Long-term Care Hospitals and Changing Elderly Care in South Korea

Seonsam Na

doi:10.17157/mat.8.3.5084

Abstract

Until recently in South Korea, the central dilemma facing children with ageing parents was how and by whom their parents should be cared for. In accordance with the norm of filial piety, the eldest son used to take responsibility. However, with the recent proliferation of long-term care hospitals, this arrangement is changing. These institutions, which play the combined role of rehabilitative hospital, long-term care centre, and nursing home, admit elderly people who do not require active medical intervention. The government’s promotion of these hospitals, centred on deregulation, ambiguity around their function, and the lack of alternative care facilities, has led to an expansion of the sector and consequently to the ‘nursing hom(e)fication’ of many of these institutions. While these hospitals ease the pressures associated with an ageing population, their mainstreaming has had an impact on healthcare, medicine, and the lives of elderly people. The hospital field has become commercialised, medical practice is being transformed, and the dignity of elderly people is being lost through hospitalisation. In this new care regime, filial piety itself is undergoing transformation—from an ideology underpinning the domestication of care, to the market idiom of service compliance. In this article, I introduce these hospitals and investigate how their growth has brought about a Korean style of elderly care commodification, revealing the undercurrents of healthcare privatisation and the neoliberalisation of welfare.

Highlights

Population ageing is a global phenomenon, as is the commodification of elderly care attendant upon it (Buch 2015; Aulenbacher et al 2018)
In relation to the trajectories leading to care commodification, differences exist among countries: in advanced economies where the welfare state is well established, commodification followed neoliberal reforms marked by privatisation, decentralisation, and the retrenchment of the welfare state (McGregor 2001; Da Roit and de Klerk 2014); in societies where welfare provision for elderly people is not fully established, commodification emerged as a surrogate measure aimed at unburdening the state of its welfare responsibilities while allowing adult children to continue to work and contribute to the country’s economic development (Coe 2017; Leung, Lam, and Liang 2020)
The details reported may not reflect the ‘typical’ ways in which patients are cared for, but they give an insight into the conditions under which elderly people are cared for in a hospital environment. In this particular LCH, which I call Hospital K, I worked for ten months as one of nine full-time physicians, charged with the Korean medicine-based care of about 80 patients

Summary

Introduction

Population ageing is a global phenomenon, as is the commodification of elderly care attendant upon it (Buch 2015; Aulenbacher et al 2018). Competition between LCHs, combined with an influx of profit-seeking actors, led to the proliferation of illegal practices aimed at cost-reduction and patient recruitment—both of which had been reasonably well controlled when the hospital sector was populated only by medics and religious organisations These practices included faking the number of medical personnel in order to receive a higher hospital grade, providing discounts on fees, and cutting back on subsidised meal expenses. On one occasion I even observed a nurse assistant insert a feeding tube into a patient—a procedure usually performed by physicians and permitted to nurses only in limited circumstances (Cho and Kim 2016, 392)—breaching what social anthropologist William Caudill (1958, 7) termed ‘the mobility block’, or the blocking of performing roles that cross professional boundaries in hospitals These cases demonstrate that by participating in the LCH regime the Korean medical profession has traded its authority, the quintessential symbol of medical power (Freidson 1988), for financial gain. These cases corroborate the claim that biomedical practice manifests in different ways, according to the local contexts in which it functions

Living and dying in hospital

Findings

Filial piety reconfigured