KIHASA has released its March issue of the Health and Welfare Policy Forum, No. 328. (The articles are available for download here.)

SUMMARY OF THE FOREWORD by Lee, Sang Jung

Older adults, children, and individuals with disabilities in Korea who could neither care for themselves nor be cared for within their families--for reasons such as family poverty, aging or disability in family members, or family breakups or conflicts--have in general been put under the protection of institutional care. Of late, however, with facility-based care criticized as against human rights, demands have been increasingly voiced for community-led care provision. Consequently, policy measures have been implemented to promote deinstitutionalization and integrated comunity care for older adults, children, and people with disabilities. However, as reliance on facility-based care remains significantly high, continued efforts are needed to further deinstitutionalize care and expand community-led care on the one hand and, on the other, to monitor and enhance the living conditions of older adults, children, and disabled people who live in residential facilities.

Older adults, children, and people with disabilities residing in residential facilities have been seen until now as objects of protection, with thier human rights brought to public discussion and attention, but by and large as rights to protection, the right to food, clothing, and shelter, and to safety. However, living though they do under protection while in residential facilities, they have the right to live a life of freedom as subjects of their own lives. Enabling them to live as such requires the guarantee of their right to self-determination. These individuals must be given options and the right to make choices of their own accord across all the domains of their lives, including choices having to do with entry into and exit from residential care and with, as facility residents, whether or not to take part in certain programs and services.

In this issue of the Health and Welfare Forum we explore the current state of the safeguarding of the right to self-determination in residential care settings for older adults, children, and disabled people and discuss policy options for improvement in both policy and practice.

MONTHLY FOCUS: Current Status of the Guarantee of the Human Rights of People in Residential Care Facilities

"Human Rights and Self-Determination in Residential Care Facilities: Concepts and Challenges," Ma, Han Eol, Duroo Association for Public Interest Law

Human rights arise from human vulnerability. They are guaranteed through communal agreements. Residential care facilities must take as their main objective the realization of human rights, given they represent the locus where the communal agreement to reinforce the guarantee of human rights for those with salient vulnerabilities is translated into practice. Meanwhile, human rights cannot be separated into parts, nor can some of them be prioritized over the others. Also, they are interdependent and interrelated. The right to self-determination shares the indivisibility, interdependency, and interrelatedness of human rights. Such is the reason why no individual’s right to self-determination can be restricted on the grounds of the protection of that individual in a residential facility setting. Nor ought the protection of the individual be forsaken for the sake of safeguarding the right to self-determination. Inasmuch as the line of demarcation that sets off those living in residential care facilities closely mirrors the arbitrary line defining the rational, reasoning agent that self-determination presupposes, the right to self-determination becomes a fundamental problem that the residents come to confront from the moment they are placed in these facilities. Residential care facilities must be committed to ensuring that their residents have not only chances to exercise their right to self-determination, but also options to choose from and sufficient contextual information based on which they can put their right to self-determination into action, as well as supporting them so that they can live in a self-actualizing way. Additionally, ways should be sought, through collaboration with civil society, to bring about changes in perspective toward conflicts of interest that arise involving the resident’s right to self-determination and the care worker’s roles.

"Current State of Human Rights in Residential Care Facilities for Older Adults and Its Policy Implications," Joo, Bohye, KIHASA

Elder care facilities such as nursing homes and elder group homes, where older adults assessed as needing long-term care live, bear spatial significance in that they are where their residents’ daily living takes place and disease management is administered in the same space. Ensuring that residents of long-term care facilities live a life of dignity is a policy challenge that requires continued attention and actions aimed at promoting the human rights of older adults. Drawing on the findings of a needs survey, this article examines the current state of the guarantee of self-determination in residential long-term care settings, an element essential to ensuring that the residents live a life of dignity. I also discuss what needs to be done to further guarantee the right to self-determination for older adults residing in long-term care facilities and ways to create conditions to enable them to live their lives in a self-determining way. The needs survey was conducted online with heads and directors of long-term care facilities and elder group homes, given the difficulties of administering a survey on residents themselves of these facilities. The questionnaire was structured around several themes, including the ‘characteristics of facility management’, ‘safeguarding of self-determination rights for facility residents’, and ‘family and community participation’.

"Current State of Human Rights in Residential Foster Care Facilities and Its Implications," Lee, Sang Jung, KIHASA

As children in foster care have to date been regarded solely as objects of protection, public attention toward their human rights has remained limited mostly to their right to protection, such as the right to food, clothing, and shelter, to physical and mental health, and to safety. However, as much as the subjects of their lives as other children are of theirs, these children, while living in foster care, must have the rights to live as the masters of their own lives, to engage in activities freely, and to express their thoughts. Ensuring these rights requires enabling the children in residential foster care to exercise their right to self-determination, which is fundamentally the right to freedom. This article presents the findings of a survey we conducted to assess the current state of safeguarding self-determination for children residing in child welfare facilities and discusses policy options for improvement. The survey involved youth in preparation for independent living who had firsthand experience with living in foster care all the way through from placement and entry into the system to exiting it.

"Current State of the Right to Self-Determination in Residential Care Facilities for People with Disabilities and Its Policy Implications," Yi, Min-Gyeong, KIHASA

I examine in this article whether the right to self-determination is sufficiently guaranteed for disabled people living in residential care facilities in the course of their daily lives, as well as at the stages of their entry into and exit from institutional care. My observation is based on a survey of the right to self-determination and needs of people with disabilities living in institutional care. The survey involved 119 individuals with disabilities selected from 15 residential care facilities across four cities. I then make several suggestions to ensure their right to self-determination. First, the ongoing efforts to help disabled individuals in facility-based care transition out to deinstitutionalization and independent community living should be pursued based on detailed support strategies that reflect the different characteristics of people of different ages with different disabilities. It is especially important to develop a model of support to enable individuals with the severest of developmental disabilities to live on their own in the community. Second, there is a need to move away from the overly administrative control of resource allocation to residential care facilities to an approach more aligned to the needs of individual residents themselves. Third, a new system can be considered whereby residential care facilities for disabled individuals can have in place support staff tasked with, among others, handling challenging behavior and assisting their residents in community participation. Fourth, there is a need for improving capacity-building education and training for workers serving in residential care facilities for disabled individuals. Fifth, support mechanisms should be built to help disabled individuals, as the subject of their own lives, make self-determined choices regarding their deinstitutionalization and community living.

POLICY ANALYSIS AND TRENDS

"Social Isolation in Different Age Groups after the Pandemic and Its Policy Implications," Kim, Seonga & Noh, Hyun-ju, KIHASA

This article aims to examine how the prevalence of social isolation changed in people of different life stages following the Covid-19 pandemic and explore its policy implications. Our analysis of Statistics Korea’s social survey revealed that during the pandemic, a greater number of individuals experienced social isolation, defined here as being without social connections and lacking a social support network. In 2023, with the impact of the pandemic having subsided, the extent to which the prevalence of social isolation changed varied depending on life stage. The proportion of socially isolated youth decreased somewhat from 2021 but not quite to its pre-pandemic level. While the prevalence of social isolation among older adults declined to its pre-pandemic level in 2023, the proportion of those among the middle-aged who saw themselves as socially isolated increased, if anything, compared to 2021. This article considers public support programs as a means that, if delivered adequately and flexibly to people of different life stages―adolescents living in self-chosen seclusion, isolated and secluded youth, middle-aged people identified as at risk of ‘lonely death’, and older adults living alone― can fill in where they lack a social support network to rely on.

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