China Senior Living 中国养老

“远 程 监 控 医 疗 护 理”  蕴 藏 无 限 商 机

同 志 好! There is no shortage of metaphor in Chinese culture. From language to art, it is a highly philosophical society and one that loves acknowledging, often in extravagant ways, its traditional values; the Chinese are also quick to turn and embrace the latest technological innovations with a coy wink and a nod.  This seemingly mild contradiction between reverence of the past and infatuation with a cutting edge lifestyle is a mystery of sorts. But why not? The Chinese love ambiguity and are not troubled in the least by incongruity.

In Ang Lee’s blockbuster Wuxia epic, Crouching Tiger, Hidden Dragon, there are many poignant moments on which to drift away in endless contemplation of China’s mysteries.  Yet one moment stands out in particular: The chief protagonist of the film, Mu Bai, knows that clinging to his personal affection for Shu Lien is contrary to his Wudan way of detachment; yet in Shu’s company he finds something that has eluded him in his meditations. In their second key exchange, during the film’s midpoint, Mu Bai goes so far as to take Shu Lien’s hand and press it to his cheek; yet even here he is held back by the implications of his philosophy. A moment later, in an uncharacteristically romantic moment that underscores Mu Bai’s Xia code of ethics, he peers into Shu Lien’s eyes and says,

“Shu Lien, the things we touch have no permanence….there is nothing we can hold onto in this world. Only by letting go can we truly possess what is real.”

Ah…..here we have it all, enigmatic, impenetrable…and perhaps inconsistent but always attractive and enticing.

In a way, and maybe a tad stretched, I find Mu Bai, his words and his actions relevant, almost allegorical to China’s healthcare evolution and in particular its epic, Wuxia-like journey to self-actualize geriatric medicine. Like Mu Bai, who struggles to reconcile his affection for Shu Lien with his Wudan discipline, the story of China’s senior health care evolution is cryptic and captivating at the same time; always searching for an elusive goal but restrained by a reluctance to let go of the past only to possess, as Mu Bai lectures, what is real. This pursuit of the abstract for some durable conclusion or permanent truth and the attainment of such, at the price of one’s culture, is what I call a “Mu Bai reality”.

Today, across China, developers are waking up to the opportunities for senior living and they are not dissimilar to entrepreneurs everywhere; aggressive and acting to fill a demand.  Many of these developers are experienced builders, but most of them do not possess the skill set necessary to offer the elderly tenants the care and service expected….much less initially promised. Further, when few if any industry wide regulations exist to standardize a product, the results can be “consumer unfriendly”, meaning seniors are moving into communities without any care regimes and no near term prospect for such. And since there is no established geriatric care practice in China, consumers don’t really know what they don’t have.

As I said in my first post on this blog, Enter the ageing Dragon, this practice is changing, as western senior care providers begin to enter the market and as China herself, learns the science and the art of elder care. China’s healthcare evolution in this sense is highly transitional and lacks permanence. As its senior care industry pupates within a chrysalis comprised of western geriatric competence, modern technologies and traditional Chinese medicine, it undergoes a profound metamorphosis; a transformation that requires it to release a portion of its cultural history in order to evolve. The question is: into what does it evolve? When China senior care industry “lets go”, as Mu Bai implores Shu Lien, what will it possess?

The “Mu Bai reality” of China’s Healthcare

When I think about the size of the population in China that (today) requires some sort of specialized geriatric attention and likely goes without, I am reminded of the Law of Large Numbers. If I were to envision a perfect world where every senior citizen in China could avail themselves of a senior living opportunity if they needed it, whether it be nursing, independent or assisted living, I would be dreaming of over 350,000 facilities. This is, to say the least, fiscally impractical and likely impossible even for a “China-sized” budget. So, I wonder, “What is the solution?” Well, the Law of Large Numbers (a theorem dictating that results obtained from a large number of trials should be close to the average of a single trial) tells me that the expected solution for all is not far from the average solution for delivering senior care to 165 million Chinese elderly.

The average solution and the answer, I believe, enabling geriatric care (to non-terminal, ambulant persons) to cover 95% of  China’s ageing population will be one that utilizes information and communication technology (ICT) to monitor, diagnose,  evaluate and maintain patients. ICT is simply a combination of information and communications technologies and is used as a general term for all kinds of technology which enable users to create, access and manipulate information. China is an increasingly interconnected country, the interactions among devices, systems and people are growing geometrically. Businesses need to meet the demands of their employees and customers to allow for greater access to systems and information: ICT enables all of these communications needs to be delivered in a unified, scalable way. This unified platform reduces costs and boosts productivity across a business and beyond. ICT has merged into most every aspect of daily life in China from commerce to leisure and even culture; witness the ubiquity of mobile phones, desktop computers and hand held devices. In most respects, save political, ICT is making China a global society, where people can interact and communicate swiftly and efficiently. There is no more mystery here, in an abstract sense, ICT has become part of China’s technology “Mu Bai reality” in the 1980’s when it “let go” of parts of its past.

The healthcare expression of ICT is Telemedicine. It is a relatively simple concept whereby a doctor can remotely assess the health of a person using devices which measure numerous criteria such as blood pressure, glucose level, temperature, weight and others.  These devices already exist, and some manufacturers are producing “all-in-one” portable combinations that sit on top of a table facilitating ease of use. After the device performs its user administered measurements, the data is transferred (wirelessly or via internet connection) to a central assessment unit for interpretation and comparison with personal historical data. If necessary, the doctor can contact the patient via VoIP and if sufficient broadband is available, live video discussion can ensue for greater evaluation. It is estimated that a doctor can “visit” and assess hundreds of patients a day via Telemedicine, dramatically reducing costs by restricting real office visits or home visits to those patients who truly require in-person evaluation. To my mind there are 5 compelling reasons (taken from Johnathan D. Linkous, CEO of ATA) why this technology works:

1. Telemedicine can increase effectiveness and efficiency in
geriatric medicine.

 2. Currently available technology is sufficient.

 3. Remote central assessment units can be
located within a hospital or other existing clinic.

 4. Technology transforms seniors from patients to consumers.

 5.  It offers greater quality of life for seniors by maintaining personal independence and the continuity of living at home.

But just because Telemedicine “works” or that ICT is a viable application to healthcare, why will it work in China? The answer is because the vast majority of older Chinese are not rich, will never be rich or live in remote areas and thus unable to afford a specialized, live-in, dedicated facility or to travel to a doctor on a frequent basis. Not even under some contemplated, distant reality of a Chinese social security or pension system will most of these people have such an arrangement. So, the least expensive, most practical solution which offers the best care to the most people will be implemented. Thus, I conclude using the Law of Large numbers that Telemedicine is the “average solution” and the way most Chinese seniors will receive geriatric care. Even those seniors living in China’s new assisted living facilities could avail themselves of this technology and facility operators increase their revenue while decreasing their fixed costs.

There is another reason to expect this outcome. China, over the past 30 years has taken large leaps and bypassed certain technology waypoints in their route to further modernization and “Mu Bai realities”.  Witness, the land line telephone: the West used land line telephones for 40 years before cellular technology was developed. But because of China’s emergence onto the global scene relatively late last century there was no need for widespread use of land line telephone technology. Essentially, China went immediately to cellular communication and skipped a whole generation of technology. Cellular was less expensive, more effective and easier to implement across a vast geographic region. Telemedicine should be no different. This example is just further support for the thesis of this blog that Telemedicine is the future not just of healthcare in China, but geriatric medicine especially.

Telemedicine is a disruptive technology in the same way that the car disrupted and reodered transportation last century. Horses, ultimately became entertainment and owned dominately by the rich.  One can only speculate today on telemedicine’s full impact on the future of healthcare, but it will certainly alter it in ways that are, initially, uncomfortable for many.

Once China internalizes the fiscal constraints of traditional, “Westernized” senior care for its burgeoning elderly population, discharges the obsession with historical geriatric care programs, it will “let go” and achieve the “Mu Bai reality” of Telemedicine.  This technology will enable modern, geriartric care for tens of millions of Chinese seniors in far flung locations, inexpensively and in a way that retains their independence. None of this is to say that Western geriatric care competencies are not highly appropriate to a China application. In fact they are, and significant export opportunity exists here for Western practitioners in so long as these skills are “trans-culturated” and delivered in a Chinese context; in doing so an ironic twist of circumstances might occur and the West may also achieve the “Mu Bai reality” of Telemedicine. A hidden opportunity lurks within Telemedicine and it is poised to leap like some striped feral beast!

As a final amusing and certainly less serious thought, I can envision an appropriate sequel to Crouching Tiger, Hidden Dragon which might contain further dialogue between Mu Bai and Shu Lien, now in their 80’s and elderly themselves, as follows:

Mu Bai, now pre-diabetic, has just completed his blood pressure analysis and his glucose test. He presses the green send button to transfer his data to the central assessment unit. He looks up at Shu Lien, who having just finished her own self-assessment with their State provided Telemedicine monitor, is preparing for a session of morning Tai Chi with co-stars Jen, Lo and Sir Te.

Mu Bai sits back in his chair and says to Shu Lien: “Shu Lien, although I am no longer as agile as I was so many years ago, but I would like to go back to Wudan Mountain for further meditation….come with me Shu!”

Shu Lien, also still young at heart but often forgetful replies: “Mu, please leave these things to the young warriors. We have mahjong after lunch and….I don’t remember….but our afternoon is busy!”

Mu Bai insists: “Dutiful wife! My Telemedicine device is portable! We are going!” Mu Bai begins to stand quickly but his ageing knees force him back to his seat.

Shu, coming to help Mu Bai stand, reassures him: “Dear husband, let us be grateful for our independent lifestyle and accept this new, harmonious living for aged persons……..Mu Bai, it has a permanence that is indeed real.”

Camera fades to nearby Wudan Mountain.

If you have not seen this movie, I highly recommend it for an insight into Chinese culture.

REMINDER: Retirement Communities World begins on October 10 and runs through October 12. The conference takes place this year in Hong Kong and it promises to be a grand show! Please consider registering – www.terrapinn.com.