Continuing care retirement community senior housing in Shanghai: an analysis of the development barriers

• DOI: https://doi.org/10.1108/IJHMA-04-2021-0038
• Published date: 13 July 2021
• Date: 13 July 2021
• Pages: 780-799
• Subject Matter: Property management & built environment,Real estate & property,Housing markets
• Author: Terence Y.M. Lam,Junjie Yan

Continuing care retirement

community senior housing in

Shanghai: an analysis of the

development barriers

Terence Y.M. Lam and Junjie Yan

School of Built Environment, University of New South Wales - Kensington

Campus, Sydney, Australia

Abstract

Purpose –Shanghai is currently faced with a rapid increase in the ageing population and demand for

elderly homes.Continuing care retirement community (CCRC) hasbeen emerging as a high-end alternative to

offer specialised accommodation to the elderly in major cities. Since the f‌irst development in 2008, the

industry is now still at the infancy stage. This study aims to examine the investmentbarriers hindering the

supply and demand of CCRCs with an aim to recommend practical and senior housing policy measures to

facilitateCCRC developments.

Design/methodology/approach –Multiple-case study method was used to conf‌irm whether the

literature f‌indings on investment barriers apply to the context of Shanghai. Four representative CCRC

developmentcases in Shanghai were examined, in which qualitative data werecollected from interviews with

experienced CCRC development managers and quantitative data from a questionnaire survey of the CCRC

residents.

Findings –Operation management experience,f‌inancial risks and government support policy were found

to be the main supplybarriers. Chinese traditional family-orientedculture and affordability were not the main

demand barriersof CCRCs in Shanghai.Poor quality of services and living environment were identif‌ied as the

main barrierssuppressing the demand for CCRC.

Research limitations/implications –Although common trends and views can be drawn from the

representativecases in Shanghai to provide valid results, furtherresearch should be conducted on other major

cities in Chinaso that the resultscan be widely applied.

Practical implications –Successful CCRC investment strategy should focus on partnering with

experienced professionaleldercare management companies, provisions of high-quality medicalprofessionals

and trained care personnel and delivery of f‌lexible care service, along with intensive capital f‌lows for land,

constructionand operating costs.

Social implications –Additional senior housing policy support should be established to promote the

CCRC supply to address the ageingneeds, particularly granting lands for CCRC developments at Tiers 1 and

2 major cities wherethe land cost is high.

Originality/value –This research’s practicaland policy measures can be applied to enable and promote

CCRC developments in Shanghai,thus benef‌itting both housing investors and the government. The f‌indings

also forma baseline for CCRC developments in othermajor cities.

Keywords Senior housing, CCRC development, Supply and demand barriers,

Practical development measures, Senior housing policy support, Shanghai

Paper type Research paper

1. Introduction

The ageing population around the world is increasing dramatically. In 2015, the world’s

population aged over 60years is 900 million and this is expected to double from 12% to 22%

IJHMA

15,4

780

Received8 April 2021

Revised1 June 2021

Accepted4 June 2021

InternationalJournal of Housing

Marketsand Analysis

Vol.15 No. 4, 2022

pp. 780-799

© Emerald Publishing Limited

1753-8270

DOI 10.1108/IJHMA-04-2021-0038

The current issue and full text archive of this journal is available on Emerald Insight at:

https://www.emerald.com/insight/1753-8270.htm

by 2050 (United Nations, 2017). China is one of the mostdensely populated countries in the

world and encounters an ageing populationchallenge. The implementation of the one-child

policy and the general improvements in health care and lifespan are two main factors

resulting in the rapidly ageing population in China. The China population aged over

60 years has increased to17.8% of the total population in 2020 (1,404 million). By 2050, the

percentage of the population over 60years will be more than 30% (United Nations, 2020).

Under this circumstance, the Chinese Governmentand the society are suffering from much

pressure from the aged populationto accommodate the expanding number of elderly people.

Shanghai is one of the major cities with the highest degree of ageing in China. National

Bureau of Statistics (2019) shows that the registered permanent residents in Shanghai are

about 14.50 million and the population aged over 60years accounts for 35.2%. Besides, the

Chinese one-child policy to control overpopulation since 1979 has created many “4-2-1”

families in which a couple needsto take care of four old parents and their child (Guo, 2007).

Consequently, most households in China lack the capability of supporting the elderly

through the traditional livingpattern of ageing at home. Under such circumstances, looking

for new ways to meet the elderly’s housing demand is essential. In 2005, the Shanghai

Government came up with the goal of “9073 patterns”to ease the ageingpopulation issues,

and this policy indicates that 90% of the elderly are supportedby their family at home, 7%

of the elderly age in retirement communities and 3% of the elderly age in social welfare-

based eldercare institutions. This senior housing policy attracts a number of investors into

the retirement communitydevelopment industry.

Continuing care retirement community (CCRC) that originated in the USA is a special

type of senior-oriented development and provides elderly residentswith independent living

(Gardner et al.,2005). The elderly in these communities still maintain independent living

with daily care services to meet their specif‌ic needs with the gradual ageing (Doron and

Lightman, 2003). Typically,a CCRC can offer a variety of housing options, medical and care

services provided to the elderly in the community where they live independently with few

health risks, and many olderresidents stay there with progressively higher levels of careas

necessary until the end of their life (Zarem, 2010). A medical and nursing unit should be

established in the CCRC, catering to the demand of the elderly who suffer from physicalor

mental illness. Zarem (2010) summarised the integrated medical and care CCRC model

adopted in the USA as follows:

A CCRC may be developed by not-for-prof‌it organisations or for-prof‌it investors.

This research focuses on prof‌it-making investment.

CCRCs are often aff‌iliated with faith-based organisations.

A CCRC may be a single-campus organisation or part of a system; the majority are

part of a system.

A typical CCRC has fewer than 300 total units; quite many have more than 300

units; some even have more than 500 units.

CCRCs are located in a range of geographical areas from urban to suburban to rural.

Typically, CCRC offers various living options on a single campus: independent

living, assisted living, and nursing. The care and services of CCRCs continue to

evolve. Additional components, such as memory support and wellness program,

have been added to their services mix.

In Israel, Ayalon (2015) found that there are different views and def‌initions of old age for

seniors to move into the CCRC, as being composed of various dimensions including

chronological age, mental age, physical age and appearance, as well as reduced physical

Continuing

care retirement

community

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