‘Top down’ approach helped China control COVID-19 crisis

The residents of China’s aged care facilities were generally comfortable complying with strict guidelines which helped to prevent the spread of COVID-19, according to a leading Chinese aged care executive.

Mr Tony Wang, CEO, Watermark Senior Living China, made the comments at Ageing Asia’s webinar series ‘Global implications of COVID-19 on the Eldercare Sector’.

Homes with higher occupancy fared better financially during crisis

Mr Wang explained that when COVID-19 struck, many elderly residents and their families made the decision to return to their family homes. 

In communities with an average occupancy rate of more than 95 per cent, only 7.5 per cent returned to their home during this period, and so these homes were less financially impacted. 

But for homes with lower occupancy, i.e. below 30 per cent, there was a greater impact, more families moved home, and fixed costs could not be covered by revenues.

A survey found one-third said operating costs were 5-10 per cent higher during the pandemic, while 11 per cent said operating costs were 20 per cent higher, mainly due to increased medical supplies and labour costs.

Government provided strict guidelines for aged care providers

The Chinese government provided detailed and prescriptive guidelines for aged care providers, Mr Wang explained.

On 28 January, China’s National Health Commission of China and the Ministry of Civil Affairs issued an ‘emergency notice’ emphasising the protection of seniors’ safety and health. It was a ‘top down’ approach, Mr Wang said, but he attributes China’s success in managing COVID-19 due to these strict guidelines.

The ‘emergency framework’ included the following seven measures.

1. Management teams formed: Management teams were formed to lead and communicate with on-the-ground staff and all the way up to the government. Management had to be available 24/7.
2. Managing community entry and exit: Mr Wang said this step was the most effective way to stop the spread of infection in senior living communities. This step involved controlling all those entering and leaving communities, with special exceptions, for example if a resident became seriously ill, or was passing away. It meant tracking travel histories, temperatures, and symptoms for residents, staff and any visitors. Staff were instructed to live on site if possible, but if not, they should not use public transport. Staff returning from outside, were required to self quarantine for 14 days. The government stipulated that rooms where residents were quarantined should include: their own bathroom, PPE, good air circulation, air conditioning turned off, and rubbish should be treated as medical waste. China also introduced a tracking system for every person, which provided a healthcare code as you move around. This technology has been “very effective”, Mr Wang said.
3. Provide psychological intervention:  Senior living communities were instructed to be aware of the psychological wellbeing of senior residents and family, and provide good education and communication. Staff were told to do their best to provide an array of activities for seniors, and should provide access to newspapers, radio, and TV to allow them to connect with the outside world. Staff should contact residents using a variety of methods, for example through text messages, phone calls, public notices, and WeChat messages. Staff should make sure residents understand the measures are being taken for COVID-19.
4. Care and monitoring of senior residents: Residents should have their temperature taken twice a day. Make sure there is good air circulation in the facility. Stop all community events where large crowds gather. Pay attention to seniors with chronic illnesses. Always ensure enough water, nutrition, light exercise and assistance in cleaning and personal hygiene.
5. Manage the internal work team: “This is a tough one because there was a shortage of PPE in the initial days, though now the situation is getting a bit better,” Mr Wang said. Senior living communities should have PPE sourced on site, and different areas of each facility should be cleaned according to different schedules. For example, kitchens and the rubbish storage room should be cleaned twice a day and kitchenware should be disinfected for half an hour daily. Some care staff returned to their care homes during Chinese New Year, causing extreme staff shortages. Using PPE was also new to many staff, which caused some difficulties.
6. Procedures for residents with suspected symptoms: Early in the pandemic, there were problems with reporting cases, but a clear reporting line was established. Strict measures must be taken to separate people with possible symptoms. Anyone who left the facility should be quarantined on their return.
7. Daily cleaning: Strict requirements were given for daily disinfection of aged care homes.

Mrs Bao: a case study

Mr Wang provided a case study of Mrs Bao, who is 84 years old. Her family had to cancel plans to travel to Quanzhou on the fifth day of the Chinese New Year. “She did not complain,” Mr Wang said, however she was not so relaxed about life under quarantine, which she said was “boring”. 

Between January and March, she spent her days exercising inside, practicing calligraphy and making handicrafts. She was able to order meals from family, but they had to be delivered at the gate and not in person. 

She learned how to use new technology, such as ‘dingdong‘ software to buy food, and joined a group so her orders could meet the minimum delivery charge. She also learned how to use ‘wechat’ to order items from the community. 

On 21 March, Mrs Bao was allowed out of the building for the first time, however she could not leave the community and it was only for a few hours on the first day and then only half an hour after that. “She was happy and took a picture for her family,” Mr Wang said.

On 29 March, family could visit her under strict rules, but they were not allowed into her room. “She felt happy but still followed strict quarantine measures.”

Before 1 May, her son asked her for dinner in a restaurant, but she declined, saying she did not go into quarantine afterwards, a requirement of leaving the community. “She’s super cautious”, Mr Wang said.

An opportunity to learn, a time to remain positive

“In China, generally speaking, I think our residents are okay with all these quarantine requirements and measures from the government and implemented by the communities,” Mr Wang said, noting the difference with their American counterparts. “As I understand from our peers in the US, even in seniors communities, that seniors are advised to stay at home in their apartment but they don’t want to listen and they want to come out, which I think has caused the situation to become out of control,” he said.

He said the key problems faced by China during the pandemic were increased costs, staff shortages, and the prohibition of visits from families to loved ones in care.

“COVID-19 has given us operators a great opportunity to rethink how we could have done better in terms of crisis preparation and management not only in communities, but also at a corporate level. For quite some time, we were struggling to even get enough PPE supply on time. 

“As CEOs, we’ll need to learn quickly about the virus and communicate well within our organization and communities. Maintaining a positive attitude is also important,” Mr Wang observed.

This article is part of a series covering Ageing Asia’s webinar series ‘Global implications of COVID-19 on the Eldercare Sector’.

Image: reall444, iStock.