"If you pay in the 1 million won-a-month range, we’ll take care of everything."
It is a familiar sales pitch at many long-term care facilities in the Seoul metropolitan area. Rather than breaking down medical fees, caregiving expenses, and meal costs, some institutions promote a single, flat monthly rate—a classic "value" marketing tactic designed to appeal to budget-conscious families.
What this pitch frequently omits are the hidden add-on charges. Total bills can escalate quickly once facilities tack on line items for patient clothing, personal hygiene supplies, premium room surcharges, non-covered rehabilitation, supplements, manual therapy, and transportation or diagnostic testing fees.
When families fail to research facility operations in advance, they risk falling for low upfront prices, only to find their loved ones receiving inadequate care in outdated facilities where a parent's health could deteriorate rapidly.
Overcrowded Rooms and Grandfathered Regulations
The physical environment of a long-term care hospital is the first crucial factor to examine. Many low-cost facilities cut overhead by crowding more beds into each inpatient room.
In February 2017, the Ministry of Health and Welfare revised the Enforcement Rules of the Medical Service Act, capping the maximum capacity of a single inpatient room at six beds. Under these rules, multi-bed rooms must allocate at least 6.3 square meters per patient and maintain a minimum distance of 1.5 meters between beds.
However, overcrowded rooms have not disappeared. Because the 2017 standard applies only to facilities constructed or expanded after the law took effect, older long-term care hospitals approved prior to 2017 are only required to maintain a 1-meter gap between beds.
Consequently, a facility housing seven, eight, or even nine patients in a single room is not necessarily operating illegally; its compliance depends on its original approval date. Nevertheless, high patient density in long-term care settings creates serious infection control vulnerabilities, significantly increasing the risk of rapid transmission during outbreaks of respiratory or contact-based infectious diseases among high-risk elderly patients.
Checking Nursing Home Staffing Standards
Labor accounts for the largest share of operating expenses in long-term care services. Discount facilities frequently reduce operating costs by scaling back staffing levels.
At nursing homes (senior long-term care facilities), monthly quotes typically include basic caregiving services, making it essential for families to independently verify staffing ratios. In June 2025, the government tightened mandatory staffing standards for care workers to one full-time caregiver for every 2.1 residents. If a facility operates below this legal benchmark, care quality will inevitably suffer.
Staff tenure is another reliable indicator of care quality. Caregivers who complete at least 60 months of service at a single institution and undergo specialized promotion training administered by the National Health Insurance Service (NHIS) qualify as "senior care workers." Facilities are permitted to assign one senior care worker per 25 residents—a metric that reflects both staff retention and operational proficiency.
Verifying Official Ratings and Conducting On-Site Inspections
When evaluating prospective facilities, navigating online forums, blogs, and marketing materials can quickly become overwhelming. Families should begin by checking a facility's official performance evaluation rating.
Unrated facilities or those with outdated evaluation records should be treated with caution. Official ratings for long-term care hospitals are published on the Health Insurance Review & Assessment Service (HIRA) website under the hospital evaluation search tool, which categorizes facilities from Grade 1 to Grade 5 by region. Ratings for nursing homes are managed separately by the NHIS, which assigns grades from Grade A to Grade E.
After reviewing official ratings, conduct a thorough on-site visit. Key details to confirm in person include whether the facility's actual bed count, establishment approval date, and caregiver staffing ratios match their written or verbal claims.
When reviewing contracts, avoid focusing solely on the aggregate monthly figure. Demand an itemized contract formatted as an estimated monthly statement that clearly separates the patient's out-of-pocket copayment for covered benefits from each non-covered fee. Visiting right before meal times or over the weekend can also provide valuable insight into real-world facility management and daily staffing levels.
In the final installment of this series (Part 5), we will examine what families need to watch out for after placing a parent in a long-term care hospital or nursing home.
