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All Aboard! This Is the China CCRC Express!

"It took more than one man to change my name to Shanghai Lily," purrs Marlene Dietrich in Josef von Sternberg's film 1932 adaptation of Harry Hervey's book Shanghai Express. She certainly has her well-manicured talons sunk into more men than she can count in this exotic far-Eastern, chiaroscuro-cinematographic adventure. Among her fellow passengers on the Shanghai Express are her disenchanted former fiance', unshakable British medical officer Clive Brook; over-zealous missionary Lawrence Grant; dope smuggler Gustav von Seyffertitz; and enigmatic Eurasian businessman Warner Oland. Coincidently, Oland made frequent appearances in other China-themed movies, most notably as Charlie Chan, the benevolent and heroic Chinese detective based in Honolulu as well as a future movie character for this article.

As the train chugs through the more treacherous passages of war-torn China, Oland reveals himself as the leader of a rebel group, who plans to hold the passengers hostage to secure the release of his imprisoned constituents. In Boule de Suif fashion, Dietrich, who portrays a notorious "Chinese coaster" has remained sexually remote throughout the trip, gives herself to Oland to save the life of Brook, the man she truly loves. Directed by Josef von Sternberg at his most orgiastic (check out the long, lingering dissolves!), Shanghai Express is 80% style and 20% substance.

Tickets, please....

This article is about China's 3 largest and most visible geriatric care developments to date. I warn you in advance, this article is painfully long but the information conveyed is important for those interested in senior living in China. Each of these projects has been in the market for at least 2 years and in one case nearly 5 years. I call them CCRC's (continuing care retirement communities) because, well, that is what they set out to be and in some part that is what the developers have accomplished...or, better yet, are clearly struggling to accomplish. One of these developments had the benefit of limited foreign assistance, the others did not. The one that did clearly benefited and consequently has the best aged-care program in China today. All are chugging along with common weaknesses and each has their strengths. In sum, it is a mixed bag and to the inexperienced eye (read: China senior living experience, not western senior living experience; I say this as nearly all western geriatric care practitioners who see their first China project immediately conclude that all China senior care is a train wreck) it might seem as if the idea of senior living in China is just on the wrong track. But it is early and the train hasn't left the station, at least not just yet.

Those who seek to conduct the senior care business in China are well advised to remember a few important rules of the China elder care experience: first, China senior living is where Western geriatric care was in 1950 but gathering steam quickly; second, never judge a project out of context, meaning: comparing a project in Chongqing to a project in Santa Barbara is meaningless as the buyers of the Chongqing project don't have that choice much less that perspective; third, the higher one stays in the acuity chain, the more leverage one has...which translates into success; and finally, stay in the 1st class coach, period.

Before this train departs, I would like to make one last observation. My thoughts below are a mildly critical analysis bordering on subjective evaluation and at times, some literary lampooning. Lest I be detained by the People's Senior Living Police at Beijing Nan Zhan (FYI: an enormous train station), I beg merciful consideration that these contemplations be seen not as cruel condemnation, malicious denigration, negative commentary or, heaven forbid, Confucian blasphemy of any CCRC discussed here or China's senior living potential in general. Quite the contrary, I am no apostate; I see a bright future and if these three communities are indications of what the Chinese can accomplish right out of the box, then the next decade will be outstanding for professionals in the China geriatric care business.

And finally, as the whistle blows, for those readers not entirely familiar with a CCRC, they are usually defined as a campus style residential complex assembling a mix of independent living residences for active but senior adults, assisted living units for older adults needing some support with their daily activities and skilled nursing care for frail or infirm adults requiring frequent assistance or acute medical care. Additionally, there are often a variety of cultural amenities, exercise facilities and commercial support services which offer basic necessities and provisions, such as hair salon, laundry/dry cleaners and variety store.

First stop, General's Garden.....General's Garden!

When I first visited General's Garden nearly two years ago, I thought, "This is it....modern senior living has indeed arrived in China". But after my fourth trip and some pretty rigorous investigation and analysis, I began to see the cracks in both hardware and software, in a sense, the General's Garden's locomotive was running out of steam.

General's Garden was opened to the public around 2009. It is located in the northeast quadrant of Beijing (off 4th ring road), not far from Beijing Capital International airport and the Museum of Film. The land was Ministry of Transport land and the property's perimeter remains a testing track for China's high-speed railway (true). I refer to General's Garden as a CCRC as it loosely embodies a simple definition of a CCRC, as outlined above. Indeed, General's Garden offers 51 villas or large townhouse style residences with private gardens, 160 independent/assisted living apartments and 280 skilled nursing units all within a gated compound. This facility also offers a 3-hole golf course (plus driving range), an unusual, man-made forested park, an unfeasibly large and as of yet unfinished 17,000m2 hot-spring clubhouse, an 160 room inn for visitors and a clinic specializing in traditional Chinese medicine.

So what happened? Well, as of January 2012, only 14 of the Villas had sold and less than 10 residents purchased golf course memberships (which by the way, through October of last year, boasted an expensive, resident Australian PGA Pro to give lessons to all those resident members) since the opening 2 years ago. I would get into detail about the amenity membership program but it is way too complicated (ex. Golf course membership is priced on ball usage). The villas ranging in size from 700-800 square meters, carry a price tag of between RMB 45 million and RMB 55 million for unfinished space and the IL/AL units go for RMB 1.5 million plus services on an as needed, menu basis. And while the IL/AL living apartments and the skilled nursing units are fairly well occupied (75%-80%), there are likely a number of reasons for the stalled performance of the villas. As an aside, I have to note that the best thing about General's Garden is the aged-care program; it was set up by an Australian group and they did a superlative job. Until recently, an Australian also continued to manage this section of the facility; he has a great deal of experience and insight into how Chinese seniors need/want geriatric care. Kudos to this master of the China senior care experience! Our access to General's Garden's business plan has allowed us to tabulate much of their rental and sales data which we share with clients.

Unlike the Little Engine That Could, ("I think I can, I think I can...") the General's Garden villas have never made it up the hill. I believe this is because:

1) the land on which the facility is built is known as "collective land" which does not convey fee title to the buyer, only a long term lease (approximately 50 years for either a villa or an IL/AL unit). Consequently, potential purchasers are faced with an unappealing opportunity to buy an enormously expensive, depreciating asset which under Chinese law cannot be hypothecated,

2) General's Garden never seemed to have a comprehensive marketing plan and buyer outreach program other than pursuing the ownership's network of political contacts for unit sales, and

3) perhaps the least understood aspect of the facility, its capitalization and financial game-plan which seemed, at best, ad-hoc. Beginning early last fall the warning signals were as subtle as a diesel engine's piercing whistle at 4am: contractors stopped receiving payments and construction stopped on the remaining units and clubhouse, there was a sharp increase in deferred maintenance, a hostile takeover occurred and subsequently, most senior management ceased receiving paychecks.

On the other hand the IL/AL units are comparatively speaking a success. And while ownership, meaning title conveyed, of such a unit is no different than that with a villa, they are much less expensive (in fact they are well priced at an average of RMB12,000m2). It is interesting to note that there has been a trend of older adults buying these units for their children to live in.....however odd. Despite its raison d'etre as a CCRC, no writ of Chinese law prevents young people from living there. I guess this is an indication of the facility's pricing as much as its attractiveness, or more likely, the parents intend to move in at some future date.

In late January 2012, new management at General's Garden, reeling from the enormity of their poorly analyzed, hostile acquisition, fired 12 persons many of whom were experienced senior managers. The terminal analysis is likely that General's Garden neglected to fully understand their market, didn't identify a target buyer and never adequately projected unit absorption against capital requirements to identify a breakeven point; a lethal mistake.

I will say though, in all fairness, this review of General's Garden must contain praise for the original management whose fundamental concept of this CCRC is a sound, well integrated facility; it is just the execution and some software that jumped the track. I have met the previous General Manager and those in his inner circle and believe he/they are talented people capable of positively impacting the senior living industry in China. His early efforts at the facility are proof of this and had it not been for the hostile take-over, General's Garden would continue to benefit from his leadership and likely turn the train around. However, without him General's Garden lacks vision and perspective; it faces a number of critical switches in the track ahead.

A fellow writer recently wrote a piece on this facility using a favorite song of mine to illuminate the bridge over troubled waters that General's Garden presently crosses and more importantly, its choppy history. I find his story on target and I salute his perspective; he has taken a measured approach to this facility's analysis. De-accelerating and moving forward less hurried is always a good thing in China.

At this point, I will step away from rock 'n roll metaphors and, given the time of year, select a more solemn reference as a testament to this facility's narrative. With its fall from grace, perhaps we can call General's Garden and its story, "The Prodigal CCRC", a parable of squandered opportunity; now lost, can and better yet will, General's Garden atone for its marketing and financial sins and find its way again?

Yanda....next stop......Yanda!

Now this is a facility to behold. While its full name is a mouthful, Yanda Golden Age Health Nursing Center, the facility is frequently referred to as Yanda. One arrives at Yanda entering under an enormous, ceremonial gate and into a Tiananmen Square-like plaza large enough to park 500 tractor trailers. After parking your car, walking around Yanda is, frankly, a little creepy and reminds me of the cities created in the narcotic-induced dreams of Dom Cobb in Christopher Nolan's Inception,.......beautiful, large, vacant and crumbling.

Yanda's first impediment is its location, situated a hard hour's drive from Chaoyang district, Beijing in adjacent Hebei province, it is tough to get too. Second, Yanda simply is overbuilt. So much of what has transpired at this facility is unclear, even the basic facts such as room count and beds are, in typical Chinese fashion, opaque. We are told there are 1,200 units at Yanda, but it feels like more. There is a 3,000 bed hospital and a 200 bed geriatric nursing facility which, management professes is quite busy but there aren't a lot of cars in the parking lot and not a single ambulance arrived during my 3 hour tour (I arrived at lunch time). But hey, I won't let my lying eyes fool me, I saw not a single patient in the nursing care center. Wait...there is more: a 250+ room hotel and four places of worship (seriously): Buddhist, Muslim, Christian and Jesuit/Catholic all sited next to a bank (presumably for those whose faith favors Mammon). And if that isn't enough, ownership built a 30 story building that serves as living quarters for the healthcare workers who will, hopefully, arrive someday soon. Whew! What a budget!

Truly statuesque, in the lifeless sense of the word, this project should be renamed the "Colossus of Hebei" as colossal is the only term that adequately defines Yanda (well, maybe "stalled" has relevance here as well but lacks a certain visual "onomatopoeia"). Now, when confronted with the enigmatic and incomprehensible my imagination always runs wild. In fact, Yanda inspired in me a rewrite of those last few dreadful lines from the famous Shelley poem Ozymandias:

 

"....My name is Yanda, King of CCRC's: Look on my campus, ye mighty, and despair! Few residents remain. Round the decay of that colossal wreck, budget-less and bare, the congested Chinese conurbation stretches far away".

 

In all seriousness, here is the punch line: Yanda is only 20 percent occupied and it could well be less. I take this fact on face value from what we are told by the tour guide. But having been there at lunch, my favorite time to visit a facility as it reveals a lot, there certainly wasn't too much activity.

This is what we do know about Yanda: unlike General's Garden, Yanda is a pure rental scheme. Most occupants lease units on a year basis, but management also quotes 2 and 3 year options. Independent and assisted living units (1 and 2 bedrooms) rent for RMB 5,600 to RMB 9,600 per month plus services which can be selected from a menu. The nursing facility offers beds/units beginning at RMB 13,600 to RMB 16,800 per month, also depending on size and acuity. There is also another quirk to the pricing; the sponsor offers a kind of sinking fund whereby if you deposit sufficient monies with them, they will pay a 6% return on your money that is equal to your monthly rent (the number of takers for this generous offer is unknown). The young lady who showed me and my staff around, gave us the above 'rack rate" pricing (and a sheet with greater detail on it) but was eager to mention that we are very lucky customers and our visit today was auspicious; management has instructed her to offer high status individuals, such as ourselves, a one-time only, VIP discount of 40% on a full year lease for IL/AL units and a whopping 60% discount for nursing units. Days later, subsequent phones calls to verify information were met with the same offer. Ok.....no surprise here.

Yanda opened up in 2010 and blew its steam before getting out of the station. The ROI has to be hurting by now and somebody is likely to take a loss going forward. It isn't an ugly project, in fact I found the basic design "ok" by China CCRC standards; but somebody has to take control of the marketing here, drive absorption aggressively and simplify the rental scheme before the buildings fall apart resolving the problem forever. This is the only prospect here: try and compete on price and program in an attempt to overcome Yanda's real weakness: location. Believe it or not, there is land allocated for a phase II....someday.

Cherish Yearn, last stop.......everybody off!

This facility's operations are as curious as its name. Located in a distant corner of Pudong, on a former duck farm, Cherish Yearn came to market about five years ago. It was an early arrival to the China senior living space and its organization, facility design and ambience all reflect its vintage. I first visited Cherish Yearn in late 2010 and quite honestly, I thought it was a disaster. From the desert like landscaping to the mold-stained stucco on the buildings it had little ambience, few residents and zero energy.

Cherish Yearn was completed in 2006 and the first residents occupied in 2007. For years it struggled with occupancy and when I returned for a second visit in early 2012, I was pleasantly surprised. Apparently, over the past two years, a new marketing program was implemented and brought census up from a low of 20% to what is reported now as nearly 80%; and after my tour I believe the true figure is not far from this level. Activity rooms are busy with geriatric calligraphers, libraries are full of bespectacled Mandarins gazing over the Central Committee daily and even the computer rooms are full of elderly Chinese pecking away on keyboards. Indeed there is so much activity at Cherish Yearn its resurrection earns it a new name: the "Lazarus of Pudong"...so there is indeed hope for The Prodigal CCRC and the Colossus of Hebei.

Like its sister facilities, Cherish Yearn is large. It offers nearly 800+ units in 15 different mid-rise buildings. Independent living accounts for at least 600 units and there is a 300 bed nursing facility. The independent units have a reported 80% occupancy but it is entirely unclear how many residents are in the nursing facility. Access to the upper floors is prohibited but the first floor, which does indeed have patient rooms, reveals no activity whatsoever and is largely dark.

Cherish Yearn's business model is founded on a membership scheme with an upfront fee and annual rental payments plus usage charges for the clubhouse and other amenities such as the dining hall. There are 2 basic plans: Plan A essentially confers title to the occupant for an entry fee of RMB 890,000. Once admitted, the resident may choose from 3 basic size units: large units (108m2 or 1150ft2), medium units (70m2 or 740ft2) and small units (58m2 or 625ft2) each of which charges an annual fee according to size. A resident who has purchased a unit under Plan A may sell the unit himself at some future date or offer to the sponsor who will re-purchase it for 90% of the entry fee or market price, whichever is less. Plan B confers a 15 year right of use for an entry fee beginning at RMB 880,000 for a large unit, the smaller units have lower entry fees; there is also a static annual fee of RMB 29,800 across all unit types. Plan B's entry fee is refundable on a straight declining basis (calculated monthly) over the 15 year lease period.

Plan A seems to be most popular with children who wish to purchase a unit for their parents and Plan B seems to be the choice for elderly who buy for themselves. There are substantially more Plan B buyers than those who avail themselves of Plan A. We have completed a full tabular analysis of Cherish Yearn's fee structure which, again, is available to clients.

It is fair to mention that in the past, Cherish Yearn experienced some controversy over both its fundamental ability to offer sub-acute care services as well as its adherence to the original land grant use rights. The issues here may have been cleared up but there has been at least one published article in the media discussing the facility's "land rights" issue the details of which was supported by a credible, well connected source who has since spoken to me directly. In some quiet corners, rumors persist regarding the facility's legality, but in the end, I can see how this may just be envious chatter over Cherish Yearn's unprecedented success. Let's not forget, the truth in China has many layers.

So, in submissive genuflection, I offer faithful congratulations to the Lazarus of Pudong. Despite all, I believe it to be the most successful CCRC project today in China and its program is unique: truly a Chinese sui generis model.

The Terminus

Shanghai Lilly's assertion regarding the time and effort it took to secure her reputation whistles true and sharp about many endeavors in China; virtues such as patience and fortitude are essential. Likewise, it will take more than just a few attempts at CCRC development to perfect the model in China. CCRC's are complex undertakings and even in the West, developers with all their access to data and experience often misstep and build mistakes. So it is no surprise that the Chinese incarnation of a CCRC is a wobbly work in waiting. While I see near term success for the smaller, sub-acute facilities currently being built along the east coast of China by both foreign experts and local developers, nothing will dissuade, much less disabuse, the Chinese entrepreneur from pulling the heavy freight of a senior living mega-project. These immense CCRC's may be the track the industry ultimately takes, but for now were I an investor or owner/operator; my concentration would remain focused on the light at the end of a tunnel: more manageable, higher acuity and, say, narrow-gauge projects; let's call them the "Shanghai geriatric express".

In closing, I have taken this article's theme, meaning Chinese films or films with a China theme, quite far...in fact I have extended it further than I ever thought. And this posting was indeed the longest of all postings to date; I did pile it on you, the reader, with endless literary metaphor on top of a mildly amusing allegory, and for this I have not a single pang of guilt. And while I often wonder about Jiang and her whereabouts, I needed to get back to the mechanics of senior living in China; thus the nuts and bolts of this post. No worries, we will revisit the human side of this business again soon and some! I have two more postings of this ilk remaining which I will publish before the summer. After a break, I will return in September with something new and refreshing, but if you have an idea or are curious about an aspect of this business; as always, I am only too happy to listen.

Bromme is President of Hampton Hoerter China, the leading healthcare management consultant, capital raise boutique and senior living advisor in Asia. While Bromme spends most of his time in China, he can also be found in his Hong Kong office or on the beach in Amagansett, NY with his family. Email Bromme at [email protected]