CARE-Net—A Smart Integrated Care Approach to Reach Older People in a Depopulated Area

ORGANIZATION: Institute for Community Care and Health Equity, Chung-Ang University; Summary A.I.; and Jeongeup City Public Health Center
LOCATION: Jeoungeup City, Republic of Korea

Special Prize for Care Network Development

THE PROBLEM

The Republic of Korea, like many countries facing rapid population aging, is also grappling with the impact of depopulation in areas outside major urban centers. In 2021, the Ministry of the Interior and Safety identified 89 regions facing depopulation. Jeongeup City is one such region, where the population has declined from 270,000 in 1960 to just around 100,000 in 2024. Approximately 31 percent of Jeongeup City’s population are older people, and they now live in a region that has significant gaps in terms of healthcare services and infrastructure, with 7 out of the 15 administrative regions that make up the City lacking a hospital or health clinic.

THE INNOVATION

Recognizing the challenges that depopulation posed for the region, the Jeongeup City Public Health Center has established a public-private partnership with Summary A.I., a technology company, and the Institute for Community Care and Healthy Equity at Chung-Ang University. Through this collaboration, they have launched a digital platform called “CARE-Net,” which connects health, welfare, long-term care services, and medical care, allowing inter-agency data-sharing and communication that enables experts to quickly identify a person’s needs and communicate with others to resolve them.

CARE-Net takes an “onion model” approach to bringing together various stakeholders involved in the provision of care to older adults, along with service recipients themselves, to provide comprehensive health services to its users. The platform itself is a “smart integrated care” hub, acting as a data warehouse for various agencies. This multiagency data provides multifaceted information about the subject, allowing experts to quickly identify the subject’s problems. It also serves to connect the staff and experts via chat and video conferencing functions to quickly share opinions and develop solutions.

One important consideration when creating this kind of comprehensive data-sharing platform was to ensure that users properly understood and could control who had access to their data. After discussions with participants in the project, CARE-Net developed a system that allows older people to choose for themselves to whom and to what extent they want to disclose their information. At the membership sign-up stage, CARE-Net provides a third-party information release agreement that specifies the organizations from which data can be used, and when family members sign up to access data, it is done with the consent of the older person using CARE-Net.

In addition to the high-tech approach of the CARE-Net platform, a key aspect of the project’s “onion model” approach has been to leverage community members to work together and provide health solutions for at-risk older people. The project organizers have worked to recruit “village care managers” who act as citizen health leaders. These care managers have a wide range of backgrounds but are required to be familiar with using smart devices. They then receive training sessions twice a month on the use of the CARE-Net system and other topics related to care management, familiarizing them with the types of services and resources that are available. These care managers are then able to troubleshoot when CARE-Net users have particularly complex health and/or welfare problems, using both online and in-person case conferences. While there were some initial concerns about including nonprofessional care managers in these discussions, it was found that the village care managers often were the most effective in leading the interventions because of their community knowledge and relationships with the individuals concerned.

Since the launch of CARE-Net in May 2023, about 3,200 people have participated in the project. While the project is still in development, they have seen some success in identifying and resolving challenges faced by at-risk older people in the community. For example, a man with Parkinson’s disease was receiving caregiving support from his wife, but when she had to have surgery herself, the village care manager helped address the situation during a case conference and facilitated an application for the couple to receive customized care services, including a live-in support worker.

KEYS TO SUCCESS

  • Integrating data from various agencies and service providers for older people can fill gaps in services created as a result of depopulation and create a “smart integrated care” environment.

  • The project’s success derives from combining technological solutions with an investment in training community leaders and leveraging their expertise and connections with the community to provide case management.

  • The project emphasized transparency in how data in the system is used and provides older people using the system with the ability to control who has access to their data and what data they have access to.

FINANCIAL STRUCTURE

The initial project was carried out with support from the National Health Smart Management Research and Development Fund provided by ROK’s Ministry of Health and Welfare. They received 750 million KRW (~US$500,000) for the first year of the project and 1 billion KRW (~US$700,000) for the second year. In the future, they plan to apply to the R&D fund for Collective Research Projects from the Ministry of Science and ICT. Use of the CARE-Net system is set to cost 15,000 KRW per month per user. However, the project is still in the pilot phase, so older people currently participating are not paying any additional fees for the system.

LINKS

KEYWORDS: Caregiving, Frailty, Medical/health services, Social/community engagement

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