Expanding home care for older patients after discharge

Shin Sung-sik The author is a welfare specialist reporter at the JoongAng Ilbo. Korea is entering an era in which care for older patients does not end at the hospital door. Last year, 2.7 million people aged 65 or older were hospitalized and discharged, equal to 2.6 out of every 10 people in that age group. Without proper home care, however, 22 percent get readmitted within 90 days. According to the National Health Insurance Service (NHIS), about 370,000 discharged patients are deemed high-risk. Many have had strokes, fractures, chronic kidney disease or Parkinson's disease. Those unable to return home often enter long-term care hospitals or nursing homes, where many remain until the end of their lives. Korea has long focused on treatment, pouring resources into hospitals and technology. That investment created world-class medical capabilities. Life after treatment, however, has gotten left behind. Many discharged patients still need medical services, meals, medication management and help with daily routines. Some large and public hospitals have tried to fill that gap. Seoul Asan Medical Center has operated programs since 2021 to manage older inpatient care and connect discharged patients with community services. Older patients with conditions are assigned specialists. One lung cancer patient improved after a dietitian prescribed a high-calorie diet. Another patient, who had been taking 21 medications, received pharmacist help that removed nine inappropriate drugs and added two necessary ones. Separate teams support patients after discharge. In one case, an 83-year-old patient with stage four cervical cancer received counseling from a social worker, who identified long-term care insurance, transportation help, rehabilitation equipment rentals and visiting nursing. Families often do not know these services exist. After additional treatment at Jeongeup Asan Hospital, one patient moved to a child's home. A public health nurse now visits twice a week to manage a nephrostomy tube, and local transportation services will be used for outpatient visits. Asan provided additional services to 6,000 people last year. Because such work is not compensated through medical fees, hospitals have little incentive to expand it. A new chapter began last month with the launch of community integrated care. As of March 27, 229 local governments and more than 1,300 hospitals had signed agreements. Hospitals assess discharged patients and refer them to local governments for tailored support. In the first month, 430 patients were enrolled. Local governments pay about 50,000 won ($34) to participating hospitals, excluding tertiary hospitals. Some services require patient co-payments. In Daejeon's Seo District, an 84-year-old woman living alone underwent gallbladder surgery at a university hospital but hesitated to return home. She could move, but her strength was depleted and dietary control was essential. Her children lived in other cities. Local officials, a welfare center and an administrative welfare center coordinated support. On discharge day, a care worker cleaned, did laundry and prepared porridge. A visiting nurse managed blood pressure and blood sugar. The welfare center provided meal kits and completed a long-term care application. Seo District helped 13 discharged patients last month. Cho Hye-won, an official at the district office, said most lived alone or had spouses with cancer. Without such services, she said, many would enter long-term care hospitals or see their conditions worsen. Satisfaction is high. An NHIS pilot project from 2019 to 2025 found patient satisfaction at 4.3 out of 5. Emergency room visits fell by up to 44 percent, and unnecessary care fell, saving about 5 million won per patient annually. Some experts say care must last longer for certain patients. Kangwon National University Hospital ran a 2023 pilot program managing discharged chronic obstructive pulmonary disease patients for one month and checking by phone thr...