Delivery of Institutional Long-term Care under Two Social Insurance Schemes: Does it work?
Objective: Institutional long-term care (LTC) is mainly provided at two different settings under the two different national social insurance programs in South Korea: long-term care hospitals (LTCH) under the public health insurance (HI), and long-term care facilities (LTCF) under the public longterm care insurance (LTHI), which was newly introduced in 2008. The aims of this study are to examine the characteristics of older people at LTCH and LTCF, and compare the needs of and the service provision for the people between the settings. Data and Methods: With a 5% national representative sample of institutionalized people aged 65 or older, a survey was conducted at LTCH (n=52) and LTCF (n=91) in 2013. The Korean version of interRAI Long-term Care Facility (interRAI LTCF), a comprehensive geriatric assessment system, was used for the study, which were executed by trained nursing and/or social work staff. The function status was examined using reliable and valid scales in the assessment system. The resource utilization of the residents at both settings was categorized into the seven resourceutilization groups (RUG), using the algorithms of the RUG-III Hierarchical Levels embedded in the system. Lastly, the data on the organizational characteristics of the institutions were collected. Results: The older people at LTCH (n=1,364) were mostly female, aged between 75 and 85, married, and admitted within 6 months. The majority of the residents at LTCF (n=1,472) were also female, but they were more likely to be older, unmarried (widowed and/or divorced), and staying longer at the institutions than residents at LTCH. More than three fourth of people at both institutions were low-income population with Medical-Aide. Dementia and stroke were two common major senile diseases in both settings. Except cognition, the mean scores of the key measures of functional status (ADL, depression symptoms, stability of conditions, and communication) were not significantly different between older people at LTCH and LTCF. More than one fourth of people at LTCH under HI were categorized as the Reduced Physical Function group, while approximately 15% of residents at LTCF under LTCI were categorized as Extensive Care, Special Care, or Clinically Complex Care groups with high health care needs in the RUG-III Hierarchical Levels. In terms of service provision, people at LTCH received more medical care, nursing care, and occupational therapies than those at LTCF, while hospitalizations and ER visits 18 were higher among residents in LTCF than LTCH: staffing level were higher in the former than latter. Policy Implications: The functional status and care needs were not much different among older people at LTCH under HI and LTCF under LTCI, though the former received more care than the latter. A significant portion of LTCH residents could have been taken care of at LTCI and/or other community settings with proper infrastructure. Unmet health care needs of the elderly at LTCF under LTCI, which is mainly for social care, should get immediate attentions. Better coordination and integration of service provisions and payment schemes for LTC under HI and LTCI are necessary to meet the complex health and social care needs of aging population.
1 September 2014