[Report] "No Diapers, Ondol Floors"... Visiting a 'Dignity Care' Nursing Hospital

Kyungdo Nursing Hospital in Yecheon Practices "4 No's": No Odors, Falls, Trauma, or Bedsores
Chairman Lee Yunhwan: "Insurance Coverage for Caregiving Fees Is Essential to Protect Patient Rights"

"Because I was completely unable to move, I developed bedsores, had a high fever, and was even on the verge of fainting. But thanks to the daily care provided by the nurses and caregivers, I fully recovered. I worked hard on rehabilitation, and now I can sit up and even move my hands like this."

Lee Gwanhyun (age 63), whom we met on December 19 at Kyungdo Nursing Hospital in Yecheon-eup, Yecheon-gun, suffered a cervical fracture in a bicycle accident four years ago and came here after undergoing surgery at a tertiary hospital. Although he still needs to use a wheelchair, he is nurturing hope as he looks forward to being discharged soon.

Jung Eun-kyung, Minister of Health and Welfare, visited Gyeongdo Nursing Hospital located in Yecheon-gun, Gyeongbuk Province on the 19th and listened to the caregiving situation within the hospital from Lee Yunhwan, Chairman of Induk Medical Foundation. Ministry of Health and Welfare

Since 2006, Kyungdo Nursing Hospital has provided specialized rehabilitation and nursing care for patients with stroke, cerebral infarction, Parkinson's disease, spinal paralysis, and dementia. In Yecheon-gun, where the proportion of elderly residents is as high as 35%, the hospital is recognized for offering excellent medical and nursing services, including patient-tailored caregiving. The hospital has 414 beds, with 12 doctors, 109 nursing staff, and 67 caregivers. Nearby, the same foundation also operates a rehabilitation hospital and a nursing home. Lee Yunhwan, Chairman of Induk Medical Foundation, explained, "Acute rehabilitation hospitals offer integrated nursing care services covered by health insurance, and nursing homes are covered by long-term care insurance. However, there is no health insurance support for caregiving in nursing hospitals, so the burden of care costs for seriously ill patients falls heavily on patients and their families."

In 2013, the hospital declared a "4 No, 2 Escape" policy: no odors, no falls, no bedridden patients, no bedsores, and no use of diapers or restraints. This so-called "dignity care" was an attempt to change the hospital environment itself to protect patients' quality of life and autonomy. For patients who are able to move, diapers are avoided as much as possible. When a patient is admitted, there is an observation period of about three days, during which their sleep, meals, and rehabilitation schedules are kept regular, and they are encouraged to use the bathroom in advance. While it may be more convenient for caregivers to keep patients in diapers, the hospital helps them use the toilet as much as possible.

Chairman Lee said, "In most nursing hospitals, caregivers bathe patients once a week, but here, nurses help patients with incontinence or those who need to wash after using the bathroom to bathe two or three times. A resident dental hygienist provides oral care for patients, and even on the coldest days, we ventilate the hospital every two hours, so there are no unpleasant odors throughout the facility."

Dementia patients who have difficulty walking alone are encouraged to move independently and safely in the Ondol Ward. There was a case where an elderly patient who had to use a wheelchair was placed in a room with a low bed in the Ondol Ward. At first, they could only move by dragging themselves, but after two weeks, as their arms and legs grew stronger, they were able to crawl to the bathroom on their own. A nurse in the ward said, "Compared to standard hospital beds, the Ondol Ward requires caregivers and medical staff to follow patients around and bend down to care for them, which is more demanding. But simply providing a space where patients can crawl makes a huge difference for them."

Kyungdo Nursing Hospital has installed low-height beds in the 'Ondol Ward' to prevent falls, enabling patients to maximize the residual functions of their arms and legs to move independently. Photo by Jo Inkyung

Dementia patients who shout or exhibit problematic behaviors are isolated in a separate calm room until they stabilize.

Patients who unconsciously try to remove respiratory or nasal tubes are distracted by wearing gloves with attached dolls instead of being restrained with restraints.

To help patients who shout loudly and disturb the rest of others adjust, the hospital invested in building a calming room with transparent bulletproof glass walls. The idea of distracting patients who unconsciously try to remove respiratory or nasal tubes by having them wear gloves with attached dolls instead of restraining their hands came from the medical staff. Ko Huija (age 66), a caregiver who has worked here for 18 years, shared, "The salary is similar to other places, but we receive a lot of training for patient-centered care, there is a supportive atmosphere among staff, and above all, because we keep patients clean and odor-free, we ourselves feel a sense of reward."

However, maintaining this level of caregiving service that reassures both patients and their families requires considerable effort and cost. According to the Ministry of Health and Welfare on December 23, the monthly caregiving fee is about 3.8 million won when one caregiver looks after one patient, and about 900,000 won per month for a four-person room. Chairman Lee said, "If there is one caregiver per six-person room, patients need at least 1.4 million won per month for hospital fees (700,000 won), caregiving fees (600,000 won), and diaper costs (100,000 won). But not many elderly people can afford to pay this amount regularly. If the cost becomes too burdensome and they move to a poorer facility, their arms and legs may be tied up overnight, and bedsores can develop due to infrequent diaper changes."

To ease this caregiving cost burden, the government will invest 6.5 trillion won over five years starting in the second half of next year to introduce insurance coverage for caregiving fees at nursing hospitals. Currently, caregiving fees are not covered by health insurance and must be paid entirely by individuals, but the goal is to reduce this to about 30%. Beginning with 200 nursing hospitals, the plan is to select 500 medical-centered nursing hospitals by 2030 and reduce the caregiving cost burden for about 80,000 patients who require caregivers due to severe illness or conditions such as dementia or Parkinson's disease. To improve service quality, nursing hospitals will need to convert existing six- to eight-person rooms into four-person rooms, and as each caregiver looks after fewer patients, the quality of care is expected to improve. Improving working conditions for caregivers and ensuring shift work are also challenges that need to be addressed.

Minister of Health and Welfare Jung Eun-kyung emphasized, "Since the socioeconomic burden of caregiving for the elderly is very high in a super-aged society, we will gradually reduce the burden of nursing care costs, starting with seriously ill patients in nursing hospitals. We will also foster and secure sufficient high-quality caregiving personnel so that medical and nursing services can be provided in a patient-centered manner in local communities, thereby fulfilling the state's social responsibility."