In 2025, South Korea entered a super-aged society. The figure that drew the attention of the reporting team was '53.9%.' Among registered people with disabilities in South Korea, 53.9% are aged 65 and above. This shows that aging and disability are related. The reporting team analyzed health statistics of the elderly population and met with people with disabilities, caregivers, and medical staff to amplify their voices. The lives of elderly people with disabilities are a signal urging a bold shift in our society's healthcare and welfare paradigm. [Editor's note]
On the third floor of an officetel building in Suwon Yeongtong-gu, the reporter entered the Home Doctor preventive medicine clinic and looked around. There were no high-end interiors, no patients in the waiting room, and no nurses attending.
There were two office desks and one auxiliary desk; that was the entirety of the facility. It had a venture office-like atmosphere. Perhaps because it was right next to the highway, the entire office shook slightly every time a large truck passed by. The sight of a robot vacuum leisurely roaming the floor was somewhat unusual.
"I moved here to save fixed costs as I won't be seeing outpatient patients."
This is a statement from director Ki Seung-guk, who is in his fourth year as a private practitioner. He conducts home visit care for elderly individuals with mobility difficulties in the areas of Suwon and Yongin, including Suji and Giheung. After dropping out of Ajou University's College of Medicine in 1998, he graduated from Seoul National University's Department of Business Administration and then re-entered Ajou University's medical school, which is a unique background.
I am a home visit doctor in my 40s, view as interactive content
The business card he handed over was written in clear white letters on a sky-blue background.
Specialist in preventive medicine
Home health care center / personal health doctor for individuals with disabilities / home visit care / industrial health center
"You probably haven't met a preventive medicine specialist very often. Because there are fewer than 10 of us a year."
Preventive medicine is a field of medicine aimed at preventing diseases, disabilities, and premature death. Among medical students in Korea, it is not preferred due to limited opportunities for private practice and difficulties in expecting profitability after starting a practice. His choice seems 'irrational' in the context of Korean society, where preparatory classes for elementary school have emerged to enter medical school.
"(With a background in business administration) I was very interested in health economics. Considering the global trend of aging, I thought that geriatric medicine, a cutting-edge medical field, would be promising. I was also influenced by my advisor, who specializes in geriatric health."
The problem was data. Preventive medicine thrives on data, yet there is little information on how Koreans age and die. Even trying to secure government health project contracts involved many variables in ongoing research.
"Director Kim Chang-oh, an authority in home health care, has opened a 'care clinic home health care center' in Seongbuk-gu, Seoul. Ah, I thought I also needed to accumulate experience and data in the field."
Essential to use map apps... up to 8 cases of treatment a day
Recently, the number of cases handled by Director Ki has significantly increased. He conducts over 100 home visit treatments a month. Thanks to this, he also hired a nurse to assist with field treatment. Even so, he hardly conducts 8 cases of treatment a day.
In October 2024, the reporter accompanied him on his treatment rounds. The treatment schedule began as Director Ki and a nurse drove separately to the home of the first scheduled patient at 9 a.m. The nurse's vital check (temperature, blood pressure, heart rate, etc.), Director Ki's consultations and prescriptions, and chart entries were repeated home after home. Navigating narrow alleys required the use of map apps.
"The blue pills… all ran out…."
This occurred during a home visit for An OO (71 years old, female, pseudonym), who was diagnosed with Parkinson's disease in 2007. An's pronunciation was somehow slow and unclear, but simultaneously urgent. The blue pills he mentioned referred to Mirtazapine, a neurology medication used for treating depression and other conditions. An's words meant 'the Mirtazapine has run out.'
The primary symptom of Parkinson's disease is severe trembling of certain body parts. Neurology medications are known to help alleviate symptoms and improve the quality of sleep for patients.
At An's words, a commotion broke out. The doctor, nurse, and caregiver all panicked and started sorting through the disorganized piles of medication bags on the table. It turned out that An had arbitrarily taken two packets of Mirtazapine at a time, resulting in a three-month supply running out in just a month and a half.
"It is really important to follow the prescribed dosage."
The director and nurse repeatedly urged to take the medications as prescribed.
The next location they visited was the space where Hee OO (82 years old, male, pseudonym), who had been lying due to right-side paralysis from a cerebral hemorrhage in 2020, lived. He is also suffering from Alzheimer's disease. Hee had spent three years in a nursing hospital but was discharged at the request of his wife, who is his caregiver.
"I'm so glad my husband's diarrhea has stopped."
Hee's wife had a bright expression. Hee had diarrhea daily, and his wife had to change his diaper every night. Her earnest request was to prescribe an antidiarrheal medication.
Instead of prescribing an antidiarrheal, Director Ki removed the constipation medication that Hee was taking. Constipation medication can cause a thinning of stools, which could lead to diarrhea. Hee's diarrhea stopped as if by magic.
"In fact, most of my home visits are just 'medication reviews.' Since there is no healthcare fee, I do not conduct emergency visits."
Among the patients that Director Ki takes care of, there were hardly any who were not bedridden. Analyzing a total of 524 treatments from the Home Doctor preventive medicine clinic until October 2024, it was found that the number of treatments for physically paralyzed patients was 299 cases (57%), and for neurodegenerative diseases it was 142 cases (27%), making elderly patients with disabilities overwhelmingly predominant.
“As seen in the movie , you can't hide the smell.”
Home healthcare is 'home health care' from the patient's perspective. When a doctor visits a patient's home, it is akin to stepping into the patient's life. They encounter information that cannot be discerned through health indicators, such as their circumstances, the presence of caregivers, and sibling relationships.
An apartment of Im OO (86 years old, female, pseudonym), who suffers from Alzheimer's disease, measuring approximately 1,150 square feet. The photographs in frames placed on a simple living room table conveyed a glimpse of her youth. She had a firm mouth and stood tall as a career woman.
Now her legs have stiffened into a straight line. After developing Alzheimer's at 75, a prolonged bedridden life has rendered her knee joints immobile.
Im, who usually displayed no response, repeatedly told Director Ki 'thank you' that day. Unexplained tears flowed quietly from her eyes.
"My mother has been very touched lately. When I wash her hands, she says 'thank you' and 'I appreciate it.' She even says she wants to eat crab soup or insists on having bulgogi. She never used to say things like that…."
The caregiver called Im 'Mother.'
Director Ki noted that he has also encountered individuals who treat their elderly parents as a means of making money.
"There are many patients and caregivers who stage things to receive disability ratings, but that case was the worst I have seen. The caregiver was neglectful, relying solely on government subsidies. The patient, an elderly grandfather, had skin infections that were swollen and emitted a foul smell."
Director Ki remarked, "As seen in the movie
I am a home visit doctor in my 40s, view as interactive content
Preventive medicine, in a nutshell, is 'cost-effectiveness.'
The reporter returned to the hospital to analyze various data and secure information. The hospital setting resembling a venture office remained unchanged. The conversation with Director Ki, sitting in front of a computer, flowed like a meeting with a data scientist.
"The advantage of preventive medicine is 'cost-effectiveness (performance against price, effect against treatment cost).' To measure cost-effectiveness accurately, ample data must be gathered, and healthcare policy researchers must enter disease codes accurately."
He believes that responding to low-risk groups should be through community health initiatives, mid-risk groups through outpatient and non-face-to-face treatments, and high-risk groups through home visit care, which forms a high cost-effective healthcare system. He explained, "You can't use a knife for cattle when you just want to catch chickens."
"Why is the government trying to reduce nursing hospitals? Keeping patients who are in 'end stages' of diseases, who do not recover, leads to doctors residing for 24 hours and claiming nursing benefits under health insurance, which drains national finances and diminishes the overall utility of healthcare."
He pulled out a document presented recently at Ajou University. The title was 'From Screening to Monitoring.'
"Elderly people do not show typical symptoms of diseases or exhibit them in altered forms. For instance, a significant number of elderly individuals may have myocardial infarctions without chest pain. The 'normal range' of various indicators holds little meaning for the elderly. We age in our respective ways."
Ultimately, the conclusion of the presentation suggested that the health of the elderly should be evaluated individually.
"More important than screening (examinations) is monitoring a person in depth."
Director Ki set a goal to gather aging data on Koreans and publish a paper in the world's leading medical journal, The New England Journal of Medicine (NEJM).
In this journey, he fears two things. One is the heat. Every summer is getting hotter, and the treatment field is becoming increasingly warm. Cars parked in narrow alleyways under the blazing sun often turn into ovens.
Director Ki revealed that he even considered quitting home visiting due to the heat last year.
The other is an intrinsic fear of disability. Some live to 100 but may spend 30 to 40 years bedridden. Director Ki frequently witnesses such cases in the treatment field.
"But anyone can become disabled in old age. An 84-year-old son caring for his 103-year-old disabled mother also said, 'I'm starting to feel tired.' Since the mother no longer recognizes or embraces her son, he realized that it is essential to meet and love each other more often while still healthy. That's the cost-effective way of loving I've come to acknowledge in the treatment field."