China Issues Standards for Independent Rehabilitation and Nursing Centers, Prioritizing Chain Operators for Approval

On November 8, VCBeat (WeChat ID: vcbeat) found on the website of the National Health and Family Planning Commission that the “Notice on Issuing the Basic Standards and Management Specifications for Rehabilitation Medical Centers and Nursing Centers (Trial)” (hereinafter referred to as the “Notice”) had been released.

This marks the official release of the national standards for independently established medical institutions, following the announcement made by Jiao Yahui, Deputy Director of the Bureau of Medical Administration and Hospital Management under the National Health and Family Planning Commission (NHFPC), at the NHFPC’s regular press conference on August 10 this year. The announcement stated that five new categories of independently established institutions would be added: rehabilitation medical centers, nursing centers, sterile supply centers, small- and medium-sized ophthalmic hospitals, and health examination centers.

At the meeting, Jiao Yahui stated that the two newly added categories—rehabilitation medical centers and nursing centers—are primarily designed to address long-term chronic care needs associated with institutional, home-based, and community-based elderly care. They mainly target populations requiring day care, caregiving services, and rehabilitation.

In the newly released "Notice," the specific scope of rehabilitation medical centers and nursing centers is clearly defined:

Rehabilitation Medical CenterA medical institution that is independently established to provide medical rehabilitation services for patients with chronic diseases, geriatric conditions, and those in the recovery or chronic phase following disease treatment, aiming to promote functional recovery or improvement; or to provide basic rehabilitation services—including rehabilitation diagnosis and assessment, rehabilitative medical care, and disability prevention—primarily focused on functional exercises supplemented by basic medical measures, for individuals with physical (including mental) functional impairments, thereby assisting patients in regaining self-care abilities as early as possible and reintegrating into their families and society.

Rehabilitation Medical CenterThe Rehabilitation Medical Center primarily serves patients who, following inpatient rehabilitation treatment at the Department of Rehabilitation Medicine in general hospitals or at specialized rehabilitation hospitals, are in a stable phase or sequelae stage. These patients require gradual functional recovery or further stabilization; while they do not need intensive medical nursing care, they are not yet suitable for direct discharge to home care.

Rehabilitation Medical Centers do not include rehabilitation departments established within medical institutions, nor do they include secondary or tertiary rehabilitation hospitals that primarily provide medical rehabilitation services.

Nursing CenterA specialized medical institution established independently to provide daily nursing care, supplemented by basic medical interventions, for individuals with disabilities, dementia, or long-term bedridden conditions, with the primary function of improving patients' quality of life.

Nursing centers do not include nursing units within hospitals, nor do they include nursing institutions established in accordance with the standards for nursing homes or nursing stations.

Overall, the core target populations in these two types of independent medical institutions include post-acute rehabilitation patients and individuals with long-term care needs.

“The Notice” points out that rehabilitation medical centers and nursing centers are primarily positioned to serve communities and families, playing a significant role in promoting tiered diagnosis and treatment and integrating medical care with elderly care. It requires health and family planning administrative departments at all levels to attach great importance to this matter, strengthen organizational leadership, improve supporting policies, and ensure effective implementation of the work.

Rehabilitation medical centers and nursing centers shall be included in the category of independently established medical institutions, bearing civil liability independently in accordance with the law. The authority for approving the establishment of rehabilitation medical centers and nursing centers shall be determined by provincial-level health and family planning administrative departments in accordance with the Regulations on the Administration of Medical Institutions and its implementing rules.

Furthermore, it is worth noting thatThe newly released document explicitly encourages the group-based and chain-operation models for rehabilitation medical centers and nursing centers, establishing standardized management and service protocols. Priority approval will be granted to applications for establishing group-based or chain-operated rehabilitation medical centers and nursing centers.

This undoubtedly sends a positive signal to the currently sluggish rehabilitation market.

“The Notice” requires that health and family planning administrative departments at all levels incorporate rehabilitation medical centers and nursing centers into the local medical quality management and control system, strengthen service risk management such as hospital infection prevention and control, strictly implement relevant professional management specifications and systems, and ensure medical quality and safety.

KangRehabilitation medical centers and nursing centers shall establish collaborative relationships with general hospitals at Level II or above within their respective regions to continuously enhance medical service capabilities and ensure the quality and safety of medical care. Where conditions permit, rehabilitation medical centers and nursing centers may provide home-based services through measures such as home sickbeds and mobile clinic visits.

In traditional rehabilitation nursing services, the professionalism of caregivers and potential safety hazards have posed significant challenges for service institutions and enterprises. From the perspective of many entrepreneurs, risk control in person-to-person care can only be addressed through standardized processes. These range from broad oversight of qualifications for nursing services to detailed specifications such as the duration, procedural techniques, and frequency of each service item. Among the nursing companies previously covered by VCBeat, incorporating these elements has been an indispensable part of senior management’s strategic design.

Therefore, the newly released standards effectively serve as a “benchmark” for the standard mechanisms and service processes of rehabilitation medical centers and nursing care centers.

Previously, in the article published by VCBeat titled “The Sports Rehabilitation Industry Is Primarily Offline-Based, Serving 100 Million Individuals with Sports Injuries: A Blue Ocean or a Sea of Hardship?”, it was mentioned that Document No. 149, the Regulations on the Administration of Medical Institutions, issued by the State Council in 1994, stipulates that medical institutions without beds or with fewer than 100 beds must apply to the health administrative department of the local county-level people’s government.

Currently, nearly all small-scale rehabilitation institutions in China fail to meet the requirement of maintaining at least 100 beds. Furthermore, local county-level health administrative authorities impose specific requirements on drainage systems, disinfection protocols, the number of rehabilitation therapists and assistant therapists, as well as years of clinical experience. Consequently, compliance with medical standards has become the primary constraint for small-scale institutions in the market.

In terms of hardware, the Notice clearly stipulates the establishment standards for rehabilitation medical centers:“Facilities providing inpatient rehabilitation medical services shall have a total of more than 20 inpatient rehabilitation beds. Facilities not providing inpatient rehabilitation medical services may opt not to establish inpatient rehabilitation beds, but shall provide no fewer than 10 day-care rehabilitation beds.”

Clear requirements are also specified for the building area of rehabilitation medical facilities and the configuration of basic medical equipment.

Meanwhile, the professional configuration encompasses five categories of functional settings:

(1) Capable of conducting functional assessments aimed at promoting function and evaluating disability, such as assessments of motor function, sensory function, and speech function;

(2) Capable of providing one or more types of rehabilitation medical services, such as rehabilitation management for brain injury, spinal cord and vertebral column injury, post-orthopedic surgery, and chronic pain during the stable or sequelae phases, and able to implement emergency medical measures related to the provided rehabilitation services;

(3) Capable of providing physical therapy, occupational therapy, speech therapy, and the application of rehabilitation assistive devices;

(4) Rehabilitation medical centers with more than 30 rehabilitation beds may provide subspecialty rehabilitation services. Rehabilitation medical centers that establish inpatient rehabilitation beds, as well as those that only establish outpatient rehabilitation beds, may both provide comprehensive daytime rehabilitation medical services and home-based rehabilitation medical guidance;

(5) The ability to provide support services such as medical imaging, medical laboratory testing, pharmaceutical care, nutrition, and sterile supply that meet the needs of the rehabilitation medical services being delivered. Among these, services such as medical imaging, medical laboratory testing, and sterile supply may be provided by third-party professional institutions.

Note: The above requirements are compiled from the original documents issued by the National Health and Family Planning Commission. For details, please refer to the links provided below.

Regarding staffing, the establishment standards for medical institutions are generally followed. For facilities required to provide inpatient rehabilitation beds, health professionals shall be staffed at a minimum ratio of 0.5 personnel per bed, with the proportion of physicians, rehabilitation therapists, and nurses being no less than 1:2:3. For facilities without inpatient beds, at least five health professionals shall be employed, including no fewer than one physician and no fewer than two rehabilitation therapists.

Meanwhile, in accordance with therapeutic specialties, each specialty is required to be staffed with at least one rehabilitation physician or a physician holding professional qualifications in that specific field. For the remaining departments, including pharmacy, laboratory medicine, auxiliary diagnostics, and sterile supply services, appropriately qualified healthcare professionals shall be assigned. Clear requirements are also stipulated regarding the professional credentials of medical and nursing staff.

In terms of hardware, nursing centers are required to have a total of more than 20 nursing beds. This requirement is not overly challenging for private capital. Given that the care services provided by nursing centers are characterized by both long-term and professional nature, they primarily target the elderly and frail, individuals with disabilities or dementia, and those who are bedridden for extended periods.Therefore, in terms of hardware, the Basic Standards for Nursing Centers (Trial) mainly make detailed provisions for the basic facilities of nursing centers:

(1) Business premises shall be equipped with at least the following functional areas: reception and intake (including admission preparation), medical diagnosis and treatment, nursing units, public activity spaces, and living support facilities; rehabilitation training areas shall be established where rehabilitation medical services are provided.

(II) Nursing units shall be reasonably delineated based on the patients’ health status, self-care ability, and medical service needs. Each nursing unit shall be equipped with at least patient rooms, a nurses’ station, a treatment (medication preparation) room, and a disposal room; a rehabilitation therapy room may be optionally provided. Nursing units providing palliative care services shall be equipped with family companion rooms (or beds).

(3) The net usable area per bed in residential rooms shall be no less than 5 square meters, and the distance between beds shall be no less than 1 meter. It is advisable to have no more than 4 occupants per room;

(4) Living quarters shall be provided with space for clothing storage, and it is advisable to include an accessible bathroom within the unit; the bathroom floor shall meet the requirements of being easy to clean, watertight, and slip-resistant.

(5) Equipped with independent bathing rooms featuring handrails and call systems, as well as effective safety measures such as anti-slip bathing facilities and equipment for transferring patients;

(6) Rehabilitation areas and indoor and outdoor activity zones shall be provided, and they shall comply with accessibility design requirements. Handrails shall be installed on both sides of activity areas and corridors; doorways shall facilitate wheelchair access and egress; and all functional rooms shall be equipped with accessible pathways.

(7) The overall building facilities shall comply with national standards for barrier-free design and meet functional requirements for fire protection, security, emergency evacuation, and prevention of falls, bed falls, self-harm (suicide), wandering, and violence. Buildings requiring elevators shall be equipped with at least one barrier-free elevator;

In terms of staffing, it is required that each bed be equipped with at least 0.6 full-time nursing staff, with a nurse-to-caregiver ratio of 1:3–4. In addition, the Basic Standards for Nursing Centers (Trial) also require the employment of at least two licensed physicians with more than five years of work experience, among whom at least one must hold a deputy senior or higher professional technical title in internal medicine.

With regard to basic infrastructure, nursing centers should be equipped with facilities similar to those required for elderly care institutions, primarily addressing the fundamental needs and safety assurances of older adults who are frail, disabled, cognitively impaired, or bedridden for extended periods.

Based on the explanations provided by officials from the National Health and Family Planning Commission at the press conference held on August 10,A key rationale behind the national government’s introduction of new policies for independently established medical institutions is not only to support social capital in healthcare delivery and accelerate the formation of a diversified healthcare landscape, but also to address the pressing issues of shortages of professional personnel and inconsistent service quality at primary care institutions.

Channel transformation has led to the “disappearance” of certain affiliated departments or those lacking profitability, particularly at the primary care level. Primary healthcare institutions with limited capabilities may choose to forgo establishing such departments, opting instead to purchase services from third-party independent medical institutions or to share resources with large hospitals at the secondary level or above. From this perspective,Independent medical institutions may become the “hot commodity” for primary care facilities.

Another significant shift is that, for medical devices, a change in the buyer profile is becoming an inevitable trend. With rehabilitation medical centers proliferating across the country, the demand for related medical device products is gradually shifting from public healthcare institutions to for-profit independent medical facilities.

Nursing and rehabilitation share deep historical roots. Although they operate as two distinct types of independent institutions, standardized nursing services are indispensable to meeting rehabilitation needs, including those of elderly individuals with total or partial disability, stroke patients, and orthopedic postoperative patients with mobility impairments.

As home-based and community-based elderly care have become the most widely adopted models for serving China’s elderly population, market demand for caregiving services has risen significantly, including day care services and in-home nursing care.

Therefore, the joint release of the Basic Standards and Management Specifications (Trial) for two types of third-party medical institutions—rehabilitation medical centers and nursing centers—is essentially aimed at encouraging social forces to establish rehabilitation medical and nursing institutions. Furthermore, the policy’s encouragement of home-based services helps bridge the “last mile” in extending professional rehabilitation medical services and clinical nursing services to community and home-based rehabilitation and care.

The release of standardized guidelines reflects market demand and attention from top-level design. The joint issuance of dual standards for rehabilitation medical centers and nursing centers effectively serves as a “shot in the arm” for the development of China’s elderly care, rehabilitation, and nursing markets.

In the post-diagnosis and treatment phase at hospitals, services provided by institutions in these sectors are characterized by high investment and high risk. Encouraging third-party medical institutions to collaborate with hospitals and absorb the majority of patients in the “post-hospital market” may well pave a “broad avenue” for private capital to enter the rehabilitation and elderly care markets.

Original Link to the “Notice”:http://www.moh.gov.cn/yzygj/s3577/201711/fac102fd386a41f1ab545315d7c26045.shtml