Elderly in China: In need of an Innovator’s Prescription

Today’s guest post was written by Ninie Wang and translated by Ashton Liu. It is their second contribution to Asia Healthcare Blog, the first being this excellent article on filial piety in China. Be sure to go here and check out Ninie Wang’s excellent Chinese language blog that deals with elderly care issues, in China. She also runs Pinetree, a company that provides in-home nursing services.

On 12 April, the Jinghua Times published an article entitled “Closure of Beijing’s First Day Care Center Causes Embarrassment for the Aging Industry.” The article reads,

In Beijing the first elderly day care center, Shijingshan Apple Valley Street Elderly Day Care Center, recently declared that it would close. However, as this occurred, community based day care centers were sprouting all over the city due to government support.

The number of elderly day care centers has currently reached 2,484. Some are supported by community level cadres and government, and others struggle to pursue market driven growth. These types of care centers are important components of Beijing’s elderly care infrastructure. However, these 2,484 care centers and the recently closed center in Apple valley are, in nature at least, not all that different..

In truth, the Apple Valley Care Center’s model was unsustainable, and would not have survived longer.  When the local government established this center, there was no support in terms of preferential policies or funding, and the center was instead dependent on the sub-district’s own resources. The elderly did not have to pay anything to enter, yet the center still hired two workers in charge of cleaning and door-keeping. As the policies concerning public finance underwent reform, funding requirements at every level of government became increasingly strict and “the day care center found it very difficult to secure any funding.”

There has now emerged another model which may prove more sustainable elderly care centers that rely on community service centers for resources, and mostly offer the elderly a variety of recreational activities.  The spokesperson for the Beijing Aging Committee Ms. Yunfeng Yang stated that the centers “primarily offered the elderly a chance to be active in the community, which helped ease their loneliness.”

[pullthis]The incentive for becoming “reliant on the community’s service centers” is that having this source of support greatly reduces an elderly center’s costs.[/pullthis]  The Fuxue Community Neighborhood Center of Dongcheng district is representative of this model, as is the largest single chunk of centers among the 2,484 registered  in Beijing.  However, this model can only address the needs of seniors who are relatively healthy and independent, while many who are dependent on others for care or those who cannot be active without assistance are excluded from their services.

“Some residents brought their elderly family members in wheelchairs asking if they could leave the senior at the center and pick him up in the evening,” the center’s management said. “One problem is that the facilities are not adequate, and in addition there are not any professional care personnel. What happens if the elderly falls and is injured? Who will take responsibility?”

Ms. Yang stated that recreational care centers primarily accept healthy and independent seniors.  She added that the community’s activity centers are a place specifically for the elderly. [pullshow]Having a foldable bed or a couple of stable beds is just in case the need arises.  But the truth is that most fully functional senior citizens do not need beds, said Yang. “After lunch they usually go home, and basically no one sleeps here.” On the one hand, the day care center’s beds are always vacant, and on the other hand many dependent and partially dependent seniors are in need of care that the day care centers do not provide. Having witnessed this often, we would like to dig deeper into day care centers’ current issues in order to examine whether or not we can find a way out.

According to the models prevalent in countries such as Western Europe and Japan, the target of elderly day care service can be divided into three groups: first are healthy and independent seniors, second are seniors who need some assistance and require a degree of care, and thirdly are seniors who cannot function independently and have often been diagnosed with numerous chronic diseases.

For the first group, the care centers primarily offer a platform for social interaction, and group recreational events. In developed countries where the population is not densely populated and where there is little interpersonal interaction out on the street, this type of service offers seniors a safe space for activities and engagement, and for them it is an invaluable service. However in China, urban areas are densely populated and many of the residential communities already have public or common space, resulting in rather friendly relations between neighbors or at least offers a space that facilitates interaction. Healthy seniors do not need to pay a fee and go to a care center to participate in social activities, so why would they need a closed area that restricts the range of their activity? Not to mention that the “senior activity centers” and “senior day care centers” as well of the activities they offer are unattractive, and often became known simply as “decorative projects,” a title given to some of the large elaborate initiatives that earn a lot of “face” for some officials but end up written-off as non-performing projects.

For the third group, there needs to be someone to provide complete care but it appears that the only options that fulfill this demand are either nursing homes or for the seniors to stay in their own homes rather than moving back and forth everyday. This group is more suited to in-home care, and would greatly benefit from having professional caregivers providing care in their own homes. Even if families are willing to consider these day care centers’ service, the lack of professionally trained staff would prevent the centers from accepting these seniors. The activity centers model has already excluded such dependent participants.

The second group, the group that needs partial assistance, seems be the right target for elderly care centers in China. What this group needs most is not to find a place for recreation or to pass time, but an opportunity to improve their physical and mental situation as well as improve their quality of living. From the perspective of an aging person, one should ask oneself this question: if everyday I go to the same place (and this place by chance happens to be unappealing) where there are no new or exciting activities (aside from playing cards or reading), and if there are no beneficial effects, even if I could go for free would I really be willing to go? Alternatively, if I could go to a place not necessarily everyday but on a regular basis, a place with professional, enthusiastic and reliable caregivers who use a series of different exercises for physical and mental well-being, and who can help me recover some of my abilities for independent living, might this be a more attractive option?

Regardless of what service is provided, it requires a market orientation and from the perspective of the user, there needs to be tangible value offered through the service. Only by offering something that is truly valuable to the user, can this type of service achieve real long-term sustainable growth. Currently, the over two thousand care centers lack a clear goal and offer little concrete value, and it is of little wonder why these centers have floundered. Through a simple calculation, one finds that even though every center may only invest 50,000 RMB (although the actual amount may very well be more than this), there is an estimated one hundred thirty million in funds that had perished in the process, and many elderly have not see any benefit. Who should be responsible for the efficiency of these public funds?

The difficulties encountered by elderly care centers reflect a discomforting reality in China’s elderly care industry. From policy formation, service design, implementation to quality control, there are still too many areas of weakness that need to be addressed. Potentially, the publication The Innovator’s Prescription could give us some inspiration to find a solution here. The book draws a parallel between the healthcare industry and personal computers. In the dawn of the technological revolution, the true visionaries did not simply target the existing market for large computers manufactured for research purposes, but recognized consumers’ latent demand for personal computers (see the author’s conceptual model). Similarly in elderly care centers, the real opportunity might lie in the group that is currently not using elderly day care services (non-consumers) who are a much larger group than current users (consumers), and in addition are a group with much simpler demands to satisfy. To begin with, a simple solution would be to create day care services tailored to the most urgent nursing care needs of seniors with willingness-to-pay rather than the wishful thinking of making self-sustainable activity centers.

Thank you for your wonderful Flickr photo stream.