• Health Policy and Management
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• v.12 no.1
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• pp.21-53
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• 2002

The purpose of this study is to measure the resource use of the elderly in long-term care services and to examine the effects of patient and facility characteristics on their use of resources. The data were collected from 510 old people over sixty years of age, residing in five long-term care hospitals and two skilled nursing homes during the period between December 1, 2000 and February 28, 2001. For a full sample, when the first level of RUG(Resource Use Group)-III categories were employed as the proxy of patient severity, facility characteristics, such as location, size and ownership, have large effects on the resource use measured by service intensity, whereas patient characteristics such as severity have little or no effect. The resource use is significantly high if the facility: (1) is located in rural areas (gun): (2) has mare than 200 beds; (3) is a long-term care hospital; (4) is private; and (5) has a low percentage of medical aid patients. The analysis of the resource use in each RUG-III categories, for which ADL(Ability of Daily Living) were employed as the prosy of patient severity, shows a similar result. The loose relationship between the needs of residents and the resource use seems to be closely associated with the ineffective reimbursement system for providers. The current reimbursement system has no provision for quality improvement and reimburses facilities simply according to their types: fee-for-service for long-term care hospitals, and monthly-flat-rate or full-coverage-national-aid for skilled nursing facilities. It will be necessary to develop a more reasonable reimbursement system that takes patient's severity into account and gives incentives for long-term care providers to offer cost-effective services.

• Research in Community and Public Health Nursing
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• v.32 no.3
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• pp.382-395
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• 2021

Purpose: The purpose of this qualitative study was to explore the transition experiences of the elderly from long-term care hospitals to their homes. Methods: The participants were eight elderly medicaid beneficiaries, who had been the subjects from the community care project in Korea. The data were collected with one-on-one interviews from April to November in 2020, and analyzed by phenomenological steps. Results: The seven themes derived in this study were 'Space to escape', 'Reliable supporter opened the way to discharge', 'Comfortable life at home', 'Obstacles to independent life', 'Struggling to live alone', 'Fence for community life', and 'Energizing in daily life' Conclusion: The results revealed the positive aspects of Community Care program in Korea. However, it is suggested that active communication between hospitals and community care institutions, and improvement of home environment to live in the community before discharge should be required. And system revision is needed to adjust activity in their home and support health problems of the elderly in the early stage of discharge. The results of this study can be referred to as the foundation of transitional care for the elderly.

• Tuberculosis and Respiratory Diseases
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• v.83 no.3
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• pp.242-247
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• 2020

Background: The purpose of this study was to evaluate the long-term survival rates of very elderly (age ≥80) critically ill patients admitted to a medical intensive care unit (MICU) at a regional tertiary-care hospital in Korea. Methods: We retrospectively analyzed data from patients who survived after discharged from the MICU of our hospital. Survival rates at 90 days, 1 year, 2 years, and 3 years were assessed between patients age ≥80 and those age <80. Survival status was evaluated using the National Health Insurance Service data. Results: A total of 468 patients were admitted, 286 (179 males, 97 females; mean age, 70.18±13.2) of whom survived and were discharged soon after their treatment. Among these patients, 69 (24.1%) were age ≥80 and 217 (75.9%) were age <80. The 90-day, 1-year, 2-year, and 3-year survival rates of patients age ≥80 were significantly lower than those in patients age <80 (50.7%, 31.9%, 15.9% and 14.5% vs. 68.3%, 54.4%, 45.6%, and 40.1%, respectively) (p<0.01). The Kaplan-Meier survival curves showed significantly lower survival rates in patients age ≥80 than in those age <80 (p=0.001). Conclusion: The poor rates of long-term survival in very elderly (age ≥80) and critically ill patients admitted to an ICU should be considered while managing and treating them.

• Korean Institute of Interior Design Journal
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• v.26 no.4
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• pp.22-29
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• 2017

This paper investigates the evaluation criteria in order to manage healing environment of long-term care elderly hospital. Elderly hospital evaluation tool developed by Korean Government is used to assess elderly hospital facilities to check the hospital facility and maintain its quality. However, the evaluation indicators and questions mainly focusing on safety indicators. Some questions are too vague for precise evaluation. In this paper, we discuss the advantages and disadvantages of the present evaluation criteria to establish new assessment tool for precise evaluation. The literature research was conducted tp set up the new evaluation criteria. From this research, we developed an elderly focusing on healing environment checklist for elderly care hospital which contains 7 factors as the primary hierarchy structure (Safety, Accessibility, Amenity, Sensibility, Friendly to nature, Territory, Interaction) and 23 factors as the secondary hierarchy structure. This evaluation criteria will help healthcare facility designers and healthcare organizations to build the healthcare facilities.

• 한국노년학
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• v.31 no.2
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• pp.371-380
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• 2011

This study was to address changes on hospital-based home care utilization after long-term care insurance(LTCI) was launched. National electronic data information(EDI) on hospital-based home care from Health Insurance Review Agency in 2007.7~2008.6(prior to LTCI) and in 2009(posterior to LTCI) was analyzed. After the launch of long-term care insurance, 40 hospital-based home health care agencies(HHCA) were diminished and regions not having any HHCA were increased from 53% to 59%. Hospital-based home care utilization was decreased in the elderly(clients 13.4%, visits 20.9%) as well as non-elderly(clients 3.5%, visits 3.9%). It is presumed that diminished HHCAs result in decreased accessibility to hospital-based home health care for non-elderly. The clients, visits, and reimbursed cost per agency were not changed. It is presumed that small agencies were closed already. The total reimbursed cost per agency in 2009 was 121,850,000 won. Results suggest that the government has to give support to open more HHCA to increase the accessibility for non-elderly. Also, hospital-based home care services utilization has to be monitoring regularly.

• Health Policy and Management
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• v.15 no.4
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• pp.136-160
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• 2005

Before introducing the national long-term care insurance in 2008, the want for long term care service has to be estimated and analysed. This study estimates the demand and analyses what determines the want of long term care service. This study investigated data of 3f6 elderlies, that was collected by age stratified random sampling. The elderies resided in Onyang 4 - dong (urban area) and Dogo-myun (rural area) In the city of Asan. The researchers visited the elderlies and their care giver, and assessed their demand for the long term care service and examined physical, mental, socio-economic status by the assessment tools for Korean Long-Term Care System. $64\%$ of the those who are entitled to be served refuse the long term care service. $26.7\%$ of them wants for home care service and $7.9\%$ want facility care service. It is estimated that the want of home care service are three or four times as much as that of facility care service. The demand for long term care service is 5.155 times higher for those who live in rural area (p=0.000), 3.040 times higher for those who do not have spouse(p=0.057), and 3.356 times higher for the people who is in medicaid than medical insurance(p=0.029). However, income(p=0.782), means(p=0.614), living alone(p=0.223), number of family to live with (p=0.341) and age of the elderly(p=0.420) are not related with the demand of long term care service. The assessment tools for Korean Long-Term Care System for need evaluation of the long term care service can reflect the demand well.(p=0.024) If medical care will cover $80\%$ of total cost, the willingness to pay of the out of pocket money of the people with medical insurance is 67,400 Korean Won(66.77 US$) for the home care service and 182,500 Korean Won(180.78 US$) for the facility care service. There is possibility that long term care demand is still small after Introducing the long term care Insurance due to the care given by family members. When developing service delivery system of long term care insurance, rural area has to be given more consideration than urban area because of the higher demand. The people who do not have spouse or are in medicaid have to be given special consideration as well.

• Journal of the Korean Data and Information Science Society
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• v.27 no.3
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• pp.773-789
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• 2016

This study was conducted to identify the sleep patterns and influencing factors of hospitalized elderly in a long-term care hospital. The sleep patterns of 142 subjects were recorded using Sleep Charts. The average sleep time of subjects was 10.7 hours a day (3.9 hours in daytime and 6.8 hours in nighttime). Sleep regularity among participants were 71.7% in all day (58.1% in day time and 80.5% in night time). The presence of dementia patients in the room (PDPR) has been identified to be a statistically significant predictor of all day sleep, and pain, PDPR, and physical function have been found to be a significant predictors of sleep regularity in all day among subjects. It suggested that elderly patients in a long-term care hospital do not slept well during night, which leads to increase in daytime sleep and decrease the quality of their sleep. Therefore, an intervention program should be developed to promote the quality of sleep among hospitalized elderly.

• Health Policy and Management
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• v.22 no.2
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• pp.183-206
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• 2012

Changing social conditions have resulted in a situation where elderly patients are no longer cared for by family and where medical care hospitals play a more prominent role. In this study, the unique elements of the medical service required from a long term care hospital were identified using conventional and exploratory analysis, and the causal relationship between medical service quality, relationship quality, and Revist intent was confirmed. The intermediary role and the quantitative importance of relationship quality (including trust and commitment) were also characterized. This study identifies the key points and indicators that the administrators of a long term care hospital can use to effectively plan their medical service offering in order to secure the commitment of customers through relationship quality. The theoretical indications of this study are set out below. First, four factors are selected as being the key elements determining service quality: medics, administrative service, healthcare environment, and subsidiary facilities. Second, it seems that medics, administration service, and the healthcare environment have some effect on the evaluations made in relation to trust and satisfaction (subsidiary facilities are not considered to be a key element). Third, patient satisfaction has a positive impact on trust and commitment and can be regarded as a key element for establishing connections. Fourth, commitment is likely to be strengthened when trust is significant. Fifth, as trust and commitment increase, revist intent strengthens. Lastly, this study illustrates how the levels of trust and commitment play a modulating role between patient satisfaction and revist intention. There are many practical indications from the findings of this study. First, the influences of medics, the administrative service, and the healthcare environment on trust and satisfaction vary. Especially, the healthcare environment is likely to be more important than medics. Accordingly, it is essential to establish an elderly-friendly environment, to improve a hospital's structure, and to maintain a clean environment. Second, medics must show compassion to their patients and be patient when providing explanations to elderly patients who often lack powers of concentration. Third, in order to establish patient trust, it is essential that medics provide an excellent medical service. Ultimately, these elements of relationship quality may strengthen the revist intention of elderly patients.

• Journal of Korean Academy of Nursing Administration
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• v.21 no.2
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• pp.174-183
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• 2015

Purpose: This study was conducted to explore the impact of nurse staffing level and oral care on pneumonia in elderly inpatients in long-term care hospitals (LTCHs). Methods: Data were obtained from the Health Insurance Review and Assessment Services (HIRA) including the profiles of LTCHs, monthly patient assessment reports and medical report survey data of pneumonia patients by HIRA in the fourth quarter of 2010. The sample consisted of 37 LTCHs and 6,593 patients. Results: Patient per nurse staff (OR=1.43, CI=1.22~1.68) and no oral care (OR=1.29, CI=1.01~1.64) were significantly related with hospital acquired pneumonia. The difference in percent of oral care by hospital was not significant between high and low group in nurse staffing level. Conclusion: In order to reduce the occurrence of pneumonia in eldery patients, effective nursing interventions are not only required but also nurse staffing levels that enable nurses to provide the intervention.

• Journal of the Health Care and Life Science
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• v.11 no.2
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• pp.351-360
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• 2023

2018 aged patient dataset (HIRA-APS), 33,821 patients admitted to long-term care hospitals were classified by major disease groups to identify the characteristics of medical use and provide effective policy data. First, it is necessary to operate specialized long-term care hospitals such as dementia, rehabilitation, hospice, and recovery specialization tailored to the characteristics of the patient's disease group. Second, the paralysis group, cerebrovascular disease group, and dementia group were the longest LOS and the cognitive impairment group is the longest by patient classification group, requiring medical demand and quality management for long-term patients. Third, the musculoskeletal disease group was the highest normal discharge, and support for the post-discharge home program is required in paralysis and cerebrovascular disease.