The math is simple, says Jane Rohde, principal with JSR Associates: With the one-child rule in place since 1979, China is facing what’s often referred to as the “4-2-1 problem.”

“Four sets of grandparents, two parents, and one child responsible to care for all of them,” Rohde told the attendees during “Resident-Centered Care in China: An Amazing Cultural Journey,” a Monday morning session at the Environments for Aging Conference in New Orleans. In a culture that has always expected the younger generation to take care of its aging family members at home, this is a significant issue; in 2015, China is projected to have 220 million people over 60 years old, Rohde said.

Historically, Rohde continued, the national long-term care system has been limited to serving elders with no family and no income. The social stigma associated with nursing homes is strong. There are very few educational programs in China to train a long-term care workforce, exacerbating the problem.

The past model of care is no longer sustainable, Rohde said, and to that end, she and her co-presenter, Jerry Smith, owner/principal of Smith|GreenHealth Consulting, have been working with a company in Hangzhou, China, called China Senior Care Inc. Its first new community is being built focusing on resident-centered care, following the Senior Living Sustainability Guide.

Rohde and Smith explained some of the challenges and expectations of building a facility like this China. “A mediocre product won’t work. Saving face is very important,” Rohde said. In other words, if someone is going to send his mother to live in a resident-care environment, everyone needs to believe that where she’s going is much better than what he could provide for her at home.

Architecturally and in the interiors, she said, Chinese clients are looking for Western style, but with a little tradition thrown in. The spaces need to be unique—“ironically, knock-offs are not OK”—and there’s a desire for whimsy and “wow,” or the element of surprise.

Smith talked about the landscape work and how it, too, had to respond to expectations. Access to nature was a driving force in the design for its link to improving health outcomes. It’s a concept the Chinese get already, he said, with groups of people regularly coming together for Tai Chi and other classes in public parks, for example.

“We figured we’d approach the garden design the same way we do here [in the U.S.],” Smith said, “with something traditional and comfortable.” But that’s not what residents (or their children) had in mind. “We want ‘Bellagio wow!’” Smith said they told him, because they want to be proud of the place their parents will be moving into.

Rohde said that the first facility, called Cypress Garden Senior Living, will be the subject of several benchmarking research studies that can be mined for data to apply in the U.S. For more on this session and the rest of the Environments for Aging Conference, go to