“I had no place to stay,” said Kim Se-young as she barely lifted a half-full spoon of porridge to her mouth at Incheon Sarang Long-Term Care Facility. “I know my daughter, my son, and my daughter-in-law is working… but I can’t help but feel abandoned.”
Kim, 72, mumbled as she half-sat, half-slumped against the propped up foldable bed on the side of the room.
The minimalist rooms at the facility house three persons per room. Strewn about are some personal belongings. Thin pink, plaid sheets cover the beds. Crayon colorings decorate the walls – if at all.
In each room, the old rest, waiting for the next meal – and death, if fortunate enough.
Super-aged Korean society changes cultural norms
These long-term care facilities, also known as aged-care facilities or “yoyangwon,” have come to symbolize a rapidly aging society struggling to keep up with changing times.
Recent statistics show Korea is rapidly transforming into a super-aged society with the elderly accounting for 24.2 percent of the total population by 2030.
Other statistics show one out of four in their 80s will get dementia.
The elderly population has risen steadily from around 5.9 million people in 2012 to almost 7 million last year, recording a 17.2 percent increase. The low birthrate, combined with overall extended life span, has created an inverted pyramid where the top tier of the old accounts for the largest share.
|Source: National Health Insurance System|
By custom, family members took care of their elderly in private homes until death. These traditions are changing by nuclear families in modern Korea.
Although those that can afford these services do so, most have done so with much emotional turmoil.
In the Goryeo Kingdom, stories tell of men carrying their old fathers on their back to far away valleys or caves to leave them to die. This cruel tradition – true or not – does not exist in modern society. However, many believe leaving their parents in aged-care facilities is like leaving them in faraway places to die.
Not one person that came here for consultation was happy with leaving their parents here,” said an aged-care facility worker. “They made their decision after taking care of their parents first, and then coming to a dead-end.”
The patient’s family burdens the cost in most cases. Although Long-Term Care Insurance covers around 80 percent of in-stay expenses, the insurance benefitted only a little more than half of the total applicants last year, indicating the rest are burdening costs privately.
|Source: National Health Insurance System|
The facility costs around 1.8 million won ($1,580) a month if uncovered by insurance. The elderly often stay for an average of seven years before death.
“Korea’s elderly care is still in its infancy. If you look at Japan, they are 30 years ahead of us in caring for the elderly with substantial financial and societal support. We still have a long way to go,” said Kim Byeong-soon, director of the facility.
Facility runners struggle to make ends meet
“We don’t do it for money,” said the director. “We can’t. We report losses every month.”
The elderly eat and reside in these facilities 24 hours a day, seven days a week, for an average of seven to eight years, which requires nurses, nurse assistants, physical therapists, nutritionists, and office workers working around the clock.
“Nearly 80 percent of our revenue goes to caregivers. We try to do as much as we can with the remaining 20 percent, such as reparations, new bedding, equipment but it’s never enough. If you consider how much money goes into hiring and paying the workers, there is no way that an aged-care facility can run without external help,” she added.
In the case of medical organizations, the affiliated hospital often covers the losses. Religious groups also have their funds. Individually run organizations do not, however, explaining why they are notorious for poor service.
They have no other choice but to cut back when they can to avoid going out of business.
“As a person who has worked in this industry, it’s obvious individually run facilities are either cutting worker's salaries or dipping into some other – often immoral – source of revenue that keeps the place running,” she said.
In the midst of her explanation, a caregiver strolled in a frail old woman in a wheelchair.
“Let me tell you something,” the old lady shouted at the director. “I can’t stay here any longer! That shrill piece of work across my room slapped my hand! She slapped it when I tried to hold her hand!”
She, like many others in the facility, has dementia. None of what she said during her five-minute tirade was true.
“We spend every day caring for dementia patients, the old, and the sick. You can’t do it without a sense of vocation,” the director added.
Facility employees overworked and underpaid
A middle-aged man peeked into the director’s office, and said, “Madame, could I talk to you about my mother. There’s been some trouble.”
Some children visit their elderly patients every day. Most don’t visit at all. For the old without visiting children, the caregivers take on the role.
Take Cho Young-ran, a 58-year-old mother of two, who worked as a retirement service worker for two years and as a care worker for three.
“I worked the 24-hour shift so I would go to work at 9 a.m., and leave at 9 a.m. the next day. We get around 1,500,000 won a month. It’s not the work for the soft-hearted,” Cho said.
Care-workers, called “yoyangbohosa,” can work in these facilities once they get a license after getting two months of training. Care-workers oversee around an average of eight patients per person.
Their duties include changing the elderly’s diapers every four hours, feeding an average of eight patients during meal time, bathing them once every five days, and helping them participate in activity programs such as coloring or origami.
“This is a high-stress, labor-intensive, low-paying job. You can’t do it without a sense of vocation,” Cho said.
“It’s challenging work,” she continued. “You’re not supposed to limit the patients because of human rights, but in the case of dementia patients, we have no choice. Those with impaired cognitive abilities curse at you and try to run out of the facility. You have to understand that they have a disease, and you can’t take it personally.”
Many quit after a year or two. The work load and stress load gets to most. Cho has now left work as a care-worker after getting injured on the job.
“There was a patient that had trouble moving. He was falling, and I tried to catch him, and I fell instead - breaking my arm,” she said.
For those caregivers that stay, they work relentlessly to attend to their patients. Despite their efforts, most elderly can be found sitting in their rooms with blank expressions. The only sounds heard are the slow swiveling of the fan and spoons cluttering.
Money and time essential for improving situations
The demand for these institutions had risen rapidly with 5,085 such facilities, 430,000 elderly residents, and 3,335 employees, as of 2015.
Despite increasing demand, these facilities have become notorious for being “low-cost, poor-service” institutions where the elderly do not receive appropriate medical care or human rights.
Currently, the long-term care insurance system has come under fire for satisfying only the government, the National Health Insurance System organization, and the elderly’s guardians.
Left out are the actual voices of those running, working, and living in the facilities.
“To make all parties happy, we need money,” said Jeong Hyoung-sun, a professor at Yonsei University and president of the Industry-Academic Cooperation Foundation. “To satisfy the patients, the government should reduce the family’s financial burdens. To increase facility workers' welfare, the directors must pay more to service workers. For administrators to pay more to their employees, we need to increase insurance premiums to increase their funds.”
But from where should the money come?
“The money will come not from the government but the people. People need to pay more insurance premiums. Japan puts the insurance premium rate at 1.5 percent of an individual’s salary. Korea’s is one-third of that rate – 0.5 percent, which is quite low compared to other countries. But this is a difficult discussion to have,” Jeong said.
“It takes time,” Professor Jeong added, pointing out Korea is around 20 years behind Japan in becoming a super-aged society. “Japan implemented the long-term care insurance in 2000 when the rate of old hit 14 percent. Korea started it eight years later in 2008.”
“It’s obvious the elderly are overlooked in these facilities. The question now is how much this society will listen to them. How are we going to help them live the last stretch of their lives?” Jeong said.
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