The Enlightenment of Korean Home-based Elderly Care Model under the Vision of Supply Side Reform

Yue Ying

Abstract：For coping with the problem of population aging actively， the community home based care model that conforms to China's national conditions and the will of the elderly has become an important development direction of China's old-age care service; and it is also one of the important ways of elderly care abroad. However， due to the short development of community home care， there are still many imperfections that the fundamental solution is to deepen supply-side reform. This paper analyzes the experience and shortcomings of Korean community home based elderly care model from the perspective of supply-side reform， which is aiming to provide inspiration for the development of home-based care for the Chinese community .

Key words： supply-side reform， Korean home based old-age care， long-term care

III.Introduction

1.Research background

As the rapid development of the aging population， the demand for social welfare of the elderly has increased. However， by the economic and social developing， the traditional family functions have been weakened that the traditional family old-age care model can not meet the current needs. In 2006， the Second National Aging Work Conference convened by the State Council that put forward the pace of building an aged care service system based on the foundation of home-based pension， community service and institutional pension in order to cope with the problem of population aging actively. The basic position of home-based pension in China's old-age service system.①However， due to the late start of the community home care service in our country and the short period of development， there are still many immature and imperfect points， which can not solve the problems and needs which are brought by the aging development. The most fundamental solution of the problem of home-based care for the elderly is to deepen the supply-side reform of the aged care service industry.

2.Purpose

South Korea， a neighboring Asian country that is also influenced by traditional Confucian culture， the aging population is rapidly developing that the Korean government is actively promoting the development of the aged care service. Under the national conditions of traditional family aged care and institutional care service， South Korea has vigorously developed home-based care services that rely on the community. This paper aims to provide inspiration and reference for the development of China's home care by analyzing the experience and shortcomings of the operation mechanism， service project content and professional aspects of the Korean home care model.

IV.Korean home based aged care model

1.Background

In 2000， 65-year-old population in South Korea reached 7.1% that entered an aging society. At the same time， life expectancy increased from 52.4 years in 1960 to 82.7 years in 2018. Among them， 11% of the elderly need the help of others in their daily lives. Korean nationals are influenced by traditional filial piety culture and are generally reluctant to send the elderly to nursing homes. Therefore， only 2.5% of the elderly choose institutional aged care service. For this reason， about 8% of the elderly with difficulties in daily life are receiving care from the family and society. Besides， many disadvantages of simple institutional aged care service are the reason why the institutional aged care impossible to meet the diverse needs of different elderly groups. However， by the number of Korean women are participating in work and the gradual miniaturization and core tendency of family size， the family support function is gradually weakened， and the traditional family aged care model is difficult to meet the needs of the elderly group.

Facing the problem of severe aging， the government attaches importance to relevant legislative work and has promulgated the "Elderly Welfare Law"， the "National Pension Law" and the "Long-term Care Insurance Law"， etc.， and supplemented by Stoller. The model （supplementation model） actively promotes formal home-based care services to supplement informal home-based care services such as traditional family aged care.

2.Operation systems

Long-term care for the elderly generally includes institutional protection， home based services， day and night-time protection household services and etc. Long-term care in Korea includes two different operating systems： the long-term care system for the elderly and the home-based welfare service system.

In 2000， South Korea began to discuss on the long-term elderly care policy. Up to July 2008， the “Korean Long-Term Care Insurance Law” was officially implemented， which is marking the completion of the Korean elderly care model from family based to social based. ② Korea's long-term care insurance system adopts a social insurance method， which is similar to that of Japan and Germany. It operates in the form of long-term care insurance and national medical insurance. According to the law， Korean nationals are obliged to participate in long-term care insurance， but for nationals who are under the age of 65 can only enjoy nursing services if they have aging diseases. Insured persons who choose to stay at home need to apply to the National Health Corps， and the qualified public servant directly visits the elderly to evaluate the family status and assign the assessment results in the form of an investigation report， and the options belong to the service user or their family members.

The Korean home-based elderly welfare service is managed by community local self-governing bodies， which is mainly based on the long-term care insurance system， and provides welfare services and health services to the elderly who are not selected for long-term care at the A and B levels. These services are mainly provided by elderly welfare institutions， social welfare institutions， community self-reliance centers， home-based aged care institutions， home-based support services centers， elderly protection agencies， health centers， wide-area dementia centers， and dementia counseling centers.

Korea's long-term care system divides elderly people with care needs into 1，2，3，4，5 and above levels （A，B，C）. In the long-term care insurance system for the elderly， the objects of grade 1-5 are provided by the National Health Insurance Company by means of insurance financing， which provides two kinds of basic services， one is home welfare service and basic institutional care. Home welfare services include home care services， on-site bath services， daily care services， short-term care and welfare supplies rental services. The contents of institutional nursing service include physical activity support service and physical and mental function maintenance service. Provide， in the form of local autonomy， welfare services， including basic care services， care for basic services， integrated care services， home care， family welfare services， family welfare services， etc.， and health services， including family health management services and management services for the elderly with dementia， for the three groups of people who exceed the level of A、B、C.

3.Service item content

As a universal social insurance system， the old-age long-term care insurance system has assumed the responsibility of long-term care and nursing care for the elderly. However， it is still difficult to cover all the elderly who need care. The home based care service can provide the elderly with the right that includes home welfare services such as welfare， health care， medical care， and daily care.

（1）Elderly care fundamental services

The fundamental services for the elderly care are to serve the elderly living alone， regularly confirm their safety， research their living conditions， welfare needs， and connect welfare services resources that aims to strengthen the social safety net for elderly who living alone and improve their quality of life. The service target on the actual 65-year-old or older living alone that regardless of whether there is a cohabitant in the household registration. The main contents include emergency safety care for the elderly living alone， short-term housekeeping support activities， and funeral support services.

（2） Elderly care comprehensive service

The purpose of the comprehensive care service for the elderly is to provide support for household activities and daytime protection services for the elderly who cannot take care of themselves; to provide them with a stable elderly life guarantee and protect their social and economic activities. This service considers the conditions of age， family income and health status and targets on elderly who are 65 years old or older， the income is below 150% of the national average income level， and the health status is the A-level and B-level seniors beyond the long-term care level. The service is provided by home-based welfare agencies and local self-reliance centers in cities， counties and districts such as home-based services， night-time protection services， family leave for dementia， and short-term housekeeping services.

（3）Home Based Elderly Agency Service

The home based care service for the elderly provides all necessary services for the elderly and their families who are unable to take care of themselves due to mental and physical reasons， thereby reducing the burden of supporting the elderly and enabling the elderly to be healthy and stable with their families and relatives in their place of residence. life. Home care services for the elderly mainly include home care services， night protection services， short-term protection services， and home bath services. This service is mainly operated by the Farming and Fisheries Village Home Elderly Welfare Institution and the Home Based Elderly Support Center. The welfare institutions for the elderly in the farming and fishing villages provide services such as home care， day protection and short-term protection for the elderly who suffer from chronic diseases such as dementia and stroke and who are unable to take care of themselves. The Home Support Center for the Elderly provides a comprehensive range of services for the elderly who are unable to take care of themselves due to health problems.

（4）Elderly protection service

The elderly protection service is provided by the elderly protection professional institutions to provide intervention services to the elderly who have been abused and neglected. The Elderly Citizen Protection Agency provides on-site investigation services for elderly abuse reporting， case investigations for cases of suspected elderly abuse， psychological counseling services for victims of the elderly and perpetrators， and counseling services for families of victims and related institutions. Not only that， but this institution also provides education for the elderly to prevent abuse and provide relevant education services for the perpetrators. Elderly professional protection agencies can also provide short-term protection services for the elderly.

（5）Home Based Health Management Service

The home based health management service program is provided by the health center to provide nurses and nursing staff with health management services for the elderly who suffer from problems such as poverty， disease， disability and senior age. The main services include improving health status， chronic disease management， prevention of complications， management of life cycle health issues， and rehabilitation management of disabled people. This service program aims to promote the healthy development of the elderly by providing physical， cognitive， emotional， and social functions to the elderly.

（6）Dementia management service

Since the dementia management law was implemented in February 2012， policies related to the prevention of dementia， treatment， care， and research for patients with dementia were continuously established and implemented. Its purpose is to alleviate the suffering of dementia patients， reduce the social burden， and thus improve the national health. The dementia management service is operated by the Central Dementia Center and the Dementia Counseling Center. The Central Dementia Center is mainly responsible for two aspects of work. First， education， training， publicity， and data collection and analysis of dementia research， treatment of dementia patients， and home management of dementia patients. Second， we will cooperate with domestic and foreign research and popularize new technologies related to prevention， diagnosis and treatment of dementia. The main business of the Dementia Counseling Center includes the registration and management of dementia patients， prevention of dementia， education， publicity， family household management， and early detection of dementia.

4.Professionals

For ensuring the quality of care for nursing staff， Korea has vigorously cultivated nursing caregivers. The Korean Long-Term Care Insurance Law stipulates that the nursing staff allocation standard is to assign different numbers and levels of nursing staff to different welfare agencies. According to the standard， the elderly care institution allocates one nursing staff to every 2.5 patients， and the common living family assigns one nursing staff to every three patients. Persons operating old-age welfare institutions are obliged to provide elderly caregivers who can perform professional functions in elderly welfare institutions to provide services for the physical and family activities of the elderly. Korean nursing staff can finally get the certificate through theoretical study and internship. The certificate is divided into two grades. The nursing staff holding the first-level certificate can provide the elderly with physical activity services and hold the certificate of the second-level certificate. Nursing staff can provide services in daily life activities. There are no academic and age restrictions on the admission of a nursing staff certificate.

V.The shortcomings of Korean home care model

1.Disadvantages of connection between service providers

The reasons of the problem of the home based care service delivery system is the lack of connectivity between service providers， which leads to fragmentation of services. There is almost no connection between the elderly long-term care insurance system operated by the Korea National Health Insurance Corporation and the community elderly health welfare services operated and managed by local governments. In addition， the services of long-term care institutions， elderly welfare homes， social welfare homes， and health centers as service providers are also scattered， and it is difficult for service targets and potential service targets to know the quantity and content of services suitable for their own situation.

Although long-term care insurance system includes agency payment and home payment service， in order to ensure the continued social participation of the elderly， it is still necessary to establish close and organic contact with the home welfare service. Although welfare services include basic care services for the elderly， comprehensive care services for the elderly， services for home-based elderly welfare agencies， and home welfare services， the provision of health care， economic standards， living environment， etc. The necessary services of the conditions， there is still no organic relationship between these welfare services.

2.Insufficient supply of services

By the concept of the continuity of care for the elderly， elderly people who need long-term care should first receive care services in the family， receive night-time protection services， and enter the elderly care institutions to obtain care services when physical conditions continue to deteriorate. Finally， enter the elderly care hospital. ④In fact， due to the strict grade determination procedure of the long-term care insurance system， the number of community home care services is insufficient and the family has difficulty in functioning as a caregiver， resulting in many people with long-term care needs usually only choose to stay in elderly care hospitals.

3.Shrinking of home care services

Elderly welfare institutions and comprehensive social welfare agencies mainly provide home-based care services before the long-term care insurance system has been launched. However， with the development of the long-term care system and the increasing level of marketization， long-term care institutions began to pursue profitability for competition. The basic services for the elderly care for the elderly living alone and the integrated care services for the elderly exclude the long-term care insurance level are mainly provided by the elderly welfare agencies and social welfare agencies， and the status of these two services is also provided by the elderly welfare agencies. The basic work or main work of a social welfare institution becomes an incidental work.

VI.The enlightenment of Korean home based care service to develop the model of home-based elderly care in China

1.Strengthen the connection between the home care service suppliers

The fundamental problem of elderly care is the lack of communication between service providers and the lack of relevant links， resulting in fragmentation of services. Therefore， the service providers will strengthen their links and give full play to the role of bridges. South Korea's home care service lacks communication and contact between the long-term care insurance system of the National Health Insurance Corporation and the home care service run by local governments. Therefore， although the long-term care insurance system provides institutional payment and home payment services， in order to ensure the continued social participation of the elderly， it is still necessary to establish close and organic links with the home care service.

2.Government-led， social participation encouraged， and jointly build a comprehensive community care system

Currently， China's aged care problem mainly depends on the government to solve. But due to various reasons， the problems such as insufficient investment and low input efficiency still exist. In order to effectively respond to the diversified needs of long-term care for the elderly， China's home-based care services strengthen government responsibilities， improve relevant legislation， actively encourage community participation， and build a comprehensive community care system that integrates functions such as care， welfare， medical care， and health care for fulfilling the needs of older people who spend the rest of their lives in a community environment that they are familiar with.

3.Training for professionals

The home-based care services are delivered by professional personnel， and the low level of education and poor professionalism of nursing staff in China severely limits the development of home-based care services. South Korea emphasizes the professional training and examination of personnel， and insists on holding a certificate to provide a strong guarantee for service quality.

I.Conclusion

In the process of modernization and urbanization， the traditional family old-age support function gradually weakened， but home pension is still the mainstream way of old-age care in our country. In order to adapt to the aging society， the most fundamental solution to the problem of home pension， such as the and diversified demand of the elderly population is to deepen the supply-side reform of the old-age service industry.Service supply-side reform can provide new impetus for pension services.

II.References

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