Community Care or Facility Care? Lessons from Korean Long-Term Care System

Background and purpose of the study

Worldwide, the population of the elderly is increasing, and related problems arise. Accordingly, different countries differ in solution due to differences in the social context; in Korea, social insurance uses a mix of home and facility benefits to mitigate it. However, some are pushing for the deinstitutionalization of elderly care, and reform Korean long-term care insurance(K-LTCI) towards the community care. However, the jury is still out whether it will be possible.

Therefore, the purpose of this study is to determine if current K-LTCI made a difference in the Korean elderly’s quality of life(QoL). In addition, it examines the difference in QoL according to the type of benefits. If there is a difference, it tries to predict the future direction of K-LTCI by checking the difference in QoL according to the type of home-based benefit. Through the results, we will compare with the other countries how Korean society properly or poorly intervened to improve QoL for the elderly, the sustainability of K-LTCI.

Method

Using the “2020 Survey on the Elderly” study analyzed the effect of K-LTCI on QOL of the elderly. The analysis determines the difference in QOL between home, facility-based benefits for K-LTCI. Furthermore, if there is a difference in QOL, home-based benefits will be categorized and measured to find the effect.

Result

Based on the analysis, with all known factors that affect QOL controlled, we found that the elderly using K-LTCI had better QoL; however, there was no significant difference between the home/facility benefits.

Conclusion and implications

Our study finds that the K-LCTI improves the lives of the elderly; however, unlike previous literature, there was no significant difference in-home or facility-based care. It may be to the delivery method of the K-LCTI, to rapidly increase the capacity and infrastructure, the government lured private funds to invest rather than public funding it; leading to uneven spread of delivery area- leading to care desert- as well as lowering the standard of service. Additionally, the home-based benefits are structured to limit hours per day, which still leaves the elderly to take care of themselves most of the time. Without the benefit for improvement of the infrastructure near or in house, by enforcing it through housing code and Korean with the disability act when new housing or infrastructures are being built, they are housebound.

In conclusion, K-LTCI had positively affected the elderly; however, nor the facility nor the home-based benefits had significant differences due to the lack or insignificant care benefits. Therefore, the aging in place for the Korean elderly is unrealistic now; however, with sufficient increase of home-based benefits and infrastructure investment, to accommodate the elderly, K-LTCI may provide the means and ways to live in community and, if they want, may use facility care. In other words, the mix of the benefits based on elderly’s context, will be mutually beneficial for them and society, and may provide the way to the financial sustainability of K-LTCI as it will lower the cost in the long term.