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Country of Dementia: Problems Around the Korean Dementia Welfare System

As the term “Country of Dementia” is coined in Korea, Koreans have started to worry more about dementia. Unlike in the past, when dementia was a disease that many of us knew only from movies or novels, it is now something that we experience in our everyday lives far more. A lot of people including patients and their families are suffering from dementia and its impacts. To solve this problem, the government announced that it would enforce a Plan for the National Responsibility for Dementia. In this regard, the Sungkyun Times (SKT) explains the dementia problem in Korea, the weak points of the dementia welfare system, and the desirable direction of the new policy referring to foreign countries.

Dementia in Korea

What is Dementia?

Dementia is a kind of symptom causing disabilities in cognitive function, which triggers difficulties in maintaining normal daily life. It stems from a broad category of brain diseases, not a certain disease. There are many kinds of dementia, and Alzheimer’s disease, which accounts for more than half of all dementia patients, is the most common and well-known type. Besides this, dementia is sometimes accompanied with aging or illnesses like hydrocephalus and Parkinson’s disease. People with dementia get cognitive dysfunction and frontal lobe dysfunction. Therefore, they cannot live their life as normally as they did before. Some patients, for instance, have a defective memory and show aggressive behavior. This means that dementia patients acutely need others’ help.

Present Condition of Dementia in Korea

Dementia is now causing a lot of problems around the world. Especially in Korea, the situation is serious since Korea is moving toward an aging society more rapidly than other countries. In fact, according to the National Institute of Dementia (NID), the number of dementia patients was about 690,000 last year. In addition, those family members who take care of patients amount to 2.7 million. The Ministry of Health and Welfare announced that the number of patients has increased so exponentially that it would reach one million by 2024, and two million by 2041.

It takes a large expense to solve the dementia problem. According to the NID, ₩2,000 is used for attending one patient, and the sum of the whole cost is ₩13.2 trillion a year. Moreover, the psychological burden of the supporters makes the problem worse.

In fact, it has even been the case where several caregivers have murdered their family member who had dementia and then committed suicide themselves, in order to ease everyone’s suffering. Recognizing the gravity of the situation, the government declared “a war against dementia” in 2008 and enacted the Dementia Management Act in 2012. It, however, failed to achieve its goal to manage dementia. As a result, the number of people suffering from dementia has become much bigger as time has gone by. Weak Points of Korean Dementia Welfare System Lack of Promotion of an Early Diagnosis System for Dementia For a long time, Koreans have not known an early diagnosis system for dementia. Setting up the National Dementia Plans several times, the government tried to prevent and implement an early diagnosis of dementia, but it failed because they did not promote the system enough. The government’s policy was to allow those aged 60 or more to receive dementia diagnosis for free at public health centers. According to the 3rd National Dementia Plan, however, it only caught one-fifth of the whole dementia prevalence rate. This is because the system was unknown to the elderly, who are the majority of the dementia patients. In fact, a statistic from the Korean Senior Citizens Association showed that 65.7% of 1,444 elderly people were not aware of the system. This is very problematic considering that the earlier dementia is found, the easier it can be treated. Drug treatment that slows the progression of dementia is much more effective as soon as it starts, and accordingly the cure rate tends to increase. This lack of promotion of the early diagnosis system for dementia naturally leads to an increase in social cost. Therefore, in order to reduce the social cost including the worsening health of dementia patients and suffering of their caregivers, it is necessary to actively promote the early dementia diagnosis system.

Weak Points of Korean Dementia Welfare System

Lack of Promotion of an Early Diagnosis System for Dementia

For a long time, Koreans have not known an early diagnosis system for dementia. Setting up the National Dementia Plans several times, the government tried to prevent and implement an early diagnosis of dementia, but it failed because they did not promote the system enough. The government’s policy was to allow those aged 60 or more to receive dementia diagnosis for free at public health centers. According to the 3rd National Dementia Plan, however, it only caught one-fifth of the whole dementia prevalence rate. This is because the system was unknown to the elderly, who are the majority of the dementia patients. In fact, a statistic from the Korean Senior Citizens Association showed that 65.7% of 1,444 elderly people were not aware of the system. This is very problematic considering that the earlier dementia is found, the easier it can be treated. Drug treatment that slows the progression of dementia is much more effective as soon as it starts, and accordingly the cure rate tends to increase. This lack of promotion of the early diagnosis system for dementia naturally leads to an increase in social cost. Therefore, in order to reduce the social cost including the worsening health of dementia patients and suffering of their caregivers, it is necessary to actively promote the early dementia diagnosis system.

Lack of Financial Support by the Government

Until now, Korea has lacked financial support from the government, which is used for treating and nursing dementia patients. The National Health Insurance Service is operating Long-term Care Insurance, but it cannot completely relieve the financial problem. According to the 3rd National Dementia Plan, the subsidy for dementia is only ₩96,000 per patient each year, which is ₩8,000 a month. Moreover, this is mainly used for the treatment of dementia, and there are almost no subsidies for nursing care. Although Long-term Care Insurance started a 24hour visiting service for nursing care for those who are judged as first or second grade dementia patients, they are only available for six days a year and there are few users.

Consequently, the expense for nursing the patients was solely deemed to be an individual’s responsibility. A statistic in 2012 by the Korean Dementia Association showed that 78% of the supporters quit their jobs or reduced working hours to care for patients in their family. In other words, they gave up at least two working hours a day, and 15 working hours a week for nursing care on average. This means that if one of the family members has dementia, caregivers will experience a great loss financially. Considering that an early diagnosis system for dementia is not provided properly, they are likely to fall into poverty, and will be unable to prepare for the support of dementia patients. Thus, it is necessary to financially support the patients with dementia including the provision of nursing care costs.

Low Quality of Dementia Welfare Service

Poor local infrastructure for managing dementia has reduced the quality of welfare services nationwide. Dementia is not a “profitable disease” like cancers and diabetes, which makes professional manpower aviod this field. This manpower shortage can be a direct cause that hinders the establishment of agencies related to dementia. According to the NID, the number of workers at the Center for Dementia is only 58, and they are located in Seoul. In addition, the amount of public specialized dementia hospitals is 79 nationwide.

Even if there are several agencies with dementia in one region, it is unclear whether the welfare services are well provided. The shortage of workforce inevitably results in poor working environments, causing a low quality of services. According to the NID and Chungcheongbuk-do council, in Chungcheongbuk-do, one dementia consultant had to treat 889.1 patients aged 65 or older on average in 2015. Furthermore, the number of the patients aged 65 or older who need care is 1,914.9 per staff in charge. In addition, the current education for training dementia specialists is hindering the replenishment of a necessary workforce. Lee Jae-Jeong, a researcher of Busan Social Welfare Development Institute, said that in Longterm Care Insurance, dementia is classified as a special management rate, which is divided into five grades, but the poorly educated dementia specialists cannot support the insurance. Therefore, this actually leads to the decline of welfare service quality.

Desirable Direction of Korean Dementia Welfare System

Korea does not have an effective system to deal with the dementia problem. It is desirable to reform the system, referring to foreign countries such as Germany and Japan that have developed their dementia welfare systems for a long time.

Role Models of Dementia Welfare Systems

■Germany

In comparison with Korea, the most noticeable difference is that most Germans are aware of the dementia diagnosis system. Those who are suspected of dementia voluntarily visit hospitals, and they are diagnosed through an interview, computed tomography (CT), and magnetic resonance imaging (MRI). In particular, Germany has over 100 memory clinics nationwide where they treat memory impairment for dementia patients. Lutz Fröhlich, a professor at Mannheim University, said that the clinics have treated one-third of all patients there for the long term. They provide patients and their families with adequate counseling. After that, they assess prior treatment and give additional advice when revisiting. Here, it is quite remarkable that there is a clear range of support for the patients. There are two main types of support. One is a medical care system which provides medical care to the patients. The other is a social support system that provides support for nursing through counseling with social workers.

■Japan

The aging pattern of Japan is characterized by a severe aging of an urban area, and the elderly with dementia has increased. This is similar to that of Korea. In Japan, however, financial support for dementia, especially for nursing care, is provided steadily. The country already implemented public nursing care insurance in the year 2000. Through the insurance, the elderly with dementia can independently live in the area where they have been living as before. People who need to care for dementia patients in their family members are allowed to take leave of absence for up to 93 days and are provided with 40% of their wages. Moreover, there are dementia management training programs for doctors and nurses in hospitals, which is to nurture professional manpower. The Japanese government has estimated that 87,000 people will participate in the programs until the end of this year.

New Solution in Korea: Plan for National Responsibility for Dementia

The new Korean government will implement the Plan for National Responsibility for Dementia to solve the rapidly growing problem of dementia. This is a change in the paradigm of dementia management. It means that the government will take away some of the financial and psychological burden caused by dementia, which were only the patients and their supporters’ area before. According to the government, if the plan is implemented, Centers for Dementia will be rebuilt as Dementia Safe Centers, and the number of these will increase by up to 252. In addition, Dementia Safe Hospitals and hospitals specializing in dementia patients are going to be established. The number of experts placed in each institution will be doubled from around 10 to 20. Every institution has to make plans for a comprehensive medical welfare service for dementia patients and caregivers. It should also conduct educating programs to prevent dementia and improve awareness of dementia and proceed with a project for early dementia diagnosis. Furthermore, by lowering the medical cost for patients with severe dementia to 10%, more sophisticated care for diseases such as cancers or diabetes will be possible.

The government announced that it will allocate ₩200 billion to the budget for dementia. The Plan for National Responsibility for Dementia is expected to solve the weak points above, and the problem of nursing care cost in particular. There is, however, still more to supplement. First of all, how to increase the number of professionals in the current situation where there is no improvement of education related to it is still an issue. To solve this problem, it will be helpful not only to train new professionals but to retrain existing personnel like they do in Japan. Furthermore, the function and role of each institution is not specified enough, so it is likely to confuse the infrastructure construction. Like Germany, it is necessary to clearly distinguish roles of institutions such as with memory clinics. Moreover, the biggest challenge is where to find the money in order to implement the plan. Since this leads to inevitable increase in taxation, it is essential to form a national consensus.

Dementia sufferers are no longer unfamiliar people. They are our family, friends, or neighbors. Of course, there have been some welfare systems for caring for dementia. However, it was certain that these systems have not been enough to work well in Korean society, because they did not reflect the actual situations of dementia patients. This means not only the government but also society has ignored the cries of help of those who are suffering from dementia. It is time to listen to them and from now on, Korea should try to get rid of the holes in the welfare system for dementia and start reforming it.

이수연  pim545@naver.com

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