What Japan's Improved CCRC Elderly Care Model Can Teach Us
In 2013, the State Council of China released documents regarding its opinions on accelerating the development of the elderly service industry in order to encourage the participation of social capital in the industry. Since then, under the joint promotion of the real estate industry, service organizations, insurance companies and other entities, the United States' continuing care retirement communities (CCRC) model has grown tremendously in China. According to the definition of the American Association of Homes and Services for the Aging (AAHSA), a CCRC is "an organization that offers a full range of housing, residential services, and health care in order to serve its older residents as their needs change over time". However, with the continuous increase of CCRC's construction scale and market demand in China, the contradictions it faces in planning and operation are on the rise. This is most prominent in the many projects that are being built in strict accordance with the American CCRC standards which are not only inadequate in design, use, and operation, but are also thought of as not being adapted to China's national conditions while also having unclear positioning and a lack of characteristics. Furthermore, such projects often have insufficient cooperative mechanisms with China's policy system and other related industries (such as professional medical institutions), problems such as a lack of sustainable operating funds and professional services have also arisen. In addition to all of the above, there are also constant controversies such as the accusation that the "CCRC may cut off the opportunities for the elderly to interact with the society, which practically means that the elderly would be imprisoned", causing many projects to lose popularity.
China is not the only country that wants to utilize the CCRC model to improve its elderly care service. Japan too, tried to introduce the American CCRC model as early as the 1990s. Although there are also some controversies, the Japanese CCRC experience may serve as a reference for the Chinese elderly community which is lacking in long-term practice and research.
Japan is known to be one of the countries that faces severe aging crisis. Under the pressure of an increasingly aging population, Japan has continuously explored new models of elderly care, and the introduction of the American CCRC model is but one of its bold attempts. However, Japan has not yet been able to fully replicate the American CCRC model. Under the joint management and promotion of implementing the model nationally and locally, Japan has carried out the practice of localizing the American CCRC model and forming lifelong active communities with its own unique characteristics. In the process of more than two decades of practical research, the Japanese government has continuously deepened the relationship between the lifelong active communities and the existing policy and institutional framework of facilities for the elderly, nursing care insurance, urban renewal, etc., and proposed the related development policy in 2014. In 2015, the planning framework and related policy documents of the concept of lifelong active community were issued to further standardize and guide the localization practice of CCRC.
Judging from the relevant planning materials of the "lifelong active community", the Japanese version of CCRC, it starts off with a very clear goal which is to alleviate the ever-increasing pressure of aging in central cities and respond to the urgent developmental needs of local cities. With such key issues in mind, the "lifelong active community" has targeted the two most important components of the American CCRC model, i.e., moving in early and continuous care. Similar to most old-age care systems, Japan's original elderly care system was very "passive", which means that the elderly people did not have to move into the aged care facilities until they were weak, at the same time, the arrangement of services was done completely from the top down. Comparatively, the CCRC model is "active". It advocates changing the profit model from "making money through nursing care" to "making money through maintaining the health of residents" in order to attract more healthy elderly people to move into the community earlier. Such a model not only curbs social security financial expenditures and reduces pension costs, but a large amount of capital and customer demand will also follow suit when wealthy, idle and healthy elderly people check themselves in. To a certain extent, this will alleviate the industrial and population decline in local cities where the "life-long active community" is located, while simultaneously avoiding the further loss of local nursing staff and related industry populations.
On the basis of retaining the core ideas and some important components of the American CCRC, the "lifelong active community" combines Japanese social and regional characteristics as well as existing systems in the transformation of the original CCRC model. The biggest change is that the original CCRC model is a centralized one, which views the entire community as a unit, while the "lifetime active community" is a scattered small-scale group that is integrated into the existing social network in the region. Compared with the original CCRC, the "lifelong active community" can activate local idle resources and promote local development, while also allowing the elderly to have an increased sense of belonging. Specifically, "lifelong active communities" that are often established after fully exploring local advantages and characteristics. For example, some "sports" as well as "art and culture" life-long active communities are built together with the surrounding public spaces, and some "street lifestyle" life-long active communities are combined with surrounding hot springs and shopping areas, while some encompass populations with different ages that are closely connected with universities, kindergartens, etc. In addition to spatial integration design, in terms of operation, "lifelong active communities" open their public and cultural facilities to local communities, hence being able to promote exchanges between residents of various age groups. It simultaneously encourages the residents to transform from being served to being the main component of local city constructions by participating in local activities and continuous learning. This in turn can enhance the value of the community through convenient transportation, active openness, and value exchanges with locals. To a certain extent, such values can offset the problem of the original "closed" approach of the American CCRC that is limited by the residents' age groups and the tightening of security.
In addition, something that is absent in the original American CCRC model as compared to Japan's "lifelong active community" is that it does not bear the important task of alleviating various social problems. In response to various practical problems that occur in different regions, the "lifelong active community" presents four important forms of realization. The first is to deal with the problem of local population decline and over-dispersion. Taking the opportunity of building "lifelong active communities" and borrowing local government land for leasing and construction, while attracting and retaining talents through occupancy subsidies, etc. The second is to deal with the rapid expansion of nursing care insurance expenditures and the reduction of annuity payments. In the process of building a "lifelong active community", more attention should be paid to how the initiative and self-realization of healthy elderly people are being promoted, and their ability of self-care are improved through external means. This is to make use of the original maintenance facilities as much as possible and actively cooperate with universities to fully make use of local medical resources. The third is to deal with the problem of a large number of idle houses and take the opportunity of building "lifelong active communities" in signing long-term building lease contracts with urban renewal agencies and to put elderly living and service functions in these idle houses. The fourth is to control the shortage of nursing manpower and strive to establish closer communication and cooperation with local medical institutions to promote the integration of local medical care and nursing care.
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