[The Era of 10 Million Elderly]② Public Nursing Homes Severely Insufficient... Passing Away While Waiting for Admission

Report on Seoul Nursing Home Operated by NHIS
Focused on Severe Cases Unlike Private Facilities
"Government Should Expand Public Nursing Facilities"

Yoon Won-gap (60) admitted his ninety-year-old mother, who suffers from dementia, to Seoul Nursing Home two years ago. Seoul Nursing Home is a nursing facility directly operated by the National Health Insurance Service in Gangnam-gu, Seoul. Yoon’s mother was diagnosed with dementia seven years ago, but it took five years to receive facility benefits and another two years of waiting. Yoon said, "I heard that there are many elderly people who die while waiting to be admitted because there are too few public nursing homes like Seoul Nursing Home."

[The Era of 10 Million Elderly]② Public Nursing Homes Severely Insufficient... Passing Away While Waiting for Admission

On the 29th, elderly residents are doing walking exercises at Seoul Nursing Home in Gangnam-gu, Seoul. Photo by Jinhyung Kang aymsdream@

Seoul Nursing Home is the only nursing home nationwide directly operated by the National Health Insurance Service. Along with inpatient care, it also operates home services such as day and night care centers and home visit benefit services. When the reporter visited on the 29th of last month, a play program with dogs was being held for the residents, and a coloring program for cognitive learning was underway at the day and night care center. The residents’ living quarters are named ‘villages’ such as Magnolia Village and Happiness Village and are designed like independent residential facilities. There are open kitchens, communal dining tables, and living rooms where residents with mobility difficulties can lie in bed and bask in the sunlight. Jeong Soon-deok (86), a female resident, said, "I moved here from a private nursing home, and the living environment is much better."

Nursing homes are divided into public and private nursing homes. Getting into a public nursing home is like picking stars from the sky. Among the elderly who have received long-term care grades, those recognized as needing facility benefits based on severity and other factors qualify for admission. Public nursing homes have so many applicants that they must receive a waiting number and wait in order of application. Seoul Nursing Home, the ‘standard model’ of public nursing homes, has a capacity of 150 residents, but as of February this year, there were 1,379 people on the waiting list. It takes about four years to be admitted. Ko Chi-beom, director of Seoul Nursing Home, said, "Private nursing homes tend to admit mostly lower-grade patients, but we operate mainly for severe care recipients, with a high proportion of grades 1 and 2, and dementia patients account for 84% of all residents."

According to the Ministry of Health and Welfare’s data on new long-term care institutions from 2021 to 2023, out of 9,355 facilities, only 20 (0.3%) are public, all established by local governments. The remaining 99.7% were established by the private sector. Since private nursing facilities cannot ignore profit, it is difficult to provide the best service to residents. The National Human Rights Commission pointed out last year that "a private-led elderly care system can cause qualitative deterioration of long-term care services and care gaps."

According to the National Health Insurance Service, as of the end of 2022, 2.52 million people have obtained nursing care worker qualifications. This number exceeds the combined total of medical personnel such as doctors, nurses, and nursing assistants. However, the actual number of active workers is less than a quarter of those holding certificates. The average monthly salary of nursing care workers working in nursing homes, as calculated by the Health Insurance Service, is in the low 2 million KRW range, making it a low-wage occupation, and most certificates remain unused.

Under current law, nursing homes must have at least one nursing care worker per 2.3 residents. However, nursing home officials and care workers say that maintaining even the minimum ratio of one per 2.3 residents is tight due to low wages, unemployment, and the need for 24-hour 2-3 shift work. Some financially strained private nursing homes even have to discharge residents because they cannot meet the required nursing care worker ratio.

Accordingly, there are calls to increase public nursing homes and improve the overall working environment of nursing facilities, including private ones. Director Ko said, "In a situation where the polarization of elderly care facilities is worsening, the government and local governments must strive to further expand public nursing homes such as national and public facilities."