"To Live at Home Until 100"… 'Anyone with Poor Health' Must Receive Medical Care and Support [Turning My Home into a Senior House]

What It Takes to Live at Home Until 100
Korea Entered a Super-Aged Society Last December
First Steps Toward 'Community-Based Integrated Care' Like Japan
Preparing for 'Integrated Care' to Support Elderly at Home
Including Home Medical Visits, Nutrition Management, and Home Repairs
Urgent Need to Address Budget, Manpower, and Experience Shortages

▲On October 28 last year, Grandma Park Jong-im is walking with a cane at an apartment in Seongbuk-gu, Seoul. Photo by Kang Jin-hyung

"Walking was never a problem until now. Even three months ago, I used to go to the swimming pool and do aqua aerobics with my friends. But suddenly, my knee joint broke down badly. Now, I can't even go to the market to buy side dishes. The surgery date keeps getting postponed because of the medical strike. My daughter, who lives nearby, comes and goes every morning to prepare meals for me, but she’s the one who suffers. Every morning, I lean on my cane and go to the public bath in front of the house to soak my knee in hot water. But if I just spend time like this and become unable to move any further, I wonder if I can live alone at home, and that worries me."
(81-year-old grandmother Park Jong-im, living in an apartment in Seongbuk-gu, Seoul, on October 28 last year)

When elderly people become sick or injured and cannot move freely, living at home becomes difficult. Depending on their physical condition, the life cycle of the elderly is divided into the stages of ‘healthy - frail - care.’ According to the report ‘Support for Continued Community Living of the Elderly’ published by the Korea Research Institute for Human Settlements, the healthy stage is defined as ‘a state where one can manage their own life.’ The frail stage is ‘a state where one requires care in one or more areas.’ About 60% of the elderly fall into this category, and it is a time to prevent further health deterioration. The care stage requires ‘a certain level of care.’ About 10% of the elderly are in this stage, and health management and daily living support are necessary to enable them to continue living at home.

When a Crisis Comes for Elderly Living at Home

▲On November 18 last year, Sachiko Watanabe (90), a grandmother living in Toyoake City, is being assisted by helpers from the 'Chatto Service' (a service that helps elderly people for 30 minutes at 250 yen) as she enters her home.

At the threshold of moving into the ‘frail’ or ‘care’ stage, elderly people face a crossroads: whether to live in their own home or move to a facility. Yuaejeong, director of the Integrated Care Research Center at the National Health Insurance Service, said, "Elderly people with mobility difficulties need doctors to visit their homes, care workers to come and prepare meals, and safety handrails in their rooms. Only by meeting these conditions can they continue to live at home."

Since entering a super-aged society in 2005, Japan has supported elderly people to live at home in this way. This system, called ‘Community-based Integrated Care,’ operates on three pillars: ‘medical care’ (hospital and pharmacy services), ‘daily living support’ (housework and welfare checks), and ‘nursing care’ (help with bathing and rehabilitation training). Doctors, nurses, care workers, and social workers ride bicycles through neighborhood alleys to regularly check on elderly residents’ homes. They can respond to emergencies within 30 minutes. The idea was that in a society where children do not take care of their parents, local governments must provide care to make it possible for elderly people to live in their own homes.

‘Community-based Integrated Care’ became established throughout Japan after 2010. As the number of late elderly people aged 75 and older rapidly increased around this time, warnings arose that social security finances would be depleted. As the number of sick elderly people increased, hospital and care costs ballooned, increasing the burden of medical and nursing care insurance premiums. It became urgent to help elderly people live independently at home.

Korea Also Took First Steps Toward ‘Integrated Care’ Following Japan, But Much Remains to Be Done

In December last year, Korea also entered a super-aged society where one in five people is aged 65 or older. In response, Korea’s version of community-based integrated care, called ‘Integrated Care,’ took its first steps. In March last year, the National Assembly passed the ‘Integrated Care Support Act’ (Act on the Integrated Support for Regional Care including Medical and Nursing Care). According to this law, from next year, all local governments must provide medical and care services to enable elderly people to continue living at home.

Currently, pilot projects are underway in 12 regions including Buk-gu in Gwangju, Jincheon in Chungbuk, Yuseong in Daejeon, and Bucheon in Gyeonggi. These regions operate integrated care services with a combined budget of 1.06 billion KRW annually, consisting of 530 million KRW each from national and local governments. Director Y said, "While the 12 regions are well-prepared, other local governments have not even started walking yet," adding, "It will take a long time to spread integrated care nationwide because budget shortages, manpower shortages, and lack of experience must be resolved."

There is a reason why ‘integrated’ is attached to ‘care.’ Lee Jae-cheol, a welfare officer in Jincheon County, one of the pilot project areas, said, "The core of integration is to properly combine medical care and caregiving." He explained, "Before selecting beneficiaries, we always visit the elderly’s homes. We even open the refrigerator to see how they eat, what medicines they take, and what discomforts they have."

Jincheon County holds weekly video meetings to manage integrated care beneficiaries. Welfare officials, medical staff, social workers, public health center staff, and dementia relief center personnel attend. Depending on the beneficiary’s condition, employees from the National Health Insurance Service, physical therapists, Korean medicine doctors, and pharmacists also participate. The officer said, "We share beneficiary information and provide necessary care services such as home medical visits, nutrition management, daily living support, and home repairs," adding, "We monitor progress and decide when to end care."

Can They Pass Away in Their Own Home?

▲On October 29 last year, Ahn Young-il (89) is receiving long-term care home medical services from medical staff at an apartment in Buk-gu, Gwangju Metropolitan City. Photo by Kang Jin-hyung

Integrated care beneficiaries are determined based on health status, not income level. They do not need to be low-income or have a long-term care grade. Anyone with poor health requiring care can receive support. Beneficiaries are sometimes recommended through hospitals, the National Health Insurance Service, or senior welfare centers, and elderly people or their children may also contact local governments directly.

Such medical and care services already exist. One sick elderly person living alone is cared for by 3 to 4 people including social workers, care workers, and administrative welfare center officials. The problem is that these people do not communicate with each other. Information about the elderly is known only within each person’s area of responsibility. For example, if an elderly person living alone does not take their medicine, the social worker providing daily living support may not know and overlook it.

Director Y said, "Just connecting existing services can start integrated care," adding, "Once integrated care is established, the homes where elderly people currently live will become senior houses, and like in Japan, more elderly people will be able to pass away at home."