"I was more afraid of being discharged than of getting hurt."

Lee Jeongsuk (92), who lives on Jangteo-gil in Jincheon-gun, Chungbuk, gazed quietly at the lunch tray brought in by her home care worker, recalling a memory from a year ago. In November 2023, she strained her lower chest while getting up from the dining table and collapsed. She was taken by a 119 ambulance to Jungang Jeil Hospital in Jincheon town, where she underwent rib surgery.

While in the hospital, except for the pain, she had no discomfort. The doctor checked her condition daily, and every meal was served in bed. But the real problem began after discharge. Taking her medication and preparing meals?all of it became her sole responsibility.

"I thought if I went home like this, I would just die. But when I was about to be discharged, a nurse came to see me. She asked if there was anyone to look after me at home. I told her I lived alone. I was worried about how I would manage at home, but the county office sent me a home care worker. She comes for three hours every day to cook and clean. Since I'm in no condition to go back to the hospital, the nurse also visits once a week."

Grandmother Lee Jungsook is opening the door and looking outside at her home in Jincheon County, Chungbuk, on November 5. Photo by Kang Jinhyung

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Jincheon-gun is a rural area with a population of 80,000, consisting of 2 towns and 5 townships. The only general hospital is Jungang Jeil Hospital in Jincheon town. Elderly residents like Lee Jeongsuk go there if they suffer a fall or develop an acute illness. Lee Jaechul, an official from the Jincheon County Integrated Care Team, said, "On average, about 10 seniors are discharged from this hospital each month," and added, "We started the Jincheon Integrated Care Service with the mindset that we must not miss taking care of these people."

For seniors to continue living at home, the period right after discharge is the most critical. It is the 'golden time' at the crossroads of recovery or deterioration. If left alone during this period, their health can rapidly decline, which can be fatal. To address this, Jincheon-gun proposed an integrated care team at Jungang Jeil Hospital, providing an annual subsidy of 350 million won.

This led to the creation of the 'Care Station,' consisting of five nurses, one nutritionist, and one social worker. Their mission is twofold: first, to counsel hospitalized seniors and identify those who need care after discharge; second, to visit the homes of these seniors and provide medical care. But it's not just about medical care?they also offer support with household chores, meals, and home repairs.

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An Eunsuk, head of the Care Station, said, "Once a week, welfare officials, Care Station nurses, social workers, and visiting health workers hold a video conference. In these meetings, we share cases of the seniors and decide what services are needed and to what extent."

Through this process, Lee Jeongsuk became an integrated care recipient immediately after discharge. Although she is over ninety, she has good cognitive abilities and can walk, so she did not qualify for long-term care grading. Therefore, she was not eligible for care worker services. An Eunsuk said, "If she hadn't received integrated care at home after discharge, her condition would have worsened to the point where she would have qualified for long-term care."

As she finished her meal, nurse Lee Inhee from the Care Station quietly opened the door. "Let me check your blood pressure first." The elderly woman extended her wrinkled arm. The nurse said, "For the first two months after discharge, you couldn't move at all, but now that you can stand up, you could even visit the local senior center sometimes. Since you’re taking your hypertension, arrhythmia, and osteoporosis medications diligently, there don’t seem to be any major issues."

The tense look on her face finally relaxed. The nurse continued, "Last summer, because it was so hot, your younger son installed an air conditioner. You didn’t turn it on even once because you were worried about the electricity bill, but maybe you’ll use it next year. Even when the weather gets cold, just looking at it makes you feel warm inside. Your son even bought you an air conditioner?how could you ever leave your home?"

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