Targeting Seniors through Community-Based Home Care, Integrated Medical-Elderly Services, and Dementia Care: Companies Leverage High-Quality Operations to Tap into the Billion-Dollar Aging Market

VCBeat (WeChat ID: vcbeat) has learned that the “4th China Elderly Care Industry Lujiazui Summit” (hereinafter referred to as the “Summit”), jointly organized by Huizhou Yixun Information Technology Co., Ltd. and Shanghai National Exhibition & Convention Center Co., Ltd., opened in Shanghai on March 27–28, 2019. Aimed at further promoting exchange and cooperation in China’s elderly care industry and advancing industrial development, the Summit invited dozens of keynote speakers, including renowned experts and scholars from home and abroad, representatives from leading enterprises, and investors in the elderly care sector, with attendance reaching one thousand participants.

On March 27, guest speakers delivered presentations on the operational performance of leading enterprises in the elderly care sector, community-based home care service models, dementia care, and the integration of medical and elderly care services. VCBeat has compiled the conference proceedings based on relevant materials for the benefit of our readers.

Without effective operations, scalable operations, profitable operations, and innovative operational models, enterprises cannot achieve successful implementation.

State-owned enterprises focus on public service, while private enterprises prioritize industry development. Idealism is reserved for the night; during the day, the emphasis is on strategy and profitability. Liu Fangxiao, Founder and CEO of Xiamen Zhiyu Information Technology Co., Ltd., stated that private enterprises should, on one hand, place their strategic focus on high value-added areas, and on the other hand, target high-frequency services.

The elderly care industry is a private, for-profit sector aimed at meeting the high-level lifestyle and cultural needs of older adults. It encompasses areas such as general health, tourism, culture, sports, beauty, parent-child consumption, and pets—sectors that are essential to focus on when entering the elderly care market.

Another critical aspect to consider is the positioning of target customers. It is essential to recognize that users are not equivalent to customers. In the elderly care industry, the users of services are not necessarily the paying customers. The only group that functions as both users and customers consists of relatively younger seniors who have recently entered the older adult demographic and possess purchasing power. So, who exactly are the users? Liu Fangxiao stated that we must clearly understand that the primary customers are, first, the government, and second, adult children. The majority of seniors are users who benefit from the services provided by the elderly care industry.

After identifying target customers, it is essential to uncover their genuine needs. Liu Fangxiao stated that the true need of the elderly is for bonds of interaction with their children and with society.

From the “Two Specifications and One Standard” in 2009, the 2010 “Plan for Promoting Management Standardization within the Civil Affairs Sector (Trial),” the 2012 “Action Outline for Social Management and Public Service Standardization during the 12th Five-Year Plan Period,” the 2013 “Detailed Rules for Comprehensive Standardization Pilots in Social Management and Public Services (Trial)” and the “Standardization Development Plan for the Elderly Care Service Industry (2013–2017),” the 2014 “Guiding Opinions on Strengthening Standardization Work in Elderly Care Services,” the 2017 “Notice of the Ministry of Civil Affairs and the Standardization Administration of China on Issuing the Guidelines for the Construction of the Elderly Care Service Standard System” and the “Basic Rules for Service Quality in Elderly Care Institutions,” to the 2018 “Classification and Evaluation of Elderly Care Institutions.” Reviewing the course of standardization of elderly care institutions in China, the state has continuously promoted the development of elderly care services toward standardization.

The mismatch between supply and demand in China’s elderly care sector is becoming increasingly pronounced. As demand grows, seniors require professional services once their basic needs are met. On the other hand, payment issues remain unresolved. The contradiction between limited affordability and currently high supply costs has become irreconcilable.

Moreover, the elderly care industry must integrate and align with the broader health and wellness industrial chain. The scope of standardization in elderly care services should continuously expand alongside scientific and technological advancements, while simultaneously improving both technical and managerial aspects, to effectively promote the development of the elderly care service sector. Therefore, a standardized system is the fundamental basis for competition among elderly care institutions.

Standardization should reflect not only uniformity but also advancement and guidance. Specifically, standardization needs to address three aspects.

First, address the talent shortage. The lack of specialized professionals and the high staff turnover rate in the elderly care industry make “poaching” a significant constraint on the development of elderly care institutions.

Second, establish standards for issue resolution. Streamline and adjust cumbersome tasks by identifying which actions are necessary and which occur frequently. In the future, address these issues in accordance with standardized procedures.

Third, address technical standards. Technical standards constitute the core of enterprise standards and serve as a means of service delivery.

Cao Sujuan, former director of the Beijing No. 1 Social Welfare Institute, stated that the practical implementation of standardization follows a three-step process: “Plan, Execute, Implement.”

What aspects? Enterprises should define their positioning, clarify their development direction, and outline a strategic roadmap.

What are the key areas? At the management level: corporate strategic direction, system adaptability, capacity for sustainable advancement, and operational efficiency. At the operational level: provision of professional services; assurance of service effectiveness; alignment of job responsibilities; continuity of system improvement; and achievability of evaluation metrics.

Which ones to implement? Standardized Practice Pathways: Full Participation, Diverse Formats, Achieving Sustainable Institutional Development.

Harvard University spent 75 years studying more than 700 individuals to answer the question, “What enables older adults to achieve happiness?” The answer is not money, prestige, a sense of accomplishment, or relentless hard work. Rather, it is a remarkably simple factor: interpersonal relationships. Strong relationships foster well-being.

Elderly care services involve a continuous process of building emotional connections and interpersonal relationships through communication with the elderly. The elderly care industry revolves around three parties and one core mission: us, the elderly, and their families. In addition to focusing on services for the elderly, it is also crucial to pay attention to “us.”

In the management process, performance evaluations should not focus solely on elderly residents’ occupancy and churn rates; evaluating behaviors is more important than evaluating outcomes. Employees should be provided with opportunities to fulfill their physiological, safety, social, esteem, and self-actualization needs.

Peter Drucker once said, “The essence of management is to inspire human goodwill and potential.” Effort and reward are directly proportional; only when quantitative accumulation reaches a sufficient level can qualitative transformation occur.

In addition to assessing employee performance and providing basic income, significant weight is placed on their understanding of behavioral norms and cultural values. Regarding specific implementation, Guan Yanbin, founder of Shanghai Nuanxinwo Elderly Care Service Co., Ltd., stated that a compensation model comprising “basic income + value storage + accumulated value” can be adopted. This approach requires universal participation in goal-setting and oversight, ensures the involvement of seniors’ family members, implements job classification, conducts regular performance evaluations with quantifiable metrics, establishes weighting standards, and empowers employees with autonomy.

Huang Huang, General Manager of Wuxi Company under Jiuru City Elderly Care Industry Group, outlined the most accessible profit drivers in the elderly care sector: policy subsidies, elderly care assessments, home-based care services, and the public-private partnership model wherein publicly funded facilities are operated by private entities. He emphasized that practical implementation requires not only passion but also a grounded, pragmatic approach.

Engaging in elderly care inevitably involves interacting with the government. During collaborations with governmental entities, it is essential to adopt their perspective, understand their needs, and comprehend the rationale behind the “publicly built, privately operated” model.

The state is vigorously promoting elderly care services; public-private partnership projects at the local level must meet a specified percentage threshold to comply with national policy requirements.

Publicly built but privately operated facilities require substantial capital investment; however, if they admit only elderly individuals without family support, many beds will remain vacant, resulting in a waste of state resources. Furthermore, the existing operational staff lack the capacity to serve elderly individuals from the general population, as these seniors are supported by their families and require standardized care services along with effective communication with their family members.

Due to the low fees and high admission thresholds of publicly built, privately operated facilities, which often prioritize applicants with personal connections, professional teams are required to assist the government in managing such public-private partnerships.

By opting for the public-private partnership model where facilities are publicly built but privately operated, enterprises can expand their bed capacity; if managed effectively, this can become a significant profit center. When such models are well-implemented, the public ultimately benefits. Positive public sentiment ensures government endorsement, which in turn further promotes enterprise development.

The four core factors determining whether cooperation will be fostered are policy, prospects, price, and location. Key points during the specific negotiation phase include: basic conditions, pricing, the three-tier system, project expectations, competent authorities, operating costs (with caution against hidden fees), and project features.

In practice, first, the public-built, privately operated model imposes relatively high comprehensive requirements on managers, including operational capabilities, communication skills with government authorities, and communication skills with residents’ families. Second, public-built, privately operated projects offer an effective pathway for asset-light operations and bed capacity expansion. Third, such projects are of significant importance to enhancing the government’s public reputation, allowing no room for failure. Fourth, these projects hold limited significance for capital operations. Fifth, public-built, privately operated projects genuinely benefit both the nation and its citizens, playing a crucial role in advancing the elderly care industry. Sixth, these projects serve as the primary platform for pragmatic elderly-care professionals and for nurturing dedicated practitioners in the field.

“Grand-sounding” words are easy to say, but concrete implementation requires actual execution.

Golden Sun Health and Elderly Care Co., Ltd. has spent 12 years exploring the path of community-based home care for the elderly. Since its inception, the company has been committed to creating a “nursing home without walls,” enabling seniors living at home to enjoy services as convenient as those provided in traditional nursing facilities. Whenever they have consumption needs or require assistance, a single press of the call button ensures that familiar staff members promptly arrive at their doorstep to provide help and support.

From its initial prototype, which relied on community-based home care service stations and established the 968885 call center with online-offline coordination and platform dispatching, Golden Sun has now developed to connect three circles: the 15-minute home care circle, the 30-minute community care circle, and the 1-hour institutional care circle. The care centers provide care, nursing, dietary, and cultural and sports services, reaching at least 1,000 households in the surrounding community. It is gradually establishing a four-in-one elderly care service system comprising home care service stations, care centers, elderly care institutions, and the big health industry.

Golden Sun has transformed from a housekeeping company and currently provides services in healthcare, domestic care, catering, and education. Additionally, Golden Sun has expanded its operations by establishing a training center, launching a time bank, and setting up a foundation. It offers basic products to seniors, introduces sticky and high-value products through low-frequency services, and provides comprehensive services covering the entire life cycle of the elderly.

At Golden Sun, all new hires are required to serve as volunteers for a period ranging from seven days to one month. This period serves as a mutual selection phase. If the fit is right, they stay; if not, their volunteer hours can be deposited into Golden Sun’s Time Bank. What founder Huang Xiaorong takes most pride in is having a trustworthy team. It is reported that Golden Sun has virtually no staff turnover; those who leave do so primarily because the company determines they are not a suitable fit by the end of the volunteer period.

Ding Shaolei, founder of Gold Medal Nurse, summarized several key challenges in home-based medical and elderly care: first, the dispersed nature of service recipients; second, difficulties in delivering medical services to homes; and third, issues related to emergency response, sudden incidents, and continuity of care.

The key to implementing the home-based integrated medical and elderly care model lies in placing nurses at its core to address operational challenges. It is essential to reshape our mindset and reevaluate the role of nurses, transforming them from passive participants in the healthcare service chain into proactive managers of patient health.

Gold Medal Nurse proposes an OMO project-based holistic nursing model, treating patients as projects and nurses as project managers. With health management as the main thread, it comprehensively addresses the all-encompassing, full-cycle needs of service recipients, integrating holistic nursing, integrated care, and case management.

In terms of specific operations, Gold Medal Nurse builds an online platform to provide home-based medical and nursing services, establishes integrated medical and elderly care institutions, and plans a city-level cloud infrastructure for medical and elderly care. It creates a comprehensive service system for integrated medical and elderly care, while empowering nursing professionals through the integration of medical and elderly care and the unified care model for the elderly and disabled. Strategic planning: Build an internet hospital to connect patients, high-end property senior care facilities, hospitals, and nursing schools.

Zhang Shurong, founder of Huixiangfu, stated that the process of selecting target clients is akin to “peeling an onion.” An elderly individual experiences four stages from retirement to death: the first stage is a 10–15-year period of health and vitality immediately following retirement; the second stage involves mild, moderate, or severe care needs; the third stage is characterized by frequent medical visits; and the fourth stage entails hospice care.

"In the sector of community-based elderly care, each company must select the elderly demographic that best suits its capabilities and establish a clear market positioning. Zhang Shurong stated that startups, due to their limited scale, should choose product lines with broad market appeal and potential for vertical extension. Furthermore, the operation of home- and community-based services is also critical."

From a market perspective, there is a prevalent vicious cycle in community-based home care characterized by the absence of a viable business model and lack of profitability. This often leads to distorted operational models, such as “community + health supplements” or “community + domestic services,” which hold limited commercial value.

Long Pan, General Manager of Kangle Nianhua, stated that it is necessary to distinguish between government thinking and corporate thinking. In recent years, civil affairs departments have been guiding enterprises to provide community-based services centered on day care. However, although community and home-care settings are integrated, there are inherent deficiencies in how effective service delivery and closed-loop mechanisms can be established between the two.

Long Pan stated that establishing a business system centered on institutions, radiating to communities, and extending into homes—integrating medical and elderly care services—is currently a relatively feasible approach. This involves creating a community-based, small-scale, and chain-operated model that fosters the integrated development of institutional, community, and home-based care. In this framework, institutions serve as the ballast stone, as their operations ensure basic cash flow and profitability. Communities will play the role of a cohesive agent to attract and engage populations in the future, while home-based care represents an area for accumulation that still requires time to mature. Efforts should also be made to integrate medical and elderly care, particularly by promoting rehabilitative nursing within institutions, with a special focus on activities of daily living (ADL) rehabilitation.

Long Pan believes that only asset-light chains of community-embedded, composite micro-institutions—anchored by beds, characterized by the integration of medical care and elderly care, and reliant on large central institutions—can possess true viability. This approach offers numerous advantages: it generates stable cash flow to ensure institutional development, strengthens team capabilities, refines service delivery, solidifies market position, and secures community-based distribution channels.

There are approximately 10 million people in China living with dementia, and data predict that the economic burden attributable to dementia will reach around $114.2 billion by 2030.

Respect the elderly, attend to their needs and wishes, and listen to their concerns. Through acceptance and validation, not only do the elderly receive emotional care, but caregivers also deepen their understanding of the elderly and of caregiving work.

In terms of dementia palliative care, Wang Siwei introduced three therapies that are relatively effective in Japan:

Touch Therapy: A nursing approach within dementia palliative care education (communication and relationships). Touch therapy involves warming another person with gentle, warm skin contact. Scientific evidence demonstrates that seven minutes of therapeutic touch can induce a sense of reassurance in the recipient by stimulating the parasympathetic nervous system, thereby promoting feelings of calm and comfort.

Reminiscence Therapy: Using pictures as a communication tool to help the elderly recall past experiences, thereby preventing dementia and alleviating its behavioral and psychological symptoms.

Clinical Art: Painting and crafting handmade works bring joy to the elderly, activate the right brain, and help prevent and improve conditions.

In terms of improving cognitive impairment, Wang Siwei introduced two aspects:

Grid Walking Exercise: A walking exercise in which elderly participants clap along to music while moving forward within a four-square grid, avoiding stepping on the boundary lines. This activity can improve gait balance and alleviate symptoms of dementia.

Hearing Therapy: The Improvement of Auditory Ability Affects Cognitive Function in the Elderly.

Furthermore, Wang Siwei emphasized that self-reliance support care aims to restore the independence of older adults by addressing issues from physical, psychological, and social perspectives, thereby improving their quality of life. In Japan, oral care for the elderly is a critical component; through oral hygiene practices and rehabilitative oral massage, the restoration and improvement of swallowing function can enhance the nutritional status of older adults.

Restraints encompass all measures employed for safety purposes to restrict a patient’s partial or total body movement, or to limit their freedom of ambulation. Restraints may be physical, chemical (primarily involving pharmacological agents), environmental, or psychological in nature, concepts that are generally well understood. Typically, when referring to physical restraints, we mean the application of devices to elderly patients to restrict their freedom of movement.

Patricia Powlas, Quality and Care Director for Orpea China, cited an example: “Imagine being tied to a chair. You need to use the restroom, but I, as a facility caregiver, am fully focused on my current tasks and completely overlook your feelings at that moment.”

True restraint constitutes a special measure, serving as a last resort after all alternative options have been exhausted. It must be based on medical orders derived from collective discussion by the entire medical team, with clearly documented rationale.

The impact of restraints on older adults spans physical, psychological, social, and care team-related dimensions. Therefore, when caring for elderly individuals with disabilities or cognitive impairments, long-term care professionals must reflect on their boundaries, practices, and decision-making, while establishing comprehensive training and assessment programs. In our behavioral decision-making, we must consistently uphold ethical reasoning, engage in continuous self-questioning, conduct regular self-assessments, and avoid falling into routine complacency.

Kelly Ording, Regional Director of Resident Services Program Development and a dementia expert at Watermark in the United States, stated that many people hold prejudices against individuals with dementia, believing they are incapable of feeling or understanding anything, while caregivers often tend to attribute all behaviors exhibited by individuals with dementia to their condition.

However, dementia care requires a person-centered approach. Person-centered theory posits that care should focus on the needs of individuals with dementia and build upon their strengths, rather than prioritizing caregivers’ work efficiency. It is essential to understand the values, preferences, and needs of older adults.

Enterprises need to encourage employees to adopt innovative care approaches, think outside the box, and collaborate strategically with other teams. Key initiatives include: creating innovative dining experiences for memory care; implementing personalized music programs to bring joy and therapeutic benefits to older adults; and facilitating intergenerational engagement by inviting young people to interact with seniors.

Rui Hairong, Director of the Xi’an Trade Union Elderly Care Nursing Home, analyzed the concept of healthy aging from a physician’s perspective, noting that “a significant component of health care requires delivery by professionally qualified doctors and nurses.” This approach involves comprehensive consideration of diverse health needs to provide all-around safeguards.

For elderly individuals who are fully independent in activities of daily living (ADLs), accounting for 87.46%, “snowbird” or sojourn-based elder care models can be adopted, complemented by regular health check-ups. For those with mild functional impairment, representing 8.37%, home- and community-based care is recommended, integrated with chronic disease management. For elderly individuals with moderate functional impairment (2.17%), community- or institution-based care should be utilized, supported by professional medical and nursing services. For those with severe functional impairment (2%), placement in specialized long-term care facilities is advised, employing a combined approach of medical treatment and nursing care.

Shanghai Donghai Geriatric Nursing Hospital is a geriatric care facility established in accordance with advanced international concepts, integrating elderly medical care, nursing, rehabilitation, and hospice care. It is reported that the hospital combines social recruitment with campus recruitment to attract excellent medical and nursing professionals; its comprehensive and up-to-date medical equipment meets rigorous technical standards; and it has established a robust logistical support system.

Founder Cai Zezhong has summarized the development experience:

First, acquire and lease idle assets to convert them into elderly care facilities;

Second, recruit outstanding healthcare professionals nationwide to form a team, cultivate a talent pipeline, and foster dedication to the cause of elderly care;

Third, actively expand bed capacity in response to social demand;

Fourth, pioneer innovative management models for geriatric care hospitals to enhance industry influence;

Fifth, increase investment in hardware infrastructure to enhance the value and credibility of participation in medical consortiums and municipal health quality control improvement platforms at all levels.

Sixth, establish specialized medical and nursing teams to promote quality improvement.

Yanda Upgrades to Version 2.0, Exploring the Integration of Medical Care, Elderly Care, and Rehabilitation, and Pioneering a Full-Cycle Continuous Care Retirement Community. Its industrial chain comprises five major sectors: Yanda Hospital, Rehabilitation Center, Nursing Care Center, Medical Research Institute, and Medical and Nursing Training Academy.

Zhou Sujuan, General Manager of Yanda, stated that the upgrade at Yanda can be likened to moving from “dating” to “marriage,” with the hospital’s medical resources now fully extended to the care center.

First, upgrade the functional capabilities of residential facilities. (1) Establish distinct care zones for seniors who are independent, semi-dependent, and fully dependent, to meet the personalized needs of different elderly residents. (2) Adhere to human-centered age-friendly design, build an intelligent information system, set up a call center, distribute smart tablet terminals to seniors, and introduce ceiling track lifting and rehabilitation training systems.

Second, upgrading medical services. (1) Yanda Hospital has developed into a Grade 3A hospital and accepts real-time settlement of Beijing medical insurance; (2) Through comprehensive community healthcare, continuous health management is provided for resident elderly individuals, with an emphasis on geriatric rehabilitation services; (3) Leveraging the unique advantages of Traditional Chinese Medicine (TCM) to provide TCM treatments and therapies; (4) Updating service concepts: Providing proactive, home-based services centered on health, including private health physicians and nurses; (5) Implementing flexible service mechanisms that integrate tiered diagnosis and treatment between community hospitals and general hospitals, combined with expert consultations; (6) Diversifying service formats: Conducting free clinic activities, holding weekly public health education lectures, and offering specialized courses in "Health Management" at universities for the elderly, enabling seniors to monitor their health status at any time.

Third, explore refined care services. (1) Social workers regularly provide home visits to offer emotional support and daily living assistance to the elderly; (2) The care team must undergo rigorous pre-service and in-service training to ensure professional care for residents; (3) Nutritional dining, with collaborative development of geriatric nutritional meals; (4) Spiritual and recreational activities, featuring facilities such as a university for the elderly and sports courts, along with monthly group birthday celebrations; (5) Campus environment, maintaining evergreen foliage throughout the year and blooming flowers in three seasons.

Fourth, standardization of service management. Establish standardized services and management. (1) Draw on international experience to implement human-centered care, prioritize people-first principles, and build a holistic care service system. (2) Multidisciplinary collaborative practice; (3) Establish a standardized management system.

Lan Bo, founder of Qinmu Home, stated that creating a closed-loop system integrating medical care and elderly care can reduce operating costs, facilitate product-customer connectivity, and diversify the offerings for elderly clients.

Lanbo emphasizes that the closed-loop system ultimately serves the entire population. By integrating health-focused apartments, medical-nursing centers, and geriatric hospitals, it achieves service, customer, institutional, and financial closed loops. This creates a comprehensive care capacity spanning from active youth to end-of-life hospice care, thereby establishing a “one-stop lifelong rotational” elderly care service system.

In the process of building a closed-loop system, many challenges will be faced: three explicit risks—operations and risk management, investment and profitability, customer segments and markets. Moreover, the construction and upgrading of an institutional closed loop require upgrades and revolutions in industrial models.