For those watching the development of China’s senior housing industry, a handful of pilot projects have garnered a lot of attention. Those of Cascade (Emeritus), China Senior Care, and Merrill in particular each come to mind. Being a pioneer isn’t easy, and each of the companies has shown the grit and determination to push through a lot of unknowns in order to build projects designed to validate that their business model can be successfully deployed in China. These operators many times garner the most attention, but their efforts are supported by, and made possible through, similar efforts to understand the China market’s unique needs on the part of a variety of service firms. One such example is JSR Associates, who has been working with China Senior Care (CSC) for the past three years as CSC develops its business plan and care model. JSR’s Principal and Founder, Jane Rohde, recently agreed to share her experiences in advance of the presentation she will be providing at the upcoming IAHSA annual conference in China (register here!).
JSR Associates has provided senior living design and consulting services for over 17 years for new, renovated, and repositioned senior living projects. These include continuing care retirement communities (CCRC), adult living communities, independent living settings, assisted living projects, adult day care, and skilled nursing projects in the US and, most relevant to the upcoming IAHSA conference, in China. JSR’s goal during the strategic planning and programming process is to overlay the plan and concepts with current trends in senior living, reimbursements, staff needs and operational function, culture change, and care models to meet the future needs of current residents, as well as the next generation of residents. These challenges are particularly acute in a market such as China where much of the operational variables are either not known, or are being built on assumptions that may prove to be in need of additional localization.
Building on their roughly three years of work with CSC, Jane added, “I have found that the basic questions to ask in regard to design, is how is the facility going to be programmed, what is the care model, and what is the design regulatory process for development of design and construction documents? Their needs to be an integrated design process that assists with developing an operational plan, as there is no Chinese benchmark for senior living projects. What I’ve seen is that all newly constructed facilities are built as tenant fit-out projects; so in order to provide a physical space environment, there needs to be a programming development phase with expertise from both the US and China that work together to establish the function of the environments. Prior to the finalization of the construction documents for the infrastructure, a programmatic layout has to be developed based upon the care model and all operational functions planned for the facility.” I would also submit that among the reasons the CSC project in Hangzhou is important is that, as Jane references, it will not be a rehabbed site; rather, it will reflect conscious design and programmatic choices made from – quite literally – the ground up, capturing what CSC and JSR believes will best serve the Chinese consumer.
Given what Jane has seen in China, she believes there “is also a demand for need-driven extended care; which includes skilled nursing and memory care. Independent living is starting to be developed, but this is choice and lifestyle driven. A Chinese elder would need to decide with their child if and when they would be making a change; versus skilled nursing and care for those with dementia, which is need driven.” She added, “There are also opportunities for evaluating higher end, as well as a middle income solutions, for Chinese families, as elders age.” That was music to my ears given my own fears that too many foreign operators are looking past the middle-income market, leaving it for the domestic Chinese players (specifically insurance companies) to focus on.
Much of what will shape Jane’s presentation at IAHSA is advice she has for foreign operators and investors who want to pair off with Chinese developers. With this in mind, I asked her what she felt both sides needed to keep in mind. Jane pointed out that in the US, “[what we have] learned has resulted in the recognition of needing flexibility in care models and adaptability to acuities as people age, regulatory barriers when providing resident-centered care environments, and provision of multiple types of care within one setting. These lessons can be applied to China, as the industry is in its infancy; therefore allowing the needs and care models to drive the licensing process.” Jane echoed concerns most of us in the sector have had about accessing trained staff: “China has a need to evaluate the need for educational programs in geriatrics and dementia, as there are few potential staff trained in any type of long term care, activities, and person-centered care provision.” In addition, Jane ended her comments on what I think is a particularly important insight: “There is a concern that Chinese developers are looking to architectural firms to provide designs that are similar to the US; however prior to engagement of the design of the building, most Chinese developers need operational and care model guidance. Without this coming first, buildings are being built and operators sought, without having facility design input. This is providing inefficiency and could also prevent a resident-centered care model to maximize resident positive outcomes; which is needed to fulfill filial piety.”
Given Jane’s experience in both the US and China, I wondered what she is most interested to see transferred from the US to China. She pointed out six factors: “Furthering the utilization of the Senior Living Sustainability Guide® (www.withseniorsinmind.org) as a means to develop resident centered-care; resident-centered care as a standard of care (versus institutionalization); household and small house models that can serve a variety of acuity levels; provision of adult day care models coupled with extended care; provision of home healthcare services that support residents living with family or in the community at-large; bring back to the US best practices based upon bench-marked research and data from China residential aged care communities to be able to improve US models.” If that last point surprises you, it shouldn’t. After all, China may have some things to teach America about community care in particular that have been overlooked given America’s historical affluence, an economic reality being tested as our Baby Boomers begin to retire themselves.
Posted on October 7, 2013 - Written by Benjamin Shobert
Article can be found: www.healthintelasia.com/iahsa-china-jsr-associates-experiences-china/