[100-Year Brain Health⑩] 14 Years of 'War Against Dementia,' Still Facing Staff Shortages... Treatment and Care Must Go Together

September 21 Marks the 15th 'Dementia Overcoming Day'
Dementia Safety Sensors Installed in 256 Cities and Counties Nationwide
Integrated Services Including Counseling, Diagnosis, Prevention Activities, and Case Management
"Considering Efficiency Relative to Financial and Human Resources Input"
"National Dementia Policy Requires Comprehensive Solutions Beyond Political Terms"

Every year on September 21st, the government designates 'Dementia Overcoming Day' to widely raise awareness of the importance of dementia management and to form a national consensus to overcome dementia. Starting in 2008, this year marks the 15th anniversary. During this time, South Korea's dementia policies have been comprehensively and rapidly implemented, and some results have begun to appear. While it is evaluated that the basic social infrastructure for managing dementia has been established through policy efforts, there is still a shortage of professionals who can operate these systems, and since the policy services have focused mainly on public institutions, limitations have emerged in responding to the rapidly increasing demand for dementia patient care.

'War Against Dementia' Accelerated Over 14 Years

With the rapid aging of the population and the swift increase in dementia patients, the government has been establishing a 'Comprehensive Dementia Management Plan' every five years to secure national-level dementia treatment measures and management infrastructure. After declaring the 'War Against Dementia' in 2008 and releasing the first comprehensive plan, the 'Dementia Management Act' was enacted in 2011. In 2017, the 'National Responsibility System for Dementia' was introduced with the goal of establishing a full-cycle dementia management system at the national care level, covering prevention, care, treatment, and family support rather than leaving dementia care to individual households. In line with these policies, the Ministry of Health and Welfare has set up 256 'Dementia Safety Centers' across cities, counties, and districts nationwide as community dementia management hubs. Teams of professionals such as nurses and social workers provide integrated services including counseling, diagnosis, prevention activities, and case management. Additionally, 115 dementia-specialized long-term care institutions are being newly established, mainly in areas without public elderly care facilities, with 25 of them completed.

Since January 2018, the 'Cognitive Support Grade' was added to the Long-Term Care Insurance for the Elderly, allowing dementia patients with cognitive issues but good physical function to use long-term care services such as day and night care. Through improvements in the health insurance system, the medical expense burden ratio for severe dementia patients was drastically reduced from a maximum of 60% to 10%, and expensive diagnostic tests that were previously non-reimbursable were included under health insurance coverage. As of August last year, approximately 74,000 severe dementia patients have benefited from the health insurance special calculation system.

The currently ongoing 4th Comprehensive Dementia Management Plan (2021?2025) aims to further solidify the national dementia management system based on these achievements and focuses on enabling dementia patients to live with their families in the community rather than in facilities or medical institutions. By linking various community resources centered around nationwide Dementia Safety Centers, patients can receive specialized management according to the progression of their dementia. Plans also include increasing care support to alleviate the economic, emotional, and physical burdens on families of dementia patients.

Need to Consider Both Public Interest and Policy Efficiency

Experts evaluate that considering the domestic reality, the government has made significant efforts to manage dementia patients, and compared to other advanced countries in the Organisation for Economic Co-operation and Development (OECD), South Korea is ahead in dementia policies and their outcomes.

Dementia incurs costs during the initial diagnosis process, but relatively low costs are spent while the early stage is maintained. However, as dementia progresses to a severe stage with various complications and the need for admission to care facilities arises, management costs increase sharply, leading to enormous national expenditures on dementia treatment and care.

Choi Hojin, Policy Director of the Korean Dementia Association and Professor of Neurology at Hanyang University Guri Hospital, stated, "To reduce social costs of dementia management, it is important to provide policy support so families can live together in the community and to delay as much as possible the period when dementia patients are managed in facilities or medical institutions. In that respect, the government's dementia policies are heading in the right direction."

However, there is criticism from the field that dementia policies tend to focus on areas where the government, as the policy executor, can achieve results rather than from the perspective of dementia patients and their caregivers as service users. Yoon Woongyong, President of the Korean Neurological Association and Director of Malgeunsu Hospital, said, "Currently, 10% of the 8 million elderly aged 65 and over in South Korea are dementia patients. Bearing tens to hundreds of trillions of won in social costs annually within the next 20 to 30 years could become a national disaster. At this point, it is time to reconsider how efficiently the many dementia measures implemented so far have been executed relative to the finances and manpower invested."

Comprehensive Solutions Needed Beyond Political Regimes

Some systems with good intentions have encountered practical limitations. The Ministry of Health and Welfare designates certain public long-term care hospitals equipped with facilities, equipment, and personnel as 'Dementia Safety Hospitals' to professionally treat severe dementia patients with behavioral and psychological symptoms of dementia (BPSD) who are difficult to care for at home. However, the fees required for managing severe dementia patients are set low, and the number of beds is limited, so private hospitals focused on profitability are reluctant to operate such facilities.

Moreover, Dementia Safety Hospitals aim to provide intensive treatment for severe dementia patients through short-term hospitalization to alleviate symptoms and then promptly help them return to the community. However, even if dementia patients' conditions improve, they often find it difficult to be discharged due to other age-related illnesses. Although the principle is that severe dementia patients who have stabilized after hospitalization at Dementia Safety Hospitals return home and receive management from nearby Dementia Safety Centers, in reality, most are admitted again to other long-term care hospitals or facilities.

An official from a care institution said, "Since dementia is best managed by preventing further deterioration rather than cured, caregivers become very tired and exhausted at this stage. Even if the patient temporarily recovers, they fear discharge because the condition might worsen again after returning home." The government plans to expand the number of Dementia Safety Hospitals from nine nationwide to 12 by the end of this year and to 22 by 2025.

It is also regrettable that the ambitious dementia policies initiated under the Moon Jae-in administration's National Responsibility System for Dementia have yet to take shape under the new government. The medical community expresses concern that although health and welfare issues related to dementia patients and caregivers should be discussed together, policy directions are currently focused only on care services. It is pointed out that medical intervention and policy support are essential to effectively manage dementia and reduce the social costs and burdens associated with it.

Policy Director Choi said, "The reality that dementia patients are rapidly increasing and that our society bears a huge burden for dementia management is a very important issue that cannot be approached differently depending on political positions. We need to properly evaluate the various dementia policies implemented over the past 14 years and seek comprehensive solutions that can supplement their achievements and shortcomings."