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Phys. Ther. Korea 2022; 29(2): 94-105

Published online May 20, 2022

https://doi.org/10.12674/ptk.2022.29.2.94

© Korean Research Society of Physical Therapy

한국과 일본의 노인 대상 지역사회 재활서비스 비교 연구: 노인장기요양보험 제도를 중심으로

이민영

국립재활원 재활연구소 건강보건연구과

Comparison of Community Rehabilitation Services for the Elderly in South Korea and Japan: Focusing on the Long-Term Care Insurance System

Minyoung Lee , PT, PhD

Department of Healthcare and Public Health Research, National Rehabilitation Research Institute, Ministry of Health and Welfare, Seoul, Korea

Correspondence to: Minyoung Lee
E-mail: wharen88@gmail.com
https://orcid.org/0000-0003-4500-4518

Received: April 5, 2022; Revised: April 22, 2022; Accepted: April 22, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: As South Korea enters an aged society, the government has emphasized the need for a soft landing of the older adults into the community after the acute and recovery periods under a national policy of “community care.” However, the institutionalization of community rehabilitation services to implement this is insufficient. Japan had already entered an aged society when the Long-Term Care Insurance System was introduced in 2000. Thus, the case of Japan’s institutionalization of the system is expected to have implications for us in supplementing a suitable system for the aged society. Objects: This study compared the institutionalization process of the Long-Term Care Insurance System in South Korea and Japan and the services currently being implemented in each country.
Methods: To examine the institutionalization process and services of the system, related legal rules and regulations, government reports, and articles were reviewed. To examine the operation status of the system, statistical data provided by each country’s government were analyzed.
Results: Japan recognized the importance of community rehabilitation even before the enactment of Long-Term Care Insurance. Thus, community rehabilitation services, such as homevisit rehabilitation and health facilities, were already stipulated in the law. Under such institutional legacy, Long-Term Care Insurance was able to establish a service system, which balanced welfare and health-related services, including various types of services with enhanced rehabilitation functions. In South Korea, rehabilitation policies were not much considered in the process of institutionalizing the system; thus, it was composed mainly of services focusing on care and recuperation.
Conclusion: In order to realize community care, rehabilitation services need to be developed in Long-Term Care Insurance System in various forms such as home-visit services, daily services, short stay, and facility services.

Keywords: Community care, Community rehabilitation, Long-Term Care Insurance, Outpatient rehabilitation, Visiting rehabilitation

Article

Original Article

Phys. Ther. Korea 2022; 29(2): 94-105

Published online May 20, 2022 https://doi.org/10.12674/ptk.2022.29.2.94

Copyright © Korean Research Society of Physical Therapy.

한국과 일본의 노인 대상 지역사회 재활서비스 비교 연구: 노인장기요양보험 제도를 중심으로

이민영

국립재활원 재활연구소 건강보건연구과

Received: April 5, 2022; Revised: April 22, 2022; Accepted: April 22, 2022

Comparison of Community Rehabilitation Services for the Elderly in South Korea and Japan: Focusing on the Long-Term Care Insurance System

Minyoung Lee , PT, PhD

Department of Healthcare and Public Health Research, National Rehabilitation Research Institute, Ministry of Health and Welfare, Seoul, Korea

Correspondence to:Minyoung Lee
E-mail: wharen88@gmail.com
https://orcid.org/0000-0003-4500-4518

Received: April 5, 2022; Revised: April 22, 2022; Accepted: April 22, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: As South Korea enters an aged society, the government has emphasized the need for a soft landing of the older adults into the community after the acute and recovery periods under a national policy of “community care.” However, the institutionalization of community rehabilitation services to implement this is insufficient. Japan had already entered an aged society when the Long-Term Care Insurance System was introduced in 2000. Thus, the case of Japan’s institutionalization of the system is expected to have implications for us in supplementing a suitable system for the aged society. Objects: This study compared the institutionalization process of the Long-Term Care Insurance System in South Korea and Japan and the services currently being implemented in each country.
Methods: To examine the institutionalization process and services of the system, related legal rules and regulations, government reports, and articles were reviewed. To examine the operation status of the system, statistical data provided by each country’s government were analyzed.
Results: Japan recognized the importance of community rehabilitation even before the enactment of Long-Term Care Insurance. Thus, community rehabilitation services, such as homevisit rehabilitation and health facilities, were already stipulated in the law. Under such institutional legacy, Long-Term Care Insurance was able to establish a service system, which balanced welfare and health-related services, including various types of services with enhanced rehabilitation functions. In South Korea, rehabilitation policies were not much considered in the process of institutionalizing the system; thus, it was composed mainly of services focusing on care and recuperation.
Conclusion: In order to realize community care, rehabilitation services need to be developed in Long-Term Care Insurance System in various forms such as home-visit services, daily services, short stay, and facility services.

Keywords: Community care, Community rehabilitation, Long-Term Care Insurance, Outpatient rehabilitation, Visiting rehabilitation

Table 1 . Types of long-term care or support required in Japan.

TypeIndicative condition (during 48 h)a
Support Required 1The person can rise, walk, and perform most other essential daily life activities by himself/herself. However, the person needs some support for task-based activities in daily life, including cooking, shopping and taking oral medicine (25 ≤ min < 32).
Support Required 2The person’s ability to handle task-based activities in daily life is slightly lower than that of individuals in the Support Required 1 category, and he/she needs more support (32 ≤ min < 50).
Care Level 1The person faces difficulty in performing essential daily life activities by himself/herself. The person’s ability to handle task-based activities in daily life is lower than that of individuals in the Support Required 2 category (32 ≤ min < 50).
Care Level 2The person is in a state similar to that detailed under Care Level 1, but requires more care to be able to perform essential daily life activities (50 ≤ min < 70).
Care Level 3Compared with state of Care Level 2, the person’s abilities to perform essential daily life activities and task-based activities are significantly lower. As a result, he/she requires almost constant care (70 ≤ min < 90).
Care Level 4The person is in a state similar to that detailed under Care Level 3, but his/her ability to act is lower. As a result, he/she faces difficulty living without constant care (90 ≤ min < 110).
Care Level 5The person’s ability to act is even lower than that of individuals in the Care Level 4 category. As a result, he/she requires almost constant care to live (min ≤ 110).

aStandard hour of need for long-term care was obtained through tree analysis using the results of 74 long-term care accreditation items to evaluate a person’s mental and physical condition. Adapted from ‘Guidebook for long-term care insurance’ of Shinjuku City Long-Term Care Insurance Division (2018) [26]..


Table 2 . Types of long-term care or support required in South Korea.

TypeIndicative conditiona
Care Level 1A condition in which the person required help in all aspects of daily life (score > 95)
Care Level 2A condition in which the person required help in most parts of daily life (75 ≤ score < 95)
Care Level 3A condition in which the person required help in parts of daily life (60 ≤ score < 75)
Care Level 4A condition in which the person required help in small parts of daily life (51 ≤ score < 60)
Care Level 5Dementia (45 ≤ score < 51)
Cognitive Support LevelDementia (45 < score)

aLong-term care accreditation score was obtained through tree analysis using the results of 52 long-term care accreditation items to evaluate a person’s mental and physical condition. Adapted from ‘Enforcement decree of the long-term care insurance act’ of Ministry of Health and Welfare (2021) [28]..


Table 3 . Long-Term Care Insurance System of Japan and its operation status.

CategoryLong-term care serviceFacilityUser
(1,000)
Service expensed
In-home
servicea
Home-visit service• Home-visit long-term care33,1761,456.79.1
• Home-visit bathing long-term care1,770123.00.5
• Home-visit nursing11,795701.02.6
• Home-visit rehabilitation4,614153.60.4
• Guidance for management of in-home medical care39,1231,053.51.1
Daily service• Outpatient day long-term care (day service)23,8811,604.512.5
• Outpatient rehabilitation (day care)7,920621.84.1
Short stay• Short-term admission for daily life long-term care10,615739.14.3
• Short-term admission for recuperation3,781152.90.6
• Daily life long-term care admitted to a specified facility5,550280.65.4
• Rental service of equipment for long-term care covered by public aid7,1132,413.13.0
Facility servicea• Long-term care welfare facility for the elderly (Special nursing home for the elderly)8,057690.718.6
• Long-term care health facility4,285566.213.2
• Sanatorium medical facility for the elderly requiring long-term carec91273.02.0
• Integrated facility for medical and long-term care14512.40.2
Community-
based
serviceb
• Regular visiting/on demand home-visit long-term/nursing care94636.80.5
• Home visit at night for long-term care17212.60.0
• Community-based outpatient day long-term care19,452596.84.1
• Outpatient long-term care of dementia patients3,43982.70.9
• Multifunctional long-term care in a small group home5,648143.22.5
• Communal daily long-term care for dementia patients (group home)13,904257.46.9
• Daily life long-term care for people admitted to a community-based specified facility35010.40.2
• Daily life long-term care for people admitted to a special nursing home2,34475.72.1
• Combined multiple Service62718.10.3

Values are presented as number only or percent. Bold text means services that require rehabilitation professionals as a manpower condition. aServices designated and supervised by prefectures, ordinance-designated cities, and core cities. bServices designated and supervised by municipalities. cServices decided to be abolished by the 2017 Long-Term Care Insurance Act revision, but there are exceptions, the number of facilities and users remaining until 2035. dOf the total service expenses, the expenses related to preventive long-term care, the expenses related to the care management as well as the expenses paid by municipalities, were not included. Adapted from ‘Actual statistics such as long-term care benefits expenses in 2018–2019’ of Ministry of Health, Labor and Welfare (2019) [40]..


Table 4 . Long-Term Care Insurance System of South Korea and its operation status.

CategoryLong-term care serviceFacilityUser (1,000)Service
expensea
In-home serviceHome-visit service• Home-visit long-term care12,243409.538.5
• Home-visit bathing long-term care4,76081.31.5
• Home-visit nursing55215.70.3
• Day and night care4,018116.513.4
• Short stay1393.90.1
• Equipment for long-term care1,532338.42.2
Facility service• Long-term care facility (nursing home for the elderly)3,725199.140.1
• Elderly group home2,14123.03.9

Values are presented as number only or percent. Bold text means services that require rehabilitation professionals as a manpower condition. aOf the total service expenses, the expenses for special cash benefits are excluded. Modified from ‘Long-term care insurance statistics’ of Statistics Korea (2019) [43]..