Japan is the country with the highest degree of aging in the world, and it is also the region with the most developed and perfect system for the elderly care industry. The pension industry solves the problem of the life of the elderly, and living habits are closely related to culture and customs. Japan's cultural characteristics have a high similarity with China, and Japan is the best model for reference in countries and regions where the elderly care industry is more developed and mature.
Under the background that China's pension industry has just started and enterprises have poured into the pension industry, in-depth investigation of the development path, gains and losses of Japan's pension industry has a good reference role in reducing detours and achieving better and faster development of China's pension industry. To this end, the author went to Japan to carry out in-depth research on its pension model, visited 6 elderly care institutions, visited 2 medical institutions and an exhibition of elderly welfare products, and conducted a number of in-depth exchanges with relevant units.
Through this survey, the development process, current status quo and industrial characteristics of Japan's pension industry were sorted out, and compared with the current situation of the pension industry in the mainland, hoping to have a more comprehensive understanding of the Japanese pension industry and form a reference for the future development of the pension industry in the mainland.
The six elderly care facilities visited in this survey are all located in major cities in Japan (see Table 1), deeply embedded in mature communities, and are typical representatives of Japanese elderly care facilities.
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Japanese elderly care facility system and charging model
1. Japanese elderly care facility system
At present, Japan's nursing care model is professionally divided to meet diversified needs, and has formed two categories: home care and facility nursing. Among them, facility nursing can be subdivided into three categories: welfare facilities, health care facilities, and nursing medical facilities. Under the three categories, it is divided into various subcategories according to the different service functions, facility positioning, and the area in which they are located. The three types of facilities categorize the needs of the elderly, so that the elderly can be accommodated from healthy to bedridden.
Welfare facilities are mainly operated by social welfare corporations, including "special care homes for the elderly", "homes for the lightly paid elderly", and "collective homes for the elderly with dementia".
Health care facilities take physical rehabilitation as the core, mainly for the elderly who are in a stable period and do not need to be hospitalized, such as the elderly who need rehabilitation training, mostly postoperative and chronic diseases, between medical treatment and welfare, based on the premise of family recovery, based on the principle of short-term stay, also known as "intermediate facilities".
Intensive care facilities are facilities that provide services for the elderly who need medical care for a long time, and are mainly operated by specialized treatment and recuperation functions, and are basically operated by corporate medical institutions, including "nursing and nursing care medical facilities (for the elderly who have the necessary long-term medical care)", "nursing enhancement hospital building (for the elderly who are suffering from chronic diseases)", "senile dementia disease nursing hospital building (for Alzheimer's patients)", etc.
2. Charging model for elderly care facilities
The reason why Japan's pension industry can achieve rapid and steady development is inseparable from its charging model and source of income. A relatively unified and widely recognized charging model has been formed in the Japanese pension industry, which is generally composed of three parts: one-time occupancy fee (head money) + monthly fee + nursing fee, of which the monthly fee is composed of multiple children.
The one-time deposit is similar to the membership fee or deposit in mainland China, but there are differences in the settlement mode. This fee is collected in one lump sum at the time of signing the contract, and often a depreciation period and depreciation method are agreed, and if the customer stops the service within the depreciation period, the balance after deducting the depreciation amount will be returned to the customer, and if the service is stopped after the depreciation period, it will not be returned.
Monthly fee refers to the monthly fee that customers need to pay, and each institution subdivides the monthly fee into multiple sub-items according to its own situation, generally including management fee (use of common areas and maintenance costs), energy consumption fee (water, electricity, heating, etc.), catering fee, etc.
Nursing care fee is the most different from the mainland, mainly due to Japan's compulsory nursing care insurance system, individuals only need to bear 10%-30% of the nursing care cost (the difference in proportion is mainly determined by the applicant's income and property), which greatly reduces the financial burden of the elderly who need old-age care.
According to statistics, the proportion of nursing care insurance fees received by elderly care facilities across Japan to the total income is close to 70%, and the lower the grade of the project, the higher the proportion, and nursing care insurance has become the most stable and important source of income for elderly care service companies.
Taking the Li'ai Wubin project of this field research as an example, all the rooms in the project are single rooms, with a floor area of about 21 square meters, and all are nursing beds.
In order to facilitate customers, Liai Wubin Project provides 4 payment modes, A and B mode are suitable for long-term customers with a stay period of more than 1 year, C mode is suitable for medium-term customers with a check-in period of 1 year, and D mode is suitable for short-term customers whose occupancy period is calculated in months.
The main differences between mode A and B are: the one-time occupancy fee that model A needs to pay is higher and does not need to pay additional rent, and the one-time occupancy fee paid by mode B is lower, and you need to pay rent separately every month, which is similar to the difference between the "high deposit + low monthly fee" model and the "low deposit + high monthly fee" model.
According to its fee schedule, if a 65-year-old elderly person with medium nursing needs (to take care of 2) stays, if he chooses the A payment mode, the fee he needs to pay is a one-time deposit of 2.38 million yuan, a monthly fee of 11,765 yuan, and the monthly fee received by the institution is about 22,148 yuan, which is a higher level.
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8 typical characteristics of embedded elderly care in Japanese communities
The reason why Japan's pension industry is worth learning from, in addition to its earlier development time and more complete industrial system, it also has a series of outstanding characteristics. These characteristics not only reflect the law of the development of the pension industry, but also the experience of Japanese pension industry participants for many years.
1. Industrial systematization - coordinated development, go hand in hand
The elderly care industry is not a single industry, but a collection of multiple industries. Japan has built a complete industrial chain in the field of elderly care, realized the coordinated development of various sub-fields, went hand in hand, and had significant advantages in industrial systematization, which promoted the overall prosperity of the industry.
At present, it has formed an elderly care and health ecosystem with elderly care services as the core and supported by sub-industries such as health care, elderly products, pension finance, tourism and entertainment, and smart elderly care. The mainland's pension industry is currently in its infancy as a whole, and the development process of each sub-sector is different, forming constraints between each other, which affects the development of the industry.
2. Location urbanization - closer to home, more complete facilities
In the early exploration and practice of the elderly in the mainland, the location of elderly care institutions often likes to find beautiful mountains and rivers, far from the central part of the city; However, from the perspective of Japan's pension practice, the elderly prefer to live in areas with more convenient transportation and complete supporting facilities such as communities, stations, and hospitals.
The location in the suburbs of the city not only inconvenient transportation, affecting the visits of children's relatives, hidden costs are high, but also make the elderly have to leave their familiar living environment, resulting in the feeling of abandonment in the hearts of the elderly, and it takes a long time to adapt to the new environment; In the beautiful scenery, sightseeing is more inclined to the short-term, low-frequency, non-rigid needs of healthy elderly.
This also reflects the problem of inaccurate customer group positioning and unclear demand positioning in the early exploration of the pension industry in the mainland. The location of elderly care facilities in Japan follows the principle of "closer to home, closer to transportation facilities, closer to hospitals, and closer to friends", and has obvious urbanization characteristics.
3. Miniaturization – smaller investment, better efficiency
In the past few decades, Japan's elderly care service models and facilities have undergone a process of continuous self-innovation with changes in market demand and policy environment. Since the end of the 60s of the 20th century, Japan has been committed to the infrastructure construction of facility pension (called institutional pension in the mainland), and has built a large number of large-scale pension institutions; Since the early 70s of the 20th century, it has changed from facility care to home care (called home care in the mainland); After the 90s of the 20th century, the home care model supported by the nursing service system has become the focus of national implementation.
The market has also developed from the initial high-end, large-scale pension real estate to medium-grade small-scale, multi-functional community-based elderly care facilities, no longer encouraging the construction of large-scale nursing homes, but setting the beds at about 100, not only making the refined management of elderly care facilities and thoughtful nursing services easier to achieve, but also the investment cost of facilities in the early stage can be effectively controlled, the construction speed is faster, the difficulty of operation is reduced, and it is easier to achieve a balance of income and expenditure economically.
The six facilities visited are all single-family buildings, with an average area of only 2,891 square meters, an average construction area of 5,190 square meters, and an average number of 94 rooms, the largest being 188 and the lowest being only 50 (see Table 5). In addition, the small scale of Japan's pension facilities is also related to land policy, and Japanese land is privately owned, and it is usually difficult for pension companies to obtain large areas of land.
4. Humanized design - scientific construction, comfortable experience
The planning and construction of elderly care facilities is the premise of elderly care services. Scientific planning and construction is not only related to the customer's living experience and the convenience of the operation team, but also helps to control operational risks and reduce the overall investment cost of the project. Japan's elderly care facilities have outstanding humanized characteristics in terms of design, especially in the intensive design of space, the convenience design of operation, and the comfort design of living.
(1) Scientific spatial layout
A visit to Japan's elderly care facilities can clearly feel the difference between their spatial planning and domestic elderly care projects.
First of all, in terms of atmosphere creation, the design of elderly care facilities in the mainland has less historical accumulation and relatively little thinking about the psychology of the elderly, so the designed architectural space will inevitably be slightly stiff and institutionalized; Japanese designers, on the other hand, pay great attention to the psychological feelings of the elderly and integrate them into the design, forming a cordial and emotional architectural space design.
Secondly, in terms of space utilization, due to the limited land resources in Japan and the small scale of a single elderly care facility, this requires designers to embed a variety of service functions (including residence, catering, communication, rehabilitation, medical treatment, work, etc.) in a limited space. Against this backdrop, Japanese elderly care facilities strive to maximize the efficiency of space utilization and strive to create maximum value in limited space.
Finally, in terms of operation docking, it can be clearly felt that Japan's elderly care facilities have deeply considered the use needs of future service objects and the needs of operation management at the beginning of design and planning, realized the front of operation management, achieved a good connection between functional spaces, and had a good integrity and practicality in space design, the main characteristics can be summarized as: customer classification residence management between vertical floors, and unit group management between horizontal planes.
(2) Unit-type design concept
The unit design concept is a design method that is very common in Japanese elderly care facilities and is very effective in improving the efficiency of operation and management. Unit design means that elderly care facilities generally form a group (unit) with about 10 people, and each group (unit) can be divided in space and ensure its interrelatedness, forming a stepped spatial layout of "regional division→ unit group →living room".
In terms of operation, different units on the same floor are connected through a looping channel, so that the nursing staff of adjacent units can assist other units in an emergency, which not only shortens the usual movement distance of staff, but also moderately reduces the number of staff during work, thereby saving operating costs. Usually each unit consists of 4 parts: living room, common area, bathing area and management area. Unit-style designs are particularly prevalent in facilities targeting advanced care for older adults.
(3) Detailed design oriented to the characteristics of the elderly
In terms of room design, Japanese elderly care facilities usually adopt the model of "small room + large public area", highlighting the rest function of the room and encouraging the elderly to go out of the room to the public area for activities; China's pension projects pay more attention to the size of the living area, and China's nursing care facilities usually focus on double rooms and multi-person rooms in order to improve per capita management efficiency, while Japan basically adopts the design of single rooms, paying attention to the respect and protection of personal privacy.
The following three units are all nursing care apartment plans of the Kyoto Arashiyama project of the Evergreen Group of Japan (see Figure 3). Although this project is a high-end project, it can be clearly seen that its nursing care room is not large (the practical area of the room is less than 20 square meters, the construction area is about 30 square meters), and the internal space settings and items are relatively simple, and there is no independent shower facility. In Japan, high-end projects do not blindly pursue the size of space and the completeness of facilities, but are mainly reflected in the quality of goods and services.
In terms of the design of public areas, an enclosure design is adopted. Under the unit design concept, the public area is the common activity space of the elderly and caregivers in the unit: it is not only the space for the elderly to carry out daily meals, activities and other life behaviors, but also the space for staff to carry out work behaviors such as meal distribution, nursing and care. The public area generally adopts an enclosed design and is open in an open form, which is convenient for staff to pay attention to the status of the elderly at any time, and is equipped with a certain storage and storage space; The common areas are designed to be bright and welcoming, inviting seniors to get out of their rooms and participate in social activities.
In terms of bathroom design, the overall bathroom design suitable for aging is adopted. Toilets and bathrooms are areas with a high incidence of accidents in the elderly, and special attention should be paid to their safety. In addition to using a large number of handrails, most of Japan's elderly care facilities adopt a high-safety overall bathroom design to prevent falls and injuries. The widespread use of age-appropriate overall bathroom also reflects the characteristics of Japan's elderly care industry chain as a whole. The bathroom makes extensive use of handrails and integrated bathroom facilities (ceiling, wall, floor, sanitary ware integration).
In terms of bathroom function configuration, the design of Japanese elderly care facilities is different from that of mainland elderly care facilities. In China, toilets, showers and wash basins are generally considered essential sanitary facilities in mid-to-high-end facilities, but in Japan we found two differences:
First, in the spatial layout, the bathing facilities (shower, bathtub) are separated from the washbasin and toilet, and set up separately, which can achieve better hygiene management and risk management; The second is a nursing room for the disabled and dementia elderly, generally without a shower, only retaining the washbasin and toilet, or adopting a unit sharing model, that is, 2-3 public toilets and public bathrooms are set up in one unit (usually 10 elderly people).
This design can not only improve the utilization efficiency of space and equipment, reduce the investment and construction cost of the project, but also solve the problem of odor and humidity because there is no shower facility, reduce the risk of falling due to slippage, so as to optimize the building layout design and reduce the work burden of nursing staff.
5. Refinement of service - excellence, details win
Refined service is the core competitiveness of Japanese elderly care institutions. Refinement comes from respect for details, guided by human needs, and provides meticulous targeted services according to the physiological and psychological needs of the elderly. They break down the daily management work into specific behaviors, actions, frequencies, etc., and continuously analyze and improve the service experience on the basis of improving operational efficiency.
(1) Strict access management
From the first step of entering a Japanese nursing care facility, people feel the rigor and standardization of its operation. Japanese elderly care facilities generally set up a strict access management system, not only to make an appointment before visiting, but also to avoid interference with the elderly after entering the facility, but also to set up a series of control measures, such as in order to prevent bacterial infection, refuse to visit people who are sick with colds; Visitors who are allowed in are asked to wear shoe covers or change into uniform indoor shoes, disinfect their hands, clean their mouths with mouthwash, wear masks, etc. These operational measures also bring some differences in space and hardware design, such as the need to add shoe changing areas and washbasins at the entrance of the facility.
(2) Strict hygiene and cleaning
The visiting team was impressed by the hygiene situation in the Japanese elderly care facility. Due to the particularity of the service objects, it is difficult to eradicate the odors of the elderly's rooms, toilets, showers, restaurants and kitchens (body odor of the elderly, disinfectant water odor, oil smoke smell, shower gel smell, urine odor, etc.), which has always been a common problem faced by elderly care facilities in mainland China, and has also become an important indicator for judging the operation and management of elderly care facilities. During this visit, we found that each elderly care facility did not feel any peculiar smell in the above high odor areas, and the hygiene management was very in place.
The good hygiene of elderly care facilities in Japan is not the result of a single factor, but a combination of multiple factors, including the strong hygiene awareness of the Japanese people, strict hygiene management system, perfect sanitation facilities and strong technical means.
(3) Strong sense of home life
Due to the certain similarity of service content with hotels and hospitals, many elderly care facilities in China will be designed and arranged with reference to hotels and hospitals, which leads to the institutionalization of many facilities. Japan's elderly care facilities pay great attention to the creation of a sense of home (space layout, soft decoration, atmosphere creation), even in public areas, they try their best to make it like home, pay great attention to detail decoration, walk in it neither like a hospital, nor like a hotel, through the home atmosphere to eliminate the strangeness and distance of the elderly after staying, everywhere reflects the refinement and care.
(4) Exquisite and attentive catering
The digestive function of the elderly presents the characteristics of gradual degradation, with the increase of age, the secretion of digestive juice in the elderly will gradually decrease, and the ability to chew will also decrease, all of which will lead to poor absorption of nutrients, and malnutrition is an important reason for the decline of resistance, so the elderly in Japan, family members and elderly care facilities attach great importance to catering services. In order to allow the elderly to eat well and truly enjoy the satisfaction and happiness brought by food, Japan's elderly care facilities enhance the dining experience of the elderly through multi-dimensional design of food hardness, nutritional richness, dietary taboos and dining utensils.
Food is treated according to soft and hardness. The elderly usually have different degrees of chewing disorders, in order to solve this problem and help the elderly promote the digestion of food, Japan's elderly care facilities will refine the food processing, make it into 4-5 types of different soft and hard food, for the elderly with different chewing ability, and classify and plate, in the taste and form to ensure that the elderly enjoy the pleasure of food.
Good nutritional balance. Most elderly care facilities in Japan are equipped with "management nutritionists" who are responsible for the nutrition of the elderly, who design nutritious meals for the elderly according to their physical conditions and dietary restrictions, and provide energy for the elderly through a variety of ingredients. The staff prepares meals in strict accordance with nutritional standards every day, accurately measuring the carbohydrate content, protein content, etc. of each food; In addition, the elderly care facility has hot and cold food trucks that can store hot and cold dishes separately to maximize the freshness and nutrition of food.
Personalized dining business cards. In order to control the diet of each elderly person more precisely, they also make personalized "dining business cards" for each elderly person. The business card will list the dining information related to the elderly person in detail, including dietary preferences, dietary restrictions, hardness and softness (chewing ability), etc.; When the elderly move in, the "management dietitian" evaluates them, discusses with the elderly themselves, their families and doctors to determine the initial content of the business card, and when the physical condition of the elderly (such as mouth, teeth, digestion, blood sugar, etc.) changes, the business card content will be adjusted accordingly; When serving meals for the elderly, the caterer will check the meal status of the elderly according to the business card, and put the business card on the dinner plate and deliver it to the caregiver, who will check again during the meal care to ensure that the meal accurately matches the elderly.
Exquisite tableware vessels. In order to improve the dining experience of the elderly and enhance their appetite, in addition to paying attention to the richness, taste and color of the ingredients, they also attach great importance to the use of tableware, and enhance the dining experience of the elderly through exquisite and exquisite tableware, and strive to bring pleasure to the elderly in every detail.
6. Operation chaining - optimize costs and enhance brands
According to statistics, Japanese chain pension institutions have exceeded 56% of the total, and industry leaders such as Ri Medical Center, Belosheng Group, Message and other industries have emerged, and companies in all sectors of the pension industry chain have been listed. In Japan, all kinds of elderly care facilities are spread throughout the community like convenience stores, and they often adopt the model of small headquarters and large front desk in management, with the headquarters formulating unified standards and providing technical support, and each project is under the guidance of the headquarters to do specific service landing.
7. Management standardization - higher efficiency, unified quality
The basis of chaining is the standardization of products and services. Under the payment framework of the nursing care insurance system, Japan has detailed regulations on the functional configuration, planning and design, service manpower ratio, service content, service process, service time required for service, and service information disclosure of elderly care facilities. In addition, each elderly care facility will also formulate its own more detailed service work guidelines to guide employees to carry out services according to standard procedures.
In addition, since 2004, Japan has officially launched a third-party evaluation system for elderly care facilities, making the information of elderly care facilities transparent, formulating unified evaluation standards, classifying and grading participating institutions, and unifying the service standards of elderly care institutions in various regions through objective evaluation of service quality and operation content.
8. Business diversification – breaking boundaries and multiple benefits
Many elderly care companies in Japan are characterized by business diversification, rather than just providing a single service to customers. The elderly care industry is a collection of multiple industries, and it is an industry that revolves around the needs of all aspects of the life of the elderly. After the success of a certain business, many companies develop extended business around the diversified needs of customers, and achieve the goal of "one development, many benefits". In this way, it can not only provide customers with more comprehensive services and improve customer service experience, but also enhance the overall competitiveness of enterprises through synergies between industries, obtain maximum benefits, and break through the revenue "ceiling".
Starting from the medical business, Ruri Medical Center has expanded into nursing, health care, health consulting and commerce and other businesses, and gradually diversified its business segments around the medical, nursing and health care needs of the elderly. Starting from the education industry, Beloson Group extends to the training of childcare and nursing personnel, and provides meal delivery services and smart elderly care equipment according to the needs of the elderly. Li'ai Company is a professional catering company, cutting into the field of elderly care from the perspective of healthy meals for the elderly. In short, Japanese pension companies usually expand their business fields around the diversified needs of the same group of customers and form a comprehensive elderly care industry group.
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Inspiration and reference for China
The business model of Japan's elderly care industry can be summarized as: relying on the construction of a sound ecological chain, based on nursing care insurance, taking community home as the main body, providing standardized services to the elderly through humanized design, refined management and chain operation, and gradually extending to surrounding related industries, so as to achieve the goal of stable operation.
In the context of the mainland's current vigorous development of the elderly care industry, Japan's pension practice can provide us with good inspiration and reference.
First, in the site selection and planning of the project, do not seek large, do not seek completeness, and give priority to location.
The development of elderly care facilities in Japan has experienced a process of scale miniaturization and site urbanization, which is the result of market selection. In the initial exploration of the elderly care in the mainland, many elderly care institutions seek to be large, thousands of beds, the scope of services covers self-care, nursing care, mediation, dementia care and other different types of customer groups, this model not only large initial investment, but also high requirements for service capabilities, at the same time, due to the large required property area, it is often difficult to find suitable properties in mature urban areas with more convenient transportation, often located in the suburbs of the city, transportation convenience and living facilities have become obstacles affecting customer choice, resulting in huge pressure on subsequent occupancy rates. Enterprises need to have a high risk-taking capacity.
"Closer to home, closer to the hospital, closer to transportation facilities, closer to friends" is a more effective site selection criterion, on this basis, through small steps and rapid replication, the construction of moderate-scale, functionally focused elderly care facilities is easier to achieve market success.
Second, in the construction of the project, it is necessary to build a standardized service system covering software and hardware based on humanization and refinement.
Through hard work, both hard and soft, the level of project construction and operation can be effectively improved. The formation of project construction and operation standards through the precipitation of practice is an effective measure to improve efficiency, control risks and reduce costs, and it is also a prerequisite for promoting project chain operation.
As a major infrastructure country, with the accumulation of practice, the construction level of elderly care facilities has been greatly improved, but the construction of service standards and the improvement of management capabilities are a long process. In the future, with the continuous maturity of the industry, service standardization capabilities will become the core of enterprise competition.
Third, in the integration of resources, we must give full play to the value of external resources such as the government.
The elderly care industry has obvious welfare and public welfare attributes, and effectively integrating external resources is an important measure to reduce service costs, enrich service connotations, and improve sustainability. Global experience has shown that it is unrealistic to completely rely on the market to solve the pension problem, the government is an indispensable force, the government can give different support in land, property, taxation, payment and other aspects, the introduction of Japan's nursing care insurance policy has activated the Japanese pension market.
In the current context of the imperfect pension payment system in the mainland and the significant situation of aging before getting rich, various types of government support are particularly important; However, in specific practice, and can not rely too much on the government, at present, many pension companies in the mainland completely rely on government subsidies to survive, without their own core competitiveness, in the future with the increasingly clear boundary between government and enterprises, such enterprises will face the risk of being eliminated by the market. In addition, pension enterprises should also make full use of the power of various social welfare organizations, which can not only enrich the connotation of services, but also save the cost of building their own service teams.
Note: This article was originally published in Insurance Theory and Practice.
Source: "Survey on Japanese Community Elderly Care Model"
Author: Li Ningchun
The copyright belongs to the original author, please inform if there is any infringement