장기요양요원의 법적 지위

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서울대학교 대학원
노인 돌봄노인장기요양보험법장기요양요원선택권공공성 강화돌봄을 받을 권리taking care of the elderlyLong-Term Care Insurance Actlong-term care workerright to choosestrengthening a public responsibilitythe right to be taken care of
학위논문(박사)--서울대학교 대학원 :법과대학 법학과,2019. 8. 김복기.
The Republic of Korea introduced the long-term care insurance scheme in July 2008. This introduction of the scheme was the state's institutional response to the aging population. At the same time, it was also the state's declaration that it would no longer leave the responsibility of taking care of the elderly to individuals and their families alone, but that the state and the social community as a whole would jointly and publicly bear the social responsibility of taking care of the elderly. Among many players engaged in the long-term care insurance scheme, a long-term care worker provides his/her care service to the elderly at the forefront of the scheme and stands at the center of various relationships surrounding the scheme.
As declared with the introduction of the long-term care insurance scheme, it is the society's responsibility to take care of the elderly, and such social responsibility must be reasonably shared by care providers in a broad sense. First, a long-term care institution's role is not limited to a mere execution of a contract of providing long-term care benefits to a beneficiary; it must fulfill its roles as a care provider by hiring and educating capable long-term care workers, and directing and supervising the payment of salary to those workers' care provision, so that beneficiaries would be able to receive benefits of a good quality. A long-term care worker must provide his/her beneficiaries with adequate benefits necessary for them based on his/her knowledge and experience. In other words, the long-term care institutions and long-term care workers get to engage in their work within the system of the state-established long-term care insurance scheme and the framework set out in the regulations. Accordingly, the state, after all, has the ultimate responsibility of properly setting up, regulating and supporting the scheme and regulations.
With the belief that it would be important to review (i) a long-term care worker's legal relationships with other players within the long-term care insurance scheme and (ii) the legal status of long-term care workers in order to ensure the sustainable development of the long-term care insurance scheme, this study has reviewed a long-term care worker's relationship with a long-term care institution, relationship with his/her beneficiary and the beneficiary's family, and relationship with the state and a local government, one after another.
First, the relationship between a long-term care worker and a long-term care institution is the contractual relationship under the employment contract. Accordingly, a long-term care institution, as an employer of a long-term care worker, is responsible for performing its obligations under various labor related statutes, including the Labor Standards Act enacted to protect employees. Still, there are many cases where long-term care institutions fail to perform their responsibilities as an employer. However, a long-term care worker, as an employee, must be protected under labor related statutes.
However, to look into a long-term care worker's caregiving work to older persons, it is not sufficient to take a look at a care worker's service only from the perspective of protecting a long-term care worker as an employee in the relationship with a long-term care institution (the care worker's employer). We also have to consider a long-term care worker's complex relationship with his/her beneficiary, who needs to be taken care of by the care worker and thereby is at a vulnerable position, on the one hand, but who is also able to exercise the right to choose in regard to a long-term care worker and compels the care worker to do things beyond his/her scope of work, on the other hand. There is no direct contractual relationship between a long-term care worker and a beneficiary, and the long-term care worker is an employee of a long-term care institution and is not an employee of the beneficiary. Nevertheless, there are many cases where a beneficiary or the beneficiary's family member mistakenly believe that a long-term care worker is an employee that they hired, i.e. a housekeeper, and such understanding gives rise to many issues, e.g. they would demand a long-term care worker to do things other than their scope of work, etc. The beneficiary's right to choose is intended for enhancing the quality of benefits given to a beneficiary and for protecting the interest of a beneficiary at a vulnerable position, and such positive functions of the beneficiary's right would surely have to be respected. Still, beneficiaries and their family members are also required to have a better understanding of the scope of their exercise of the right to choose and a clear limit to it. In addition, one should not overlook the needs (i) to provide the beneficiaries with sufficient information and education, (ii) to promote active communication between the beneficiaries and long-term care workers and (iii) to develop a sound long-term care institution, in order to prevent the beneficiaries' right to choose from ending up being a nominal and perfunctory right.
Meanwhile, the public nature of the long-term care insurance scheme is required to expand further to improve the quality of long-term care benefits and to enhance the quality of life of a long-term care worker who, in practice, provides the beneficiaries with long-term care benefits. That is because it is difficult to expect that a small scale private long-term care institution would engage in a fierce competition for improving the quality of benefits provided to the beneficiaries and would guarantee job security to its long-term care workers. Socialization of the service of taking care of the elderly based on the long-term care insurance scheme means that that the state and the entire society would take a responsibility for taking care of the elderly. Accordingly, the state and local governments would be required to make proactive efforts to further expand the partial progress made up to now for the socialization of the responsibility of taking care of the elderly.
Long-term care is not a personal matter that should be handled by an individual or a family but a public matter that our society as a whole should be responsible for. The work of taking care of others has its own distinct feature, that the work would be done for a person, as an end in him/herself, and by a person, unlike other types of work, the purpose of which would be to complete a job or to process a task, etc. Therefore, key assignments in this kind of care giving work should be 'to treat a person as a person should be treated', and 'to respect a life as a life should be valued'. It is not necessary to emphasize that the targets of the above assignments should include not only the beneficiaries who need to be taken care of but also long-term care workers who take care of the beneficiaries.
우리나라는 2008년 7월 노인장기요양보험을 도입하였는데, 이는 고령화에 대한 제도적 대응임과 동시에 더 이상 노인 돌봄의 책임을 개인과 가족에게만 부담시키지 않고 그 책임을 국가와 사회공동체가 공적으로 나누어 부담하겠다는 사회적 책임의 선언이기도 하다. 장기요양보험제도 내에는 여러 행위자들이 있는데 장기요양요원은 장기요양보험의 최일선에서 돌봄을 제공하는 위치에 있을 뿐만 아니라 장기요양보험을 둘러싼 여러 관계들의 중심에 있다.
노인장기요양보험의 도입으로 천명한 바와 같이 노인에 대한 돌봄은 사회적 책임이고, 이러한 사회적 책임은 광의의 돌봄 제공자들에게 합리적으로 분배되어야 한다. 장기요양기관은 수급자와 장기요양급여제공계약을 체결하기만 하면 되는 것이 아니라 수급자에게 양질의 급여가 제공될 수 있도록 역량을 갖춘 장기요양요원을 고용하고 교육하며 이들의 급여 제공을 지휘·감독하여 제공자로서의 역할을 다하여야 하고, 장기요양요원은 자신의 지식과 경험을 바탕으로 수급자에게 필요한 적정한 급여를 제공하여야 하며, 결국 이들 장기요양기관과 장기요양요원은 국가가 조성해 놓은 장기요양보험의 체계와 규칙의 틀 속에서 움직이게 되므로 국가는 이를 제대로 조성하고 규제 및 지원할 궁극적인 책임을 진다.
본 논문에서는 장기요양보험제도의 지속가능한 발전을 위해서는 장기요양요원과 장기요양보험제도 내의 다른 주체들과의 법적인 관계 및 장기요양요원의 법적 지위에 대한 검토가 중요하다는 문제의식 하에 장기요양요원과 장기요양기관, 수급자 및 그 가족, 국가 및 지방자치단체와의 관계를 차례로 검토하였다.
우선 장기요양요원과 장기요양기관 사이의 관계는 근로계약 관계에 해당하고 장기요양기관은 장기요양요원의 사용자로서 근로자를 보호하기 위해 마련된 근로기준법을 비롯한 각종 노동 관계법령상의 의무를 이행할 책임을 부담하지만 이러한 의무가 이행되지 않는 경우가 많다. 장기요양요원은 근로자이기 때문에 노동 관계법령상의 보호를 받아야 한다.
그런데 장기요양요원의 돌봄노동은 사용자인 장기요양기관과의 관계에서 근로자인 장기요양요원을 보호하는 측면만 살펴보는 것만으로 충분하지 않고, 돌봄을 필요로 하는 취약성을 지니고 있으면서도 한편으로는 장기요양요원에 대해 선택권을 행사하고 업무외행위를 강요하기도 하는 수급자와의 복합적 관계가 고려되어야 한다. 장기요양요원과 수급자 사이에는 직접적인 계약관계가 존재하지 않고, 장기요양요원은 장기요양기관의 근로자이지 수급자의 근로자가 아님에도 수급자 또는 수급자의 가족이 장기요양요원을 본인들이 고용한 근로자 즉 가사사용인으로 잘못 생각하는 경우가 많기 때문에 업무외행위의 강요 등 문제가 발생하는 측면이 있다. 수급자가 받는 급여의 질을 향상시키고 취약한 약자로서의 수급자의 이익을 보호하기 위한 수급자의 선택권의 순기능은 존중되어야 하겠지만 선택권의 행사 범위와 한계에 대한 인식 확대 또한 요구된다. 선택권이 허울뿐인 것으로 전락하지 않기 위해서는 수급자에 대한 충분한 정보 제공과 교육, 수급자와 장기요양요원 사이의 활발한 의사소통, 건실한 장기요양기관의 양성이 필요하다는 점 역시 간과되어서는 아니 된다.
한편 장기요양급여의 질을 개선하고 장기요양급여를 제공하는 장기요양요원의 삶의 질을 향상시키기 위해서는 장기요양보험의 공공성 확대가 요구된다. 영세한 민간 장기요양기관에게 수급자에게 제공하는 급여의 질을 향상시키기 위한 경쟁과 장기요양요원의 고용 안정을 기대하기 어렵기 때문이다. 장기요양보험제도를 통한 노인 돌봄의 사회화가 의미하는 것은 국가와 사회가 노인 돌봄을 책임진다는 것이므로, 부분적으로 진행된 노인 돌봄의 사회화를 확대하려는 국가와 지방자치단체의 적극적인 노력이 요구된다.
장기요양은 개인이나 가족의 문제가 아니고 우리 사회가 함께 책임져야 할 공공의 문제이다. 돌봄노동의 특성은 일의 완성, 업무의 처리 등을 목적으로 하는 여타의 노동과는 달리 인간을 목적으로 하는 인간의 노동이라는 점이다. 인간을 인간으로 대접하는 것, 생명을 생명으로 존중하는 것이 돌봄노동의 중심과제가 되어야 한다. 이러한 과제는 돌봄을 필요로 하는 수급자뿐만 아니라 수급자를 돌보는 장기요양요원에 대해서도 실현되어야 함은 물론이다.
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