With 280 million people over the age of 60 (19.8% of total population) and 210 million above 65 (14.9% of total population) by the end of 2022, China both enjoys and faces the challenges of an increasing life expectancy. Adding (quality) life to years became crucial to the stability and vigor of the whole society. Despite continuous healthcare reform, China's existing model of care still focuses on the diagnosis and treatment of diseases. 51% of China's medical insurance budget is spent on 5% of the beneficiaries who are more aged (average age 61) with higher prevalence of multimorbidity (4.2 diseases on average). Not only are they utilizing more medical resources, it is also estimated that long-term care cost for older adults in China will reach CNY¥1 trillion by 2030 and increase to over CNY¥5 trillion by 2050. The combined health and care costs of those above the age of 80 can amount to 14.4 times that of people between 65 and 74 years of age. At current rate, the number of care dependent older adults in China will grow from 42.5 million in 2020 to 63 million in 2030 and 96 million in 2050 (CSSB, 2021), presenting enormous challenges to care financing, provision, quality and equity. While China committed to the goal of building an active, healthy-ageing society, it was in urgent need for an innovative care model which can fundamentally change people's mindset towards age and ageing, offer a cost-effective and equitable solution to the major burden of care dependency in old age, a program that can be adopted by different stakeholders while aligning their efforts.

Older people in general, Older people with chronic health conditions or disability, Older people with vulnerabilities, Both older and younger people

Education, Health, Information and Communication, Labour, Long-term care

Government, Civil Society Organization, Academia, Health Care, Social Care, Private Sector

Older people were part of the process at multiple or all stages

The China ICOPE Pilot project implementation was supported and monitored by a cross-sectoral steering committee consisted of representatives of Ministry of Civil Affairs, National Health Commission, National Healthcare Security Administration, National Committee on Aging, National Research Center on Aging, Beijing Bureau of Civil Affairs, Beijing Health Commission, Beijing Healthcare Security Administration, Chaoyang Elderly Care Service Center. The Steering Committee and a multi-disciplinary panel of advisors met every three months to discuss key challenges in the process and advise on important milestone decisions. The pilot was implemented through a network of 213 partner organizations including 36 departments/centers of 19 hospitals, 109 community health service centers, 37 community care stations for the elderly (12 government agencies and 25 run by civil society organizations). A geriatrics interdisciplinary team including departments or units such as emergency, geriatrics, nursing, psychology, nutrition, cardiovascular, neurology, neurosurgery, orthopedics, oncology, rehabilitation and pharmacy are coordinated to provide guidance and support to the health and care teams in primary care settings. The ICOPE Pilot support system helped different roles follow the ICOPE care pathways and share care plan implementation data

For older people, the impact of China ICOPE Pilot included changes in both their ideas and behaviors. It gave them a focal point (integrated care managers) for their health needs, introduced new definition of age and ageing, improved their understanding of healthy ageing and the value of it, and demonstrated the possibility to restore/maintain physical and mental functions regardless of their age. For families of older people, the pilot gave them a new perspective to see their elderly and plan for the future, offered a helping hand that could bring family members peace of mind, support them in caring for their elderly. For communities, the pilot was a concrete example of how innovative models could be implemented by empowering both providers and recipients of care. Through the accumulated evidence, the value of community engagement could be quantified and then promoted

For many months, we encountered misunderstanding and ignorance. The terms "integration of medical and social care" (医养结合) in China mainly referred to adding medical arms to nursing homes, or offering long-term care by hospitals. The concept was institution-oriented rather than person-centered. In order to disrupt relevant definitions and practice, we worked with government, research, education, health and care organizations, leveraged traditional print and TV media as well as social media to communicate about the concepts, through expert webcasting, seminars, training sessions, etc. We created and kept updating materials for different audience, distributed folders and small tools to help people learn more about intrinsic capacity, healthy ageing and self-care. Another major issue we faced were the heavy workload of healthcare professionals during COVID-19 pandemic. We tested and introduced tele-care that could better utilize fragmented pieces of time for integrated care managers to carry out or monitor the implementation of care plans, with more emphasis on the empowerment of older people and their families. We kept pushing for reduced burden of care because of the pandemic challenge, which might have longer-term impact as part of the new normal

The empowerment of older people and their family members. It is said often that individuals should be responsible for his/her own health. When it comes to older adults, ambiguous advice such as "eat more protein", "be careful when doing physical exercises" might not be easy to follow. With the China ICOPE Pilot, we used locally adapted care pathways to develop personalized care plans which give very detailed, specific action items for older people and their family members or caregivers to follow, with a call center to answer their questions or provide online/offline support. The high satisfaction rate among participants demonstrated feasibility of such an approach. The sustainability of impact through capacity building. We intentionally invited many partner organizations with diverse disciplines at multiple levels in the health and social care system to join the pilot. By offering standardized, modulized training that could be tailored to different backgrounds, the talents who went through the program could adapt to the integrated care approach rather quickly, and agreed to continue even beyond the pilot period. The endorsement of a higher purpose. There were many mistakes made in carrying out the first pilot, and new issues occurred often. We did design an incentive plan in the pilot program, yet for those who had been kept busy by pandemic-related tasks, the financial incentives were too little to be effective. However, as the pilot was part of the Decade of Healthy Ageing initiative with a potential to leave broader lasting impact, such endorsement attracted more partners and talents, and kept us going when facing tough challenges.

There is a virtuous circle of the UN Decade of Healthy Ageing and the China ICOPE Pilot. The initial discussion of potentially piloting the ICOPE program in China came from the proposed action areas of the Decade. Being part of the Decade gave the pilot program the endorsement to secure multi-stakeholder support and central government funding. Once the Decade plan was fully articulated and understood, the pilot became a great opportunity to put all the concepts and plans in action. It was concrete enough with previously accumulated evidence to be adapted and deployed in local settings, which gave everyone involved in the promotion of the Decade a clear roadmap to follow. Public educational campaigns before and during the implementation of our pilot program, and seminars of the initial pilot findings and suggestions that were organized afterwards, also contributed to increasing awareness, knowledge of the Decade and inspired the design of many more relevant programs