Value co‐creation to improve ageing‐in‐place programs in China

Four papers in the first special feature on China's ageing in place (AIP) in Issue 1 of Volume 42 of this journal show how the balancing act between the interests of different stakeholders in China transcends the traditional logic of alleviating public spending by ageing in home and community. In this issue, further papers in the special feature show that China's revised AIP programs are not only focussed on increasing (instead of alleviating) government investment in the establishment of a significant number of small public community centres and non-public care teams, but also involving the participation of family members, relatives, friends and older volunteers to mitigate conflicts among various stakeholders. These papers draw attention to current advances in value co-creation to improve AIP services. Regrettably, AIP policymakers and implementers appear to lack a comprehensive understanding of the extensive challenges associated with older adults who live alone in home and community. Despite the anticipated advantages of AIP, older adults participating in such programs who reside independently or lack support often experience additional health issues such as anxiety, depression or loneliness.1 While municipal administrations in China have introduced innovative initiatives known as ‘Butler services’ (管家式服務) and ‘Nearby and accurate elder care grid’ (就近精准養老服務網格) in urban settings to provide attentive and responsive elderly home and community care services,2 there is a growing recognition of conflicting values and varied expectations regarding AIP care among different stakeholders.1, 3-6 AIP is viewed differently by various stakeholders. Policymakers, public administrators and government economists may see AIP as a means to reduce public expenditures, while city planners, housing designers and geriatricians may consider it a tool for promoting healthier lifestyles among older adults. Simultaneously, grassroots service providers, peer or voluntary caregivers, and family members may perceive AIP as a charitable or accommodating activity aimed at respecting the preferences and emotions of older adults, taking into account their deeply ingrained behaviours and prejudices. For instance, when considering the meal service at an AIP community centre, operators may prioritise providing easy-to-digest and healthy taste-free foods, while older adults may prefer their entrenched favourite and more flavourful dishes instead. Faced with these paradoxes, co-design and co-production of AIP services among relevant stakeholders could address conflicting thoughts and requirements. This collaborative effort results in tangible value generation during the execution phase, termed as ‘value co-creation’ in the design and implementation process.7 Service beneficiaries may jointly create value through engagements with the service provider (co-production), including enhancing current services (co-design).8 Drawing on data from the United States, Canada, Europe and Australia, there is a growing interest in engaging older adults in the co-design of technology aimed at preserving their well-being and independence.9, 10 Yet, there exists significant variation in the co-design processes concerning the level of engagement of older adults. Key factors influencing co-design success or hindrance encompass the establishment of robust stakeholder relationships.11 China is diligently fostering strong stakeholder partnerships through private entities for collaborative efforts, yet there is relatively less emphasis on co-designing AIP programs with older adults. To address these challenges, China has opted to address value conflicts between older adults who prioritise their own preferences for AIP, and care providers who advocate for elder independence and healthy lifestyles, through a combination of public and non-public initiatives. The following four papers in this second special feature contribute to this emerging field of scholarship. Zhou and Walker's paper, ‘Adult children and older people's demand for community care services in urban China’, demonstrates that the informal care extended by adult children influences the likelihood of older adults seeking community care services.12 Adult children possess a deeper understanding of theirageing parents' preferences compared to external caregivers offering in-home services. Moreover, the paper reveals that the co-creation dynamic between sons (rather than daughters) and their ageing parents enables the former to provide not only everyday caregiving but also financial assistance and emotional solace. Shi et al.'s paper, ‘Choice of formal and informal care among community-dwelling older people with or without dementia under a long-term care insurance pilot program in China’, examines the influence of formal and informal care on older adults who benefit from long-term care insurance (LTCI) and reside within the community.13 Their regression analysis findings indicate that a majority of LTCI beneficiaries (excluding those with dementia) opt for a family member over a third-party domestic assistant or caregiver. This choice is based on the family member's enhanced understanding of the older adults' innermost thoughts and requirements, facilitating AIP policymaking and implementation through value co-creation. Value co-creation is increasingly important, and the design of age-friendly smart city is no exception. Woolrych and Li's paper ‘Exploring the role of smart cities in supporting ageing-in-place in Chongqing, China’ manifests that achieving favourable results in the context of a smart city necessitates the integration of both hierarchical and grassroots strategies.14 This integration allows for the establishment of avenues for older adults to impact and mould smart city initiatives in a manner that fosters trust and respects the perspectives of older adults. This collaborative decision-making requires value co-creation, which allows a recalibration of the smart city discourse in conjunction with older adults to create genuinely sustainable urban environments that uphold the right of older adults to age in their preferred locations and habits without compromising AIP goals. Urbanisation-induced displacement is another significant example of value co-creation. Zhan and Ye's paper ‘Disrupted Ageing in Place: Urbanization and Displaced Older Villagers in Suzhou, China’ demonstrates that relocating rural older adults from traditional villages that undergo urban redevelopment to new high-rise apartments within the same or nearby neighbourhoods has widened the rural–urban disparity in social welfare within the country.15 The transition and reconstruction of AIP services for displaced older villagers during the urbanisation process could yield adverse effects unless policymakers and administrators possess a thorough understanding of the values and aspirations of the older population. The scenario highlights how informal community initiatives within the framework of intact village settlements, which largely maintain the social connections of older villagers, can reconstruct the AIP programs. In this setting, older villagers self-organise into informal village structures to provide collective activities that meet their own needs and preferences in their communities. In the light of all these insights, further research on additional combined efforts in both the public and non-public sectors are needed to explore how to reconcile value conflicts among different AIP stakeholders to allow and facilitate co-design and co-production through value co-creation. These papers set a significant research agenda for future.

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