Long-term care service utilization before and during the COVID-19 pandemic in older patients with hip fractures: a Korean nationwide cohort study
This nationwide Korean cohort study reveals that during the COVID-19 pandemic, older patients with hip fractures maintained similar long-term care application rates but experienced higher recognition and service initiation, accompanied by a significant shift toward home-based care likely driven by increased functional needs and institutional aversion.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
When an older person breaks a hip, the injury is about more than just the bone. It is a turning point that often changes how they live for the rest of their lives. Many find they can no longer walk, dress, or eat without help, and they require ongoing support to manage daily life. In South Korea, the government runs a system called Long-Term Care Insurance to provide this support. It acts as a safety net, offering services that range from professional help at home to care in nursing facilities. This system is designed to step in when a person's independence fades, ensuring they do not have to face their recovery alone. However, when a global health crisis strikes, the way people access these services can change. The question researchers asked was simple but vital: when a pandemic disrupts hospitals and families, does the path to getting this essential care break down, or does it adapt?
To find the answer, a team of researchers in South Korea looked at a massive collection of health records spanning more than six years. They focused on nearly 200,000 older adults who had suffered their first hip fracture. The team split this group into two eras: the years before the coronavirus pandemic began in early 2020, and the years during the pandemic. By comparing these two groups, they could see how the crisis affected the journey from the hospital bed to long-term support. They examined every step of the process: how many people applied for care, how many were approved, and what kind of care they actually received.
The results revealed a story of resilience rather than collapse. When the pandemic hit, the number of people applying for long-term care did not disappear; it stayed remarkably steady. The rate of new applications was nearly the same in both periods, hovering around 17 percent. This suggests that even when hospitals were overwhelmed and families were worried about infection, the pathway for older patients to ask for help remained open. The system did not shut its doors.
However, once people applied, the outcome changed in a significant way. During the pandemic, a higher percentage of applicants were approved for care compared to the years before. Before the crisis, about 86 percent of applicants received approval. During the pandemic, that number rose to 89 percent. This shift indicates that the people applying during the pandemic were, on average, in greater need. The researchers suggest that the isolation and restrictions of the pandemic likely caused a faster decline in physical strength and function for many older adults. Because they were frailer when they applied, they crossed the threshold for eligibility more easily. The system recognized this increased need and responded by granting more approvals.
The most striking change occurred in the type of care people chose. Before the pandemic, most approved patients received care at home, but a significant portion still went to nursing facilities. During the pandemic, the preference for home care surged. The proportion of people receiving care at home jumped from roughly 63 percent to 69 percent, while the use of institutional care dropped. This shift was not just a statistical blip; it reflected a real change in behavior. With nursing homes facing outbreaks and strict visitor bans, families became wary of placing their loved ones in those settings. At the same time, evidence showed that patients recovering at home fared better than those stuck in facilities where movement was restricted. The pandemic accelerated a move toward keeping care in the home, a trend that was already starting but suddenly became the clear choice for many.
The study concludes that the long-term care system in South Korea held up well under pressure. The process of applying for help did not break, and the system successfully identified and supported those whose needs grew sharper during the crisis. The data shows that while the pandemic made life harder for older adults, it also clarified where they needed help most. The surge in home-based care suggests that when institutional settings feel unsafe, families and patients will naturally gravitate toward support that keeps them in their own homes. This finding offers a clear lesson for the future: in times of public health emergencies, ensuring that home-based care is accessible and well-resourced is just as important as keeping hospitals running. The system proved it could adapt, but the shift toward home care highlights a deep-seated need to protect the most vulnerable from the risks of crowded institutions.
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