This article defines the current community embedded elderly care as “a new type of elderly care model that integrates various service resources through sinking and integration to create a comprehensive elderly care complex that combines home, community, and institutional services, enabling elderly individuals to enjoy high-quality elderly care services close to home or at home.”
It should be noted that although community embedded elderly care contains the word “community,” it cannot be directly equated with traditional community elderly care or community home-based elderly care. The “community” in community embedded elderly care has two meanings: it serves as both the provider of elderly care services and the place where these services are utilized, and community embedded elderly care is a collection of high-quality contents from community elderly care and community home-based elderly care.
To further distinguish the similarities and differences between various elderly care models, this article compares home-based elderly care, community elderly care, community home-based elderly care, and community embedded elderly care from the dimensions of living scenarios, activity scenarios, and service projects, and draws a concept category diagram of elderly care models, as detailed in Table 1 and Figure 1.
Current Development Status of Community Embedded Elderly Care in China
Based on the above analysis framework, this article will focus on the dimensions of demand embedding, resource embedding, subject embedding, and concept embedding in community embedded elderly care, systematically sorting out the service projects, service facilities, and operational models in community embedded elderly care, in order to better present the overall development situation of community embedded elderly care in China.
1. Service Projects of Community Embedded Elderly Care
The service projects of community embedded elderly care are relatively broad. Currently, domestic scholars generally pay more attention to the care and nursing attributes of community embedded elderly care in relevant studies, but in fact, the service projects of community embedded elderly care go far beyond this.
Based on sorting out relevant policy documents released by some pioneering regions and combined with recent research findings, this article roughly categorizes the service projects of community embedded elderly care into professional care, meal services, medical care, emotional comfort, cultural spirit, technical support, and other services, with each section including different service projects, as detailed in Table 3.
First, the professional care sector is the core subject of community embedded elderly care.This type of service focuses on addressing the questions of “where to care,” “who will care,” and “how to care” in traditional elderly care models. Since the various service projects in this sector (especially day care and short-term care) have strong integration and nesting attributes, some scholars have once equated these services directly with community embedded elderly care. However, as the connotation of related services has enriched and the forms of embedding have diversified, the relationship between the two has been further clarified.
Second, meal services and medical care are the basic components of community embedded elderly care.These services focus on meeting the two major needs of elderly individuals in the community for meals and medical care, corresponding to the most basic physiological and safety needs in Maslow’s hierarchy of needs. Therefore, the overall demand for these services is relatively high and urgent. Today, meal services and medical care have become key support sectors in the construction of community embedded elderly care services.
Third, emotional comfort, cultural spirit, technical support, and other services are important supplements to community embedded elderly care.These services can better meet the multi-level and personalized material and spiritual needs of elderly individuals in the community, improving their quality of life, corresponding to the advanced social, respect, and self-actualization needs in Maslow’s hierarchy of needs. However, due to differences in the basic conditions and developmental levels of communities in different regions, the promotion of service projects in these sectors is generally lower, and the development gap between different regions is relatively larger.
2. Service Facilities of Community Embedded Elderly Care
Home, community, and institutional facilities are important spatial carriers for socialized elderly care service resources to sink to the grassroots level. Based on the placement locations, functional positioning, and service cycles of different service facilities, this article specifically divides community embedded elderly care service facilities into three categories: home-based, community daytime, and institutional resident types, with detailed classification and corresponding main service facilities shown in Figure 2.
First, home-based facilities.These primarily target elderly individuals who are long-term home care recipients. The representative facilities mainly include various types of home elderly-friendly designs, such as safety handrails, non-slip floors, indoor sensor lights, elderly seating and sleeping furniture, elderly smart home devices, and monitoring call systems. These home elderly-friendly facilities can effectively reduce the difficulty of elderly individuals’ home activities, and some smart devices also feature networking functions such as risk warnings and emergency calls. Various forms, scenarios, and functions of home-based facilities work together and complement each other, creating a safe, convenient, and comfortable home care environment for elderly individuals.
Second, community daytime facilities.These include daytime activity and daytime care types. The former mainly targets elderly individuals with intact activity abilities and relatively healthy bodies. From the perspective of functional integration, this type of facility can be divided into single-type (e.g., community senior dining halls) and compound-type (e.g., comprehensive elderly service centers, community life stations). These facilities widely cover a series of functions such as dining, socializing, entertainment, sports, and education, which can better meet the multi-level elderly care needs of elderly individuals in the community and improve their quality of life; the representative facility for the latter is the community daytime care center that provides day care services.
Third, institutional resident facilities.These include short-term resident types and long-term resident types. The former’s representative facility is the community senior care home, which provides full-time services for elderly individuals and families in need (such as those temporarily without caregivers at home or needing short-term rehabilitation due to illness). In order to allow more elderly individuals in the community to receive care, short-term resident facilities usually impose restrictions on the duration of elderly individuals’ stays; the latter’s representative facilities include community elderly service centers and other institutions. In addition, some scholars have also classified the gradually emerging elderly communities in recent years into this category of facilities.
3. Operational Models of Community Embedded Elderly Care
Currently, domestic scholars mainly categorize the operational models of community embedded elderly care from two perspectives: one is based on the overall characteristics of geographic regions, such as the Shanghai model, Beijing model, Chongqing model, Hefei model, Shijiazhuang model, etc.; the other is based on specific service performance forms, such as the “Party building + elderly care” model, “property + elderly care” model, and elderly care station model.
Similar to traditional institutional elderly care, the development of community embedded elderly care relies not only on the government but also on the extensive participation of social entities. The various entities each perform their respective duties and embed into each other, giving rise to a rich variety of operational models.Based on this, this article summarizes five main operational models of community embedded elderly care based on the nature of investment and operational entities involved in the elderly care service supply process, as detailed in Table 4.
Overall, the current five operational models of community embedded elderly care are characterized by clear distinctions and varying advantages and disadvantages. Among them, the public construction and private operation model has the highest popularity nationwide and occupies an absolute position in economically developed provinces and cities such as Beijing and Shanghai, making it the most typical operational model in community embedded elderly care today. Under the public construction and private operation model, the forms of public-private cooperation between the government, market, social organizations, and individuals are more diverse, and the thresholds for service operation entities are relatively relaxed, which gives this operational model good practical operability and regional applicability.
In addition, the public construction and private operation model can also maximize the activation of social elderly care service resources, promote the sinking of high-quality services to the grassroots level, thereby better achieving the basic functional positioning of community embedded elderly care—allowing more elderly individuals to enjoy high-quality and inclusive elderly care services nearby.
In contrast, the private-public assistance model is more prevalent in regions with limited local fiscal capacity. Under this model, the construction funds for community embedded elderly care service facilities are mainly raised by private entities, while local governments only need to provide certain site and financial support, thus helping to further reduce the fiscal expenditure pressure on localities; the market operation, collective economy, and charitable mutual assistance operational models are more niche, with the market operation model mainly targeting elderly individuals with a certain economic foundation and a focus on quality of life, the collective economy model mainly distributed in areas with relatively developed village collective economies, and the charitable mutual assistance model mainly distributed in rural and other underdeveloped areas.
Problems Faced by Community Embedded Elderly Care Practices
Although some regions have achieved certain results in community embedded elderly care, they are still in the exploratory stage of experience. The practice of community embedded elderly care in China still faces multiple challenges from demand embedding, resource embedding, subject embedding, and concept embedding, which warrant deeper reflection.
1. Demand Embedding: Mismatch in Supply and Demand, Lack of Effective Linking Mechanisms
On one hand, the supply and demand relationship of community embedded elderly care services is characterized by total imbalance. Influenced by traditional filial piety concepts, many elderly individuals are still unwilling to enter any places or facilities with social elderly care attributes, nor are they willing to accept socialized elderly care services provided by non-family members. In addition, some elderly individuals have relatively little understanding of community embedded elderly care, and they hold a more resistant or cautious attitude towards such elderly care service facilities and services, which also suppresses their related elderly care needs.
On the other hand, the supply and demand relationship of community embedded elderly care services is characterized by structural imbalance, specifically manifested in two aspects: first, mismatches in service project supply and demand. For example, research has found that many communities schedule different learning courses and recreational activities for elderly individuals every day, yet the actual effectiveness of these schedules is often unsatisfactory, often leading to a polarization of “overcrowded” and “unattended” situations.
Clearly, this results from service providers’ inability to accurately grasp the needs of elderly individuals and their difficulty in flexibly adjusting service supply strategies. This formalistic and rigid service supply model wastes elderly care service resources. Second, the mismatch in supply and demand between different regions is concentrated in the geographical space, where the layout of community embedded elderly care service facility networks in some areas is not coordinated with the scale and density of the elderly population within their regions.
Overall, the dual imbalance in the supply and demand relationship reveals the lack and insufficiency of linking mechanisms for needs in the development process of community embedded elderly care. Although many regions have established digital elderly care information service platforms, research during the investigation found that most platforms are flashy but impractical, with missing basic data, delayed information updates, insufficient information accuracy, and network latency making it increasingly difficult for “services to find people.”
2. Resource Embedding: Limited Professional Service Talent, Uneven Service Quality
Taking talent resources as an example, the current elderly care service industry in China is labor-intensive, and due to factors such as high pressure on grassroots positions, low pay levels, low social recognition, and limited development space, the development of community embedded elderly care is facing a severe personnel crisis, concentrated in three aspects:
First, structural imbalance.The service workforce is aging, with personnel aged over 50 becoming the norm, and there are few young frontline personnel joining, leading to a noticeable lack of vitality in development. Additionally, there is a severe imbalance in the gender ratio of the service workforce, with men generally less willing to engage in related work;
Second, insufficient qualifications.Many workers generally have low educational levels and lack professional knowledge and skills. In some rural and underdeveloped areas, some workers can directly take up positions without professional training or relevant qualifications, which may impact the quality of elderly care services and leave service risks;
Third, high mobility.During the investigation, it was found that due to the similar nature of work, many workers choose to switch to the more relaxed and less pressured household service sector after working in institutions for a while. As a result, institutions need to frequently recruit employees and retrain them, and this high frequency of personnel turnover not only increases the cost of elderly care services but also impacts service quality, hindering the long-term stable development of community embedded elderly care.
In addition to frontline personnel, the development of community embedded elderly care also relies on specialized management. However, there are significant differences in the industry background, resource base, concept orientation, and professional level of the operating parties, which may lead to substantial disparities in the quality of community embedded elderly care services provided in different regions. The construction of evaluation systems and standardized management for related elderly care services remains a significant challenge.
3. Subject Embedding: Intertwined Rights and Responsibilities, Difficult Coordination Among Multiple Subjects
Currently, the operational models of community embedded elderly care are rich and diverse, and in practice, the participating subjects of different models also exhibit diverse characteristics. Therefore, in various links involving the interests and rights and responsibilities of multiple subjects, it is inevitable that a series of coordination issues will arise:
First, the construction of community embedded elderly care service facilities will to some extent occupy public land resources in the community. The decoration and renovation of facilities and subsequent operations may also negatively impact community residents (noise pollution, influx of outsiders, etc.), which can provoke residents’ resistance and behavior, resulting in a NIMBY (Not In My Back Yard) effect;
Second, in the construction and operation of community embedded elderly care service facilities, private entities face strict qualification reviews, particularly in fire safety inspections. The complex review procedures, lengthy review cycles, and strict review standards significantly increase the costs and pressures of facility operations, which is not friendly to some grassroots operating entities;
Third, for public-private cooperation operational models such as public construction and private operation and private-public assistance, depending on the type of contracts, the management rights and operational rights of community embedded elderly care service facilities, as well as ownership and usage rights, may exhibit varying degrees of separation, leading to deviations in action logic, competition between public and private entities, and deviations in operational orientation.
In addition, these issues also reflect the constraints of funding and land in the development process of community embedded elderly care. The former is concentrated in aspects such as difficulties in timely and full disbursement of fiscal subsidies and limited risk resistance capabilities of small micro-institutions; the latter focuses on the limited availability of land resources in communities and difficulties in facility construction land approvals.
4. Concept Embedding: Regional Foundations Vary, Experience Paradigm Promotion Hindered
Community embedded elderly care in China originated in Shanghai, a city with strong economic strength and high urbanization levels. In the long-term exploration and practice of this elderly care model, Shanghai has accumulated relatively rich experiences. However, are these experiences and paradigms equally applicable to other regions? The answer is clearly negative.
China is vast, and there are significant differences between different regions in terms of natural geographical features, economic development levels, basic population composition, and local cultural concepts, making it difficult to implement a standardized elderly care model nationwide. This is particularly evident in:
First, the differences between developed and underdeveloped regions.Developing community embedded elderly care requires investment in resources such as land, labor, and technology, and these investments ultimately rely on substantial financial support. The elderly care service industry has the characteristics of high upfront investment and long return cycles, making it difficult for regions with low economic levels and limited fiscal revenues to develop this elderly care model.
Second, the differences between urban and rural areas.Unlike cities, rural areas generally have relatively weak foundations for developing community embedded elderly care, with very limited social resources available for integration. Most rural communities require more support to develop this elderly care model. In addition, influenced by strong filial piety concepts, rural elderly individuals are generally less accepting of social elderly care than their urban counterparts.
Third, the differences between plain and mountainous areas.Compared to plain areas, mountainous regions have more complex terrain, more closed transportation, and dispersed resident distribution. Communities here are no longer the communities understood under the “plain thinking” concept, and promoting community embedded elderly care in mountainous areas will face greater cost issues and a series of fairness issues in resource allocation.
Countermeasures and Suggestions for the Development of Community Embedded Elderly Care
In March 2023, Premier Li Qiang pointed out during a survey in Hainan that “home-based elderly care is the main form of elderly care in our country. We should actively explore community embedded elderly care services around the expectations and needs of elderly individuals, and effectively address their needs for meals and medical care.” In May of the same year, the opinions issued by the Central Committee of the Communist Party of China and the State Council on promoting the construction of a basic elderly care service system listed the implementation of the national basic elderly care service list as a key focus of national elderly care work in the near future.
The community, as the basic unit of residents’ lives and social governance, is the “last mile” for achieving the sinking of elderly care service resources to the grassroots level and promoting the comprehensive implementation of basic elderly care services. This article believes that the important foundation for the development of elderly care services in China is community embedded elderly care. This embedding is not only geographical but also encompasses the comprehensive embedding of real needs, facility resources, diverse subjects, and value concepts.Community embedded elderly care is not only the only way to achieve the goal of all elderly individuals enjoying basic elderly care services but also the key direction and inevitable trend of the future development of modern elderly care models in China.
In this regard, governments, communities, enterprises, and social organizations should further clarify their respective responsibilities, combine regional characteristics, rely on favorable resources, and work together to promote the high-quality development of community embedded elderly care. Specifically:
First, local governments should strive to change traditional governance concepts and methods, encouraging more market and social entities to participate in the supply of elderly care services. At the same time, they should clearly recognize their responsibilities as main bodies in the development of elderly care undertakings. Promoting community embedded elderly care cannot do without government policy support and publicity guidance, and operating community embedded elderly care cannot do without government coordination and supervision.
Second, grassroots communities should always uphold the purpose of serving residents, continuously improve the internal management and service system of the community, actively link various elderly care service resources based on the elderly individuals’ needs, and enhance the public service capabilities of grassroots communities.
Finally, enterprises and social organizations should standardize service orientation and manage operations properly. The elderly care service industry itself has certain public welfare attributes, so whether in public-private cooperation or market-oriented operations, operators should adhere to the principle of unifying economic and social benefits, working in alignment with the government’s original intention of developing community embedded elderly care.
So, what specific approaches or means should we use to achieve the goal of high-quality development of community embedded elderly care? Combining the multi-dimensional embedding issues mentioned above, the following four suggestions are proposed:
First, strengthen the construction of information platforms and optimize the service supply structure.Building and maintaining elderly care service information platforms is aimed at grasping the real elderly care service needs of elderly individuals in the community more timely, comprehensively, and accurately. Therefore, it is necessary to strengthen the construction of information platforms with a long-term perspective and pragmatic attitude, ensuring that “basic skills” are well done in hardware facilities, data collection, and information processing, truly making the elderly care service needs linking mechanism in the community practical, detailed, and sustainable. On this basis, service suppliers should also integrate social resources in a targeted manner based on the actual elderly care service needs they grasp, timely adjusting the relevant elderly care service projects to further optimize the service supply structure of community embedded elderly care.
Second, improve the working environment for frontline personnel and enhance talent team building.On one hand, gradually improve the salary and welfare levels of frontline personnel while ensuring that the work content and intensity remain largely unchanged, focusing on the mental and physical health of grassroots employees, and creating a good and comfortable working environment to achieve the dual goals of reducing personnel turnover and stimulating employees’ enthusiasm for work; on the other hand, governments and social operators should deepen cooperation with local vocational high schools, universities, research institutions, and other departments, actively exploring the integration mechanism of “talent training” and “talent delivery” through the establishment of professional internship sites, building practical teaching bases, and signing targeted employment agreements to optimize the structure of the elderly care service talent team.
Third, balance the needs of multiple subjects and refine support policies.High-quality elderly care service resources sinking require the coordination of the government, community support, social participation, and public recognition. Therefore, in the process of developing community embedded elderly care, it is essential to fully listen to the demands of multiple subjects, consider the rights and interests of both public and private sectors, actively explore cooperative mechanisms for joint discussion, construction, and sharing, and break down information barriers in the coordination process among multiple subjects, thereby better eliminating institutional obstacles in facility construction and operation and elderly care service supply. In addition, local governments should also refine and implement relevant support policies for community embedded elderly care based on actual situations, such as simplifying approval processes, providing tax and fee incentives, expanding activity funds, and assisting in linking resources to ensure that government-related funds can be disbursed on time and in full.
Fourth, rely on local resource conditions and explore more embedding models.Community embedded elderly care does not have a predetermined paradigm. Blindly copying the development models of cities like Shanghai and Beijing and using “urban thinking” to develop rural areas or using “plain thinking” to assess mountainous areas will likely result in “mismatches”. In fact, the most important aspect of developing community embedded elderly care is to grasp the core, take root in the local context, and adapt to local conditions. Localities should make full use of their advantageous resource conditions (such as land, funds, talents, markets, culture, etc.), pay attention to the sinking and integration of resources, and explore development paths for embedded elderly care that align with local realities, such as the rural community of Datong City relying on collective economic development to build nursing homes autonomously and the charity association of Yanchuan County raising funds to build happiness homes throughout the county.
【Investigation Time】: December 22-27, 2024
【Investigation Location】: Japan, Nagoya-Osaka
【Participants】: Developers of rural revitalization projects, agricultural development, local leading enterprises, cultural tourism groups, cultural tourism platforms, local government development and reform commissions, cultural tourism bureaus, health and wellness commissions, civil affairs bureaus, relevant departments of the elderly cadre bureau; real estate, property, insurance finance, elderly care, big health, cultural tourism, elderly universities, travel agencies, and core senior management personnel of related upstream and downstream industry chain enterprises, including company chairpersons and general managers.
【Organizer】: Beijing Yifang City Zhihui Technology Co., Ltd.
【Registration Phone】: 176 0065 5161 Teacher Wei
【Investigation Features】: Practical expert explanation + case analysis + module summary
Specific Agenda
—Day 1 December 22
【Morning】Fly to Nagoya
【Afternoon】Visit Nagoya DELA City Farm
【Evening】Check into Nagoya hotel
★
Evening welcome dinner, enjoy the most beautiful night sky in Japan
★
—Day 2 December 23
【Morning】
Sunflower Elderly Care Hospital–One of the largest comprehensive health care service groups in Aichi Prefecture, representing personalized care and small-scale nursing models
Guest Speaker:Mr. Kobayashi, Head of Sunflower Elderly Care Hospital
Sharing Topic:Operational Sharing of Sunflower Elderly Care Hospital
Highlights of the Investigation:
1. Operational model of a large-scale comprehensive health care service group in Japan;
2. Personalized care and small-scale nursing models;
3. Providing various elderly care solutions.
【Noon】Special lunch in Achi Village
【Afternoon】
Achi Village–Creating a hot spring + forest therapy base for “Japan’s first starry sky” IP
Guest Speaker:Mr. Shirakawa, President of Achi Hirugami Tourism Bureau
Sharing Topic:Experience in Creating Japan’s First Starry Sky Village
Highlights of the Investigation:
1. Ranked first in the “National Starry Sky Continuous Observation” activity;
2. Formed a rural night economy model led by starry sky night tours, attracting 160,000 visitors annually;
3. A model rural tourism destination for night tours in Japan.
—Day 3 December 24
【Morning】
MOKUMOKU Farm–Japan’s number one “parent-child farm”
Guest Speaker:Yoshida Osamu, Founder of MOKUMOKU
Sharing Topic:Operational Strategy of MOKUMOKU
Highlights of the Investigation:
1. An agricultural farm themed on “nature, agriculture, and pigs”;
2. With a regional population of only 100,000, it attracts 500,000 tourists annually and has 50,000 members;
3. Annual revenue of about 400 million RMB, becoming one of the wealthiest rural areas in Japan, a miracle in the farming industry.
【Afternoon】
La Colina Omi Hachiman–A phenomenon-level internet celebrity store in Japan that attracts more than 3.2 million visitors every year
Guest Speaker:Yoshiyuki Ishizaki, Member of the Kyoto City Commercial Promotion Committee, Chairman of the Shiga Prefecture Chamber of Commerce and Industry Sales Strategy Vision Research Association
Sharing Topic:La Colina’s Explosive Product Model
Highlights of the Investigation:
1. How to integrate agricultural secondary production with rural nature design;
2. The sustainable development business model of rural internet celebrity stores;
3. More than 3 million visitors every year, with annual dessert sales exceeding 20 billion yen.
—Day 4 December 25
【Morning】
Arima Onsen Town–Japan’s most famous hot spring health preservation town
Guest Speaker:Keisuke Imai, President of the Arima Onsen Association
Sharing Topic:Customer Acquisition Strategy of Arima Onsen Health Preservation Town
Highlights of the Investigation:
1. Created a comprehensive tourism destination integrating health, dining, accommodation, travel, and shopping;
2. Arima Onsen is the oldest hot spring in the Kansai region and one of Japan’s three famous springs;
3. Extending the industrial chain and structuring a system of characteristic products centered around Arima Onsen.
【Afternoon】
Colorful Town Health Preservation Comprehensive Community–A comprehensive health preservation community with medical care + nursing + care
Guest Speaker:Ryo Matsui, General Manager of Project Operations
Sharing Topic:Planning and Operation of Colorful Town Health Preservation Community
Highlights of the Investigation:
1. Created a comprehensive health preservation community themed around care;
2. The community includes special elderly residential areas, fee-based elderly residences, community service areas, short-term residential daytime care service communities, medical facilities, farms, and tea houses.
—Day 5 December 26
【Morning】
Future Medical International Base–Japan’s top future medical technology research complex
Guest Speaker:Dr. Yu (Tao) from Osaka University, Medical Doctor, former President of the Japan Association of Chinese Life Sciences, current Director of ASONE, a listed company in Japan, and responsible for the Qrossover Lounge at the Osaka Future Medical International Base.
Highlights of the Investigation:
1. Introduced and shared the planning and positioning of the Future Medical International Base;
2. Visit to the “Future Medical International Base” in Nakashima Island;
【Afternoon】
Dojima Health Care Clinic
Guest Speaker:Dr. Mamoru Sato, Director
Sharing Topic:Operation and Service of Japanese Community Health Care Clinics
Highlights of the Investigation:
1. Learning the operational management model of Japanese community clinics;
2. Understanding the patient management process of the clinic;
3. Exploring how to provide comprehensive health management services through innovative service models under limited space and resources;
4. Learning from how clinics operate under strict medical regulatory environments in Japan, maintaining high patient satisfaction through compliance management while offering diversified service projects.
—Day 6 December 27
【Morning】Sightseeing & Shopping
【Afternoon】Return flight to China
#Japan Investigation #
Registration Method
1、Phone Registration:Teacher Wei 17600655161
2、WeChat Registration: Scan the code and note “Japan Investigation” + Company Name + Contact Information
Note：☆This investigation belongs to a high-end business activity and will charge a fee. Please be advised, non-serious inquiries are not welcome, thank you!
Previous Japan On-site Photo Display:
Knowledge content on agricultural, cultural, commercial, health, and tourism project, including but not limited to rural revitalization/cultural tourism, rural town project top-level strategy, industry IP, integrated content design case studies, etc. Selected benchmark cases, experience the latest content, from complex operation to business innovation, learn, think, and gain on-site. As of now, more than 600 professional courses have been updated.
Knowledge content on agricultural, cultural, commercial, health, and tourism project, including but not limited to rural revitalization/cultural tourism, rural town project top-level strategy, industry IP, integrated content design case studies, etc. Selected benchmark cases, experience the latest content, from complex operation to business innovation, learn, think, and gain on-site. As of now, more than 600 professional courses have been updated.
