By Jane Rohde, AIA, FIIDA, ASID, ACHA, CHID
LEED AP BD+C & Green Globes – CIEB Assessor

At the recent J+J Senior Living Design Symposium, I presented the “Amazing Journey” of working in China on the first resident-centered nursing home.  The long term care market in China is in its infancy; however this “clean slate” does not translate into transferring western care philosophies directly into a different culture.

I have found that working to understand the Chinese culture, the design process, and the expectations are key to providing a successful solution for elders and their adult children.

I’m often asked why is senior living needed in China, as the expectation is for children to take care of their own elders.  There are several reasons for the need for long term care services, including:

1) The one child policy has limited the number of children that are available to provide care services
2) Higher education has created the condition that many younger adults move to metropolitan areas or go abroad to universities, resulting in many remaining in urban areas for employment opportunities, separating the children from elders geographically
3) The development of the middle class resulting in dual income households and both spouses working
4) The realization and acceptance that dementia is impacting the senior population in China, as it is worldwide
5) Adult children are often responsible for two sets of parents and four sets of grandparents – therefore if one or two have dementia, children are seeking supportive services

While working on designs and recommendations, China Senior Care started with a functional program process – evaluating every operational process that would be anticipated within the project.  Ann Jiang, VP for Operations of China Senior Care, told us “the functional program is the source of all things.” Therefore Mark Spitalnik, President and CEO of China Senior Care, now refers to me as the “sorceress.”

A title that I wear proudly, as we see the incredible outcomes develop by using the functional program as a framework for decision making throughout the project design, operational development, and construction process.  (For more information on the functional program process; see Part 1 of the new 2014 Guidelines for Design and Construction for Residential Health, Care, and Support Facilities available at www.fgiguidelines.org.  Another resource is the Senior Living Sustainability Guide® (SLSG), which is available for free download at www.withseniorsinmind.org.)

From a design perspective, we think of the process as needing to be “Chinafied” – meaning that we work on the environmental design to be supportive of the operational plan and organizational philosophy. However, this needs to include a Chinese filter for appropriateness that serves Chinese elders and their families. The mixing of east and west expertise is the collaborative success of the project.

The design includes current thinking on skilled nursing homes (called Residential Aged Care taken from down under from the Australians and the Kiwis), utilizing a household model of eight (8) resident rooms — two per floor, which are joined horizontally for access by both residents and staff.  The first floor includes community space, a clinic, and therapy spaces, and designated space for an Adult Day Health Care program.  Resident-centered care philosophies are new to China, as well as the concept of adult day care, which is utilized in Taiwan, but to date services have not been widely offered on Mainland China.

The construction process is well underway for China Senior Care’s flagship residential aged care community, Cypress Gardens, and it is anticipated to open in November, 2015.  There will be operational mock-ups and training for staff taking place prior to residents moving in – as educating the staff was an essential tenet of the leadership developing the long term care model.

The goal is to continue to benchmark outcomes for continual improvement on a regular basis.  It is my hope that much of this important information will help positively inform work in the senior living marketplace in the United States, too!

Jane Rohde is the founding Principal of JSR Associates, Inc. located in Ellicott City, Maryland.  She champions a global cultural shift toward de-institutionalizing senior living and healthcare facilities through person-centered principles, research and advocacy, and design of the built environment.  Clientele includes non-profit and for-profit developers, government agencies, senior living and health care providers, and design firms.  Jane speaks internationally on senior living, aging, healthcare, evidence based design and sustainability.  For more information or comments, please contact Jane Rohde at jane@jsrassociates.net.
Photo descriptions:
1. Cypress Gardens: Construction Progress Photo: Exterior Front
2. Cypress Gardens: Household Rendering
Cypress Gardens: Completed Exterior Rendering: Facing North
Cypress Gardens: Completed Exterior Rendering: Facing South