I. What are the context and rationale behind the policy making?
With a view to breaking down the barriers between medical care and wellness care from the source, achieving alignment between medical care/wellness care policies, perfection of the system, and the integration of services, and better solving the difficult and thorny problems elderly people face when they receive medical care/wellness care at home and in the community, Jing’an District started, in August 2023, to experiment with the medical care/wellness care integrative care/nursing service mode featuring the “five-bed coordinated operation” in the whole District, so as to explore ways of providing elderly people with integrated and continuous health and elderly-care services that are people-centered and meet diversified needs.
In accordance with the guiding principles of the Regulations of Shanghai Municipality on Elderly Care Service, the Notice on Issuing the Several Measures for Further Improving the Medical Care/Wellness Care Integrative Development of the Elderly Care Institutions in This Municipality (SMCAB D [2024] No.5), and in the light of the experiment results in Jing’an District, the Implementation Opinions on Improving the “Five-bed Coordinated Operation” to Further Promote the Medical Care/Wellness Care Integrative Development of the Elderly Care Institutions in Jing’an District are formulated and published in order to further improve the home services/community institutions coordination and medical care/wellness care integration, thus satisfying elderly people’s demand for medical care/wellness care.
II. Which groups will this policy affect?
Elderly people residing in elderly care institutions or enjoying home-based elderly care beds in Jingan District may, through signing a “five-bed coordinated operation” contract with the relevant elderly care institution, enjoy free services such as hospital admission assessment, green-channel transfer to different beds, basic public health services, and health education.
III. What core initiatives does this policy include?
1. Improving the service network to make medical care/wellness care integration more convenient and accessible. First, elderly care institutions are encouraged and supported to sign a cooperative contract with medical institutions like community health service centers. The medical institutions within a community may, in the light of their own advantages, sign differentiated and specialized cooperative contracts with neighboring elderly care institutions, while elderly care institutions with appropriate conditions are encouraged to expand their medical care/wellness care integration service scope through purchasing services. Second, community health service centers with appropriate conditions are supported to establish community doctor service points and family doctor work rooms within or near elderly care institutions in the light of the actual conditions of these institutions, and the community health service centers and elderly care institutions may conduct cooperative operation. Third, elderly care institutions with appropriate conditions are supported to establish their internal medical institutions, the administration of which is subject only to filing for record.
2. Integrating the service items to ensure more suitable and better-quality medical care/wellness care integration. Elderly care institutions and the medical institutions they cooperate with are encouraged to set up joint medical care/wellness care management teams so as to jointly provide the residents of the elderly care institutions with diversified and individualized services that meet the different care/nursing demands at different stages—services that include, but are not limited to, disease treatment, rehabilitation care, traditional Chinese medicine service, preventive heathcare, long-term care and nursing, and terminal care. Meanwhile, elderly people on home-based elderly care beds are supported to share the medical and health services and facilities of the elderly care institutions, so that they have access to more suitable, continuous and high-quality health services.
3. Standardizing the service process to make the transfers among medical care/wellness care beds more efficient and convenient. Evaluation of the establishment and transfer of the five types of beds (home-based elderly care beds, elderly care institution beds, home-based medical beds, medical institution beds, and terminal care beds) will be further improved, and priority will be given to transfers to designated institutions and emergency and first-aid green channel service. For example, when the care environment of an elderly person worsens, the elderly care institution shall open a green channel to prioritize him for a home-based elderly care bed or an elderly care institution bed. When the health of an elderly person on a home-based elderly care bed or an elderly care institution bed deteriorates, the elderly care institution shall promptly communicate with the “five-bed coordinated operation” contract member unit to transfer his health records, open the corresponding green channel, and set up a home-based medical bed or transfer him to a medical institution bed. When an elderly person’s health has improved, he may return to the home-based elderly care bed or the elderly care institution bed through the green channel. When an elderly person needs terminal care, he has the priority to be transferred to a terminal care bed to receive end-of-life comfort care.
4. Expanding the service scope to extend medical care/wellness care integration into communities and homes. Family doctors will sign contracts with more elderly people on home-based elderly care beds and elderly care institution beds, and provide targeted health management for the elderly people under contract. Family doctors will provide integrative health services characterized by “combination of treatment and prevention” and “combination of general practitioners and specialists”. For elderly people with needs, services such as home-based medical beds, nursing plans, and home nursing are offered, so as to promote the integration of home-based elderly care beds and home-based medical beds.
5. Weaving a dense data network to make medical care/wellness care integration more precise and intelligent. Through constructing the “five-bed coordinated operation” smart elderly care platform, data on elderly people’s medical care and wellness care will be combined to provide a more precise health profile for them. Therefore, the “five-bed coordinated operation” information connectivity can be really achieved to provide elderly people and their relatives with smarter and more convenient medical-care and wellness-care services.
IV. Interpretation of key terms
1. The medical care/wellness care integrative care/nursing service mode featuring the “five-bed coordinated operation”
The term means a medical care/wellness care integrative service mode in which elderly care institutions, community health service centers and regional medical centers jointly establish a medical-care/wellness care collaborative management team, which, on the basis of refined health assessment, classifies elderly people’s life into four periods: healthy active period, assisted living period, mobility-impaired period, and terminal care period, and hence provides targeted and diversified services such as health education, preventive heathcare, traditional Chinese medicine, disease treatment, rehabilitation care, long-term care and nursing, and terminal care. By means of the “five-bed coordinated operation”, the elderly may enjoy bed transfers, information sharing, and resource sharing among the “two elderly care beds” (elderly care institution beds and home-based elderly care beds) and the “three medical beds” (home-based medical beds, medical institution beds and terminal care beds), which represent a mode of sustainable interactions among the five types of beds. Therefore, a full-chain integrated elderly care service will be provided, encompassing all the four periods of treatment in hospital, rehabilitation care, life care for patients in stable condition, and terminal care, thus alleviating the worries of the elderly.
2. The home-based elderly care bed
The term means an elderly care service mode in which elderly care institutions that have the proper conditions, are based on home care and nursing, and are supported by home adaptation for the elderly and intelligent management, extend professional care and nursing to elderly people’s homes so that at home they can enjoy professional care/nursing integrated service similar to that at an institution. Elderly people enjoying home-based care beds may share the facilities and services of the elderly care institutions. The elderly care institutions here refer to the care institutions and senior nursing homes that are registered and established according to law and filed with the civil affair department.
3. The elderly care institution bed
It means a long-term care bed provided by an elderly care institution to offer the elderly person with daily living care and physical nursing.
4. The home-based medical bed
It is a special form of medical service that allows elderly people to receive medical treatment and nursing care at home. It is mainly used for elderly patients who need long-term nursing owing to a disease or advanced age but have difficulty visiting the hospital for treatment. Therefore, the home-based medical beds and medical staff’s regular home visits are needed to provide the elderly patient with medical treatment and nursing service including examinations, treatments, and nursing care.
5. The medical institution bed
It means a therapeutic bed in a designated medical institution. At present, the medical institutions involved in the “five-bed coordinated operation” are mainly Grades 1 and 2 medical institutions with therapeutic beds.
6. The palliative care (terminal care) bed
The term means that special inpatient wards are provided for end-of-life patients, and offer them physical, mental and humanistic care. In the “five-bed coordinated operation”, end-of-life elderly patients are given priority for admission to wards with terminal care beds so as to receive end-of-life comfort care.
Policy consultation hotline: 33094747, the Elderly Care Service Section of the Civil Affairs Bureau of Jing’an District