[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 on the verge of fainting. However, thanks to the nurses and caregivers who treated me diligently every day, I fully recovered. I worked hard on rehabilitation, and now I can sit up and even move my hands like this."

On December 19, at Kyungdo Nursing Hospital in Yecheon-eup, Yecheon-gun, Gyeongbuk Province, Lee Gwanhyun (age 63), whom we met, shared his story. Four years ago, he suffered a cervical vertebra fracture in a bicycle accident, underwent surgery at a tertiary general hospital, and then came to this facility. Although he still needs a wheelchair, Lee 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. Located in Yecheon-gun, where the elderly population ratio reaches 35%, indicating a very high level of aging, the hospital is recognized for its excellent medical and nursing services, including patient-tailored care. With 414 beds, the hospital employs 12 doctors, 109 nursing staff, and 67 caregivers. Nearby, there are also a rehabilitation hospital and a nursing home operated by the same foundation. Lee Yunhwan, Chairman of Induk Medical Foundation, explained, "In acute rehabilitation hospitals, integrated nursing and caregiving services are 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 caring for severely ill patients falls heavily on patients and their families."

In 2013, the hospital declared its "Four Nos, Two Eliminations" policy: no odors, no falls, no bedridden states, no bedsores, and no use of diapers or restraints. This so-called "dignity care" was an initiative 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 maintained consistently, 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 patients use the toilet as much as possible.

Chairman Lee added, "In most nursing hospitals, caregivers bathe patients once a week, but here, nurses assist patients with incontinence or those who need to wash after using the bathroom two or three times per week. A resident dental hygienist manages patients' oral hygiene, 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 allowed to move safely and independently in the Ondol Ward. There was a case where an elderly patient who previously needed a wheelchair was placed in an ondol room with a low bed; at first, they could only move by dragging themselves, but after two weeks, they gained strength in their arms and legs and were able to crawl to the bathroom on their own. A nurse in the ward said, "Compared to regular beds, ondol rooms require caregivers and medical staff to follow patients around and bend over to assist them, which is more demanding. However, simply providing a space where patients can crawl brings about significant changes 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 transparent, bulletproof glass-walled calm room. The method 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 was an idea from the medical staff. Ko Huija (age 66), a caregiver who has worked here for 18 years, said, "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 care for patients so that they are clean and odor-free, we ourselves feel a sense of fulfillment."

However, maintaining this level of caregiving service, where both patients and their families can feel secure, requires significant effort and cost from many people.

According to the Ministry of Health and Welfare, when one caregiver looks after one patient, the monthly caregiving cost is about 3.8 million won, and for a four-person room, it is about 900,000 won per month. Chairman Lee explained, "If one caregiver is assigned to each six-person room, the patient needs at least 1.4 million won per month, including 700,000 won for hospital fees, 600,000 won for caregiving fees, and 100,000 won for diapers. There are not many elderly people who can pay this amount every month. When the cost becomes a burden and they move to a poorer facility, patients may be restrained overnight and left in soiled diapers, inevitably developing bedsores."

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

Minister of Health and Welfare Jung Eun-kyung emphasized, "In a super-aged society, the social and economic burden of caring for the elderly is very high. We will gradually reduce the burden of nursing care costs, starting with severely ill patients in nursing hospitals, and ensure that medical and nursing services are provided in a patient-centered manner in the community by securing a sufficient number of high-quality caregivers, thereby fulfilling the state's social responsibility."