Systemic Design for Change in Community Care for Older Adults: the Shanghai Jing’an "five-bed linkage" care model

The Linfen Community is situated in the "shanty kingdom" of Zhabei District, towards the northern part of Shanghai's city centre. In 2015, Zhabei District merged with the economically affluent Jing'an District to form the new Jing'an District. This district's demographic structure resembles an "inverted pyramid," with a significant proportion, 41.5%, of its population being older adults aged 60 and above. As one of the foremost areas in Shanghai to confront profound ageing challenges, the Linfen Community Health Service Centre (LFCHS) is at the vanguard of fostering innovations in community nursing to address the healthcare accessibility delays prompted by an ageing population. This research aims to enhance the existing care model by integrating systemic design methodologies. It aims to dismantle the "last kilometre" barrier in older adult care, facilitate the transition from China’s innovative "Five-Bed Linkage" service model to a sustainable care model, and forge a new service model while making recommendations for future advancements. Through the interpretation of systemic design tools, it analyzes the current state of integrated care services in both China and globally. By employing qualitative interviews and utilizing stakeholder maps, among other design tools, the study seeks to thoroughly understand the current service model, identify challenges from a cross-cutting scale perspective, explore challenges, and engage various stakeholders in the co-creation of a new model via design workshops. The outcome of this research is developing a tailored approach for older adult individuals at varying stages of the disease, aiming to construct a more complete, efficient, and human-centred integrated healthcare and care service system. This system is envisioned as sustainable from different perspectives and information dissemination channels. This comprehensive approach promises to address current needs and adapt to future developments in healthcare provision for ageing populations.