What Pinetree Can Teach Homecare Providers
I visited the Pinetree Homecare and Home Healthcare provider in Beijing during my trip last February. I spent the afternoon with Ninie Wang who is the founder and chief executive officer of Pinetree Care Group. This was part of my research into innovative eldercare service models. The pronunciation of Pinetree closely resembles the Chinese word for easy or something that is easy to do and carry out. One of the core philosophies of the organization is care that is easy. Pinetrees are green all year round and symbolize good health and vitality.
A Pioneer in Home Healthcare
Ms. Wang is an energetic and lovely woman with a background in finance and telecommunications. She realized that her interests and talents were more suited to a career as an entrepreneur while she was working for a large telecom provider. Ms. Wang soon became interested in the lives of the elderly. She was interested in entertainment and observed a gap between entertainment for the young that is available today and entertainment for older generations. These discussions and thoughts led Ms. Wang towards eldercare. She researched innovative eldercare organizations in Europe, the United States, and Asia. Ms. Wang decided to found Pinetree Care Group in 2003.
There were no other home healthcare providers in China during this time. Ms. Wang is a pioneer in her field in China. She has a remarkably well developed philosophy that focuses on the needs of each individual. Ms. Wang works with medical professionals to develop training in house. She also works with hospitals to deliver person centered care and improve care coordination. She has managed to introduce technology that helps in care coordination. Pinetree has over three thousand employees today that serve over forty thousand clients. Since 2003, Pinetee has helped over two hundred thousand clients. Pinetree mainly serves individuals who can pay for services out of pocket. Publicly provided homecare services are very limited in Beijing and elsewhere in China. The city government of Beijing is beginning to purchase and offer Pinetree homecare and home healthcare services to some residents.
Nursing Homes in Beijing
Average life expectancy in Beijing is more than eighty years old. Individuals in Beijing can expect to live as long as someone born in the United States or Sweden. There are three and a half million individuals in the Beijing area over the age of sixty. There are only one hundred twenty thousand beds in nursing homes. Public nursing homes are generally of a higher standard according to Ms. Wang because the government has invested in training staff and building facilities. The government will send employees abroad to study best practices in nursing homes. An individual pays somewhere between three thousand and five thousand Chinese Yuan or around five to eight hundred US dollars per month for a place in a nursing home. Wait times in some areas amount to over one hundred years for a place in a publically well recognized nursing home in Beijing.
The government has invested in building nursing homes in some remote suburbs. Individuals feel it is too far away from their families and choose not to move. They will wait a very long time to obtain a place in a Beijing nursing home. Nursing homes are completely empty buildings in other areas. Public nursing homes are generally of a higher standard than private nursing homes. An individual has to pay up to ten thousand Chinese Yuan or over one thousand five hundred US dollars in a private care home to receive the same quality of care as in a public care home. In China, there are around two hundred million people who need assistance in the form of homecare or residential care. Only around thirty percent of all the nursing homes in China provide medical insurance. These nursing homes have an in house clinic where they offer medical services to their residents.
Investing in Long Term Care
I asked Ms. Wang about reimbursement from the government and insurance for long term care. Her answer made me realize that the Chinese system is very different from other systems of insurance I have studied. There has been an ongoing debate in China for about five years on the topic of long term care insurance. The central government has decided not to introduce long term care insurance to residents. This means that three and a half million individuals over the age of sixty in Beijing lack long term care insurance. These individuals save over half of their lifetime income for old age and pension expenses. China wants to move to a domestic consumer market. It will be critical for the Chinese government to provide affordable healthcare services. Saving rates will likely remain as high as fifty percent of income otherwise. The government has chosen to have the private insurance market explore options for long term care insurance.
Philosophy of Care at Pinetree
Ms. Wang talks about the Pinetree care philosophy and opportunities and challenges in this sector. Chinese tradition encourages families to take care of older family members. Families still play an important role as informal caregivers today. This becomes unsustainable when the middle generation is struggling to balance family life and taking care of children and parents. As much as fifty percent of individuals over the age of sixty live alone in an empty nest. This statistic is higher in large cities like Beijing and Shanghai. These individuals sometimes need homecare services because they have difficulties traveling to their local health station or hospital.
Ms. Wang refers to Pinetree hires as a hybrid care worker. She realized that teamwork was a critical element to improving quality of care while researching best practices internationally. Teamwork is a luxury that few can afford in China however. For example, teamwork means that a physiotherapist works together with a geriatric physician and an elder nurse. In China, this type of teamwork may be part of future care organizations. Today, eldercare workers need to be trained in different disciplines. They also need to assume different perspectives when they care for individuals at home. Ms. Wang explained that her hybrid care workers have an understanding of the medical aspects of geriatric medicine. The care workers see the doctor perspective. Employees of Pinetree also have insight into social work because they encounter issues when they care for individuals at home that require the insights of a social worker. An older person may need to apply for benefits from the government for example. A care worker is better equipped at helping this individual they understand the social services. It is also common for care workers at Pinetree to provide rehabilitation services. In this way, the care worker must understand basic physiotherapy and be able to carry out a training program with the elderly at home. Pinetree trains talented care workers to assume this hybrid perspective.
The core philosophy of Pinetree is restorative care as opposed to replacement care. Replacement care refers to tasks that a care worker assumes instead of letting the individual carry out these tasks to his or her best capabilities. A domestic aide may clean the kitchen so that the individual does not need to perform this duty. Care workers at Pinetree understand how he or she can support the individual while still letting the individual clean the kitchen. Pinetree is not focused on cleaning services. This is simply an example to illustrate how Pinetree care workers focus on restorative care. Restorative care refers to care that helps an individual restore his or her capabilities.
Costs and Technology Use to Improve Care Coordination
Pinetree Care charges forty to forty five US dollars per session of care. Most individuals pay no more than two hundred Chinese Yuan or thirty US dollars per hour of homecare services in Beijing. The home healthcare services of Pinetree Care Group are affordable and accessible yet tailored to the luxury segment in China. These are individuals who can afford such services. Ms. Wang explains that most individuals struggle to pay for these services. The government does not provide subsidized care. Very few decide to invest in homecare services even though this can improve their quality of life. This means that many families and individuals are struggling. They are hoping for long term care insurance to improve their lives.
Ms. Wang has not only studied best practice around the world. She has also introduced care technologies to improve care coordination and participation of family members. She demonstrated to me how she uses the videoconferencing tool, Nemo. She turns the Nemo application on in her mobile phone and demonstrates what the video conference between an individual and his or her care worker may appear. Pinetree Care Group has persuaded hospitals in the Beijing area to collaborate with a Pinetree group in an effort to improve care coordination.
Continued Care Beyond the Home through Technology
When an individual travels to the hospital, Pinetree Care Group continues to offer their services to the individual. They will visit the person in the hospital, read medical records to doctors, and begin preparations to change the services and the support they provide at home afterwards. While the person is in the hospital, Pinetree Care Group gathers doctors, nurses, homecare workers, and family members in a conference call through Nemo. The individual can teleconference with as many specialists as he or she needs at the same time with the application. The Pinetree Care workers listen to the conversation as a care plan is developed. The individual may be at home or the hospital while this meeting takes place.
Furthermore, family members can join the teleconference wherever they are in the world. This allows them to understand the care plan and provide input. Pinetree care workers often talk to the relatives of individuals who receive care through Nemo. The application is especially important when difficult decisions are being decided. It is important to listen to the feedback and input of relatives and individuals. It improves the quality of communication and when there are difficult decisions then at least everyone feels they have participated. Pinetree charges five hundred Chinese Yuan or approximately eighty US dollars per month for individuals who want to receive homecare through Nemo. This only covers remote homecare. An individual can also combine this with a blended care model where you receive some care in person and some care remotely. Ms. Wang refers to the Nemo as a companion robot. You can turn on the web camera and keep your parent company for a couple of hours through the Nemo. This provides greater companionship. Ninie Wang talks about the importance of also looking at wellness factors and companionship in elder care.
Improved Quality of Care at Pinetree
Pinetree frequently measures the quality of care it delivers in a study with a control group. They measured several parameters over three months with their clients. Pinetree customers had their vital signs stable ninety seven percent of the time. This compares to the control group in which individuals only had vital signs stable twenty eight percent of the time. The disease symptoms improved among Pinetree care recipiences at a fifty percent rate. The same figure for the control group was fourteen percent. The customers of Pinetree were around forty percent less dependent on care. The same figure for the control group was around five percent. Fifty percent of clients with Pinetree Care Group reported increased comfort at home. The control group only reported nine percent. A range of similar parameters shows that Pinetree customers are happy and satisfied with the care they receive. This is part of the continued success of the Pinetree Care Group in China.
A Complex Market Here to Stay
The Chinese eldercare market is here to stay. The market will continue to grow rapidly in the coming years. Although government policies in long term care insurance and reimbursement for the type of services described above are developing as a slow rate, Ms. Wang is optimistic. She believes in the type of care services that Pinetree delivers. I believe that many care organizations around the world can look take inspiration from the concept of hybrid care workers and person centered care. The companion robot has the opportunity to extend care services at a low rate to many individuals while also reducing loneliness. More research is needed to fully understand what a companion robot can do to the quality of life of individuals. Technology can be a powerful tool. I also believe that in person care is very important. Ms. Wang has managed to build a successful care organization in a complex environment.
The City of Beijing is large. Care workers travel long distances every day. Ms. Wang has developed care planning tools, provided navigation support to her care workers in the field, and built an in house training system that supports her care workers. Pinetree Care Group has also developed a risk management system that was implemented from day one. A risk management system is important because the government does not regulate home care services as strictly as countries like Sweden or the US.
It will be interesting to follow the development of Pinetree in the coming years. For our work at ACCESS Health International, it would be interesting to see some of the care concepts that Ms. Wang has developed at Pinetree Group spread across China and into other countries. This includes not only low and middle income countries but also high income countries. All countries can learn from the care philosophy and technology of Pinetree Group.