If you had the chance to reimagine the way that rehabilitation services and geriatric care are delivered to patients, what changes would you make?

That is just one of the compelling questions that a team of specialists from Partners HealthCare International (PHI) and the Spaulding Rehabilitation Network (SRN) are exploring as part of a collaboration with the Hazens Group in Shenzhen, China.

PHI signed a five-year agreement with the Hazens Group in 2018 to support the construction and launch of the new Shenzhen Hazens Hospital.

The SHH campus will open in phases between 2019-2020 and will have a total of 1,200 beds, including a 600-bed general hospital, a 300-bed cancer center and a 300-bed rehabilitation/geriatric hospital. Satellite ambulatory centers and senior community centers are also planned as part of a larger network strategy.

Geriatric care will be a cornerstone of the project, as China has a rapidly growing elderly population and is projected to have the largest population of people aged 65+ by 2030.

“Because the Hazens campus will have acute care, hospital, outpatient clinics and rehabilitation, they are trying to put together a continuum of care, of which rehabilitation and geriatrics will be a cornerstone of their work,” explains Elizabeth (Betsy) Cox, Director of Global Nursing Programs for PHI.

In July, a team of physicians, nurses, physical therapists and administrators from Hazens traveled to Boston to get a firsthand look at how rehabilitation and geriatric care are delivered throughout the SRN. The team had an opportunity to tour many of the SRN sites, such as inpatient, outpatient, long term care, independent and assisted living as they consider their vision of care.

“Spaulding is fortunate not only to be able to guide development of rehabilitation practices with our Hazens’ colleagues, but also to learn from them about integrated medicine in rehabilitation,” says Dawn Lucier, International Program Manager, Spaulding Rehabilitation Network.

The discussions during the visit ranged from the highly detailed—how they might provide physical therapy to someone who just had a hip operation, for example—to a larger conversation about strategy and vision.

“In the first year, you are setting up the expectations and building the relationship and sharing knowledge, so you can create something that incorporates best practices and is locally relevant,” Cox said. “That’s the phase we are in right now.”

Rehabilitation and Geriatric Care in China

In China, rehabilitation services are a fairly new concept. The country does not have the same kind of campuses that combine independent living, assisted living and dependent care that you often see in the United States. Neither do they have coordinated networks of care for aging patients.  While it will take time and resources to build up these networks and facilities in Shenzhen, the team also has an opportunity to think about new ways to deliver care.

Geriatric care and rehabilitation services in the United States are shaped in part by strict guidelines about what services and treatments can be provided in which setting (a hospital vs. a skilled nursing facility), as well as specific admission and discharge criteria and health insurance reimbursement policies.

The interprofessional team is pushing themselves to consider the collaboration as a blank slate: if you don’t have the constraints that other countries faced in their development of rehabilitation services and geriatric care, what would you include on the campus and in each setting so care is more seamless for the patient, regardless of how payments and regulations are structured?

Eastern Connections

The collaboration is also providing the team with an opportunity to explore new strategies in integrated medicine.

For the past two decades, Western medical providers have begun to incorporate aspects of Eastern medicine such as yoga, tai chi and acupuncture into healthcare under the umbrella term of integrated medicine.

The SHH team comes with an Eastern foundation, so those elements will be incorporated into the care delivery process from the start, says Cox.

“Now we are trying to figure out how to deliver that care in a way that takes the best of both disciplines and is very patient-centric. This is the type of work where both groups learn from each other.”