people over 65 who are diagnosed with dementia steadily rises.

But the problem surrounding an arbitrary shift mostly based on preference poses harm for patients, especially because many don’t receive appropriate care based on their individual needs.

A study by Kwon Soon-man, a professor and the deputy dean of the School of Public Health at Seoul National University, showed that many seniors actually don’t receive the services they need.

Kwon studied 3,000 residents in both hospitals and facilities, and 55.2 percent of those surveyed in hospitals were found to have received unnecessary treatment. Conversely, 30.3 percent of those in nursing facilities needed treatment offered by hospitals.

“It’s important to make a distinction between hospitals and private care centers,” he said, “because the services they offer are different. But now that line is rather blurred.”

Lee Gi-hyo, a professor in the School of Public Health at Inje University, noted that some institutes deliberately turn a blind eye.

“I know some hospitals would give the green light to people even if they don’t need hospital treatment,” Lee said. “This is a kind of moral hazard. Other institutes even offer discounts in order to compete with cheaper nursing facilities.”

Many health professionals have made various suggestions to improve or curb these potentially harmful practices. Professor Lee noted that nursing homes would need to expand the treatment provided in order to prevent the elderly from moving.

“Even if a person only has chronic, aging-related diseases, they need treatment on top of general care,” the health professor said. “So there should be more facilities that are between a hospital and nursing facilities.”

Others emphasized that nursing homes should try to improve their housing features to attract more people.

“Technically, a hospital cannot and should not serve as a dwelling place. A hospital is where patients are treated,” said Kwon Yong-jin, head of a public hospital called Seoul Bukbu Hospital. “So nursing homes have to ramp up residential functions.”

Heo Dae-seok, a health professor at Seoul National University, added that, ideally, more people would use in-home services for the elderly.

“In Europe and Japan, elderly care service centers are centered on in-home services,” the professor said. “But in South Korea, not many people are keen on in-home service.”

“The government, first, needs to raise awareness about the fact that it is best when older people are treated in their own homes. But recently it has only focused on giving out incentives when the elderly are treated in nursing facilities.”

BY SHIN SUNG-SIK [ejpark@joongang.co.kr]