[Interview] As Korea ages, WHO adviser urges moving seniors’ care into the home

GENEVA, Switzerland -- By Kim Ji-hye / Korea Biomedical Review correspondent -- Jang Hyo-bum has spent much of his career asking a simple question with complicated answers: how should societies care for older adults?

When we met in Geneva during the International Hospital Federation’s World Hospital Congress, held Nov. 10 to 13, he had just stepped out of a panel on aging policy in rapidly aging European systems, and the conversation kept circling back to Korea.

Korea established national long-term care insurance in 2008 and, within a few years, built out beds, agencies and coverage at a pace few countries have matched, he said. 

Nearly two decades on, the program reaches more than 9 percent of Koreans over 65, easing a burden that had long fallen on families, especially women. The question now, he argued, is not breadth but depth. 

The issue has shifted from how much care the system can deliver to what kind of care older people actually receive and whether it reflects what they want and need.

A system under pressure

From his post in Geneva as a medical officer for ageing and health at the World Health Organization (WHO), Jang has watched Korea’s rise with a mix of admiration and concern. 

Roughly 19 percent of South Koreans are over 65, and projections put that share near 30 percent by 2035. 

Most long-term care continues to be delivered in institutions, often privately run. Rules cover staffing ratios and training. What is harder to measure are the daily realities that matter most to residents: autonomy, connection and a sense of being heard.

“It is not that institutional care is inherently wrong,” he said. Some people need round-the-clock nursing, especially those with advanced dementia or complex conditions. “But many others could be supported at home or in their communities if the right services and infrastructure existed.”

International comparisons point the same way. Several peers, including Denmark, the Netherlands and Japan, have rebalanced toward home and community services, pairing care teams with assistive technologies and housing adaptations to reduce dependence on beds. 

Korea has begun to move in that direction. Lawmakers passed the Integrated Community Care Act in March 2024, with implementation set for 2026. 

Pilots in places like Gwangju, Jincheon and parts of Seoul are testing aging-in-place models that combine home modifications, meal support, care coordination and regular check-ins to help people remain at home longer.

“The law creates a framework,” he said. “But making it work requires significant coordination across sectors, including health, social services, housing and transportation, and most local governments are still building that capacity.” 

Structural incentives also pull families toward facilities. Eligibility hinges on functional assessment, and many households perceive institutions as more reliable even when co-payments are similar.

Workforce is the pinch point. Training periods can be short, pay is modest and turnover is high. That combination makes it difficult to scale home and community care. “This is not unique to Korea,” he said. “Almost every aging society struggles with long-term care workforce shortages and the undervaluation of care work.”

Oversight presents a parallel challenge. Regulators can count staff and inspect safety measures. They struggle to enforce what distinguishes living from warehousing. 

“There is excellent attention to clinical care,” he said, but at times less emphasis on the social and relational dimensions, such as daily choice, connection to family and community, and room for personal identity.

End-of-life care

The pandemic exposed vulnerabilities in congregate settings everywhere and pushed end-of-life care into view. Korea has legal rights on paper, including the right to refuse life-sustaining treatment in defined circumstances, but service options lag. 

“Legal rights matter,” Jang said. “But they need infrastructure behind them. Saying someone can refuse a ventilator is meaningful only if other forms of support are available, including pain management, emotional care and family counseling.”

Small pilots suggest what that could look like. A home-based palliative program in Busan reported better quality of life and lower depression among terminal patients. Scaling such models requires payment, training and workforce changes. 

“Countries like the United Kingdom, Canada and Australia have made palliative care a core component of their health systems,” he said. “Korea is starting to move in that direction, but there is still a significant gap between need and availability.”

WHO collaboration and global standards

From Geneva, he is helping build standards meant to make quality visible. The WHO effort, supported in part by funding from the Korea, shifts attention from buildings and ratios to rights, relationships and outcomes such as autonomy, communication, safety, function and social participation.

The aim is practical: a reference that countries at different income levels can adapt, with indicators that guide policy, training and accountability. In 2023, WHO and Korea’s National Health Insurance Service (NHIS) convened a regional forum on aging and long-term care in Seoul to compare approaches on workforce, quality monitoring and community models. 

“There’s interest in deeper collaboration,” Jang said, particularly on shared tools, training frameworks and measurement with other rapidly ageing countries in the region.

He is careful not to cast this as a fight between safety and independence. The aim, he says, is both. “More beds is not the future,” Jang said. “The future is about whether the care we provide, wherever it is delivered, supports people to live with dignity, maintain connection and make meaningful choices until the end of their lives.”

Korea is positioned to lead if it chooses to. The country moved from building capacity to maintaining it in record time. The next step is deciding what to measure and reward. 

“Korea has always been able to move quickly when there is political will,” he said. “The question is whether we can apply that same energy to the harder work of transformation.”

No country, he adds, has fully solved the balance between public responsibility and family care. “No country has solved it completely,” he said. “But the systems that work best are the ones that recognize care as a shared responsibility, not something left to families alone and not something entirely delegated to institutions.” 

The infrastructure is largely in place and the law is on the books. What comes next is slower: valuing care as a profession, measuring what matters and trusting local teams to deliver.