Another Perspective on Geriatric Care in China

Following my recent interview with Dr. Sean Leng, I wanted to pursue another voice who would be willing to provide additional context to the challenges unique to delivering quality clinical geriatric care in China.  Fortunately, was willing to answer some questions related to this topic.  Dr. Wang holds a MD in Western Medicine from Chongqing Medical School and Beijing Staff Medical College, a Bachelors Degree in Medical Sciences and Clinical Medicine and a Masters in Gerontology from the University of Arkansas.  She has been accepted at UCLA for a PhD program studying aging issues.  In addition, Dr. Wang owns American Longevity Healthcare, Inc. a company that provides consulting services for China’s long-term care providers; both private operators seeking to expand in China as well as China’s existing government run institutions.

I first wanted to explore with Dr. Wang what she felt the most obvious missing gaps are in terms of education, certifications, or basic training in geriatrics within China.  Her answer was consistent with what Dr. Leng had shared earlier:  “[China] lacks a foundation.”  As Dr. Wang sees it, the right solution would be a “collaborative and coordinated service network system from China’s Department of Health … health insurance to deliver such a service (whether from government or the private sector), Ministry of Civil Affairs of China (a main government organization to develop and implement the elderly care policy related in China), Chinese Committee on Aging … and China’s high education and occupation education as well.”

Together, such an approach would, according to Dr. Wang, “develop the specific policy, law, regulation, management and monitoring strategy of all [the related] services and the labor force of professional care to take care of China’s elderly.”  Dr. Wang’s suggestion points to the issue of what the right role of the Chinese government needs to be in order to provide the context within which a thriving senior care market can evolve.  Within the senior care market in China, much of the dialogue over the most critical factors Beijing needs to evolve circle around land-rights issues, ensuring access and offering incentives for developers to build out additional senior care space and these are all certainly important issues for the government to address; however, what Dr. Wang points out are some of the other more intangible factors the government needs to address in order for the senior care market to successfully transition western practices into China.  The most obvious need is for the Chinese government to expand what it will pay for in terms of services.  Initially, this will likely involve an expansion of the New Rural Co-Operative Medical Care System (NRCMCS), both in terms of the aggregate total amounts the government will cover, as well as the type of services that will be covered.  Secondarily, the Chinese government will need to ensure it expands coverage for eldercare in general – whether through dedicated housing or in-home care providers.  Obviously, this sort of expanded services would be targeted initially for those most in need.

Beyond these factors, China needs to develop a group of regulations, ranging from assessment protocols to healthcare delivery protocols based on best practices, in order to protect the industry from un-necessary litigation.  The latter concern is of particular importance, as Western operators will be held to higher standards by the Chinese market.  In a space where outcomes are not fully understood by the Chinese themselves, it will be easy for litigation to arise in cases where expectations do not match outcomes.  The necessary arbiter in such moments will need to be a body of promulgated regulations from the Chinese government; in the absence of these, downside risk cannot be accurately calculated.

Dr. Wang pointed out that while the West has what she calls “two legs” for addressing elderly care issues – a medical model and a community model – China really only has a family model.  As she put it, “all services related in the long-term care for the elderly have only depended on family.”  Because the family has acted as the caregiver, China has not prioritized clinical geriatric training like it needs to.  She added, “Regarding the government officers in China, physicians and nurses, most of them have not had an opportunity to get a better education and training to update their professional knowledge and skills related to the gerontological / psychosocial and geriatric care because the Chinese traditional family care model has been [the] only access or resource … There has been no need for them to update their knowledge and skills … due to a ‘blank area’ in the programs of long-term care for the elderly in in China.”

During a recent meeting in Beijing, I learned a bit more about China’s last two attempts to create certification programs for their elderly nurses; the gist of both attempts was that nurses who were already serving in state-run nursing homes could essentially pay to get a certificate rather than a disciplined certification program built around new training that elevated nursing standards.  Dr. Wang added some additional comments on the Chinese government’s recent efforts:  “Regarding nurses, the Department of Health has mentioned [this need for training and certification] in the previous five year nursing plan … but has not implemented it well in the real world … China put it again in the [most recent] Five Year Plan, but no specific resources or training curricula were developed … the government’s five research projects in nursing care planned in the Five Year Plan has not included the training and education / research in geriatric nursing … especially for Alzheimer’s and Dementia care … so there is a blank space in China.”  She went on, “China’s nurses have not provided the bed-side assistants for the patients in hospitals, especially for the elderly patients.  All such services have been provided by family members or paid caregivers from outside … The nurses seriously lack professional knowledge about the nature of nursing and the skills related due to their poor education and training, especially for elderly care.  They believe it is a responsibility for the elderly’s family and not the nurses, whether in an acute or chronic care setting.”

Thus far, western operators who have expanded into China – Cascade / Emeritus, China Senior Care, Right At Home, and pioneering entrepreneurial endeavors like PineTree, have all had to prioritize finding, training and retaining nurses and assisted living helpers in ways that reflect the under-developed nature of China’s nursing industry.  I believe looking at both Dr. Leng and Dr. Wang’s comments over the last several weeks, a pressing need and opportunity exists for a consortium of western nursing schools, certification agencies, and possibly even NGOs to begin finding ways to significantly expand China’s geriatric nursing capacity.  In some ways, the model between PUMC and John Hopkins needs to be expanded a hundred fold in order for Western CCRC and in-home care models to be successfully expanded into China.