노인장기요양보험제도가 가족에 미치는 영향 연구

The Impact of the Korean Long-Term Care Insurance System on the Beneficiaries and Their Family Caregivers: Focusing on Quality of Life and Family Relationships

Ⅰ. 연구개요 1. 연구의 필요성 및 목적 □ 2008년 7월부터 시행되고 있는 노인장기요양보험제도는 가족의 노인장기요양부담을 완화하고 노인의 삶의 질을 향상시키려는 목적으로 제정되었으며, 독립적인 일상생활 영위가 불가능한 노인 등에게 신체활동과 가사지원 등을 사회적 연대원리에 의해 제공하는 것임. 이 제도는 '돌봄의 사회화'에 초석이 되었다는 점에서 의미가 있으나 현재 제도 도입 초기 단계이므로 제도가 노인의 삶의 질과 가족에게 어떠한 영향을 미쳤는지에 대한 연구는 거의 이루어지지 않았음. □ 따라서 본 연구의 목적은 노인장기요양보험제도가 노인과 부양가족의 삶의 질과 가족관계에 미친 영향을 분석하여 제도 도입 취지가 얼마나 실현되고 있는지 파악하고 제도 보완의 시사점을 도출하는 것임. ○ 본 연구에서의 부양가족은 노인돌봄에 있어 주된 역할을 하는 가족 중 노인의 배우자, 노인의 성인자녀 및 성인자녀의 배우자로 한정(이하, 주돌봄자)하며 구체적으로 가족구성원 개별의 차원에서는 제도 시행이 노인과 주돌봄자의 삶의 질과 부양부담(주돌봄자에 한함)에 어떠한 영향을 미쳤는지, 이용자의 제도에 대한 만족도는 어떠한지를 살펴보고, 가족 전체의 차원에서는 제도 시행이 가족관계에 어떠한 영향을 미쳤는지를 살펴봄. ○ 이와 함께 공적 요양서비스를 이용하는 과정에서 가족들이 어떠한 변화를 겪게 되었는지, 주돌봄자들이 인식하는 제도 개선방안과 그들이 원하는 정책지원 욕구는 무엇인지 알아봄.

The Korean government implemented the Long-Term Care Insurance(LTCI) since July of 2008 in order to improve the quality of life among older adults and to decrease the caregiving burden among family caregivers. In Korea, the LTCI system provides support in physical and/or housework activities for individuals who have difficulty with daily living for a period of at least 6 months due to old age (age 65+) or those with geriatric diseases. Beneficiaries are supported through the following long-term care(LTC) services once they receive an approval certificate of LTCI (grade 1, 2, 3): (1) in-home care services such as home-visit care, home-visit nursing, short-term respite care, home-visit bathing, day and night care, and welfare equipment, (2) LTC facility (e.g., aged care facility, senior congregate housing) service where older adults are provided with meals, care, and other daily activities, (3) special cash benefits (e.g., family care expense, exceptional care expense, nursing expenses of LTC hospitals). Although the implementation of LTCI is evaluated as a major step in supporting family caregivers, few studies have evaluated to what extent the goals of LTCI have been achieved. Instead, previous research has focused mainly on the expansion of LTCI infrastructure, the financial issues associated with the LTCI system, and the satisfaction with LTC services rather than examining the impact of the system on beneficiaries and their family members. The aim of this study was to respond to this research gap by examining the impact of LTCI on older adults and their family members, and to provide policy recommendations for policy makers and LTC service providers. Our research questions were as follows: 1) Does the LTCI system improve the quality of life among older adults who are the beneficiaries of the LTCI? 2) Does the LTCI system improve the quality of life among family caregivers by decreasing their caregiving burden? 3) Does the LTCI system improve the family relationship among older adults, major caregivers, and other family members? 4) To what extent are family caregivers satisfied with the current LTCI system, and what are the challenges associated with the current LTCI system? Both quantitative and qualitative methods were utilized in this study. Data were collected from a purposive sample of 600 family caregivers who were the major care providers for their dependent spouses or parents living in Seoul and GyeongGi Province, stratified by beneficiaries' LTC grade and types of LTC services that they use. Data collected for this study also consisted of structured interviews (n=28) carried out by our research team. The structured interviews for family caregivers lasted approximately 60-180 minutes, depending on the number of participants in each group, and full recordings of sessions were obtained and transcribed. Major questions that were asked to our study participants included, but were not limited to: sociodemographic characteristics of the participants, characteristics of the care-recipient, caregiving burden, overall LTC utilization, and the impact of LTC services on their lives. With respect to quantitative analysis, descriptive statistics as well as multivariate models were obtained using PASW Statistics software. In order to assess the statistical significance of associations, analysis of variance for continuous variables and Pearson chi-square analysis for categorical variables were conducted to examine differences among in-home care service users, aged-care facility users, and those who do not use LTC services. For the qualitative analysis, a comprehensive content review of all data, including line-by-line analysis, was conducted. Our sample composed of family caregivers who used in-home care services (52.5%), those who used aged-care facility (22.5%), and those who did not use any type of public LTC services (25.0%). Major findings of our study are as follows: First of all, two major reasons for using the L