Master of Fine Arts
Innovation through Business, Engineering and Design, specialisation design. School of Design
Meal Delivery Service to Chinese Elderly
Author: Huiwen Zheng
Supervisors LNU: Miguel Salinas Supervisors IKEA: Anne JM Norman Examiner: Lars Dafnäs
Date: 13 Jan, 2020
Abstract
The main purpose of this report is to document a design process towards the product development of meal delivery service to ageing population in China. The designer has spent six months working with the analysis of the background and doing the design research in two countries, China and Sweden. The gathered data is used to assess and develop the product specifications for a certain touchpoint in the delivery service. The whole design process was using service design thinking as the main guide.
Keywords
Human needs, Service design thinking, Product design, Design for ageing, Anthropology, Sustainability, Human-centred methods, Humanity design
Acknowledgement
I would like to express my sincere gratitude to my academic supervisors Miguel Salinas from Lnu and Anne JM Norman from IKEA, besides all the interviewees for sharing their expertise and valuable guidance.
Table of Contents
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1. Introduction
1.1 Project Description and Results 1.2 Personal Background and Motivation 1.3 Aims and Purposes
1.4 Delineation of Field of Study 1.5 Delineation of Project
1.6 Research Questions 2. Theory
2.1 Human Needs 2.2 Design for Ageing 2.3 Service Design 2.4 Social Sustainability 3. Methodology
3.1 Case Study
3.2 Stakeholder Maps 3.3 Interviews
3.3.1 Expert Interviews 3.3.2 Contextual Interviews 3.3.3 Group Interviews 3.4 Field Visiting
3.5 Shadowing & Observation 3.6 User Journey Map
3.7 Artifact Analysis 3.8 Concept Sketch 4. Empirical findings
4.1 Case study - The good kitchen 4.2 Senior living in Sweden 4.3 Senior living in China
4.3.1 Ageing population in China 4.3.2 The elderly situation in China 4.3.3 Data collection in China
4.4 Comparison between Sweden and China system - problem mapping
4.5 Concept formulation for product development - Different needs from three perspectives
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5. Design Project 5.1 Process description 5.2 Result
6. Summary and Discussion 7. References
8. List of illustrations
IV
1. Introduction
To live a “good” life is a desire of many people. Today, together with a growing standard of living in economically advanced countries, the human life is prolonged. The ageing population has been growing worldwide over the past few decades; however, some countries are not well prepared to confront this challenge. China like many other developing countries is witnessing the rapid aging of its population. The amount of people retiring is increasing dramatically and it will continue to do so in the future.
Therefore there are many senior citizens who cannot live independently, lacking of means to hire service for help. In this case, politicians have recognised the challenge in the demographic development and they see as important that they act in time and in a way that satisfies the needs of the aging population. Thus, the nation has paved some social organisations and communities, providing care services to the senior citizens.
However, these services can only meet the basic needs. The quality of the elderly’s life cannot be guaranteed.
As decision makers, they must know that the elderly do have high expectations concerning standards of life and they are not a homogenous group of people, as there are many differences in needs and wants within this group. The existing solutions are not yet implemented in a large scale and the fact that seniors require different levels of assistance to manage daily life make difficult to apply standards. For instance, there are only a few types of living for the older residents in China and not all elderly can afford them.
1.1 Project description and results
In this study, the designer spent six months collecting qualitative data and used service design tools to analyse it in a comprehensive way. The research has been conducted on the basis of the elderly living situation from the perspective of alimentary issues in both China and Sweden. The aim of this study is to identify what are the difficulties and the requirements the elderly have when they live alone at home, meanwhile, finding innovative design solutions to help them to improve the life quality. By comparing both the Swedish and Chinese elderly living situation at the same time, the designer could understand similarities and differences in order to find a well-developed service system solution. This research was focused on the diet problem of the elderly and based on the human-oriented thinking through different types of interviews, observations, shadowing, field visiting, etc. After a long study, this research resulted in a project aimed to provide a warm meal delivery service to Chinese seniors through designing a new eating box.
1.2 Personal Background and motivation
As a designer from China, I have studied and lived in Sweden for the past two years. The differences in life style and life quality between these two countries’ citizens has brought me to deep concerns, especially the big gap of the elderly people living situation.
In China, it is difficult for the elderly to attend social activities freely and independently. They have limited public facilities to go out alone safely, cities in China are not ageing-friendly at all. Thus, every moment I saw an elderly person walking alone on a street in Sweden, it reminded me of my grandmother. She lived alone at home since my grandfather passed away in 2016. There are only a few organisations in my hometown that can provide the elderly home care services and only with a low quality. Therefore, she
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experienced a tough time to cook herself a meal, because my grandfather was the chef at home. Actually, she had never cooked in her entire life.. In the meantime, she rejected to live with us. She thought living with her children would bring more inconveniences to each other. We, the family were extremely worried about her nutrition and the safety if she cooked alone. We were worried about how she managed to cook well-balanced meals every day. This situation happens to many Chinese families, the elderly choose to live by themselves instead of relying on their children.
In other cases, some seniors have only one child due to China’s one-child policy 1 which was established in 1979 and phased out in 2016 for restraining the Chinese population. If the elderly’s children are far away from them or without time to take care of them, then they will not have family nearby to help with meals or groceries.
By contrast, in Sweden, people do not depend so much from their relatives and the elderly are living in a more individual environment. The Swedish society’s social commitment has built a well-developed system for their citizen from birth to death. Under this circumstance, the majority of people live in an independent way and can use an amount of social services to improve or maintain their life quality. Even as a foreigner living here, I could receive the help from the local organisation as well, which gave me the sense of belonging to this society. It triggers my curiosity to know how and why the elderly can live independently in Sweden, having access to various care services or even visiting grocery stores completely alone. All opportunities for the elderly are an equal thing, either in health or with disabilities.
1. 3 Aims and purposes
In the Chinese culture, a proverb says that food is paramount to people . The food is the most important part 2 in Chinese culture, the origin of the health. If seniors live alone, how they will handle the food becomes a big issue. They may face many problems indeed, but certainly, the food issue will be the biggest trouble. They may have for example a hard time preparing meals for just one person or they may not have the energy to cook. Not only may dementia cause them to forget to eat, but they may also be too old to make their own meals safely. Some can have physical problems that limit their daily grocery store visits, as fresh ingredients are also part of the food culture. When seniors do not eat enough or they eat fast food or food that are not very nutritious in nature, it can lead to a multitude of health problems. Some health factors can be malnutrition, getting sick more often due to a weakened immune system, problems managing diabetes or blood pressure, depression or mental confusion . Therefore the elderly need to be treat differently and 3 seriously compared with the much younger adults.
The purpose of this project is to analyse Chinese seniors’ diet condition when they live alone at home and identify needs, by using design thinking to address current and future challenges in order to provide a better life for the elderly. The project does not focus on only eating simple food or fast food but also warm and
Matt Rosenberg, China's Former One-Child Policy - The Aftereffects of China's One-Child Policy, ThoughtCo. [website], 31 January, 2018, para 1, <https://www.thoughtco.com/chinas-one-child-policy-1435466>,
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accessed 26 June 2019.
F Wu & H Zhang, China's Global Quest for Resources: Energy, Food and Water, 1st, ed., Routledge, Abingdon, 2017.
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Marion Lacey, Older people eat well - Literature review, doc 88, [website], 30th April 2014, page 3, <http://www.doc88.com/p-5595210622438.html>, accessed 5 May 2017.
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fresh food, making it possible for the elderly to stay in their homes, where they are happiest, and maintain their independence.
1. 4 Delineation of field of study
The present study, the designer will only focus on the Chinese context, scanning the completely existing food delivery system and in order to design for the elderly in China who live alone in their homes. The meal delivery service in Sweden will be used as comparison and example in the beginning of the research phase.
During the whole research period, a series of design opportunities has been discovered as part of the service design approach, but at the end product, a meal box, will be put forward as a solution to be designed. In order to contribute with a holistic design solution in the limited time, the designer focused on designing the meal box which is the key touch point in the whole service system to improve the elderly eating experience.
1. 5 Delineation of project
This meal box design main consideration is to keep the heat of the warm food, not beyond the optimum dietary temperature. In addition, avoiding making an electric food box either, the box should stay warm for many hours itself, therefore, the elderly can eat warm meal for both lunch and dinner.
1.6 Research questions
The investigated problem in this thesis has two main research questions and each of them has a sub question.
The first one is an open question related to the situation in Sweden and China:
• What is the nowadays eating situation of the elderly in Sweden and China?
Or, in other words, What problems and needs the elderly have in both countries?
Basic on the first research result, the second question is working on solving the problems and satisfying the needs of the elderly that found in the first step, which will have the close connection with the final design concept:
• How could design help to address current and future challenges for a better life for the elderly?
To be precise: How to provide the elderly with a warm meal to increase their life quality?
2. Theory
In this chapter, several theories will be quoted to present and frame this research. Firstly, the Max-Neef theory and Maslow model will be used to clarify why the food and nutrition are at the top of the human needs’ list. Especially when it comes to the elderly people, these needs become even more important because of their vulnerability. Secondly, the designer will explain the life circumstances around the elderly. As a person grows older, the physical and mental abilities gradually become weaker their bodies are not the same as they used to be.
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Service design theory is introduced to discover and define the most vital questions in the whole system as well as the touch points. The last, social sustainability theory described the meaning of this project.
2.1 Human Needs
Manfred Max-Neef, a Chilean economist concerned with issues of poverty as the basic human need enumerates the subsistence, protection, affection, understanding, participation, idleness, creation (in terms of free time, rest, time for reflexion, identity and freedom, as shown in figure 1 below.
Figure 1. Matrix of needs and satisfiers
In evaluation of the most important needs of the senior citizens, workers of organizations providing them services mostly followed their practical experience. The most accentuated feature was the basic biological needs, the food and hygiene. 4
The American scholar A. H. Maslow defined the man’s essential needs as follows: 5 1. The physiologic needs (food, warmth, sex, etc.);
2. A need for safety, (mutual) love, the sense of belonging and acceptance;
3. A need for appreciation (need of independence, freedom, strength, self-confidence face-to-face with the world, prestige, respect from other people, appreciation and attention);
J. Vanus, J. Koziorek, and R. Hercik, DESIGN OF A SMART BUILDING CONTROL WITH VIEW TO THE SENIOR CITIZENS' NEEDS, 12th IFAC Conference, Czech Republic, September 25-27, 2013, page 422,
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<https://www.sciencedirect.com/science/article/pii/S147466701537364X> , accessed 5 May 2017.
Christopher D. Green, A Theory of Human Motivation, Classics in the History of Psychology, [website], August 2000, section 2, <http://psychclassics.yorku.ca/Maslow/motivation.htm>, accessed 5 May 2017.
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4. A need for self-fulfillment (a desire to become more and more what a man is able to become);
5. A cognitive need to know and understand.
2.2 Design for ageing
Older adults experience a weakening of their leg muscles which affects their ability to sit and get up with ease. Another important everyday activity that is affected due to old age is walking. A frail old male adult takes 16 times longer to walk in comparison with an average healthy male adult. In case of a sudden change in equilibrium, it is difficult for them to regain their balance as quickly as younger adults making them more susceptible to fall. Muscular Skeletal - Movement, Balance, Flexibility, Strength and Control: This includes 6 bone and joint disorders affecting posture, mobility, flexibility and dexterity. Arthritis and osteoporosis are two examples of this kind of disorder. They lead to difficulty in walking, turning over in the bed, difficulty in bending arms and cause a lot of pain. 7
2.3 Service design
How can new services be created? How can services be improved with limited resources? Service design seeks answers to these questions. It is a methodology of improving the quality of services and processes as well as using innovation to develop new ones. The improvements are directed at both service users and providers . It is innovation based on design thinking, processes and tools. Service design puts people at the 8 centre of its approach. It brings the users’ point of view to innovation processes. This distinguishes service design from other drivers of innovation. Taking a design approach ensures that solutions are suited for everyday life and meet the needs and demands of the users. These include not only customers or end-users, but all the involved in the ecosystem, such as the elderly in this case and staff who provide the services to them. Service design looks at the complete experience of how a service is delivered and performed. It is a holistic approach that considers all the various factors and touch points that influence the context in which a service is rendered.
The design process starts from observing the prevailing situation and identifying problems and possibilities.
To determine new solutions, service users and other stakeholders are involved in the innovation process from the onset. It is called “co-designing” or “co-creating”. “Empathy” is a core concept in service design, the better way to empathies users is to let them participate in the shaping of their services. Service design is based on interdisciplinary work groups to include all kinds of insights. The method may combine expertise from various disciplines such as psychology, sociology, anthropology, marketing, business, engineering and the arts. Methods from different fields such as surveys, ethnographic interviews and visual planning can bring new insights into the process. Service design tools can help designer to increase the understanding of the complexity of senior care nowadays, and can create real pathways for innovative services and solutions that help address the challenges in China.
Harshika Bhatt, BIOPHILIC DESIGN FOR THE ELDERLY: DESIGN OF A SENIOR LIVING COMMUNITY ALONG THE DELAWARE, Master thesis, Philadelphia University, Philadelphia, May 2015, page 5.
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Harshika Bhatt, BIOPHILIC DESIGN FOR THE ELDERLY: DESIGN OF A SENIOR LIVING COMMUNITY ALONG THE DELAWARE, Master thesis, Philadelphia University, Philadelphia, May 2015, page 4.
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DAA , Making ageing better-a look at how service design can innovate senior care, idz [website], 18 Jan 2016, page 6, <https://idz.de/dokumente/DAA_FINAL_BOOK.pdf>,accessed 5 May 2017.
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2.4 Social Sustainability
This section may provide insights on how social, cultural and familiar factors influence subjective well-being in the very old age. Old age is the start of a new phase of life. As people age they have to face many changes.
Most of these changes might not be positive and so they could lead to a feeling of depression. According to a report by the National Alliance on Mental Illness, “ Depression in older persons is closely associated with dependency and disability and causes great suffering for the individual and the family”. Depression could be 9 caused due changes in the biological, personal, cultural, mental and economic aspects of their life. 10
Life Satisfaction
Generally, older adults who live alone are of particular concern to policymakers. Younger family members are often natural providers of economic support and physical care for coresident elders, particularly in places where the government old-age security system is immature. 11 However, many elderly parents do not wish to be a burden on their children and so wish to be as independent as possible within the dwelling and thus the need for home care service. 12
The existing literature so far has provided consistent findings showing that older adults’ quality of life is influenced by personal and environmental factors and their interactions. Many individual- and family- 13 related factors, which greatly influence older adults’ perceived satisfaction, are embedded in socio-cultural contexts. Also, the World Health Organization’s Quality of Life Group (WHOQOL) has defined the 14 concept of Quality of Life (QOL) as “an individual’s perception of their position in life, in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. 15
Life satisfaction continues to be an important construct in the psycho-social study of ageing. It is one of the commonly accepted subjective conditions of quality of life and seems to be one of the facets of successful ageing, both of which are key concepts in ageing. Research reports that life satisfaction is strongly related to socio-demographic and psycho-social variables. It has been found that two socio-demographic 16 characteristics (income and education) influence life satisfaction both directly and also indirectly through psycho-social factors such as activity-physical activity level, satisfaction with leisure activities, and social contacts, perceived health, and physical illness. 17
3. Methodology
Harshika Bhatt, BIOPHILIC DESIGN FOR THE ELDERLY: DESIGN OF A SENIOR LIVING COMMUNITY ALONG THE DELAWARE, Master thesis, Philadelphia University, Philadelphia, May 2015, chapter 2.
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Harshika Bhatt, BIOPHILIC DESIGN FOR THE ELDERLY: DESIGN OF A SENIOR LIVING COMMUNITY ALONG THE DELAWARE, Master thesis, Philadelphia University, Philadelphia, May 2015, chapter 2.
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Erin Hye-Won Kim, Public transfers and living alone among the elderly: A case study of Korea’s new income support program, demographic-research, [website], 2015, Introduction, <https://www.demographic-
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research.org/volumes/vol32/50/32-50.pdf>, accessed 5 May 2017.
K.J.Parker, Multigenerational living:Design for Ageing, Conference Paper Singapore, Singapore, Spring 2000, page 90, <https://link.springer.com/article/10.1007/s12126-000-1014-x>, accessed 5 May 2017.
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Bramston, P., Chipuer, H., & Pretty, G, Conceptual principles of quality of life: an empirical exploration, University of Southern Queensland, Toowoomba, 2005, page 3.
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Huali Qin, Adding life to years: predicting subjective quality of life among Chinese oldest-old, Master, Georgia State University, 2007, page 1
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Helen Herrman and others, 'Study protocol for the World Health Organization project to develop a Quality of Life assessment instrument’ Quality of Life Research [online Journey] page 153-159, < https://www.researchgate.net/
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publication/224904023_Study_protocol_for_the_World_Health_Organization_project_to_develop_a_Quality_of_Life_assessment_instrument_WHOQOLWHOQOL-GroupQual_Life_Res1993221531598518769>
accessed May, 2007.
Aruna Dubey and others, 'A Study Of Elderly Living In Old Age Home And Within Family Set-Up In Jammu’, 5 Studies on Home and Community Science, 2011, pp.93-98.
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Aruna Dubey and others, 'A Study Of Elderly Living In Old Age Home And Within Family Set-Up In Jammu’, 5 Studies on Home and Community Science, 2011, pp.93-98.
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This paper presents in this section exploring opportunities of using design anthropology as a holistic and critical approach to addressing societal challenges and change, and a way for designers to engage in participatory research and design that extend beyond the empirical. 19 A series of design methods have been conducted by the author to explore the design opportunities in the meal delivery service.
This process started with the Case Study, the method could provide the designer insights to explore an unknown field that has a complex situation. Then, the methods for collecting the data in Sweden and China were Stakeholder Maps, Interviews, Field Visiting, Shadowing and Observation. These tools were used to understand the people and the surrounding context. Afterwards, the method Customer Journey Map has been chosen to analyse the data and find deeper meanings and connections, meanwhile, creating the key touchpoint of the whole service process. This was also how the learnings were turned into an opportunity for the later design process. When it came to the design and solve the problem phase, design methods are:
Artefact Analysis and Concept Sketch. These two are used to analyse current market’s existing design products and create a new concept that will fit the design context.
3.1 Case Study
Case studies are useful in exploratory research for understanding existing phenomena for comparison, information or inspiration, but can also be used to study the effects of change, new programs or innovations.
The case study method focuses on gaining detailed, intensive knowledge about a single instance or a set of related instances. These instances, or cases, maybe of individuals, organizations, entire communities, events, or processes. The details of cases emerge during data collection and analysis. Case studies have been 18 proposed as useful for designers, bearing some resemblance to the design process. Case studies require the researcher to determine a problem, make initial hypotheses, conduct research through interviews, observations, and other forms of information gathering, revise hypotheses and theory, and tell a story. 19
3.2 Stakeholder Maps
As the design process begins, in the planning, scoping, and definition phase, it is particularly critical to identify who all the key constituents are that might have a stake in design outcomes. Stakeholder maps serve this purpose, as a visual reference point for the design team in planning for user research activities, and guide to appropriate communication with stakeholders throughout the project development process. 20
In this service design process, it was important to be exhaustive, identifying the end users at the earlier research stage. Even, some characters are created speculatively, with the brainstorming method. The key relationships between roles or people could use the reference from the previous method’s result - case study.
3.3 Interviews
Martin B and Hanington BM, Universal Methods of Design: 100 Ways to Research Complex Problems, Develop Innovative Ideas, and Design Effective Solutions, Rockport Publishers, United States, 2012, page
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64-65
Breslin, Maggie, and Richard Buchanan. "On the case study method of research and teaching in design." The MIT Press, Vol.24, 2008, page 36-40, accessed 25 Nov, 2018.
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Martin B and Hanington BM, Universal Methods of Design: 100 Ways to Research Complex Problems, Develop Innovative Ideas, and Design Effective Solutions, Rockport Publishers, United States, 2012, page 470.
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There is no better way to understand the hopes, desires, and aspirations of those you are designing for than by talking with them directly. When we want to discover their hidden emotion or their real feelings of our 21 questions, the best way is to talk with them and ask them questions in person. Especially for the elderly, sometimes they may not good at express their thoughts through words, but nuances of personal expression and body language will give us an answer. By listening their own words, we can also learn so much about a person’s mindset, behaviour, and lifestyle by talking with them where they live or work. It is a direct contact with participants to collect firsthand personal accounts of experience, opinions, attitudes, and perceptions. 22
3.3.1 Expert Interviews
Experts can speed up the process of a topic, giving the key insights into relevant history, context, and innovations. Experts can often give us a systems - level view of our project area, tell us about recent innovations - successes and failures. In this project, the expert of food, nutrition, management, politics, and 23 logistic, they are all experts in their professional field. As a designer, it is hard to grasp or understand those areas of knowledge in a short time without external help. Meanwhile, the expert may provide the access for the field visiting of their working area helping the designer have a better understanding of the working process.
3.3.2 Contextual Interviews
Contextual interviews combine observations with interviewing. During these interviews, researchers watch and listen as users work in the user’s own environment, as opposed to being in a lab/studio. It tends to be more natural and sometimes more realistic as a result. In a contextual interview, the researcher watches and 24 listens, without giving the user tasks or scenarios. To start the conversation, we can ask questions as the user navigates. This unstructured interviews have the advantage of being conversational and more comfortable for participants, but it relies on the researcher to guide the session and collect the necessary information within an allotted time. This method is more suitable for having a conversation with the elderly. They prefer to 25 talk or chat with someone about their stories and feelings instead of being interviewed.
3.3.3 Group Interviews
Though a Group Interview may not offer the depth of an Individual Interview in someone’s home, it can give the researcher a compelling look at how a larger set of the people for the design operates for. The best Group Interviews seek to hear everyone’s voice, get diverse opinions, and are strategic about group makeup. For example, an all-female group might give us insight into the role of women in a society whereas a mixed group may not. If we are looking to get smart quickly on what is valuable to a community, Group Interviews are a great place to start. The same to the elderly society, if the government or researchers want to create an 26
“Interview”, Design Kit [Website], <http://www.designkit.org/methods/2> accessed July 6, 2019
21
Martin B and Hanington BM, Universal Methods of Design: 100 Ways to Research Complex Problems, Develop Innovative Ideas, and Design Effective Solutions, Rockport Publishers, United States, 2012, page 295
22
“Interview”, Design Kit [Website], <http://www.designkit.org/methods/43> accessed July 6, 2019
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Affairs ASfor P, “Contextual Interview”, usability.gov, <https://www.usability.gov/how-to-and-tools/methods/contextual-interview.html> accessed July 6, 2019
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Martin B and Hanington BM, Universal Methods of Design: 100 Ways to Research Complex Problems, Develop Innovative Ideas, and Design Effective Solutions, Rockport Publishers, United States, 2012, page 295.
25
“Interview”, Design Kit [Website], <http://www.designkit.org/methods/20> accessed July 6, 2019
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idealised community for the elderly, it is better to gather them together, do the group interview and observation at the same time.
3.4 Field Visiting
Field visiting is a method to bring the researchers into straight contact with people, places, and things they are researching. Spending time with people and engaged in real-world activities which helps designers/
researchers understand the relevant behaviours firsthand. Here, researchers could ask stakeholders specific simple open-ended questions. Meanwhile, it is easy to observe the participants. Choosing this method can 27 provide the researcher the chance to find surprising behaviours and insights about the unmet need of the elderly.
3.5 Shadowing and Observation
Shadowing provides key insight into the participants’ daily routine activities and decision making patterns as the researcher can follow them closely. It is an observational method that includes tracking their daily life in parallel with them, collecting the detailed and real-time exposure. Shadowing observation should be well documented, with photographs, notes, sketches or audio as far as possible. Moreover, shadowing is not intended to be a covert research method used to follow people without their permission. Usually, the 28 elderly have their regular daily routine activities, using this method helped the designer-researcher to gain a true sense of the user’s actions. It was an exploratory research method to understand and it has empathy of the target group.
3.6 Customer Journey Map
The Customer Journey Map is a flow map that visualises users’ steps through interacting with a product or service. This method divide the whole process into moments to analyse. Each part can be evaluated that may show the problems or opportunities for the further innovations. Through creating discussions around which 29 touch points are working optimally, which are insignificant, which are weakness altogether, etc. The Journey Map helps designers to develop a shared vision about ways to improve more effectively improve existing user behaviour within their actual contexts of use. In this project, the Journey Map played a vital role in 30 organising together all primary research material together that I studied previously into an integrated story. It reflected people’s actual needs, feelings and perceptions of that occurred before, during, and after service interactions. It is used to capture the uncovering hidden opportunities to create better value for the elderly.
3.7 Artefact Analysis
Most sociocultural groups have their particular customs, behaviours, traditions, thoughts and practices of daily life. That is to say, each group has its own culture. The artefact analysis method was used to understand
Vijay Kumar, 101 Design Methods, Wiley, New Jersey, 2013, Chapter 3.6.
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Martin B and Hanington BM, Universal Methods of Design: 100 Ways to Research Complex Problems, Develop Innovative Ideas, and Design Effective Solutions, Rockport Publishers, United States, 2012, page 444
28
Vijay Kumar, 101 Design Methods, Wiley, New Jersey, 2013, Chapter 4.17.
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Martin B and Hanington BM, Universal Methods of Design: 100 Ways to Research Complex Problems, Develop Innovative Ideas, and Design Effective Solutions, Rockport Publishers, United States, 2012, page 556
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artefacts’ physical, social and cultural contexts through a systematic examination of the material, aesthetic and interactive qualities of the objects. An artefact analysis can be a useful tool for examining and comparing precedent and competitive products. It can be also used to discover peoples’ perceptions. Every Asian 31 country has their own food culture; all have different tableware and kitchenware. When the designer starts to design for a specific group, he or she needs to learn the given culture to better understand specific solutions to needs. Because design has a huge impact on how people behave and their lives as designers, we have been trained to solve problems and make people live better. It is important to understand that our design is not neutral; design is an intrinsic ethical activity. That is why designers should know about ethics in different cultures and learn to incorporate them in their design work.
3.8 Concept Sketches
Concept Sketches helps creators to convert ideas into concrete graphics that are convenient to communicate and discuss with others. Compared to describe in words, forms are easier to understand and more efficient.
When we think closer to refined concepts, it sometimes sparks more ideas for further exploration. This 32 method is very helpful when designers need to discuss my ideas with experts or other stakeholders. It may lead to many more new concepts, subconcepts or concept improvements than just ideation based on only abstract thinking.
4. Empirical findings
4.1 Case study - The good kitchen
At the beginning of this project, using Case Study method can provide the insight of how to start design a service. I found a design case on website named: The Good Kitchen. It was designed by the Danish 33 innovation and design agency Hatch & Bloom. They were assigned to design a new meal service for The Municipality of Holstebro. The design team spent six months to create the idea, a meal service with more quality, more flexibility and more freedom of choice for the elderly.
In this project, Hatch & Bloom used Journey Mapping to trace the elderly from the beginning to the end.
They rode with food service employees who delivered the meal and accompanied them into the homes, watched clients preparing the food and adding ingredients, set the table and then finally ate the meal.
Journey Mapping is used to trace the journey of a customer as they experience a product or service. It is similar to Flowcharts which is used in business environment. The crucial difference between Journey Mapping and flowcharts is that the Journey Mapping can recognise the both functional and emotional jobs that most of us are trying to do. A lot of unarticulated needs turn out to be on the emotional side. This makes this tool very valuable for uncovering hidden opportunities to create better value for people.
Martin B and Hanington BM, Universal Methods of Design: 100 Ways to Research Complex Problems, Develop Innovative Ideas, and Design Effective Solutions, Rockport Publishers, United States, 2012, page
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29-30.
Vijay Kumar, 101 Design Methods, Wiley, New Jersey, 2013, Chapter 5.13.
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'How An Improved Food Service Creates A Better Life Quality For Elderly People’, This is Design Thinking! <https://thisisdesignthinking.net/2016/05/the-good-kitchen/> accessed 6 July 2019.
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Hatch & Bloom also interviewed the supervisor of the food preparation process in her workplace and the kitchen. When the design group was in the kitchen, they observed that the public service kitchen employees are demoralised and unmotivated. They noticed and realised that the kitchen workers were not enough focused on the needs of the elderly. This issue would need to be addressed as well. So, the team decided to broaden the scope of the project beyond from just improving the menu and they helped the municipal officials to understand why this was necessary. After the research stage, they found both the seniors and the kitchen workers were both experiencing feelings of disconnection and alienation.
In Danish culture, the elderly hope to receive the assistance from a relative or a friend, they think cooking is a more personal need compared to the cleaning the room. If they cannot receive the help from closed people, perhaps they could hire someone to come. It is the last resort to receive assistance from the government.
They would feel embarrassed and painful when they lose the control over their food choices. Hatch & Bloom also found that they were lonely and hated eating alone because it reminded them that their families were no longer around. All of these factors contributed directly to the nutrition problem. The less they enjoyed their situation the smaller their appetites. On the other side, the kitchen workers occupied with providing the meal service were making the same boring low-cost meals repeatedly, not because they lacked skills or they just did not care but because of the perceived economic and logistical constraints that prevented them from doing something more interesting.
Hatch & Bloom used another design method: Co-Creation, inviting key stakeholders into a creative design process. By doing this, it creates ownership and engagement as well as produces better ideas. In the whole co-creation process, the design team uses the phrases “what is” – “what if” – “what wows” – “what works”
as the storyline. In the end, this process yielded a host of dramatic changes of a new menu, new uniforms for staff and new feedback mechanisms. Equally important was to make everyone involved cognisant of the real people they were serving or being served by. Today, seniors know who is shaping their meatballs and preparing the gravy in the kitchen. It increased greatly the satisfaction of both. Anne Marie Nielsen, the director of The Good Kitchen said, if you have professional pride, you will also cook good food. Good food has to come from the heart!
4.2 Seniors living in Sweden
The Swedish, like citizens in most developed countries, recognise that the ageing of their population presents many challenges. One of this is serving a great amount of food to senior citizens who rely on government- sponsored meals every day. At the beginning of the project, I started with comparing and analysing the Chinese and Swedish context, the existing meal delivery system in both countries, which is the key role in my study. The delivery service delivers the daily meal to the elderly’s home, supporting their life existence as an important goal. The developed system in Sweden is a good model, which can be used as reference for the Chinese food delivery system, both in looking for strengths and challenges of this system.
I started to interview some stakeholders from meal delivery system in Växjö (Sweden). It involved local organisations, politician, service providers, etc. The connection between these people are shown below, figure 2. According to the research of the previous case study, I found the clue of how to figure out who
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might be the stakeholders in my meal service system and which methods could be used to gain the insights efficiently, as illustrated below, figure 3.
Figure 2. Stakeholder Map of Interviewees in Sweden
At the beginning, I contacted Maria Granath; a communication responsible, she works in the Region Kronoberg, a local government agency in Växjö, providing services to the citizen, including traffic, health care, business development, school education and culture, etc. Maria Granath was one of my previous projects’ collaborators and luckily she is the director of the communication office in Region Kronoberg. So she introduced Lone Larsen to me, the manager of the public care department in Region Kronoberg. Maria said Lone might help me to find the correct people to contact.
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Figure 3. Methods used in Sweden
- Interview with Lone Larsen
On March 8, 2017, I got chance to meet Lone Larsen in Region Kronoberg. She introduced me to her working area with the elderly group. She gave me information on an overall structure of the kinds of services that were provided to the elderly in Växjö. Region Kronoberg provides the healthcare services to the elderly in hospital when they are sick or ill. There are other municipalities taking care of the elderly at home the rest of the time. For example, in Växjö is the Växjö municipality (Växjö Kommun in Swedish) that takes this responsibility. In the municipality, there is a department called social services that provides the services to the elderly of getting clothes on, taking a shower, checking their safety, getting food from grocery shops or warming up food. There is another department called healthcare, where nurses and assistants are working at.
They help the elderly to take medicine or get the connections with the hospital if they have any illness.
Within this service system, there is an issue when the elderly get sick. For example, once the elderly felt back painful, they seek for help by calling the social service department for help. However the social helper replies them that they needed to call the healthcare department. Then, the elderly call the nurses. After a nurse comes to check the problem, the elderly are told that they need to go to a doctor to check the problem.
The whole situation becomes a very complicated one for the elderly when a need must be split up in different organisations. It is difficult for the elderly to know who is taking care of what part. Even if technology, medicine and treatment are becoming better, this service system still cannot level up to the same speed.
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This situation explains how the Swedish government has tried to cope with the problem. From 2010 to 2014, a project called Better Life for the Most Sick Elderly People was launched by the government in all over Sweden. Even when this project was finished at 2014, most of municipalities still continue it without the government's sponsoring. In order to improve the elderly’s life quality, municipalities have made a great effort to launch a series of projects about the elderly. One of these projects was called Senior Event, interviewing the elderly of what kind of services they want. Lone Larsen shared with me a previous interview that she did on a Senior Event about where the home is and what a home means to the elderly.
There were 30 people being asked where they want to live after they become getting old. The biggest need of the elderly was that they want to have more freedom and more choices in nowadays structured system, they want to have more possibilities to make their own choices. For instance, they can be flexible to change the activity type or activity company people. Almost everyone answered that they would like to live in another place, where they can have more activities instead of staying at their apartments. For example, if there was a building, where they can have an integrated restaurant to have meals, then they would not need to prepare food or cook at home, and this building could have a social room where they could meet friends or family.
They told Lone that they would like to move in such apartment building complex before they get old and when they are still healthy and active. Besides, they would not need to move to the nursery house if they could get help in this building. This place could be the home to the elderly for the rest of their life and many of the elderly said they do not want to meet only old people after they were getting old.
Lone suggested me when we use service design thinking, we need to understand why the elderly have these needs instead of just meeting their requirements. She told me for example, “Now the government has provided a range of services to the elderly home as they want the elderly to stay at their own home, but there are still many people in the nursery house or hospital”. The reason why this happen was because sometimes the elderly’s family want to have their private space, so it is easier for them to send their husband or wife to the hospital. Therefore, the government needs to take care of their families and beloved ones but the politicians want also the elderly to stay at their home as long as possible. When we use service design thinking, we need to map the stakeholders; not all individuals are really individual but connected. If we want to provide a good life for the elderly, we need to know what happens outside the hospital, to know how they live and who they live with. When they answer they want to stay at home, we need to define the words that describe the meaning of home, which may not refer to their actual living place.
Designers need to think from the humanistic perspective. Lone said, a man came to told her that he felt he was not an important person anymore although he has everything he needed at home, food, clothes, etc.
There were social helpers coming to his house everyday providing services that they did to others. He had no choices, so he felt that he was not himself anymore because his personality has disappeared. All services came to his house he could only accept it. Under this circumstance, if there were a good system for the elderly to book their activities themselves from the municipality, that would be a much better solution to him. Lone Larsen explained too, that in 2016, a foundation of Ingvar Kamprad, IKEA, donated a big amount of iPads to the nursery homes. This was a big step for the elderly’s services; the nurses are starting to use the technology in their jobs now.
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Lone also told to me, nowadays, many of the elderly could use the computer to communicate with the municipality to apply services, such as food services ordering. The elderly fill a form and apply online, there will be a person in municipality to guarantee and decide which menu fit them. Because different people may have different meal needs, such as the size of food cut, or issues like some elderly not eating gluten, or sugar, etc. After the service started, every 4 weeks or 6 weeks, the menu will be updated and send to the elderly. Each region has its different schedule. There are several meal delivery services to the elderly’s home, both private and public services. Lone recommend me the two main services in Växjö. One is provided by the central kitchen at Älgvägen. They deliver frozen food pre-packages to the elderly home once a week, the seniors or caregivers will heat and prepare the food every day. However, as they do not provide the hot food to the elderly, this solution may not fit my target group. In Chinese culture, people normally eat hot food for their daily meal, especially the elderly. Another meal delivery service in Växjö is provided by the Växjö hospital kitchen. They are more closely to my research topic because they provide the hot meal service daily.
I was very lucky that Lone arranged the chance of interviewing Björn Lagenwall, the head chef of the kitchen, and the dietician Susanne Ask. They are both the key stakeholders in this meal delivery system.
They plan the menu together every season, improving and adjusting the old menu according to the feedback from the diners as well as other factors.
- Interview with Susanne Ask
Susanne is a registered dietician, working as business developer for the meal services in Region Kronoberg.
These meals were serving to hospital patients and Region Kronoberg staff. She is also responsible for food habits and nutritious in the public care department at the strategic level and making action plans. Since 2007, Susanne and her colleagues have started to focus on the malnutrition issue, identifying it among the elderly and the sick people. According to Susanne’s saying, people over 65 are all identified as malnutrition cases.
There are only 2 dieticians in Växjö municipality that can educate the chefs. It is a common problem in Sweden, many regions are lacking of competence in nutrition educating. This may affect the elderly or patients’ safety very much. For example, in hospital, nurses help patients or the elderly to order the food. If they do not know nutrition knowledge, then they will not know what food to order from the kitchen, such as the food with high calcium or with low. Also, at the elderly home or community service house, if the people do not know what they can eat, then the kitchen will never know how to deliver the right food to them. The same applies in the industry food; they need to know the nutrition as well, the right proportion of vitamins or proteins. As the menu planer, Susanne follows the guideline from the national level, because all municipalities need to use the same language. Meanwhile, Susanne recommend me if I want to build this service system in China, I need to think about the education issue at the beginning.
In this interview, Susanne explained to me that the elderly meal experience were made up of three parts. All of them are very important to the diners, food, meeting and room. If one is missing, it will affect the elderly’s appetite and their health as well, for instance, the meeting between the food delivery person and the elderly, or the social helpers who prepare the food for the elderly, all of them play role. Susanne told me that she is trying to work on each
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meeting point with the elderly, such as menu planning or food ordering at hospital. Because the chef has almost no chance to meet the elderly at all, it is very important for her to do this. She also recommend me that showing the nutrition proportion on the food package may enhance the elderly’s attentions and interests.
- Interview with Björn Lagenwall and Field Visiting in the central kitchen, Växjö
I spent a half day at Växjö hospital kitchen to interview Björn Lagenwall and I had a field visiting in the kitchen. Björn is the head chef and manager at the central kitchen, he has the responsibility to use all budget for delivering the good food and collect invoice once a month received from the client. He introduced me to the whole service process at his office including the computer system AIVO.
Figure 4. AIVO Computer System
AIVO is a computer system to set the menu with dieticians and communicate with other stakeholders, all the nutrition requirements can be visible in this system, following the dieticians' instruction to make sure all diners will meet their nutrients demand. As shown above figure 4, in this interface, there are many different requirements for different people on the left side, such as gluten-free and lactose-free to target such intolerances. Each of them has its own specific numbers of energy, protein, fat, vitamin, salt, etc. Björn set the menu based on those numbers, as shown below figure 5. The kitchen usually vary the recipe every 5 weeks with the same base because the meat taste changes every season.
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Figure 5. AIVO Computer System-Menu
Figure 6. Customer Journey Map of Meal Delivery Service in Sweden
Björn explained how the meal delivery service work every day, as shown above figure 6. In total, 2500 lunch meals will be delivered at lunchtime daily. There are 5 places needing to be delivered food by transportation, 2 kindergartens (day care centre for children), 1 local jail (in police station) and 2 restaurants (in mental
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hospital restaurant near university and Region Kronoberg headquarter). Björn told me that they have three cars (2 lorries, 1 car) to deliver these meals. It has been split up into 2 time periods to deliver the food due to the distance of different locations. The first leaves the central kitchen at 11:15 am and the next leave at 11:45 am. All meals will be ready at 9:30 am in the kitchen and start serving at 11:00 am. Besides the above places, 270-340 meals out of 2500 meals will be delivered to hospital patients in the same building with centre kitchen (figure 7). This service start from 10:40 am every day. The lunch ordering time is different. Outside of the building is start from morning, at breakfast time every day and stop time at 9:30 am, in the building placing the order is a day before.
Figure 7. Meals for Hospital Patients
In central kitchen, there are 20 chefs in total, they divide the workload according to workdays and weekends, mostly working every third weekends at the kitchen together, resulting in reducing the total number of working chefs needed per day. There are 16 chefs to prepare meals on workdays and only 5 chefs on weekends. Some food were cut in advance, which can save more time when there are fewer employees.
Under this kind of working management way, it can save much labour hours and budget. It good for the employees as well, they could have more resting time outside of kitchen.
Figure 8. Cooking Machines with program Figure 9. Fry Machine
In the kitchen, there many kinds of cooking machines, as shown above figure 8 and figure 9-Many of them are controlled by computer programs to cook food automatically. They have steam, fry, bake and grill functions. Except sauces and soups, many dishes are cooked by those machines in different programs.
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When the food cooking is finished, the chef will package it in a meal steel box (figure 10) and put the filled boxes on shelves (figure 11). Those steel boxes are not for serving, they are only for transportation to keep the food warm. They can be used for at least 20 years. Meanwhile, at the food destination, the social helpers, teachers, guard and nurses are all preparing before the food arrive, they will put the food on the dishes or in a nice bowl outside of those boxes for diners.
Figure 10. Meal Boxes Figure 11. Shelf for transportation in kitchen
There is a paper sticked on each meal box with the description of food such as the client’s preference and requirement, to make easier for staff to put it into the right trolley (figure 12). On each trolley there is a list with the printed destination and food category information (figure 13). The staff will read this information to make sure they do not make any mistake. Later when the drivers come, they will also find the list and pick up the right trolley through this list (figure 14). There is another sticker on the trolley to communicate with drivers that they need to wait when the trolley is not ready to be picked up. As shown below in figure 15, the
“Ej klar” means not finished in English.
Figure 12. Staff put meals into trolley Figure 13. List on each Trolley
Each trolley has a heat insulated box above and a cool box underneath. The temperature can be adjusted separately. The max temperature of a warm box is 80 degree and the minimal temperature is 60 degree, which is the perfect temperature for the food, as it must be over 55 degree. When cooking hot food, the temperature needs to reach up to 72 degree for killing bacteria. Because some patients are very weak, the risk is high they may die if bacteria exists in their food. For the cool box, the normal temperature is 5-8 degrees;
the breakfast, jam and dessert are put inside.
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Figure 14. Driver picking up Trolley Figure 15. Sticker on trolley
The cars are all isolated to keep warm and cool inside, there is a temperature control system in the cars, which can be monitored remotely by the office computer. Once a week, there will be an expert to put a device in the food randomly, to see what happens in the transportation or at destination. The box with the control device will have a sign on it: “don’t touch”. When the drivers see it, they know what it is for and will not delivery the box. Later Björn will get the report from the expert after the meal box is back. It aims to achieve a high quality food for diners, a perfect temperature and nice colour look, as the food colour will affect the diners’ appetite.
Figure 16. Menu sticked on the wall with comments
In the kitchen, there are many papers (figure 17) sticked on the wall: update menus with opinions and comments (figure 16), news, empty places for everyone here to communicate to each other. Björn uses this method to make the kitchen as easier, better, efficient as it can be. On every Monday afternoon Björn will organise meetings to take care of comments on the board, finding the way to improve the service. He explained to me that he demands staff and chefs who raise questions, to find the solution at the same time;
this will help to solve the problem more efficiently. On this wall, some of them are thank you card from the clients. The staffs and chefs are very happy to see this and may boost their working motivation.
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Figure 17. Feedbacks and Announcements sticked on the wall
In the kitchen, the waste is not taken way. The staffs will throw leftovers in the grinder (figure 18). The small knifes in grinder cuts the waste up, then water will flush it away automatically. There is a tank outside of the building which is connected with black pipes to store smashed leftovers and the tank will be emptied every second week. It goes out to factories making gas, in an ecological and sustainable way. However, these machines are very expensive, around 300,000 Swedish krona for one. There are only 2 grinders in Växjö city.
Figure 18. Grinder for waste
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Björn mentioned to me, supervising the system is the main part of his job, but he believes the rest is much more important, as going down to see the people working in the kitchen and listening to their complains.
Taking care of the human beings, getting to know the people and allowing people to know who you are makes everything work, by talking to them, being informed, taking care of problems. Björn said his work is all around human beings with thoughts, feelings and emotions. Not only diners but also employees’ emotions need to be taking care of too. They may get bored of cooking the same meals every day and need to follow accurate instructions. In the future, Bjorn hopes to meet directly to the diners instead of hearing their information from staffs. There will not be a fixed menu, so the diners can order the food they want, by a phone or an iPad. Instead of the kitchen telling the diners they should have this or that, they can have the right to choose what they want to eat.
- Interview with Thomas Thornell
Thomas is the vice director of social democratic party in Växjö, he usually works with the elderly. According to Thomas’ interview, the average age of the elderly in Sweden is 83. When they get old, people start to eat less, in Sweden, they call it “the lack of food”. The government has provided services to solve this problem.
There are two kinds of solutions, the one consists in most of the elderly ordering home delivery service and the other is to move to the elderly to care homes where they have chefs to cook in house. In the latter situation, the food is better than the delivery to home service.
There are around 511 seniors ordering the food service in Växjö while 7500 people above age 75 are making their own food. In the food delivery service, the elderly receive all packages food once a week. The reason why the municipality do not send the elderly hot food every day is that the elderly usually have the same time to eat meals, so it is hard for them to deliver the food at the same time. If the elderly do not eat the food immediately, the nutrition will lose away. Thomas prefers the elderly to heat the food by themselves, even if the food may taste not good, but nutrition is still there. They also deliver extra nutrition drinks for the elderly such as blueberry soup, because when the people get older, muscles will get atrophy due to energy loses.
Logistic and taste of the food are the two biggest problems in the delivery service. There is a grading system once a year sending survey to the elderly, some seniors’ relatives or children fill it for them if they cannot do it by themselves. The satisfaction in Växjö municipality was only 66% compared to the rest of Sweden that is 75%. In order to balance the food taste and nutrition at the same time, Växjö authorities are trying to find a way of improving the service quality. Because when the elderly get old, their taste gradually decline, so making the smell of food and air for dining become very important. The logistic complain was because the food deliverers wait only 20 seconds outside of the door when delivering to homes, if the elderly do not response in these 20 seconds, the food will be left outside, often in summer the food will get destroyed. Now they have changed the system to make sure the food goes to the right person. For example, a phone call ahead if the elderly is not at home or an agreement to delivery on a specific time every time. This change has provided more communications compare to before, which improved the satisfaction numbers recently.
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Another challenge for the food delivery service is coming from budget decline. In 2015, the budget for 2016 was 20 million krona cut. The solution to this problem is to help the elderly keep healthy and going out often. The municipality to afford taking care of the elderly in the long runs as long as the taxes are enough.
The pension system in Sweden is 65, and now the average age is 83. It is also a big pressure for the government. It costs 50.5 million from municipality to put into food service every year.
4.3 Senior living in China 4.3.1 Ageing population in China
Figure 19. Demographics of Chinese population
The data (figure 19) above was gathered from United Nations Department of Economic and Social Affairs. 34 It shows China has a population of 1.38 billion people, which includes the largest ageing population in the world. There are currently 209 million people aged 60 years and over and 22 million people aged 80 years and over. While the total population of China is expected to stand still, the proportion of people aged 60 years and above will rise from 209 million to 492 million while people aged 80 years and over is expected to increase from 22 million to 120 million in 2050. As we can see, when it comes to the 2050, there will be a double amount of ageing population compared with 2015. The growing amount of ageing population makes the society to think about the specific needs of the ageing group. The population ageing is poised to become one of the most significant social transformations of the 21 century, including the labour and financial markets, the demand for goods and services, such as housing, transportation and social protection, as well as family structures and intergenerational ties.
The data from United Nations has presented in China 2010-2050, there will be a projection period of 35 fertility variant. It can show us there will not enough workforce due to lacking of young people when it comes to the 2050. The primary reason of this consequence is due to one-child policy which has greatly impacted the fertility rates, as shown in figure 20 below.
'Aged Care Investments In China | Ansell Strategic’, Ansell Strategic, <https://www.ansellstrategic.com.au/aged-care-investments-china/> accessed 17 April, 2017.
34
United Nations Statistics, World Population Prospects, Volume-II-Demographic-Profiles, 2017, <https://population.un.org/wpp/Publications/Files/WPP2017_Volume-II-Demographic-Profiles.pdf>, accessed 5 May
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2017.
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Figure 20. Medium fertility variant in period 2010-2100, China
Another consequence of the government’s one-child policy has resulted in the emergency of “4-2-1” family structure (a single child requiring to support two parents and four grandparents) placing a heavier burden 36 on children to be able to support their parents/grandparents. In Asian cultures, there are traditional and social expectations that the children/family will take care for elderly people. With a rapidly ageing population, the ability for children to fulfil these expectations will become increasingly difficult.
All rapid shift in the country’s demographic composition will present itself with a number of challenges in the future. Although the demand drives for aged care services is strong in China, the service sector for seniors is still in its infancy. A research from Ansell Strategic Pty Ltd has reported there are currently 37 40,000 aged care institutions with approximately 5.7 million beds, representing approximately 27 beds per 1,000 elderly people. Even by 2020, the Chinese State Council plans to reach a target of 35 to 40 aged care beds per 1,000 elderly people. It shows that there is still a significant shortfall. The example of Ansell Strategic Pty Ltd shows that there are many different perspective demands of the elderly in the future.
4.3.2 The elderly situation in China
Figure 21. Elderly situation in China
The national level solution 9073-policy from China government was started in Shanghai in 2011. Literally, 38 it means 90% of the aged live at existing homes with assistance of service and care, while 7% of the aged move to new senior communities where age services and care are provided, and 3% of the aged live in special aged institutions, as shown above figure 21. Under this guideline, there are three types of spatial developments: nursing institutions, community service facilities and home modifications.
Denis Green, 'Elderly Care: Coping With The 4:2:1 Problem', China Outlook, 30 July, 2014 <http://chinaoutlook.com/elderly-care-coping-with-the-421-problem/> accessed 5 May 2017
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'Aged Care Investments In China | Ansell Strategic’, Ansell Strategic, <https://www.ansellstrategic.com.au/aged-care-investments-china/> accessed 17 April, 2017.
37
Keng Hua Chong and Mihye Cho, 'Creative Ageing Cities. Place Design With Older People In Asian Cities’, Routledge Ltd, New York, 2018, part V.
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