Social Work Perspective: Comparing Korean Social Workers' Education and Knowledge of Advance Directives

Abstract

Korean Elderly Patients and their Family Caregivers in Long Term Care SettingsThe proportion of older persons in South Korea is gradually growing. In 2000, the elderly population rate was 7.22% of the total Korean population, and it is gradually increasing, up 12.22% in 2014 (Organization Economic Cooperation Development: OECD 2014). Also, the life expectancy of the Korean population is reaching 79 years for men, and 85.5 years for women in 2014 (Korean Statistical Information Service: KOSIS 2015). According to the World Health Organization (WHO 2014a), the highest life expectancy at age 60 in 2013 was recorded in the North American region by 23 years and the lowest record was in South-East Asia region by 17 years. To compare with Europe and West Pacific regions, the life expectancy age at 60 of South Korea was recorded by 24 years. Among three East Asian countries-China, Japan and Korea-China was recorded with the lowest life expectancy at age 60 by 19 years and Japan was the highest record by 26 years.Korean elderly are enjoying extended longevity and living longer than ever before. However, they have remained about 13 to 19 years with 2-3 functional needs for activities of daily living (ADL), depending on long-term care services as well as multiple medical cares (Korean Statistics 2015). 89.2% of Korean elderly patients were diagnosed with non-communicable diseases (NCDs) with cancer accounting for most of the total deaths from NCDs (WHO 2014b). These indications for elderly patients are leading them to have more "personal care" components that are frequently provided in combination with care and basic medical services such as nursing care (wound dressing, pain management, medication, health monitoring), as well as prevention, rehabilitation, and hospice and palliative care (OECD 2013).They have also benefitted from full national health care insurance coverage, financed by universal health care insurance established in 1988. Also they have benefitted from a newly-extended national long-term care (LTC) insurance that is financing a full coverage of LTC services with only a less-than-20-percent co-payment regardless of income and properties (National Health Insurance Service: NHIS 2014). LTC benefits include a range of services which were requested by persons with a reduced degree of functional capacity, physical or cognitive, and who are consequently dependent for an extended period of time on help with basic ADL. The Act on LTC Insurance for Senior Citizens was passed unanimously in the Assembly's plenary session on Apr. 2, 2007 and enacted on Apr. 27; it was enforced as of Jul. 1, 2008. This is a type of social insurance is based on the principle of social solidarity. The nation and society agreed to share the responsibility for LTC and nursing care for senior citizens with Alzheimer's disease or stroke instead of leaving the entire burden on their families. The LTC benefit covers health expenses for LTC institutional facilities over six months. On the contrary, the Medicare plan only covers a very short period of LTC services for skilled nursing facility and home care services in the U.S. It offers very limited coverage for LTC institutional services based upon insurers' income and properties (Center for Medicare & Medicaid Service: CMS 2015).The geriatric hospital is a health institution intended to provide longterm acute care services, financed by NHIS to provide medical and nursing care in case of diseases, injuries, rehabilitation, and nursing etc., for elderly patients who do not have acute conditions. The duration of their hospitalization is longer than in an acute hospital, and their discharge is often delayed for several reasons. In 2014, the ratio of geriatric hospital expenses increased almost 18.8% compared with the 2013 expenses, including doctor's visits and other medical expenses (NHIS 2014). Table 1 shows the increasing ratio of health expenses for the geriatric hospital from 2008 to 2014. …