Abstract
South Korea is now one of the most rapidly aging societies in the world and meeting the elderly’s needs requires a systemic and paradigm change. In this study I argue that community-based care of the elderly in the community should be seen as complementary to, and arguably more fundamental than, enhancing long-term care services per se. Based on qualitative interviews and observations, this paper presents a case study of Silver Wings, the community-based initiative of local non-governmental organization (NGO) Saerom to provide older people’s self-help groups with support from HelpAge Korea. The study analyzes the activities and capacities of local NGOs in promoting “aging-in-community” and the findings suggest that such initiatives can certainly contribute to improving well-being and also to reducing long-term care needs. Lessons and challenges of the initiative, as well as policy suggestions, are also discussed.
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Notes
As of 2015, those aged 80 and above represented only about 2.8% of the total population and 21.2% of the older population (65+). These proportions, however, are projected to grow rapidly and to account for 14% of the total population and nearly 40% of the older population in 2040 (He et al. 2016, 138, Table B-1).
Most of the early baby boomer generation in Korea, born between 1955 and 1963 after the Korean War (1950–1953), started retiring from 2016.
The Welfare of the Aged Act was enacted in 1981 but was mainly targeted at poor and needy elderly.
Korea’s aggregate public social expenditure was only about 10% of GDP in 2014, which was lower than half of the OECD average of 21.6% (OECD Social Expenditure Data, accessed October 25, 2015).
While only 2.5% of the total population receive public assistance (Basic Livelihood or BL benefits), about 6% of older population aged 65 and over receive such assistance, accounting for about a third of the BL beneficiaries. Two-thirds of them are women (Statistics Korea, KOSIS, accessed November 27, 2015; see Yang 2016a, for overall status of older persons in Korea today).
There are currently 344 public welfare centers for seniors nationwide, of which 74 are located in Seoul and 52 in Gyeonggi province.
There are about 64,000 senior citizens’ halls across the nation, about 20% of which are located in Seoul and Gyeonggi province. Proportionally larger numbers of senior citizens’ halls can be found in rural areas (MoHW 2015: 10). The reason behind the underuse of these halls is beyond the scope of the current study but is worth future research.
The 2012 reform expanded the number of categories for eligibility from 1 [critical, the highest benefit levels] to 3 [moderate, the lowest benefit levels], to currently 5, and that dementia was now included as a criterion. In 2010 for example, the actual beneficiaries stayed as low as at 5.7% among women (or 4.6% in total including men).
In the early 2000s and before the introduction of the LTCI, only a very small proportion of the poorest elderly were eligible to use care services provided under the National Basic Livelihood Security Law (domiciliary and nursing home services) (Sunwoo 2004).
The coverage and eligibility, as well as benefit levels for successful applicants, are low and less generous compared to other countries such as Japan and Germany, which both offer long-term care services under comparable insurance schemes. LTCI beneficiaries accounted for 14.5% of Germany’s older population and 18.5% of that of Japan in 2011. The average in other OECD countries was 11% (cited in Chon 2014). Meanwhile, co-payment by beneficiaries in Korea remains relatively high at 15% (domiciliary services) or 20% (institutional services) of the total LTC costs, compared to only 10% for both services in Japan (Chon 2014, 708).
Basic livelihood income support in Korea is provided to those whose income is below 30% of the median income of the total population. Medicare, housing, and education allowances have higher thresholds, i.e. 40%, 43% and 50% below median income, respectively (Homepage of the Ministry of Health and Welfare, Korea, accessed on 17 Apr 2017). This criterion of relative poverty was introduced in July 2015, replacing the older market basket method of basic necessities.
Youth unemployment rate in Korea is still low (10.7%) compared to other OECD countries’ (average of 13%) but it records an increase over the last four consecutive years unlike the majority OECD countries showing a declining trend (OECD data, accessed April 17, 2017).
Lim (1999, 2001) published a series of studies regarding the historical development of community care in Korea, but his concept and approach remain closer to “aging in place” than to “aging in community”, by focusing on the kinds of care services available and useful for communities rather than on human relations and networks.
The use of the term “self-help” in the HAK initiative could be misleading, as its readers might expect financial independence and sustainability for individual participants in the elderly group, or to result from the elderly group’s management and activities (or indeed both). This, however, turns out to be nowhere close to the meaning of the English term.
This is recognized as one of the most disastrous accidents in the nation in recent times. When the Sewol Ferry sank in April 2014, about 300 out of 476 passengers, mostly high school teenagers, drowned due to a combination of the ferry owner’s greed, irresponsible crew members and the incompetent government and coast guards who oversaw the rescue operation. More shocking was the Social Networking Services’ (SNS) broadcast of the actual sinking of the ferry for over two hours and the following three days’ rescue process, the so-called “golden time” for rescue, but which turned out to be useless. One year later, the captain was sentenced to life imprisonment, while a Special Investigatory Committee on the SEWOL Ferry Disaster was established under the terms of a Special Probe Law enacted in November 2014. The ferry was finally raised from the water three years after sinking while investigations are still ongoing at the time of writing.
A city in Gyungsangnam-do, far south-eastern province, where extra high voltage power transmission towers have been planned but delayed since the mid-2000s due to strong opposition from the villagers living on the intended site. Disagreement between the villagers and the Korea Electric Power Corporation on the need for the tower construction and possible damage caused by the construction and maintenance of a new nuclear power plant nearby (which the power towers were meant to support) raised questions ranging from development to democracy. At least two villagers who opposed the plan killed themselves in protest, and many other villagers and citizen-supporters were injured and fined for their opposition. The issue remains unresolved and under debate at the time of writing.
Korean NGOs can apply for government funding but it is often based on competitive bidding. Currently, there are not many NGOs whose activities are targeted at senior citizens and in fact those HAK-sponsored activities (including Silver Wings) turn out to be partial, not a major, activity of the NGOs concerned.
I dealt with this issue extensively elsewhere (see Yang 2016b).
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Acknowledgements
I would like to thank senior members of Silver Wings and every staff of Saerom, who were willing to spend time with me for the research. I also thank Mr. Cho Hyun-Se, President of HelpAge Korea, who accepted cheerfully my idea of assessing their initiative and kindly arranged for my visits and interviews with the selected case communities. This research was permitted by the HUFS Institutional Review Board (HIRB-201512-HR-004) and this is a revision of the paper presented at the International Conference on Long-term Care for Elderly in ASEAN plus Three: Research and Policy Challenges, organized by the Asia Research Institute, National University of Singapore, 1-2 March 2016, which I was invited to take part in. This revision benefited from helpful comments by Leng Leng Thang and two anonymous reviewers. It is also supported by a research fund of the Hankuk University of Foreign Studies.
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Yang, Y. The Role of NGOs in Enabling Elderly Activity and Care in the Community: a Case Study of Silver Wings in South Korea. J Cross Cult Gerontol 33, 217–228 (2018). https://doi.org/10.1007/s10823-017-9323-7
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DOI: https://doi.org/10.1007/s10823-017-9323-7