Questions/Answers

Seongdong District in Seoul, Korea, formulated a senior-friendly healthcare program in preparation for an aged society. To support the healthcare of the elderly, Seongdong formed a team of doctors and nurses called the “HYO Team.” The district’s efforts to address senior residents’ health issues, deliver healthcare and welfare services to all, and encourage seniors to participate in social activities prompted the formation of partnerships among academia and the public and private sectors and led to improved quality of life for residents. As of 2019, seniors account for over 14.9% of Korea’s population, and that figure is expected to exceed 20% in 2025. As older people are projected to account for 46.5% of the population by 2067, with the country’s median age rising to 60 years or older, Korea is projected to become one of the nations with the largest senior population in the world. In 2018, seniors living alone were 24.2% of the population, and the proportion of the elderly with depression was among the highest in OECD nations, contributing significantly to the high suicide rate in the elderly. The number of seniors aged 65 or older stands at 43,554 (14.4%) and that aged 75 or older (the “old-old”) is 17,543, compared to Seongdong’s total population of 302,198. Seongdong introduced its senior-friendly healthcare program, called the “HYO Policy” in a bid to make healthcare services more accessible to old-old suffering from serious economic poverty, frailty, and social isolation. Specifically, Seongdong plans to register over 20% of all seniors aged 75 or older for the HYO Policy for supervision, help over 75% of seniors manage their diabetes, intensively monitor over 5% of frail seniors, and reduce unmet healthcare needs to below 10% through financial assistance for medical expenses by 2019.

Category 1: Inclusive and balanced services provided to all Seongdong District introduced the HYO Policy to provide all seniors aged 75 or older with the home healthcare and welfare services they need. In 2016, poverty among seniors in Korea was 5.4 times higher than for other age groups. Old-old seniors are vulnerable financially and physically, as they have chronic diseases (2.7 diseases on average), physical limitations (ADL limitations 18.5%), health problems (24.4%), and nutritional problems (71.9%). The HYO Policy has improved isolated seniors’ capacity to manage their health and eliminated harmful societal and environmental factors through public-private partnerships.

Seongdong’s HYO Policy is related to four sustainable development goals (SDGSs). (SDG 1) To help the elderly who cannot afford the services they need, Seongdong worked together with over 100 private clinics, 4 social welfare centers, and 10 seoul public hospitals in the district to provide financial assistance to help cover medical expenses, improve living environments, supply daily necessities, and provide home care services for people with reduced mobility. (SDG 2) Using private resources, we deliver meals to people suffering from malnutrition, in addition to poverty and reduced mobility, to ensure they maintain a healthy diet. (SDG 3) The HYO Team visits older people with little access to healthcare services due to physical and financial difficulties to provide free health checks, disease control, and solutions for eliminating health hazards (removal of risk factors for falls, undesirable habits, social isolation, etc.). (SDG 10) The HYO Team is making special efforts to make health and welfare services more accessible to socioeconomically disadvantaged old-olds in order to reduce inequality by utilizing local resources and forming partnerships with the public sector, including the Ministry of Health and Welfare and its Integrated Health Promotion Programs and Seoul City’s Health and Welfare Project.

Seongdong formed partnerships with over 100 private clinics, 10 seoul public hospitals, 4 social welfare centers, 17 care center networks, and the Seongdong Volunteer Center. Older residents apply for the HYO Policy themselves, but their children or neighbors help them apply for home visiting services, showing the shifting burden of senior healthcare from individuals to society. The program has allowed older patients to save KRW 1,106 million in medical expenses, as local hospitals covered medical bills for over 90,023 cases. Also, the national government will provide financial assistance totaling KRW 258 million in 2019 and KRW 265 million in 2020.

Seongdong has solved financial and human resource issues by building partnerships with the Ministry of Health and Welfare, Seoul City, 10 seoul public hospitals, and 100 private clinics. Seondong Community Health Center is responsible for supervising seniors’ health-related habits, helping patients keep track of their medications, and addressing health hazards, while private medical institutions provide patients with professional medical services. We also teamed up with private welfare institutions to improve their house environment (73 person). We also provided financial assistance for medical bills (90,023 cases) using private donations and provided AI speakers (500 person), loT sensors (185 person), and AI robotic dolls (50 person), donated by companies, to help people with dementia. While helpful for loneliness, these devices also saved lives. In the national and local governments, health-related departments are separated from welfare-related departments and administrative departments. The HYO Policy, however, is organically related to the Ministry of Health and Welfare and its Integrated Health Promotion Programs, Seoul City’s health and welfare programs, and community projects. As the control tower of the HYO Policy, Seongdong Health Center formed a taskforce with health, welfare, and administrative departments to provide seniors with healthcare, welfare services, and neighborhood community activities.

The HYO Policy focuses on the healthcare concerns of older women, who are more likely to be poor and live alone than men. As of 2017, the life expectancy of women in Korea is 87 years, while that of men is 81.2 years. According to a survey, 24.6% of older women and 11.2% of older men expressed fear of being sick alone. The facts that 1.5 times more women than men overall and 3.6 times more frail older women requiring intensive care have registered with the HYO Policy demonstrate Seondong’s effort to address gender-based vulnerabilities.

HYO nurses call a resident to inform him or her of the services and get the resident’s consent (Step 1). The nurse visits the applicant and conducts an assessment (Step 2). After classification (intensive, regular, or self-empowerment) (Step 3), the nurse discusses with the HYO doctor to draw up a tailored healthcare plan (Step 4). The HYO Team visits the resident’s home to plan and discuss problem-solving measures (Step 5). A doctor visits the resident and provides a capacity-building program (Step 6). After 8 weeks of care (Step 7), the HYO Team reevaluates and reclassifies the applicant depending on his or her status (Step 8). So far, 24.2% (4,244) of old-old have registered, and 288 people (6.8%) are in the intensive group. Also, 75% of old-olds with diabetes have controlled the disease, and their social relationship rating has risen from 23.9 to 31.6, and their depression rating has fallen from 19.6 to 17.7. In addition, unmet medical treatment stood at 8.7%, with over 90,023 cases benefitting from the partnership between the HYO Team and private clinics, 808 welfare services, and 38 care service providers.

We hoped to prove that the policy would be essential for older people by carrying out consistent monitoring and periodical evaluations, such as surveys of the district’s older population, expert evaluations, and research on the effect of the policy. To increase healthcare accessibility for local seniors, Seongdong District installed small health centers in the 17 local offices. In 2017, we held a town hall meeting with the district mayor of Seongdong to address healthcare issues for old-old people. As a result, we decided to launch the HYO Policy for the old-old. In 2017, Seongdong started providing the home visiting healthcare service of the HYO Policy in five areas, including health checkups, chronic disease management, depression and dementia management, and financial support for medical bills, for district residents aged 75 and over. We also started conducting surveys on issues regarding welfare services, in addition to healthcare services. In 2018, we conducted research for the development of the HYO Policy assessment index and created the healthcare management program for the intensive management of the old-old with frailty issues. In 2019, we assessed the effectiveness of the HYO Policy, especially the “socialization” program tailored to socially isolated older adults and intensive healthcare management for frail seniors. To help older people with mobility difficulties, we increased welfare services by building a medical welfare network and expanding our partnership with the welfare service. As a result, the number of old-old registrants increased from 4.7% in 2017 to 17.1% in 2018 and 24.2% in 2019. Welfare services utilization also rose from 104 in 2017 to 587 in 2018 and 2,318 in 2019.

In Korea, the health and nursing of old people have been treated as entirely personal or family matters, with public institutions providing healthcare and nursing services only to low-income older adults without families. Despite conflicting opinions on policy, the HYO Policy has helped improve older adults’ capacity to manage their health, resulting in improved physical and social health. In other words, older people’s right to health has been improved. In recognition of the positive effect of the HYO Policy, the government expanded the healthcare policy, which had been exclusively for the low-income old-old, to cover all older adults.

Seongdong District pioneered the introduction of innovative healthcare programs tailored to the elderly. We surveyed the health conditions and diseases of residents aged 65 and over and used the data to start delivering the home-visiting service to the old-old for whom quality healthcare services were inaccessible due to mobility difficulties or poverty. We then teamed up with the private sector to develop the “Making Friends” socialization program for the socially isolated. We have also provided AI speakers to elderly people living alone and AI robotic dolls to seniors with dementia.

Well-developed primary healthcare contributes to health equality by ensuring the accessibility of quality healthcare with the use of minimum resources. Seongdong District’s HYO Policy was inspired by the Alma-Ata Declaration, which presented the concept of primary healthcare and strategies for Health for All. It is also modeled after the Dutch GOLD (Get Old People Healthy) program, a medical insurance plan in which doctors affiliated with local private clinics visit their patients aged 75 and over at home twice a year. But the HYO Policy delivers free healthcare services provided by doctors affiliated with public institutions to the old-old.

The HYO Policy is Korea’s first comprehensive healthcare and welfare service for older people. It has been benchmarked by the national and local governments and covered by the media as a model healthcare service to prepare for population aging. Seongdong District gave a presentation for local governments that were chosen for the trial community care program by the national government (July 2019), and the Ministry of Health and Welfare Community Care Promotion Team visited Seongdong (October 2019). The Korea Health Promotion Institution benchmarked the HYO Policy to redesign the national home-visiting healthcare program (September 2018), and local governments, including Gyeonggi Provincial Government, Gangneung City, Gwangju City, Seoul’s Jung district, and Busan’s Seo district, flocked to Seongdong to benchmark the program. Furthermore, Seoul City launched the Seoul Care Service, which aligns with the HYO Policy (October 2018). The HYO Policy is garnering much attention from the media, as it serves as a model for the healthcare programs being drawn up by the national and local governments in preparation for an aging society. Two of Korea’s major broadcasting companies, SBS (Newstory aired in February 2019) and KBS (KBS Documentary aired in May 2019), covered the HYO Policy to help spread it nationwide.

It has been assumed that elderly care service programs require substantial financial and human resources. The HYO Policy, however, has solved the problems through public-private partnerships, as well as community engagement. The HYO Policy has significantly contributed to improving older adults’ health, welfare, and social connections, ultimately enhancing the quality of their lives. In this respect, the HYO Policy can be applied to any region without large amounts of funding or workforce.

Seongdong District recruited 19 medical professionals, including 2 doctors and 17 nurses, to form the HYO Team. We also hired dieticians, physical trainers, social workers, and dental hygienists to provide comprehensive healthcare services for the elderly. We opened the HYO Center in the Seongdong Community Health Center and installed small health centers in all 17 local offices. Seongdong District receives KRW 500 million in financial support a year for the program from the national government and Seoul City. We also receive financial assistance from the private sector to cover the medical bills of low-income seniors.

Seongdong District enacted the “Ordinance for the Operation of the HYO Policy by Seongdong District, Seoul City” for the old-old to establish the legal grounds for the policy (March 2019). We formed the HYO Council, consisting of representatives of medical associations, welfare experts, professors, and local residents, to forge private-public partnerships (May 2019). We also encouraged community engagement to create senior-friendly communities and improve seniors’ social relationships. We received KRW 258 million in financial support for the HYO Policy in 2019 and another KRW 265 million in 2020.

Yes

The evaluation was conducted by the University of Seoul, based on a survey of 3,737 registrants in 2018. The quantitative evaluation assessed the prevalence of chronic diseases, the public approach to health issues, and health and welfare services utilization. The qualitative evaluation was a satisfaction survey that analyzed the effects of the HYO Policy. The second-year evaluation is scheduled to be completed in 2020. The HYO Policy has won many awards, including the Excellent Administrative District Awards of Seoul City (2017), Local Government Awards (2017, 2018), and Excellent Institution Awards of the Korea Healthy Cities Partnership (2019).

The internal evaluation, “Research on the Development of the HYO Policy Assessment Index,” assessed the HYO Policy in terms of first-contact care, accessibility, continuity, coordination, and comprehensiveness. First-contact care and accessibility are important because the program is the first healthcare service that local residents use, and continuity is essential for providing quality and effective healthcare service for all stages of life. Coordination assesses partnerships with bigger hospitals and public institutions, while comprehensiveness assesses the delivery of comprehensive healthcare services such as treatment, rehabilitation, disease prevention, and health management. The external assessment indexes include continuity, innovativeness, administrative creativity, and public-private cooperation.

The HYO Policy is designed to solve health issues together with seniors in order to improve their capacity to manage their health themselves and eliminate health hazards. According to a survey of the old-old in comparison with the young-old, the old-old are more frail (14% to 25.4%), more likely to develop arthritis (18.2% to 19.5%), more the impaired (1.7% to 2%), and more likely to have issues with depression and social isolation. Seniors with frailty issues showed improvement (11.3 to 10.1) after the completion of the 8 week intervention. We also worked with the private sector to operate the “Socialization” program for older adults with depression and socially isolated seniors in 2019. After the completion of the program, the participants showed marked progress in all areas, including their depression score (19.7 to 17.7), social relationship score (23.9 to 31.6), muscular strength score (17.4 to 25.1), and the Timed Up and Go (TUG) test’s score (12.9 to 8.1). Seongdong District was chosen for the 2020 public-private partnership project “Healing, Well-being, and Health” for socially isolated elderly people.

operates the program using local resources and partnerships with local institutions. The Korean government takes a top-down approach to healthcare for seniors, as each department of the national, city and county, and provincial governments formulates plans and local governments carry them out. Accordingly, local governments find it difficult to operate integrated healthcare programs for older adults. It was thus challenging for Seongdong District, a local government, to integrate the healthcare and welfare projects formulated by the national and city governments. In Seongdong District, the community health center functions as the control tower for healthcare, welfare, and administration and undertakes the HYO Policy in partnership with participating institutions. Seongdong District also built a dense safety network with the public and private sectors, local residents, and stakeholders from all walks of life to deliver integrated healthcare and welfare services. We team up with private medical institutions to provide professional medical treatment for older adults and local private organizations to offer welfare services through a horizontal relationship. To address the issue of social isolation, we run various socialization programs for seniors jointly with volunteer centers.

Seongdong District placed top priority on community engagement to hear the voices of older people. We held a town hall meeting to discuss health vulnerability in older adults (April 2017) and launched the HYO Policy (September 2017). At a policy meeting joined by 131 experts in welfare and healthcare and community members, we consolidated partnerships with local communities (September 2018). We signed an agreement with over 100 local clinics, 10 seoul public hospitals, 4 welfare centers, 17 care center networks, and a volunteer center. We also held a council meeting with project partners, including 13 volunteer representatives, scholars, and representatives of 16 organizations, including the health center, to discuss diverse matters, including ideas for the project, performance and assessment, and financial assistance. The HYO Policy is hailed as a senior-friendly healthcare policy that helps Seongdong District residents aged 75 and over lead comfortable and healthy lives in their neighborhoods.

Korea is now witnessing a shift in responsibility for elderly care from the family to the government, especially since the implementation of the Long-term Care Insurance Act in 2008. Seongdong took the initiative in solving problems in healthcare services for seniors and strengthening seniors’ right to health by building partnerships with various departments and the private sector. The HYO Policy serves as a model for senior-friendly local communities, as it involves the use of local resources and administrative support, enactment of an ordinance, and operation of a council. The ICT-based AI speakers and robotic care dolls donated by private businesses monitor older people around the clock to allow for prompt responses to emergencies. In fact, there have been some cases where these cutting-edge devices saved the lives of older people who had a sudden heart attack or bone fracture. Seongdong is analyzing the data on the HYO Policy in preparation for taking the healthcare program to the next level. We will continue to do our best to create an ICT-based smart community where older adults are able to lead healthy and comfortable lives by shifting the paradigm of elderly care in line with the 4th Industrial Revolution.