How a determined drive to improve air quality gave rise to a new model of care for a rapidly ageing population
Earlier this week the air quality index in Delhi hit record levels. The choking smog was so bad that 5 million children were given face masks, the public were advised to stay indoors and 30 flights were diverted because pilots could not see well enough to land.
The contrast with India’s neighbour China is extreme. A decade ago Beijing easily outstripped Delhi as the world’s most polluted capital, so I was pleasantly surprised to breathe relatively clean air when I visited the city last month.
Given that an estimated 55 million people in China have asthma, and lung cancer has become the most common cancer across the country, especially among older adults, it’s no wonder the country has made a concerted effort to clean up its act. Indeed, according to Greenpeace East Asia, average concentrations of "PM2.5" particulates in Chinese cities fell by 12% from 2017 to 2018. In Beijing the reduction was more than 20%.
A Life or Death Contract
So how did they transform a capital city in the grip of suffocating and potentially fatal smog in such a short time?
As reported in the Washington Post. In 2014, Beijing's mayor said he had made a "life or death" contract with central government to reduce the city's PM2.5 concentration to 60 micrograms per cubic meter from about 90 at the time. In late 2016, with the target apparently out of reach, he was replaced.
Under the new regime 5,600 environmental inspectors were hired from around the country and dispatched into the industrial heartland surrounding the capital. Tens of thousands of polluting factories were forced to clean up their operations or were simply closed, while millions of households were hurriedly shifted off coal-fired heating and onto natural gas.
According to Li Shuo, a senior policy adviser with Greenpeace. “There were so many actors involved, it was difficult to get enforcement on the ground; it's not only the energy sector, it's heating, it's iron and cement, it's construction and transportation," he said. "And who knows which direction the wind will blow?"
Against the odds, and with a little help from the wind, the target was met.
Furthermore, this particular cloud has a silver lining for seniors. I am told there is approximately one derelict coal powered factory every 2 or 3 streets across Beijing. These sites have been nationalised and there is a city funded plan to transform most of them into a new breed of networked day care centres for older adults.
I visited the prototype centre last month, (as pictured above). Residents get their own room, which they are encouraged to personalise. Common and recreational space is tastefully decorated, as is a large hospitality room where meals are shared in a convivial environment.
Overall, design, while utilitarian, feels warm and welcoming, with a strong visual theme reflecting the essence of classical Chinese architecture, which is a really nice touch.
The USP which sets this concept apart, is residents or “guests”, as they are called by management, are not obliged to stay full time. The idea is children drop their, mostly single, parent off in the morning and pick them up at the end of the day, or they can stay overnight if preferable.
It’s this sense of freedom and flexibility which is most appealing. In effect they have reinvented the crèche for Chinese Babyboomers, and the impression during my visit was the guests were making the most of it and really enjoying themselves.
A Five Year Plan
What can we learn from the Chinese? First and foremost this revolution in long term care is a consequence of joined up thinking. Beijing is currently 2 years into a 5 year industrial development policy and operational management strategy for long term care.
The stated aim is to consign no more than 4% of over 60 years olds to full time institutional care, 6% to community care centres and 90% to home care.
Lets face it, for better or worse, China’s one-party system allows it to deliver change quicker and to a greater scale than most. President Xi Jinping has made the State’s intent clear. He is reported in China Daily as saying: “We will respond proactively to population ageing. We will adopt policies and foster a social environment in which senior citizens are respected, cared for, and live happily in their later years. We will provide integrated elderly care and medical services, and accelerate the development of old-age programmes and industries."
Under Xi's leadership, the country has seen a raft of measures put in place to meet growing demand. With a senior care givers workforce of around 300,000 and an over 60 population of 249 million, among which 40 million are partially to fully incapacitated, the government plans to train 2 million senior caregivers by the end of 2022.
To this end, China recently issued a new set of professional standards for caregivers to encourage more people to join the understaffed workforce.
The new standards scraped education requirements for entering the workforce, shortened the window of time needed to reach the highest professional level and updated the required skill set to suit the growing need for community care for older adults.
In parallel, China has stepped up the supply of care homes, eased market access for private and foreign investors, and offered tax exemptions on community-based care services.
According to China Daily, by the end of 2018, there were 163,800 care institutions and facilities, nearly half of which were built with private investment, offering 7.46 million beds for senior citizens.
Community-based services and facilities covered all urban areas and over half of rural communities.
Private enterprises are moving fast to tap into the potential demand. Taikang Insurance Group, one of the country's major insurers, has invested in and put “elderly care institutions” into operation in four cities, including Beijing and Shanghai. China Life, and other major insurerers, are working on similar projects.
Earlier this year Innovate UK and KTN organised a Healthy Ageing Expert Mission to China, to gather market insights and set groundwork for early dialogues between key stakeholders and the business community.
They reported that the innovation opportunities are those around standards, training, regulation and policy development; new business model development; technology and service innovation; extensive scale product testing and crosscutting impact research.
The key market challenges include underdeveloped elderly care infrastructure; workforce issues of resources, training and skills; business culture; and business models.
The report cites a study on the need for home care services in urban China, revealing that 49% of older people have certain daily needs that require formal assistance. Some 25% need help with domestic chores, 18% with personal care, and 14% with social conversation. However, it estimated that urban home care services can only satisfy 16% of expressed need. This constitutes a huge business development opportunity for industry and SMEs.
Last week I wrote about Dr Jianbing Liu’s efforts to improve quality of life for home based older adults in the capital. Dr Liu is Director of Service Engineering and Smart Health for Seniors at the Beijing Academy for Science and Technology. He is leading the Academy's drive to recruit cross-border partners to collaborate on developing, what Dr Liu calls, service innovation experimental platforms to support community services for senior citizens.
And, if that wasn't enough, Dr Liu also runs a senior day care centre and living lab which offers a wide range of novel courses designed to enhance cognitive and emotional wellbeing. These include music therapy, horticultural training, nostalgia therapy, group sandplay and physical fitness training, involving various forms of dance.
What I found particularly innovative is these courses are 'gamified', meaning participants can compare their scores with the cognitive ability of people with similar conditions.
Old Age Posthouses
Another Beijing based innovation initiative is called the Old Age Posthouse. Operated by the state owned CHJ-Care industry group, the company runs 130 “service stations” across the capital and provides outreach services including qualified care givers, social workers and volunteers which currently benefit over 1.5 million Beijing residents.
While most of the service stations are generic, CHJ have recently started theming. So if you are a retiree with a passion for opera, ballet, theatre, or literature there is a service station for you. They even have one which specialises in English, based near Peking University, the station is the number one meeting point for retired professors.
To learn more about healthy ageing in China, the Innovate UK/KTN report is an excellent resource. If you would like to follow AAA’s adventures in China and beyond, and are not already signed up to our LinkedIn Group here is the link.
Next time, I will tell you about AAA's involvement in an exciting large scale healthy ageing demonstrator covering 14 European territories.
Image used with permission: A former coal powered factory is transformed into a care centre for older adults in Beijing