LTCcovid Country Profile – Printable Version

1.00. Brief overview of the Long-Term Care system

In 2008, South Korea introduced a universal, public long-term care insurance to complement the existing national health insurance. The LTCI covers residential, domiciliary and community-based care. By the end of 2018, approximately 9% of the population aged 65 and older were eligible for LCTI coverage (source: https://www.tandfonline.com/doi/full/10.1080/01634372.2020.1797977).

A shortage of qualified home-based care services in South Korea means that most older people have no choice but to depend heavily on residential institutional care. From 2012 to 2017, the number of long-term residential care facility beds per thousand people aged 65 years old and over significantly increased from 51.1 to 60.9, and the number of beds in long-term care hospitals was  36.7 per thousand people, the highest among OECD countries  (source: https://www.tandfonline.com/doi/full/10.1080/01634372.2020.1797977).

Long-term care hospitals (LTCHs) under the national health insurance play a role in long-term care provision; the average length of stay at such hospitals was about 168 days per year in 2016 Lengthy hospitalizations are likely a result of residential institutional care being financially supported by the national health insurance (NHI) and Long-Term Care Insurance (LTCI) (source: The-Long-Term-Care-COVID19-situation-in-South-Korea-7-May-2020.pdf).

Update for: Republic of Korea   Last updated: January 6th, 2022

1.01. Population size and ageing context

In 2020, the population was 51.27 million out of which 8.10 million (16%) were aged 65+. This proportion is projected to almost 43% by 2060 (source: The-Long-Term-Care-COVID19-situation-in-South-Korea-7-May-2020.pdf).

Update for: Republic of Korea   Last updated: November 25th, 2021

1.03. Long-term care financing arrangements and coverage

Total LTC expenditure in Korea represented 1.0% of Gross Domestic Product (GDP) in 2019 (source: https://stats.oecd.org/Index.aspx?QueryId=30140), of this, expenditure through the public LTC Insurance system accounts for 0.37% of GDP (source: https://www.sciencedirect.com).

A universal, public LTC insurance (LTCI) for the older population was introduced in 2008, and it requires no means-test (The-Long-Term-Care-COVID19-situation-in-South-Korea-7-May-2020.pdf ). Services include institutional and home/community care (COVID_LTC_Report-Final-20-November-2020.pdf).

In terms of eligibility, the intended beneficiaries of the system are all Koreans, it mainly targets older people (age 65+).  In 2018 around 8.8 % of the total older population were covered by LTCI (source: https://www.sciencedirect.com), which comprises 2.7% of older adults living in LTCFs (2018) and 6.2% of older adults in receipt of community based LTC (2018) (source: COVID_LTC_Report-Final-20-November-2020.pdf).

Update for: Republic of Korea   Last updated: November 23rd, 2021

1.08. Care home infrastructure

Providers of institutional care facilities are mostly private; the majority are individual-owned, small-size homes, and their numbers have rapidly increased, resulting in fierce competition (source: https://www.sciencedirect.com/science/article/pii/S016885102030275X). Services comprise residential care homes, long term care hospitals, and community services. There has historically been a reliance on institutional care, and in 2018 the Government announced a “Community Care” policy, to shift care to home and the community.

The recent outbreak revealed that care institutions are particularly vulnerable to COVID-19 for the following reasons: (a) the high population density of long-term care hospitals: the number of beds in one room is 5.12 on average in long-term care hospitals compared to 3.61 in general hospitals, (b) difficulties in requiring people with dementia or respiratory disease to observe needed hygiene and/or to wear masks; (c) the pre-existing health conditions of most residents in care institutions that make them more susceptible to infection (source: https://www.tandfonline.com/doi/full/10.1080/01634372.2020.1797977).

Update for: Republic of Korea   Last updated: January 6th, 2022

1.10. Workforce conditions: pay, employment conditions, qualification levels, shortages

In 2018, there were 3.9 Formal LTC workers per 100 older adult population. Ninety percent of workforce is personal support workforce. LTC facilities in Korea have mandated staff to resident ratios and a national curriculum of minimum requirements for LTC workers has been established whereby care workers must pass certificate tests. Training and career development options are available for care workers in the form of modular training (sources: who-cares-attracting-and-retaining-elderly-care-workers; https://www.oecd-ilibrary.org; COVID_LTC_Report-Final-20-November-2020.pdf).

Update for: Republic of Korea   Last updated: January 6th, 2022

1.14. Pandemic preparedness of the Long-term care sector

While Korea faced similar challenges as other countries in terms of initial shortages of PPE and staff, the memory of MERS facilitated a quick and decisive response from government. This prior experience of a pandemic left a legacy which enabled 1) a good level of societal buy-in with infection control measures (eg wearing facemasks); 2) legislation was already in place to allow for close monitoring of personal data.

Update for: Republic of Korea   Last updated: November 25th, 2021

2.01. Impact of the COVID-19 pandemic on the country (total population)

As of February 5, 2021, there have been 80,524 confirmed COVID-19 infections in South Korea, and 1,464 deaths, according to Our World In Data, corresponding to 2.8 deaths per 100,000 population.

Update for: Republic of Korea   Last updated: August 3rd, 2021

2.02. Deaths attributed to COVID-19 among people using long-term care

Data on the numbers of deaths linked to COVID-19  is reported in a regular briefing document provided by the Central Disease Control Headquarters. While the report is released daily, specific data on deaths of people who use Long-Term Care is reported sporadically. The most recent data is from 23rd October 2021.

Of the 2,745 COVID-19 deaths in the whole population by 23rd October 2021, 465 (16.9%) have been attributed to those in long-term care hospitals, while 253 (9.2%) have been attributed to long-term care facilities, or nursing homes. Another 97 (3.5%) deaths were attributed to other community-based LTC providers such as adult day care centres and senior welfare centres.

As for place of death, vast majority of deaths (92.2%) occurred in the hospital inpatient setting. The remaining 4% occurred in the ER, 3.2% at home, and 0.6% other (overseas, in transport, etc.)

In 2019, according to OECD data, there were 210,284. Therefore, 0.12% of this population are estimated to have died from COVID-19. There were 483,433 patients hospitalized in the 1,560 long-term care hospitals in 2018. Therefore, 0.1% of this population would have died from COVID-19.

Update for: Republic of Korea   Last updated: February 20th, 2022   Contributors: Hongsoo Kim  |  

2.04. Impacts of the pandemic on access to care for people who use Long-Term Care

In terms of wider impacts, the National Health Insurance Services has temporarily stopped providing the eligibility test for potential beneficiaries, since it requires in-person interviews and assessments of older people and families. ‘Certificate tests’ for care staff have been paused. A report from May 2020, further described that community care for older people and people with disabilities were closed in late February 2020. The Ministry has requested staff working in community-care centres to prepare for safe reopening and to support people with care and support needs with the delivery of meals, welfare checks, and supportive activities. The government also provided a supplementary budget to temporarily support economically disadvantaged groups (Source: https://ltccovid.org/wp-content/uploads/2020/05/The-Long-Term-Care-COVID19-situation-in-South-Korea-7-May-2020.pdf).

Update for: Republic of Korea   Last updated: August 2nd, 2021

3.01. Brief summary of the overall pandemic response (not specific to Long-Term Care)

General measures introduced to manage the pandemic include early adoption of extensive testing and contact tracing, low cost tests and treatments covered by the health system, social distancing, and immigration control (Source: https://ltccovid.org/wp-content/uploads/2020/05/The-Long-Term-Care-COVID19-situation-in-South-Korea-7-May-2020.pdf).

The government plan to implement mass vaccination of key groups starting February 2021 (Source: https://www.reuters.com/article/us-health-coronavirus-southkorea-novavax/south-korea-in-talks-to-secure-40-million-doses-of-novavaxs-covid-19-vaccine-idUSKBN29P0BB). Laws introduced after earlier public health shocks (Sars in 2003 and Mers in 2015) allow the Korea Disease Control & Prevention Agency to access phone data, credit card records, and CCTV footage to trace people’s movements.

Update for: Republic of Korea   Last updated: September 7th, 2021

3.02. Governance of the Long-Term Care sector's pandemic response

The Government raised the infectious disease alert level to “highest” on February 23, 2020. On January 29 they introduced a monitoring system to check social welfare facilities’ compliance with the guidelines, and from February 9, the central headquarters conducted daily monitoring on, for example, isolation of care workers. Constructive relationships with key institutions such as the president’s office, the Ministry of Health, and the Korean Centers for Disease Control and Prevention enabled a decisive response (Source: https://ourworldindata.org/covid-exemplar-south-korea). The Korean National Health Insurance Services developed and published guidance for all welfare and LTC facilities on February 20, 2020. This set out containment measures within Korean LTCFs including site monitoring, resident quarantining, identification of high risk staff and visitors, targeted screening, and stringent personal hygiene measures for staff and residents. They also published a a response plan for COVID-19 to effectively react to suspected and confirmed cases of the virus within the service boundaries of each institution (e.g. suspected/affected care recipients, suspected/affected care providers) (Source: https://ltccovid.org/wp-content/uploads/2020/05/The-Long-Term-Care-COVID19-situation-in-South-Korea-7-May-2020.pdf).

Update for: Republic of Korea   Last updated: September 8th, 2021

3.02.03. Measures to support, facilitate and compensate for disruptions to access to care

Even though 99% of community services were closed from February 28, 2020, onwards, staff members working in community care services are continuing to provide care such as delivering meals, ‘checking on welfare’, and ‘supporting activities’.

Update for: Republic of Korea   Last updated: September 9th, 2021

3.03. Monitoring Covid-19 impacts in the Long-Term Care sector: data and information systems

To track the movements of people with COVID-19 infections, the government used Global Positioning System (GPS) records from cellular phone or credit card records to generate a movement map. Once the movement map was made, the map was displayed on the Web or notifications were sent to inhabitants in the relevant neighbourhoods so they could take additional precautions. To monitor people under quarantine, applications on smartphones using GPS data were introduced (Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7160162/).

Update for: Republic of Korea   Last updated: September 9th, 2021

3.05. Long-Term Care oversight and regulation functions during the pandemic

Nationwide monitoring and inspection of LTC hospitals was conducted to ensure the ‘exclusion’ of workers with a recent travel history to affected regions or countries, or those with symptoms.

Update for: Republic of Korea   Last updated: September 10th, 2021

3.06. Support for care sector staff and measures to ensure workforce availability 

There have been multiple measures to support care sector staff and ensure workforce availability in South Korea.

In order to minimize the risk of care workers to be infected with COVID-19, care workers who were considered to have been in close contact with cases were quarantined at home, whilst those who continued to work were temporally housed in a hotel, or voluntarily moved into the LTC facility. In some facilities a quarantine was upheld for 14 days during which nurses and nurse assistants voluntarily agreed to be quarantined in the LTC facility to continue resident care.

There were steps to address worker shortages by seeking volunteers and paying family carers, and, in areas of high outbreaks, healthcare workers were directed to sites with large clusters of infections, for example, an additional 2,400 health workers were recruited in Daegu alone.

Update for: Republic of Korea   Last updated: November 25th, 2021   Contributors: Elisa Aguzzoli  |  

3.07.02. Approach to isolation of people with confirmed or suspected Covid-19 infections in care homes

Evidence on experiences of cohorting to separate groups of residents (starting March 2020)

A study describes an emergency response to a COVID-19 outbreak in a long-term care hospital (LTCH) spread over floors 2 through 5 in a five-storey building in Bucheon, South Korea. As of March 12, 2020, there were 142 patients, with six to ten patients assigned to each room, and bed distance of less than one metre apart.

In response to an index case, all patients were considered contact persons. Patients in a dischargeable condition were isolated at home. Of the other patients, 73 were transferred to public hospitals and nearby private acute care hospitals. The remaining patients were in isolation cohorts after the beds were repositioned to maintain a bed distance of 2 metres or more. There were no more infected persons (Kim, 2020).

References:

Kim, T. (2020). Improving Preparedness for and Response to Coronavirus Disease 19 (COVID-19) in Long-Term Care Hospitals in the Korea. Infect Chemother. https://doi.org/10.3947/ic.2020.52.2.133

Update for: Republic of Korea   Last updated: January 14th, 2022   Contributors: William Byrd  |  

3.07.03. Visiting and unpaid carer policies in care homes

Visiting policies for care homes have been fluctuating in line with the severity of cases. In March of 2021, the MoHW announced its plan to promote on-site visits for families after confirming negative for COVID19. However with the increase in community infections, no official policy was set forth regarding the visits. During the national holidays of Chuseok in September, family visits to LTCHs and LTCFs were made temporarily viable (9/13~9/26) for those whom both the resident and visitor were completely vaccinated.

As of December 2021, most facilities are carrying out remote visits through facetime and on-site visits are restricted.

Update for: Republic of Korea   Last updated: January 26th, 2022   Contributors: Hongsoo Kim  |  Jae Yoon Yi  |  

3.08. Access to testing and contact tracing for people who use and provide Long-Term Care

South Korea is notable for the speed of their drive to mass test, as early as February/March 2020. The government built hundreds of high-capacity screening clinics and worked closely with the private sector to ensure an adequate supply of tests. This enabled early testing of care home residents and staff. In March 2020, at one care home in Daegu, more than 70 patients and employees tested positive for the contagious disease, including 17 staff (https://world.kbs.co.kr/service/news_view.htm?lang=e&Seq_Code=152108). Diagnostic tests were conducted for 460 inpatients in LTCHs who were being treated for unknown pneumonia, as early as 5th March 2020. According to the Korean Convalescent (long-term care). In October authorities focused COVID-19 testing on all employees and patients of long-term care hospitals, mental health care providers and care homes located in the wider capital area, totalling around 160-thousand people (http://world.kbs.co.kr/service/news_view.htm?lang=e&id=Dm&Seq_Code=156889).

Regarding ‘healthcare workers’ operating across various settings including long-term care centres, there were clusters of outbreaks in Daegu within long term care centres. The government tasked health officials with conducting universal Covid-19 tests by RT-PCR for everyone in those facilities. Confirmed Covid-19 patients were transferred to a designated Covid-19 hospital or a community treatment centre. These centres with outbreaks were reinspected regularly. (https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0159).

The central and local governments respond to infected cases rapidly by tracing each case and isolating contacts. For the epidemiological survey, interviews are conducted with patients, families, and also healthcare workers, if necessary more objective data including medical records, mobile GPS, CCTV, credit card records, etc., may be collected and verified. Information about the travel routes of infected cases is provided on a website run by the government, in which no information that can identify a person is provided.” (https://ltccovid.org/wp-content/uploads/2020/05/The-Long-Term-Care-COVID19-situation-in-South-Korea-7-May-2020.pdf).

Update for: Republic of Korea   Last updated: September 8th, 2021

3.09. Access to Personal Protection Equipment (PPE) in the Long-Term Care sector

By early March 2020 Korea had a strategic plan to distribute supplies of PPE: the Central Disaster Management Headquarters established a working group and IT system to distribute 5.46 million masks to long-term care providers.

Update for: Republic of Korea   Last updated: November 25th, 2021   Contributors: Elisa Aguzzoli  |  

3.11. Vaccination policies for people using and providing Long-Term Care

COVID-19 vaccine rollout in care homes

By the 13th September 2021 approximately 99.9% of those eligible for the vaccine in Long-Term Care Hospitals (LTCHs) had received the first dose and 90.0% the second dose. In Long-Term Care Facilities (LTCFs), 99.9% had received the first dose and 91.8% the second dose (Central Disease Control Headquarters data).

Booster rollout in care homes

The Central Disease Control Headquarters announced that the rapid rollout of booster shots for LTCF staff and residents would be a priority. Currently 466,648 people are eligible for the booster shot in LTCF and LTCHs and as of the 26th November 2021, 285,909 have received a third dose of COVID-19 vaccination.

This vaccination effort has been supported by personnel from the Ministry of Defence (60 military nurses) to carry out the booster shot vaccinations in LTCHs and LTCFs.

There are no published statistics allow to separate numbers of staff and residents who have been vaccinated.

Impact of COVID-19 vaccination on mortality in care homes

The Central Disease Control Headquarters analysed vaccination, infection, and severity data from seven mass infections in high-risk facilities (LTCH, LTCF, adult day care) to identify associated factors. They found that the severity of infection was higher among non-vaccinated people compared to those who were vaccinated. Analytic results suggest a 75% protective effect of vaccination on severity.

Update for: Republic of Korea   Last updated: January 26th, 2022   Contributors: Hongsoo Kim  |  Jae Yoon Yi  |  

3.12. Measures to support unpaid carers

Family members were paid to provide the necessary care to older adults care at the same wage as professional caregivers after they receive two hours of training (https://ageingasia.org/wp-content/uploads/2020/12/COVID_LTC_Report-Final-20-November-2020.pdf).

Update for: Republic of Korea   Last updated: September 7th, 2021