Integrating Medical Care and Elderly Care in China: Making Yiyang Jiehe Work in Practice

An older person in China may leave hospital after treatment for pneumonia, stroke or a fracture with no further need for acute inpatient medicine but a substantially greater need for everyday support. They may require rehabilitation, medication management, help with bathing, closer observation or temporary nursing input. If those needs are divided between separate health and elderly-care systems, the person and family can become responsible for reconnecting services at precisely the point when they are least able to do so.

This practical gap sits at the heart of yiyang jiehe, the integration of medical care and elderly care. Across the China Ageing, Long-Term Care & Community Support Knowledge Hub, the wider challenge is how an ageing population can move more coherently between prevention, treatment, rehabilitation and long-term support. Medical–eldercare integration is one of the mechanisms through which China is attempting to connect those stages.

The policy direction is now well established and continues into the 2026–2030 period, with national planning supporting medical–eldercare services, community-supported home care, home medical services and stronger care for older people with disability or dementia. Yet integration is not achieved simply by adding a clinic to an elderly-care institution or signing a cooperation agreement with a hospital. The operational test is whether responsibility, information, workforce and funding follow the person when needs cross organisational boundaries.

Yiyang jiehe addresses a structural divide between treatment and daily support

Healthcare and elderly care solve different problems.

Healthcare diagnoses, treats and manages disease. Elderly-care services help people manage daily life when function, mobility, cognition or stamina have declined.

For many older people, those needs coexist.

A person with heart failure may require medication review and clinical monitoring while also needing help with dressing and meals. Someone recovering from a hip fracture may need rehabilitation alongside temporary home support. A resident in an elderly-care institution may develop an infection requiring medical assessment without needing permanent hospital admission.

The difficulty arises when each system treats the other as external.

Hospitals may discharge people once acute treatment is complete without sufficient visibility of what support exists at home. Elderly-care providers may recognise deterioration but lack rapid access to clinical advice. Families may carry messages between organisations because records and responsibilities do not move with the person.

Yiyang jiehe is therefore less about institutional merger than functional connection.

The stronger model allows medical and elderly-care services to remain professionally distinct while operating through dependable interfaces.

China has developed several routes to medical–eldercare integration

There is no single national operating model for yiyang jiehe.

Different localities and organisations combine healthcare and elderly-care functions in different ways according to local infrastructure, provider capability and population need.

Common approaches can include:

• elderly-care institutions establishing or incorporating medical services where permitted and appropriate;
• medical institutions developing elderly-care or rehabilitation functions;
• elderly-care institutions establishing formal cooperation with nearby healthcare organisations;
• community and primary-level health services supporting older people receiving care at home;
• home medical, nursing and rehabilitation services extending professional support into households; and
• digital and remote arrangements connecting local services with specialist expertise.

These models are not interchangeable.

An institution with substantial nursing capacity may be able to manage more health needs internally. A smaller community elderly-care service may depend on strong links with a nearby community health centre. Rural areas may use township health centres and county hospitals differently from large cities.

The relevant question is therefore not which organisational model appears most integrated on paper.

It is whether the chosen model creates timely access to the right expertise.

Integration should not turn elderly-care services into hospitals

One of the risks in discussing medical–eldercare integration is assuming that stronger healthcare involvement means making elderly-care settings increasingly medicalised.

That is not the objective.

An elderly-care institution remains a living environment, not merely a lower-intensity hospital. Home care remains support delivered in a person’s own dwelling. Community services should continue enabling participation, independence and ordinary daily life.

Medical input should strengthen those environments without allowing diagnosis and risk management to dominate the person’s identity.

This distinction is especially important for people with multiple chronic conditions.

They may require regular medical oversight while still valuing routines, family contact, social activity and personal choice more than frequent clinical intervention.

The wider principle of person-centred planning for older people therefore remains fundamental. Integration should make healthcare easier to access around the person, not reorganise the person’s life around healthcare.

Primary-level healthcare is central to making integration scalable

China cannot integrate elderly care with medical services primarily through major hospitals.

The number of older people living with chronic disease is too large, and many needs require continuity rather than highly specialised episodic treatment.

Community health centres, township health centres and other primary-level services therefore have a strategically important role.

They can support chronic disease management, routine medical follow-up, medication review, basic rehabilitation and early identification of deterioration close to where older people live.

This is particularly important for people receiving home and community-based elderly care.

If every new symptom requires a hospital journey, integration remains weak irrespective of how many formal cooperation agreements exist elsewhere in the system.

Primary-level healthcare can create a more accessible bridge between everyday elderly care and specialist medicine.

But this depends on sufficient workforce capability and clear escalation routes.

Local practitioners need to know which conditions can be managed close to home and when county or higher-level hospital input is required. Elderly-care workers need to know how to reach those practitioners when concerns arise.

Operational scenario: deterioration identified by a home-care worker

An 82-year-old man receives assistance with meals and bathing at home. He has chronic heart failure managed through local healthcare services.

During several visits, his care worker notices that he is becoming more breathless and that his lower legs appear increasingly swollen.

The worker is not expected to diagnose the cause.

In a fragmented system, she may simply tell the family to arrange a hospital appointment. The family then decides whether the change is serious enough, potentially delaying assessment.

In a stronger integrated pathway, the worker has a defined escalation route to the local health service. A clinician reviews the man, identifies worsening fluid retention and adjusts treatment before an emergency admission becomes necessary.

The elderly-care service then receives updated information relevant to daily support, including signs that should trigger further escalation.

The value of integration lies in the sequence.

A non-medical worker notices functional or physical change, reaches an appropriate medical professional, and receives enough information back to continue safe support. Neither service attempts to replace the other.

This type of boundary management connects directly with the broader theme of multi-agency working. The quality of care depends on whether different organisations can act together without blurring professional responsibility.

Hospitals remain important, but discharge is where integration is tested

Hospitals will continue to play a major role in the care of older people with acute illness, complex diagnostics and specialist treatment.

The integration challenge appears most clearly at discharge.

Medical stability does not necessarily mean functional recovery.

An older person may no longer require a hospital bed while still being unable to manage safely at home without additional support.

This creates a critical interface between healthcare and elderly care.

A strong discharge pathway needs to identify what has changed, not simply what treatment has been completed.

Relevant questions include whether the person can transfer safely, manage medication, eat and drink adequately, use the toilet, understand instructions and resume their previous living arrangement.

Where those abilities have changed, elderly-care and rehabilitation arrangements may need to begin immediately.

The broader theme of hospital discharge and step-down for older people is therefore central to yiyang jiehe. Integration becomes meaningful when discharge planning follows the person beyond the hospital door.

Rehabilitation is one of the strongest bridges between the two systems

Rehabilitation sits naturally between medical treatment and long-term support.

After stroke, fracture, surgery or serious illness, some loss of function may be recoverable.

If rehabilitation is weak or delayed, temporary dependency can become permanent. If long-term care assumes that every post-hospital limitation is fixed, the system may inadvertently reinforce loss of ability.

Conversely, rehabilitation cannot replace ongoing support where substantial impairment remains.

A mature integrated model therefore combines restorative and compensatory approaches.

Therapists may work towards improving mobility or self-care while elderly-care workers provide the assistance still needed today.

As function improves, the balance between the two can change.

This requires communication.

Care workers need to understand which activities the person should continue attempting independently. Rehabilitation professionals need information about how the person manages between formal therapy sessions. Families need realistic expectations about what recovery may look like.

Integration is therefore partly a shared understanding of goals.

Elderly-care institutions need dependable clinical relationships

Many residents of elderly-care institutions live with chronic illness and increasing dependency.

Some institutions have incorporated medical services. Others rely on relationships with external healthcare organisations.

Either model can work if responsibility is clear.

The risk arises where the institution assumes the healthcare provider is responsible for a problem while the healthcare provider expects the elderly-care team to manage it.

Medication changes, wound care, deteriorating cognition, recurrent infections and end-of-life needs can all expose those boundaries.

Formal cooperation arrangements therefore need operational substance.

They should clarify how routine medical review is accessed, what happens when a resident deteriorates, how records are shared appropriately, which organisation provides particular interventions and how emergency transfer is handled.

A signed agreement without these practical pathways may demonstrate partnership administratively while providing little additional protection to residents.

Operational scenario: reducing unnecessary hospital transfer from an elderly-care institution

A resident in an elderly-care institution develops a low-grade fever and increasing confusion overnight.

The institution’s care team is concerned but uncertain whether hospital transfer is immediately necessary.

In a weakly connected model, staff may call emergency services because there is no timely clinical alternative. The resident is transferred to hospital, assessed and later returned after treatment for a relatively uncomplicated infection.

In a stronger medical–eldercare arrangement, the institution has an established route to medical assessment. A clinician reviews the resident promptly, determines that treatment can initially be managed in the institution and sets clear escalation criteria.

The care team monitors hydration, temperature and cognition while the medical professional remains responsible for clinical treatment.

If the resident deteriorates, transfer proceeds without delay.

The purpose is not to prevent hospital admission at all costs.

It is to ensure that transfer occurs because the person requires hospital-level care rather than because the elderly-care setting lacks access to clinical advice.

The scenario also highlights why integration can improve continuity and reduce distress for frail residents where safe treatment closer to their living environment is possible.

Workforce boundaries need to be explicit

Medical–eldercare integration creates new opportunities for teamwork, but it can also create unsafe ambiguity about roles.

Elderly-care workers should not be expected to perform clinical tasks beyond their competence simply because healthcare is being brought closer to the care setting.

Likewise, nurses and doctors should not become responsible for every aspect of everyday living support.

Integration works when different professional roles become better connected, not when they become indistinguishable.

This places greater importance on training, supervision and escalation.

Frontline elderly-care workers need enough health literacy to recognise changes that require professional review. Nurses working across medical and elderly-care boundaries need clarity about clinical responsibility. Rehabilitation staff need to communicate goals in ways that care workers can apply safely during everyday support.

The broader older people’s workforce and practice competence agenda is therefore integral to yiyang jiehe.

Integration cannot safely expand faster than the workforce’s ability to understand and operate within new interfaces.

Information has to travel with the person

Integrated care becomes difficult when healthcare and elderly-care organisations each hold partial information.

A hospital may know the person’s diagnosis and medication changes but not how they function at home. A home-care provider may understand mobility and daily routines but not know that a clinician has changed treatment. A family may become the only link between the two.

Digital records and interoperable systems can reduce this fragmentation where governance and technical infrastructure allow information to be shared appropriately.

The objective is not for every organisation to see every piece of data.

It is for the professionals responsible for the next stage of care to have the information necessary to act safely.

This connects directly with interoperability and system integration.

Organisations considering comparable challenges can use the Digital Transformation Readiness Assessment to examine whether information governance, workforce capability, technology and operational processes are aligned. It is not a Chinese health-system assessment, but the underlying integration questions are relevant across care systems.

Shared information still requires shared responsibility

Better records do not automatically create better coordination.

A system can make information technically available while leaving nobody responsible for acting on it.

If a hospital discharge summary notes that mobility has deteriorated, somebody needs to decide whether elderly-care support should change. If a community worker records repeated falls, there needs to be a route into clinical assessment. If a clinician changes medication, the people supporting the older person day to day need enough information to understand relevant implications.

Integrated information therefore needs an operational owner at each transition.

The central governance question is always the same: who is expected to do what next?

Payment systems can either support or fragment integration

Medical–eldercare integration is not only an organisational challenge. It is also a financing challenge.

Healthcare, long-term care and elderly-care services may be funded through different mechanisms, administered by different authorities and subject to different eligibility rules. Basic medical insurance, long-term care insurance, public subsidies, local elderly-care budgets and private household payments can all form part of the wider financing environment.

Those distinctions matter because providers respond to the way services are paid for.

If a hospital is reimbursed for treatment but has no incentive or practical route to support post-discharge continuity, integration may remain weak. If an elderly-care institution is expected to manage increasingly complex health needs without appropriate clinical funding, responsibilities can shift without the resources needed to support them.

Likewise, if rehabilitation, nursing and personal support sit within separate payment routes, families may experience a fragmented package even when professionals agree that needs should be managed together.

The stronger opportunity lies in aligning payment with the pathway rather than expecting providers to absorb the cost of coordination informally.

This does not require all services to be financed through one mechanism. It does require clarity about which system pays for which element of support and how transitions between them are handled.

Long-term care insurance is becoming increasingly relevant to integrated pathways

China’s evolving long-term care insurance system adds another important layer to medical–eldercare integration.

Where eligible older people receive benefits for defined long-term care needs, insurance can help finance services that sit outside conventional medical treatment but remain essential to daily functioning.

This creates the possibility of a more coherent pathway after acute illness.

A person may receive hospital treatment through medical insurance, rehabilitation through healthcare or related services, and ongoing personal support through long-term care arrangements where eligibility criteria are met.

The challenge is preventing those funding transitions from becoming service gaps.

An older person should not have to wait unnecessarily for essential support because one benefit ends before another becomes operational.

Functional assessment therefore becomes particularly important.

It can help determine whether the person’s needs have moved from short-term recovery into longer-term dependency and whether long-term care insurance or other elderly-care support should become part of the pathway.

This is one reason integrated care needs to connect clinical information with functional evidence rather than relying only on diagnosis.

Home medical services can extend integration into ordinary housing

Medical–eldercare integration is most visible when healthcare and elderly-care services operate within the same institution, but its larger strategic significance may lie in supporting people who remain at home.

Home medical and nursing services can reduce the need for frail older people to travel repeatedly to hospitals or clinics for care that can be delivered safely in the household.

Depending on local capability, this may include selected forms of nursing, follow-up, rehabilitation, chronic disease management or other professional support.

For people receiving home-based elderly care, this creates the possibility of a more integrated package around their existing living environment.

The practical challenge is scale.

Home medical visits consume professional time and travel. They therefore need to be targeted where they add the greatest value rather than becoming an unrealistic substitute for all clinic-based care.

Workforce geography also matters. A large city may support specialised mobile teams more easily than a rural county where professionals cover wide areas.

The relationship with complex care at home is therefore relevant. The transferable issue is how professional health input can be organised around people with substantial needs without assuming that institutional care is always the only viable setting.

Operational scenario: combining home nursing with everyday elderly care

A 78-year-old woman returns home after surgery with reduced mobility and a wound requiring professional nursing attention.

Her daughter can provide some support but works full time. A home-care worker assists with meals, personal care and safe movement, while a local health service provides scheduled nursing input.

The two services need different information.

The nurse needs to know whether the wound is healing and whether there are signs of infection. The care worker needs to understand any practical precautions relevant to bathing, dressing or movement without being expected to undertake clinical treatment.

If each service works independently, advice can conflict or important changes can be missed.

In a stronger integrated pathway, the nursing team records relevant changes and communicates practical implications to the elderly-care service. The care worker escalates any observed deterioration through the agreed route. The daughter knows which service to contact for clinical questions and which for daily support.

The arrangement is temporary. As the wound heals and mobility improves, nursing input reduces while everyday support is reviewed separately.

This is integration in its most practical form: different services retaining their own responsibilities while coordinating around one person’s changing needs.

Community rehabilitation can reduce the gap between hospital and home

China’s medical–eldercare integration agenda also depends heavily on rehabilitation outside acute hospitals.

Hospital-based rehabilitation is important after major illness or injury, but many older people need continued therapy and functional support after returning home or entering an elderly-care setting.

Community-based rehabilitation can extend that recovery period while keeping care closer to ordinary life.

It can also reduce the risk that people lose gains simply because specialist contact ends abruptly at discharge.

The strongest arrangements link rehabilitation goals with the support provided by families and elderly-care workers.

For example, if a therapist is working on independent transfers, everyday support should avoid unnecessarily completing the task for the person. If safe walking is a goal, the care plan should reinforce appropriate activity between formal sessions.

Integration therefore requires more than referral. It requires the practical objectives of one service to influence how another service behaves.

Dementia exposes the limits of purely medical or purely social models

Dementia is one of the clearest examples of why medical and elderly-care systems need to work together.

Diagnosis and treatment sit within healthcare, but the majority of daily consequences are experienced through cognition, communication, behaviour, safety and dependence on others.

A person may require medical review for coexisting illness while also needing consistent routines, environmental adaptation and skilled everyday support.

If behavioural distress is interpreted only as a medical symptom, unnecessary hospital transfer or medication may follow. If every change is assumed to be part of dementia, an infection, pain or other treatable condition may be missed.

Integrated care therefore requires both perspectives.

This connects with the wider theme of quality and governance in dementia care. Strong services need to distinguish between changes requiring clinical assessment and those requiring adjustment to care, communication or environment.

Article 11 in this series examines dementia care in China in greater depth. Within yiyang jiehe, the key lesson is that cognitive impairment often crosses the boundary between healthcare and long-term support repeatedly rather than fitting neatly within either system.

Medication management is a practical test of integration

Medication is another area where fragmented responsibility can create risk.

Older people with multiple chronic conditions may take several medicines prescribed by different clinicians. Hospital treatment may lead to changes that need to be implemented after discharge.

Elderly-care workers or family members may then support the person with daily routines without fully understanding what changed or why.

A robust integrated pathway needs medication information to move accurately across settings.

This does not mean all elderly-care workers should undertake clinical medication management.

It means relevant staff and families need clear information about what the person is taking, what support is required and which professional should be contacted if problems arise.

Medication-related risk can also be functional.

Dizziness may increase falls. Sedation may affect mobility or cognition. Complex regimens may become unmanageable for a person living alone.

Integration therefore requires clinical review to consider the person’s actual living circumstances.

Multidisciplinary working needs defined decisions, not just meetings

Medical–eldercare integration often involves several professional groups: doctors, nurses, rehabilitation staff, elderly-care workers, managers and sometimes social or community organisations.

Bringing them together can improve understanding, but multidisciplinary activity should not become an end in itself.

The value lies in decisions.

Who is responsible for the current problem? What needs to change? Which service will act? When will the person be reviewed? What happens if improvement does not occur?

The broader principle reflected within decision-making and escalation is especially relevant here.

Integrated working becomes operationally meaningful when shared discussion produces clear ownership.

Organisations examining similar cross-boundary arrangements can use the Governance Maturity Assessment to consider whether responsibility, escalation and evidence are sufficiently connected. It is not a Chinese regulatory tool, but the governance questions are directly applicable to integrated service models.

Rural integration requires tiered networks rather than duplication

Medical–eldercare integration is particularly challenging in rural China because specialist workforce and institutional capacity are distributed unevenly.

It would be unrealistic to expect every village to maintain the same clinical capability as a county hospital.

A stronger rural model therefore uses different levels for different functions.

Village services may identify changes and maintain routine contact. Township health centres can provide broader primary-level healthcare and rehabilitation support. County hospitals can provide specialist assessment, diagnostics and more complex treatment.

Elderly-care services need dependable routes into this hierarchy.

The strength of the model lies in referral and return.

An older person should be able to move upwards for specialist care when necessary and then return to local support without losing continuity.

Digital consultation may strengthen this arrangement, but only where the local service has enough workforce capability to act on specialist advice.

The issue is therefore not whether rural areas can replicate urban integration. It is whether they can create reliable networks between levels.

Digital integration can extend specialist reach but cannot remove local responsibility

China’s wider digital-health development creates significant opportunities for yiyang jiehe.

Telemedicine can connect rural or elderly-care settings with specialists. Shared platforms can improve access to records. Remote monitoring can help track selected conditions between appointments.

These tools can reduce unnecessary travel and shorten the distance between local services and higher-level expertise.

But digital connection is not equivalent to operational integration.

A specialist can provide advice remotely, but somebody still needs to assess the person locally, implement treatment, monitor the outcome and escalate if circumstances change.

Technology therefore redistributes work rather than eliminating it.

The wider theme of digital skills and workforce adoption becomes important because staff need to use new systems confidently and understand their limitations.

Digital tools also create privacy and information-governance questions, particularly when health and elderly-care organisations exchange data across different systems.

Integration should be measured through continuity and outcomes

It is relatively easy to count organisational signs of integration.

A locality can record how many elderly-care institutions have medical partnerships, how many joint facilities have been established or how many telemedicine connections exist.

Those indicators show infrastructure.

They do not necessarily show whether older people experience better care.

Outcome evidence should examine whether people receive timely clinical support, whether avoidable transfers decrease, whether discharge arrangements are more reliable, whether rehabilitation improves function and whether families spend less time navigating between systems.

This is where quality data and performance metrics become part of integration governance.

The Quality Dashboard Builder can help organisations examining comparable service systems structure measures around access, continuity, workforce, quality and outcomes. It is not a China-specific monitoring instrument.

The central principle is simple: integration should be evaluated through what improves for the person, not merely through how many organisational connections have been created.

Integration needs governance that can see across organisational boundaries

Medical–eldercare integration becomes difficult when each organisation governs only its own activity.

A hospital may measure discharge performance. An elderly-care provider may monitor visit completion. A community health service may track chronic disease reviews. Each indicator can look satisfactory while the person still experiences poor continuity between them.

Integrated governance therefore needs visibility across transitions.

Leaders need to understand where people are repeatedly transferred, where discharge arrangements break down, where elderly-care providers struggle to obtain clinical input and whether the same coordination problems recur in particular localities.

This is not an argument for removing organisational accountability.

Each service still needs clear responsibility for its own quality and professional practice.

The additional requirement is a mechanism for recognising problems created between organisations rather than inside them.

This aligns with the broader principle of quality assurance and governance. Evidence needs to show not only whether individual services perform well, but whether the wider pathway remains coherent.

Regional variation means integration will not look identical everywhere

China’s scale makes one uniform model of yiyang jiehe unrealistic.

Large cities may have dense networks of hospitals, community health centres, specialist clinics and elderly-care providers. Smaller cities and rural counties may rely on a narrower range of organisations and stronger use of tiered referral between village, township and county levels.

Population need also differs.

Areas with larger concentrations of very old people may require more rehabilitation, nursing and dementia capability. Places experiencing substantial out-migration of younger adults may need formal services to compensate for reduced family availability.

Integration therefore needs national direction combined with local design.

The aim should be consistency in function rather than identical organisational structure.

Older people should have reasonable access to coordinated medical and elderly-care support even if the mechanism through which that coordination is achieved differs geographically.

Operational scenario: a county sees repeated emergency transfers from care facilities

A county reviews emergency hospital activity and notices that several elderly-care institutions are repeatedly transferring residents for conditions that might sometimes be managed earlier or closer to the institution.

Individual cases initially appear unrelated.

Further review shows a common pattern: institutions have limited access to timely clinical advice outside routine hours, so staff default to hospital transfer when deterioration occurs.

The county does not simply instruct providers to reduce transfers.

Instead, health and elderly-care authorities examine the underlying interface. A clearer clinical advice pathway is established, escalation criteria are agreed and staff receive training on recognising deterioration and seeking timely review.

Emergency transfer remains available whenever hospital-level care is required.

Over time, leaders monitor not only transfer numbers but also adverse events, response times and resident outcomes to ensure that reduced transfer does not become unsafe avoidance.

The scenario illustrates mature integration governance.

The objective is not a numerical target in isolation. It is to understand why the system behaves as it does and redesign the interface without shifting risk onto residents or frontline staff.

Families remain important coordinators, but should not be the integration mechanism

Families frequently provide essential continuity across China’s health and elderly-care systems.

They accompany older relatives to appointments, manage medication information, communicate changes to care workers and make decisions when needs increase.

This contribution is valuable.

But a system should not depend on families acting as unpaid case coordinators in order for professionals to communicate.

That model disadvantages people whose children live far away, work long hours or have limited ability to navigate complex services.

It can also increase stress at moments of illness or discharge.

Integrated care therefore needs to support family involvement without making it the only bridge between organisations.

The wider principle of involving families and advocates is relevant here. Families should be partners in decisions where the older person wishes them to be involved, but professional coordination remains a system responsibility.

Person-centred integration requires clarity about choice

Integration can become highly organisational unless the older person’s own preferences remain visible.

A technically efficient pathway may still produce poor experience if people are repeatedly moved between settings, given little information or expected to accept services they do not understand.

The person needs to know why a referral is happening, who will provide the next stage of support and what choices remain available.

This is particularly important where the boundary between medical and elderly care affects where the person lives.

An older person may prefer to remain at home with additional support rather than enter an institution. Another may choose institutional care because family support is no longer sustainable.

Integration should widen those choices by making professional services more flexible around different settings.

It should not narrow choice by making one pathway administratively easier than the alternatives.

Quality problems at the interface need to feed back into service design

Integrated systems improve when individual incidents are used to identify recurrent patterns.

A delayed discharge may appear to be one operational problem. Repeated delays caused by uncertainty over post-discharge support indicate a wider interface issue.

A medication error may be managed as an individual event. Several errors after hospital discharge may reveal poor information transfer.

The same principle applies to avoidable emergency transfers, rehabilitation delays and repeated family complaints about navigating services.

The strongest governance approach therefore combines case-level learning with thematic review.

The broader discipline of learning from incidents and continuous improvement is especially relevant to integrated care because many failures are created by the interaction between otherwise competent services.

Local leaders need mechanisms for translating recurring interface problems into changes in referral pathways, information systems, workforce arrangements or funding rules.

Integrated care needs resilience as well as routine coordination

Integration is often designed around normal operating conditions.

But older people with complex needs are particularly vulnerable when services are disrupted by extreme weather, outbreaks of infectious disease, workforce shortages or technology failure.

A robust medical–eldercare model therefore needs contingency arrangements.

If a community health centre cannot provide usual visits, elderly-care organisations need to know which alternative route is available. If digital systems are unavailable, critical information should still be accessible safely. If staffing falls suddenly, local services need ways to prioritise people at greatest clinical and functional risk.

Resilience matters because highly interconnected systems can create new dependencies.

Integration should reduce fragmentation without creating single points of failure.

The next stage of yiyang jiehe is likely to be about depth rather than labels

China has spent several years developing policies, partnerships and institutional models around medical–eldercare integration.

The next stage is likely to depend increasingly on operational depth.

A facility can be labelled integrated while still relying on families to organise clinical appointments. A hospital can have a formal elderly-care partnership while discharge information remains incomplete. A digital platform can connect records technically while staff continue making decisions in isolation.

The stronger question is whether integration changes everyday practice.

Can a care worker obtain clinical advice promptly? Does a hospital understand the person’s functional situation before discharge? Can rehabilitation continue after the person leaves inpatient care? Do medication changes reach those supporting the person? Does local governance recognise repeated problems across organisational boundaries?

These are more demanding tests than organisational designation.

They are also closer to what older people and families actually experience.

What China’s medical–eldercare integration offers international systems

China’s yiyang jiehe model is shaped by its own health system, administrative structure, elderly-care sector and family context. Other countries cannot simply reproduce its institutional arrangements.

The transferable lessons lie in how integration is understood.

First, health and long-term care can remain distinct while still operating through dependable interfaces. Integration does not require every service to become one organisation.

Second, primary-level healthcare is essential to scale. Hospital-centred integration cannot meet the routine needs of a large ageing population.

Third, rehabilitation is a critical bridge. Without it, temporary functional loss can become permanent dependency.

Fourth, workforce boundaries need clarity. Better teamwork should not mean asking non-clinical workers to absorb clinical responsibility.

Fifth, information sharing only creates value when responsibility for acting on information is explicit.

Finally, integration should be measured through continuity, outcomes and reduced navigation burden rather than through the number of partnerships or joint facilities alone.

Conclusion

China’s medical–eldercare integration agenda addresses one of the most important structural challenges created by population ageing: older people increasingly need medical treatment, rehabilitation and long-term support at the same time, while those services are often organised through different institutions, professions and funding mechanisms.

Yiyang jiehe offers a framework for connecting them, but the strongest version is not defined by organisational labels. It depends on practical interfaces: hospitals that understand post-discharge function, primary-level health services that can support people close to home, elderly-care providers that can recognise and escalate health deterioration, rehabilitation that continues beyond acute treatment, and information that reaches the professionals responsible for the next decision.

The implementation challenge is therefore one of governance as much as service design. Responsibilities need to remain clear, workforce capability must match expanding expectations, payment should not create avoidable gaps, and local data should reveal where people repeatedly fall between systems.

For older people and families, successful integration should feel less like navigating separate sectors and more like receiving coherent support as needs change. China’s next phase of yiyang jiehe will be strongest where national ambition becomes dependable local coordination without over-medicalising later life or weakening professional accountability.