Research Report
A Study on the Establishment of Legal and Systematic Foundation for the Settlement of Community Care as a Care Service for Super-Aged Society
I. Background and Purpose of Research
▶ Background and Necessity of this Study
○ As the issue of the sustainability of the social security system was raised ahead of the entry into the super-aged society in 2025, interest in community care increased.
- Community care is drawing attention as a care service system that meets the needs of users and guarantees self-determination due to the provision of facility- and provider-oriented services and the service system provided separately according to individual laws.
- Community care refers to the transition from institutional-centered separate care to people-centered integrated care, and is introduced in Europe as a way of social service delivery system while maintaining life independence and autonomy as much as possible.
- In Korea, it has been suggested as a national task since the last government, and the introduction of 'Integrated Community Care' as a Korean-style community care has been promoted.
○ Since the introduction of integrated care for the community constitutes a change in the existing social service delivery system in that the community provides health and medical services, care services, and housing support that were provided separately under individual laws and regulations.
○ The realization of integrated care for the community will have to be successful by establishing a legal basis for the system as a care service strategy for the super-aged society, so it is necessary to review various related issues.
- The authority and responsibility of the central government and local governments, how to secure finances, how to link and integrate social security benefits divided by individual laws, how to link medical, health, and social security information, and improve related legislation should be discussed.
▶ Purpose of this Study
○ The purpose of this study is to establish a legal and institutional basis for linking and integrating existing services such as health, medical care, care, and housing support while considering the characteristics and autonomy of the community and self-determination.
Ⅱ. Major Contents
▶ Progress and key points of community care promotion
○ In November 2018, the government announced the basic plan for integrated care for local communities, presented road maps and four major tasks, and has been promoting leading projects to create an integrated care model for the region since 2019.
- According to the basic plan, the legal base and related infrastructure will be expanded by 2025 in preparation for the super-aged society in 2026, and the main tasks will be presented in connection with housing, health care, nursing and care, and services.
- The leading projects implemented by 16 local governments were to create a local autonomous model, except for the common provision base (integrated care information window, dedicated organization, local care meeting, and public-private consultative body) proposed by the government. The target of the project was initially specified as the elderly and the disabled, but recently, a convergence model is being attempted.
○ Integrated care is provided so that anyone in need of integrated care, such as the elderly and the disabled, can receive the necessary services in his/her place by investigating and determining his/her needs.
○ However, the concept of integrated care, the priority target of integrated care, and the relationship with existing systems such as long-term care insurance for the elderly and elderly care services have not yet been clearly presented.
▶ Review of legislation to promote overseas community care
○ The UK established a local government-led social service system, promoted community care based on this, and established a legal system for the connection between health care and care services.
- In order to link health care services centered on the National Health Service (NHS) with care services centered on local governments, the Health and Welfare Committee was established to promote linkage and pilot projects to create an integrated care service model.
- In 2014, the Framework Act on Care was enacted to support the community care system by stipulating the principle and delivery system, service quality management, and establishment of a better care fund, and recently, the integrated care system is being introduced around the NHS.
○ Sweden established the provision of local government-centered social services through Adele reform, which combines the principle of community residence for the elderly and the de-facility movement, and gave the basic local government, Commune, the main responsibility for caring for the elderly.
- Focusing on the Social Service Act, local governments are responsible for providing social services and conducting community care by establishing decentralization such as finance.
○ In response to the aging population, Japan has established a regional comprehensive care system with the goal of integrating medical care and nursing care since 2012, and legislation has been implemented for this purpose.
- The local comprehensive care system is supported through local comprehensive care centers, nursing homes, and home care-related projects by enacting legislation to reform the social security system in 2013, the local health care and nursing care law in 2014, and the nursing care insurance law in 2017.
○ In that all three countries have clarified the subject of system implementation, authority and responsibility, financial issues, and the link between health care and care services by enacting the basis law for community care promotion, Korea also needs to establish a legal basis and revise related laws.
▶ An Analysis of Community Care-related Laws in Korea
○ In addition to the Framework Act on Social Security, Social Security Benefits Act, Social Service Rights Act, and Social Welfare Service Act, this study analyzes related laws by dividing them into health, medical, care service, and housing support.
- According to the analysis, social security in the region has already been established, but it has not been realized properly due to practical problems such as lack of local manpower and infrastructure, poor linkage between health care and welfare services, and existing barriers to provision of segmented and supplier-oriented services.
- Therefore, in order to promote community care, it is necessary to closely review and adjust related legislation so that various necessary services based on the needs of users centered on the region can be integrated or linked.
▶ Legal Issues in the Promotion of Community Care
○ The legal issues to be considered in preparing the legal basis for promoting community care (integrated care for local communities) in Korea are as follows.
- First, the concept of integrated care needs to be clearly presented along with the need for legislation. Integrated care is not to create new services, but to reorganize the delivery system of existing care services into community-based and user-centered.
- Second, the form of legislation is considered to be appropriate to ensure consistency with the existing legislative system in that the integrated care system is reorganized and involves revision of other laws such as housing support, visit, or home care.
- Third, regarding integrated care affairs and organizations, it is necessary to consider overlapping functions with existing local social security systems, such as community security consultative bodies and hope welfare support groups, and integrated case management.
- In addition, various issues such as securing financial resources, preparing integrated judgment tools for evaluating needs, case management methods, securing and treating personnel in charge, and linking information should be discussed.
▶ Improvements of Community Care-related Legislation
○ In order to promote community care, it is necessary to establish a legal basis and reorganize related laws through a review of the overall social security legislation.
- As in Japan, it is possible to consider revising related laws collectively, and there may be a step-by-step approach depending on importance and urgency.
○ Among various related laws, this study proposes improvement measures for the Long-Term Care Insurance Act, Medical Act, and Housing Support Act for the Elderly.
- It is necessary to integrate and operate services that are similar to and overlap with existing elderly care services such as the Long-Term Care Insurance Act for the Elderly, and to stipulate integrated home care benefits that are currently divided.
- In order to revitalize visiting and home care services in the community, it will be possible to ensure consistency with Article 33 of the Medical Service Act by enacting the Integrated Care Act and the Integrated Care Act. In addition, it is possible to consider integrating medical or nursing service functions in integrated care with the functions of the public health center in charge of visiting health services.
- As for residential support represented by care-safe housing, the current laws and regulations allow the use of houses that combine services such as welfare housing for the elderly and housing for the weak, so the minimum housing standards, safety standards, and housing renovation support should be applied to care-safe housing.
Ⅲ. Expected Effects
○ It can be used as a basic data for future academic research by analyzing issues and overseas cases from a legal perspective and deriving implications for related legal systems and future improvements.
○ Contributing to the establishment of a legal system for the stable implementation of the integrated care system in the community, such as eliminating blind spots and establishing relationships between related institutions and experts.