Opening a Long-Term Care Facility?

Korea's elder-care system runs through three legally distinct tracks that first-time operators routinely conflate: a 노인의료복지시설 (nursing home, either a 10+-resident 노인요양시설 or a 5–9-resident 노인요양공동생활가정), a 재가노인복지시설 (home-visit or day-care service, most commonly a 방문요양센터), and a 요양병원 (long-term care hospital, a full medical institution under the Medical Service Act rather than the Welfare of Older Persons Act). All three can become a 장기요양기관 — the designation that lets a facility bill Korea's long-term care insurance — but the establishment path, facility standards, staffing ratios, and regulator differ sharply between them, and this office has handled filings across all three.

The Three Facility Types, and Where They Sit in the System

Under Article 34(1) of the Welfare of Older Persons Act, 노인의료복지시설 splits into 노인요양시설 (10 or more residents) and 노인요양공동생활가정 (5–9 residents, a smaller home-like setting). 재가노인복지시설 delivers one or more of six services defined in the Act and its enforcement rule: 방문요양 (home-visit care), 주·야간보호 (day/night care), 단기보호 (short-term respite care), 방문목욕 (home-visit bathing), 재가노인지원 (in-home support and counseling), 방문간호 (home-visit nursing), and 복지용구지원 (assistive-device supply/rental). A 장기요양기관 is any of these that has additionally been designated under the Long-Term Care Insurance Act (Article 31) to provide benefits to insurance recipients — 재가노인복지시설 provide 재가급여 (in-home benefits) and carry facility code 2, while 노인의료복지시설 provide 시설급여 (institutional benefits) and carry facility code 1. A legacy facility code 3 existed for 재가장기요양기관 that had only filed a설치신고 without going through the full 노인복지법 재가노인복지시설 설치 process before December 12, 2019 — code 3 is being phased out entirely, with those facilities required to complete proper 재가노인복지시설 설치 and re-designate under code 2.

Setting Up a Home-Visit Care Center (방문요양센터)

This is the lowest-capital entry point into the system, which is why it's the most common first inquiry. The center head (시설장) must hold a Level 1 or 2 사회복지사 license (any level, regardless of years of experience), a medical license (doctor/dentist/oriental doctor), or — the slower path — 5+ years as a Level 1 요양보호사 plus a Ministry of Health and Welfare-designated training course. A Level 2 사회복지사 is the fastest qualification route for someone starting from scratch. Minimum staffing beyond the center head includes 1 사회복지사 (once the center serves 15+ recipients), the required 요양보호사 headcount (15 or more, 5 or more in rural areas), plus nurses/nursing assistants, physical therapists, office staff, and a driver as needed. The facility itself must have at least 16.5㎡ of dedicated floor area, and centers offering vehicle-based bathing service need a mobile bathtub or bathing vehicle.

Filing runs two parallel document sets: the 재가장기요양기관 설치신고서 (Form 20 under the Welfare of Older Persons Act enforcement rule) with a general/staffing/facility-status overview, business plan, staff credentials and employment contracts, proof of building ownership or lease, a building-use certificate, and operating regulations; and the 장기요양기관 지정 신청서 (Form 19 under the Long-Term Care Insurance Act enforcement rule) filed in parallel. The 9-step designation review — application receipt, document screening (the applicant's service history and any administrative-sanction record are checked through the 행복e음 national database), an on-site inspection confirming staffing and facility compliance, deliberation by the local 지정심사위원회, a pass/fail decision, system registration, mailed certificate issuance (within 30 days of receipt), notification back to the insurance corporation, and ongoing post-designation monitoring — runs through the local 시·군·구청, not a national body, so exact document formatting and local practice can vary by jurisdiction.

The business plan is where most applicants stumble, because a generic template won't clear the local scoring rubric. Seoul's Gangnam-gu criteria, as one example, require an average score of 80+ across five weighted categories: the operator's and caregivers' service-delivery capability (55 of 100 points — by far the largest weight), the soundness of the service plan (15), resource-management structure (15), staffing-management structure (10), and staff welfare (5). The rubric differs by district, so the plan has to be built against wherever the facility will actually operate, not a one-size-fits-all draft.

Establishing a Nursing Home (요양원 / 노인요양시설)

A 노인요양시설 (10+ residents) requires at least 23.6㎡ of floor area per resident — a 20-resident facility needs roughly 472㎡ (about 143 pyeong). A 노인요양공동생활가정 (5–9 residents) needs at least 20.5㎡ per resident — a 9-resident home needs roughly 184.5㎡ (about 56 pyeong). Bedroom rules are specific and frequently missed on first drafting: at least 6.6㎡ per resident, a maximum of 4 residents per shared room, separate men's/women's rooms in mixed-gender facilities, individual storage for each resident's belongings, at least 1/7 of the floor area as operable exterior windows, wheelchair/bed-accessible layout, and appropriate heating, ventilation, and lighting. Smaller 공동생활가정 facilities may combine the office, care-worker room, and volunteer room into one shared space, and physical-therapy/program/nursing rooms can be separated with curtains rather than full partitions — a meaningful cost saving on a small footprint. A dedicated medical/nursing room stocked with routine medications and hygiene supplies is required regardless of facility size.

Filing follows the same dual-document structure as a home-visit center — a 노인의료복지시설 설치신고서 (Form 16) plus attachments (articles of incorporation if the operator is a corporation, a site/floor plan and equipment specification, resident fee/deposit terms, a service-and-medical-linkage business plan, and proof of site/building ownership or, for smaller and government-designated facilities, a right-of-use document) — followed by the same 장기요양기관 지정 신청서 (Form 19) used for home-visit centers.

Long-Term Care Hospital (요양병원) — A Fundamentally Different, Harder Path

A 요양병원 is not a welfare facility at all — it's a hospital-grade medical institution under the Medical Service Act, and establishing one runs through two sequential regulatory layers rather than one. First, a 의료법인 (medical corporation) must be established: the founders and the corporation's 이사장 (board chairman) must themselves be licensed medical professionals (doctors, oriental-medicine doctors, etc.), and the establishment-permit application — articles of incorporation, founding purpose statement, business plan, endowed capital-asset documents, appraisal reports — goes to the metropolitan/provincial governor for document, site, and 심의위원회 review before corporate registration. Second, once the corporation exists, it applies separately for a 요양병원 개설허가 (hospital opening permit), which requires clearing detailed facility and staffing standards and passing a mandatory 의료기관개설심의위원회 review under Medical Service Act Article 33(4) — only after that does the hospital file its own 장기요양기관 지정 신청 with the National Health Insurance Service, a third, final step.

Facility standards scale with average daily inpatient count: at least 7.4㎡ per bed in a shared room with 1.1㎡+ between beds, dedicated internal-medicine/surgery/rehabilitation-medicine treatment rooms of 12㎡+, a surgical room of at least 24㎡ once the hospital has 30+ beds, an X-ray/ultrasound examination room, physical- and occupational-therapy rooms of 30㎡+ each, a preference for 4-bed-or-smaller wards with accessible bathrooms, a central-supply room, a waste-processing room, and — a 2024-08-01 rule change — a dedicated mortuary/end-of-life room once the hospital reaches 300+ beds. Staffing scales the same way: 2 doctors for up to 80 average daily inpatients, plus 1 additional doctor per 40 patients beyond that; nurses at 0.48 per bed; nursing assistants at 0.36 per bed; social workers, physical therapists, and dietitians each at roughly 0.015 per bed; plus pharmacists and radiologic technologists as the examination facilities require. Because a 요양병원 combines a permit-based (not registration-based) medical-institution track with corporate governance requirements, the process commonly runs 3–6+ months, against roughly 1–3 months for a nursing home's registration-based filing.

Nursing Home or Long-Term Care Hospital — Which One Fits?

The functional line is whether a prospective resident needs daily-living support (요양원) or active medical treatment (요양병원): a nursing home is care-focused, staffed around 요양보호사 without a resident doctor (an on-call 촉탁의 visits periodically), billed through long-term care insurance; a long-term care hospital is treatment-focused, staffed around resident doctors and nurses who can administer medication, order tests, and perform procedures, billed mainly through national health insurance with larger non-covered charges for nursing/attendant care. In practice, many residents move between the two as their condition changes — stable and needing daily support fits a nursing home; wound care, medication titration, or active rehabilitation after a stroke or surgery points toward a long-term care hospital. On the establishment side, a nursing home can be founded by an individual holding the right credential and only needs a registration-style 설치신고, while a long-term care hospital requires a medical corporation and a full permit-style 개설허가 — meaningfully more capital, more required medical-professional involvement, and a longer runway before opening.

The 2025 Designation-Renewal Deadline (지정갱신제)

Every existing 장기요양기관 — nursing home or home-visit center alike — needs to track this regardless of how long it's been operating. Following a November 2019 Ministry of Health and Welfare announcement, designation now carries a 6-year validity period. Facilities designated before December 12, 2019 had until December 12, 2025 to complete their first renewal review; as of December 2025, roughly 16,944 facilities nationwide fell into this renewal window. Renewal applications must be filed between 180 and 90 days before the current designation expires. The review pulls administrative-sanction history, past evaluation results and grades (two consecutive lowest-grade "E" evaluations weighs heavily against renewal), operating and business plans, resident-rights protections, staff-training records, accounting and budget compliance, and staffing structure — history of elder abuse or frequent business suspensions/closures is a significant deduction, which is precisely the point: the renewal system exists to stop facilities with a troubled record from simply closing and reopening under a new registration to escape scrutiny. Facilities that don't file in time face the same beneficiary-protection and data-transfer procedures used for a facility closure. Separately, facility code 3 (legacy 재가장기요양기관 without a full 노인복지법 설치신고) is being fully absorbed into code 2 as part of this same renewal wave — those facilities need to complete a proper 재가노인복지시설 설치신고 alongside their re-designation, not just a straightforward renewal.

Facility Occupancy: The Long-Term Care Grade System

Because nursing-home occupancy depends entirely on incoming residents holding an approved grade, an operator's business case rests on understanding it too. The National Health Insurance Service assesses applicants into Grades 1–5 plus a 인지지원등급 (cognitive-support grade). Grades 1–2 qualify automatically for 시설급여 (institutional benefits, i.e. nursing-home admission); Grades 3–5 default to 재가급여 (in-home benefits only) but can be approved for facility admission through a separate 급여종류·내용 변경 신청 to the local 등급판정위원회, typically on evidence of caregiver hardship, inadequate housing, or documented dementia-related behavioral symptoms; the 인지지원등급 cannot use facility benefits at all. Grade assessment itself runs through NHIS — application, a roughly 1–2-week home visit assessment, a physician's opinion statement, and committee deliberation, about 30 days total, with a 30-day window to appeal an unfavorable result.

What Working With This Office Looks Like

Most engagements start with matching the facility model — home-visit center, nursing home, or long-term care hospital — to the operator's credentials, capital, and timeline, since the three tracks diverge completely from the first filing onward. From there, this office prepares the 설치신고 (or, for a hospital, the medical-corporation and hospital-opening applications) and the parallel 장기요양기관 지정 신청, drafts the business plan against the specific local district's scoring rubric rather than a generic template, coordinates with the relevant 시·군·구청 or 시·도 authority and the National Health Insurance Service through document review, site inspection, and committee deliberation, and — for facilities already operating — manages the 6-year designation-renewal filing and any facility-code-3-to-2 transition.