Need for nursing home renovation in Korea highlighted by pandemic
Kim Yoon, chair of the department of health policy and management at the university, and his team followed the changes in health status of some 160,000 elderly patients, who were either newly registered at nursing homes or started receiving elderly care services at home in 2015 through 2017.
They found that the death rate of the patients admitted to facilities was much higher than those receiving care at home during the same period. A total of 22 percent of those admitted to hospitals specializing in elderly care in 2015 died by 2017. In comparison, just 12 percent of those being taken care of at home died by 2017, and 11 percent of those admitted to general hospitals died within the same time period.
“It raises a red flag, because having one out of five people admitted to elderly care facilities die within two years — that’s not normal,” Kim told the JoongAng Ilbo last month.
Elderly facilities were in the spotlight across the globe as they became the hubs of coronavirus-related deaths across Europe, the United States and other countries last year.
Korea was no exception.
As of Monday, Korea had recorded 1,474 deaths of Covid-19 patients, of whom 365, or 24.8 percent, were deaths of patients who contracted the disease while they were being treated at some 70 hospitals specializing in elderly care. Among patients who contracted the disease from medical facilities, including general hospitals, the death rate for those in long-term care hospitals was the highest.
Whilst the phenomenon is not unique to the country, some local health care experts have been pointing to a number of loopholes in the elderly care system, which they say, if addressed earlier, may have made a difference in the coronavirus numbers.
“The way that Korea had been running many of its elderly care facilities has been problematic for a while,” said Kim Keun-hong, professor of social welfare at Kangnam University. “If these facilities are left to their own at their current state, they will serve to be nothing more than death houses — just a place where the elderly are abandoned to spend the last days of their lives.”
The JoongAng Ilbo spoke to a number of researchers, doctors and caregivers who have been watching the elderly care facilities and providing services to the elderly patients, to find out where things may have gone wrong for Korea’s elderly care.
According to the office of former lawmaker Kim Seung-hee in 2019, people aged over 65 in Korea spend an average of two years at some sort of nursing home before their death.
And not all of them do so because of severe medical conditions.
Yoon Dong-won, a nurse at Hangeoleum Rehabilitation Hospital, a hospital that specializes in elderly care in central Seoul, interviewed 71 elders admitted to three hospitals specializing in elderly care in Seoul in 2018 and found 41 were admitted to be treated for worsening health conditions, whilst another 16 were admitted because they "had nowhere else to go.”
These people needed someone to help them with their basic daily activities at home, Yoon found, but they didn’t have the financial means to pay for them, or their children refused to provide care for them at home.
Elderly care at home can be very expensive in Korea, unless the recipient of the care is at least 65 years old or is diagnosed with dementia, a brain-related illness or Parkinson's disease. In those cases, the Korean government covers 85 percent of the costs for care at home, but only up to 1.49 million won ($1,300) per month. Additional costs must be borne by the individual.
In comparison, the monthly cost for care at a nursing home or a long-term care hospital can start as low as 600,000 won a month, according to the JoongAng Ilbo’s survey in 2017.
As a result, the facilities end up accepting some patients who cannot afford at-home care and may not have critical conditions but still need assistance in basic activities such as eating, washing or using the bathroom.
Many of these patients end up experiencing a feeling of abandonment and isolation from their family members, according to some experts.
“The families stop coming after a while,” said a nurse at a long-term care hospital in Seoul. “In some cases, some even refuse to pick up the belongings left behind by the patient after their death.”
A doctor at a long-term care hospital in Seoul told the JoongAng Ilbo that in June last year, as one of his patients, a woman in her 80s, started to show critical symptoms and near-death signs, the hospital contacted her son.
“We kept trying to reach the son, but he couldn’t be reached,” the doctor said. “Even though we left messages for him telling him that his mother is severely ill and that he should get ready for her passing, he ended up not showing up even after she died.”
Such cases are actually quite common across elderly care facilities in Korea, according to Sohn Deok-hyun, head of Korea Convalescent Hospital Association. Sohn runs a long-term care hospital for the elderly in Seoul.
“There is a patient whose family stopped paying for her medical costs for a few years now,” he said. “The costs total some 30 million won. But I know that this is not a case unique to my hospital. At every long-term care hospital for the elderly, there is a family like this.”
The situation can be quite different for the patients offered care at home.
Lee Young-chun, a 56-year-old woman who lives in Gwangju, Gyeonggi, has been caring for her husband, aged 63, at their home since he had a stroke 14 years ago. She and her son, 34, are the primary caregivers, but they have also hired a caregiver who comes to their home four hours a day.
“My husband was in a coma initially, but now he is well enough to be able to go to the bathroom on his own,” she said. “If we had sent him off to a hospital, I don’t think we’d have seen the same level of recovery. Of course medical attention is important, but I think the love and attention that family members can give them can also make a huge difference.”
The system to offer elderly care at home in Korea is not as institutionalized as some other countries which have previously renovated their elderly care policies. One example well-known in Korea is that of Sweden, which has focused on providing affordable care for the elderly at their homes since 1992.
By paying less than 300,000 won a month, Sweden's elderly citizens have access to daily care at home, including cleaning, shopping for groceries, help with hygiene matters and taking a walk outside.
Whilst there is no one-stop solution to elderly care in Korea, Kim Yoon of Seoul National University says that Korea may start by dividing the roles among long-term care hospitals and care homes.
“It might be better for long-term care hospitals to only accept patients with critical conditions,” Kim said. “That would, first of all, provide more room for patients admitted to the facilities to receive the right attention and care, and may provide room for other facilities to develop care for less critical patients.”
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