A social network analysis model approach to understand continuing care retirement community policies in China

A social network analysis model approach to understand continuing care retirement community policies in China | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A social network analysis model approach to understand continuing care retirement community policies in China Xuechun Wang, Bo Xia, Qing Chen, Martin Skitmore, E Jiaxuan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4664312/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background China experiences rapid population aging. Continuing Care Retirement Communities (CCRCs) are an emerging institutional living arrangement in China for providing older residents with care services. Although the authorities have issued a multitude of supportive policies, it lacks a comprehensive overview nor in-depth analysis of these policies. This study aims to investigate the dynamical trends of policy hotspots and the progression of coordination between departments. Methods We conducted a thorough content analysis of 186 central-level policies from 2000 to 2022. The temporal distribution and features of CCRCs policies over time were examined, followed by co-word analysis and Social Network Analysis (SNA) to identify policy hotspots and cooperation among promulgating departments in each phase. Gephi-supported visualization was used to create graphical maps, highlighting policy focuses and the relationships among government departments. Results China’s CCRCs policy has transitioned from an exploratory phase (2000-2013) to an industrialization phase (2014-present). SNA analysis reveals that during the initial phase, policy themes focused on market-based elder care, support measures, supervision, government-market cooperation, and talent introduction. In contrast, the industrialization phase emphasized health, technical innovation, senior care industry growth, and pilot projects and reform. Of the eleven departments initially involved, the Ministry of Civil Affairs (MCA) was the most active, with participation eventually growing to 36 departments, resulting in 191 interdepartmental collaborations and forming three departmental cooperation clusters. Conclusions CCRCs are moving towards increased commercialization, with the market increasingly sharing the responsibility for providing services for older adults. Moreover, the participatory governments proceed to increase, but there is still a lack of coordination amongst them. Ageing Cooperation between government departments Continuing Care Retirement Communities Content analysis Quantitative policy analysis Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Background China is aging at an unprecedented rate due to the sustained lower fertility caused by its one-child policy and increasing life expectancy [ 1 ]. According to the National Bureau of Statistics of China [ 2 ], the number of people over 65 years old in the country was 1.9 billion in late 2020 − 13.5% of the total population. Meanwhile, the United Nations has forecasted that the proportion of older adults will rise to 25.0% by 2030 [ 3 ], and this is expected to grow to 26.1%, around 3.7 billion by 2050. The rapid growth of the older population poses great challenges for the Chinese government and society to provide and coordinate housing, and care for the increasing number of people involved [ 4 ]. Historically, China has benefited from a robust and thorough system of family commitments, in which older adults are relied upon by their younger counterparts for considerable assistance in raising their family. [ 5 ]. Meanwhile, those in need of intense health care, who constitute a small percentage of the older population, are housed in such institutions as nursing homes [ 6 ]. Downsized family structures and relevant societal developments, however, have relentlessly pressured care, shaking customary local patterns of home and institutional care [ 7 ]. Continuing care retirement communities (CCRCs), emerging as a new residential arrangement that is primarily invested by the commercial sector in China, provide a series of alternative accommodation and facility options with sophisticated health services in relation to the aging process for more affluent older individuals [ 8 ]. Compared with other residential settings, the CCRCs provide at least some autonomy for older residents, at least upon their first entering as independent residents [ 9 ]. When people age, become progressively incapacitated and lose their independence, they can move to more intensive levels of care in the same setting [ 10 ]. However, CCRCs are still in their infancy in China, in contrast to those in western countries, which are firmly established, widely marketed and well-regulated housing options for older adults [ 8 ]. To support and regulate the development of Chinese CCRCs, a series of policies has been promulgated in recent years starting with 2013 - largely recognised by the industry as the “first year of CCRCs”, thanks to the unprecedented intensity of CCRCs policy introduction at that time. The SC’s Several Opinions on Accelerating the Development of the Service Industry for older adults serves as the most essential programmatic policy to stimulate the development of the industry and emphasises that measures should be taken to encourage the market-invested care service for older adults to become the “protagonists” presently and in the foreseeable future. The 2013 policy motivated the growth of CCRCs, as evidenced by the increasing number of investors entering the market [ 8 ]. Subsequently, various government departments have formulated policies aimed at promoting investment in the finely tuned and diverse CCRCs services as its expansion, including policies in areas with integrated medical and nursing service communities, integrated tourism and nursing care communities, and smart nursing care communities [ 11 ]. Additionally, these departments have launched policies in many other aspects related to CCRCs, such as service standardisation, land supply, talent training and job placement mechanisms, tax incentives and pilot projects. The CCRCs industry is playing an increasingly significant role in accommodating and serving older adults in China [ 12 ]. However, there is still a dearth of pertinent investigations into CCRCs policy changes. Therefore, this study aims to analyse the dynamic changes and trends through a comprehensive content analysis of China’s CCRC-related central-level policies from 2000 to 2022. The following specific questions are addressed: (1) How have CCRCs policies evolved since 2000? (2) What were the policy priorities at various stages of the industry? and (3) How did various government departments participate and collaborate in CCRCs policy formation? The findings of the study will help Chinese CCRCs stakeholders facilitate an understanding of the evolving process of the market-invested care management system for older people in China and explore future pathways of transformation. It not only yields important insights for industry practitioners, who may contemplate accessing the field and comprehending the orientation of policy support, but also serve as a reference for formulating strategies for the upcoming phase, to address current deficiencies and ensure the industry’s sustained healthiness. Methods Content analysis, as a prevalent research approach to the analysis of social sciences paperwork, converts qualitative content into quantitative data, uncovers the significant content of diverse materials and thus assists in discovering the core of phenomena [ 13 ]. According to Norton (2008), content analysis, in comparison to a qualitative method, is better suited to refining and deriving logical relationships and deep-seated laws symmetrically and fairly from the textual contents of policies [ 14 ]. As such, the content analysis of government policies aids policy stakeholders in elucidating the core of these policies and gaining insights into policy topics or hotspots, ensuring that appropriate investment pathways are sought to correspond with these policies [ 15 ]. Content analysis is now extensively used to analyse the content of multiple policies [ 16 ], which encompass a variety of fields, including epidemics [ 17 ], food security [ 18 ], urban development[ 19 ], environmental protection [ 20 ], education [ 21 ], housing [ 22 ], transportation [ 23 ] and mental health [ 24 ]. Therefore, it is well suited to tracking the progress of CCRCs policies. To explore the dynamic changes and trends in China’s CCRCs policies, two important steps are involved: the collection and filtering of CCRCs policies and their subsequent analysis in both qualitative and quantitative modes. In the analysis phase, the temporal distribution and features of CCRCs policies over time are examined, followed by a co-word analysis and Social Network Analysis (SNA) to ascertain the CCRCs policy hotspots and cooperation among promulgating departments in each phase. These are both practical approaches for visualising this type of intricate linkages that have historically been used in policy research [ 25 ]. The Gephi program was adopted to produce a graphical map to explain policy hotspots and the relationships among government departments [ 26 ]. Data collection A total of 186 policies enacted by the central government from 2000 to 2022 were collected. This involved a close examination of the policies before searching, to find the Chinese phrases commonly used in policy documents to represent CCRCs. This resulted in the identification of “Baoxian-Yanglao-Shequ (保险养老社区)”, “Baoxian-Yanglao-Shequ (保险养老社区)”, “Yanglao-Shequ (养老社区)”, “Yanglao-Dichan (养老地产)”, “Yanglao-Gongyu (养老公寓)”, “Laonian-Yiju-Shequ (老年宜居社区)”, “Laonian-Zhuzhai (老年住宅)”, ”Laonian-Gongyu (老年公寓)”, “Yanglao-Jigou (养老机构)”, “Yanglao-Sheshi (养老设施)”, “Yanglao-Fuwu-Sheshi (养老服务设施)”, “Laonian-Yanghu-Jigou (老年养护机构)”, “Yanglao-Fuwu-Jigou (养老服务机构)”, “Yiyang-Jiehe-Jigou (医养结合机构)” and “Shequ-Yanglao-Fuwu-Jigou (社区养老服务机构)”. Subsequently, policy documents that contained these specified keywords were searched using the Peking University Law Database (PKULaw), which is the most comprehensive database of Chinese legislation, regulations, rules, directives and guidance available [ 27 ]. Afterward, central government and ministry websites were adopted as a supplementary database for data validation to test whether the selected policy sample covered all Chinese CCRCs policies. Since the relevant policies originate from a closely-knit government decision-making network, the websites of all the Chinese central government departments were searched, including the State Council (SC), the Ministry of Civil Affairs (MCA) and the National Working Committee on Aging (NWCA) (Table 1 ). Table 1 Policy-making government departments and their acronyms Policy-Making Agency Acronyms Central Committee of the Communist Party of China CCCPC State Council SC National People’s Congress NPC People’s Bank of China PBC Ministry of Civil Affairs MCA China Banking Regulatory Commission (revoked) CBRC National Development and Reform Commission NDRC General Office of the State Council GOSC National Health and Family Planning Commission (revoked) NHFPC Ministry of Education MOE National Tourism Administration NTA Ministry of Finance MOF National Health Commission NHC Ministry of Industry and Information Technology MIIT State Development Bank SDB National Health Commission NHC State Taxation Administration STA Standing Committee of the National People’s Congress SCNPC National Working Committee on Aging NWCA Ministry of Human Resources and Social Security MHRSS State Administration for Market Regulation SAMR China Banking and Insurance Regulatory Commission CBIRC National Administration of Traditional Chinese Medicine NATCM China Disabled Persons’ Federation CDPF Logistic Support Department of the Central Military Commission LSDCMC National Healthcare Security Administration NMSA Ministry of Natural Resources MNR Ministry of Housing and Urban-Rural Development MHUD Ministry of Commerce MOC National Women’s Federation NWF Joint Prevention and Control Mechanism of the State Council JPCMSC CPC Political and Legislative Affairs Committee CPCPLAC Supreme People’s Court SPC Supreme People’s Procuratorate PRC Ministry of Public Security MPS Ministry of Justice MOJ Ministry of Science and Technology MOST China Insurance Regulatory Commission (revoked) CIRC Ministry of Land and Resources (revoked) MLR General Administration of Sport of China GASC Standardisation Administration of China SAC National Health and Family Planning Commission NHFPC Table 1 Policy-making government departments and their acronyms (Table 1 , placed at the end of the manuscript). In addition, to ensure the accuracy and validity of the policies chosen, all pertinent policies were thoroughly scrutinised to identify those directly tied to, or applicable to, CCRCs. This resulted in a small number of keyword-based retrieved policies being discarded as not being relevant to CCRCs. It was also determined that the policy-making governments must be at the national level (such as the SC and its subordinate agencies) rather than the provincial or municipal level as - first, CCRCs vary significantly across provinces and regulations imposed by local authorities are heterogeneous, uneven and lack authority; second, the majority of local governments execute only the policies from the SC and their subordinate agencies. Finally, 186 national-level CCRCs policies were eventually selected based on these principles. Data analysis By conducting a thorough content analysis of 186 central-level policies from 2000 to 2022, this paper utilizes Co-word analysis and Social Network Analysis (SNA) methodologies, accompanied by Gephi-supported visualization of collaboration network, to investigate the dynamics behind policy trends, hotspots and the progression of coordination between departments. SNA is the study of the patterns of relationships that compose social structures, viewed as networks of connections between the individuals and groups that comprise them [ 28 ]. Such intricate systems are denoted by node and edge patterns (lines). The nodes represent constructional components (such as, terms in a policy document), whereas the edges reflect the connections between them (such as, the co-occurrence relationship of two keywords in the same policy document) [ 29 ]. Algorithm and Graph visualisation advancements in SNA-enabled computer-based applications have aided academics in a variety of sectors in comprehending the intricacies and interactions between nodes in any such network. Additionally, visualisation and presentation tools such as Ucinet, NodeXl, NetDraw, E-Net, KeyPlayer, Automap, Pajek and Gephi have been established to view and display data networks [ 30 ]. The most frequently recognised keywords and associated network diagrams are displayed via the Gephi program. The following benefits justify the use of Gephi in the present study: (1) it provides a statistical and metric framework for analysing such social network properties as degree centrality and other metrics, (2) it has exceptional and robust visualisation capabilities for navigating complicated networks, and (3) it has been used in many other studies [ 31 ]. Selected policies are examined here using the SNA approach for two purposes. One is to examine policy hotspots, and the other is to explore collaboration across policy departments using SNA. The technical procedure employed for both is the same, divided into three steps: (1) using Python to extract keywords from policy documents; (2) generating a co-word matrix using Python, a more versatile programming language than BibExcel, which requires prior data cleaning and extraction; and (3) raising a graphical atlas analysis through Gephi combined with SNA. Therefore, correspondingly, in the process of achieving the first goal, the keywords (high-frequency terms in policies) were first found by employing the Python algorithm text segmentation toolkit to cut phrases into fragments for examination. Then, clusters are identified to investigate the link between the keywords by first cleaning data, such as by merging keywords with the same semantic meanings (for example, “pilot project” and “demonstration project”). A keyword co-occurrence matrix involving 40 terms is then visualised by modifying the weights and filtering away low-frequency words. The primary hotspots of CCRCs policies are reflected in the visual network graphs. For the goal of exploring the interconnections between policy-making departments, the name of the department that formulated the policy is the object to capture by Python. Then, the data is further cleaned (for example, the same departments with alternative names are tallied consistently and abolished departments are integrated with the replacement department). Following that, a matrix of keyword co-occurrences is generated to highlight the primary government agencies engaged in the design of CCRCs policy, as well as the departments’ collaborative connections. Findings Temporal distributions Figure 1 presents the distribution of the 186 CCRC-related central-level policies spanning from 2000 to 2022, showing the non-linear growth in the number of documents and the significant turning point. The development trajectory of CCRCs can be split into two subperiods based on the phrasing of the Chinese government documents or largely acknowledged industry viewpoints, and this segmentation is validated by the dynamic trend of the number of policies. Phase I is from 2000 to 2013 and Phase II is from 2014 to 2022. In 2000, China became an aging society. Policies of Opinions on Accelerating the Socialization of Social Welfare (2000) and the Decision on Strengthening the Work on Aging (2000) advocated that market-invested housing and facilities for older adults should be supported along industrialisation lines. Since the central government mandated that departments at all levels must establish preferential policies for older adults to inspire the market to invest in CCRCs, some CCRCs policies were launched in this phase. Between 2014 and 2022, the volume of CCRC policies increased significantly, with the cumulative number increasing from 47 to 186. In particular, there were more than double the number of policies released in 2014 than the previous year, which is a result of the SC promulgating its Several Opinions on Accelerating the Development of the Older People Service Industry in 2013. The policy, which is a programmatic statement for the evolution of the CCRCs industry, specifies the fundamental orientation of the advancement, the main force on which to rely on it, primary path and its ultimate aim. The following policy analysis is based on these two historical phases. Hotspots and changes in policy content CCRCs policy hotspots evolved throughout these two periods. This section examines the evolution of these by the Gephi visualised co-occurrence matrix. Figure 2 and Fig. 3 illustrate the co-word networks for each of the two subperiods, respectively. In the network, the size of the nodes represents the frequency of occurrence of a term, while the thickness of the lines denotes the intensity of co-occurrences. All keywords belonging to the identical cluster are represented by nodes of the same colour. Phase 1: Exploratory stage (2000–2013) From 2000 to 2013, China’s CCRCs policies had five broad theme areas, as shown in Fig. 2 , which are the market-invested care services system for older adults (pink), supportive measures (blue), supervision and assessment (orange), cooperation between the government and market (light green) and introduction of talents (dark green). Although the largest node in each cluster reflects the topic of a cluster to some extent, it is not always accurate. Therefore, the source of each keyword was found and the policy document reviewed to clarify and interpret the meaning of the clusters. Keywords such as “private capital investment”, “nursing and care market” and “comprehensive innovation in products for older adults” in the pink cluster indicates the marketisation tendency of the care service for older adults. “Government department coordination” and “government management and organisation” that are likewise highlighted, implying that government departments must play a key role and collaborate with each other to manage CCRCs. Moreover, the diversification trend of the care providers is conveyed in the keywords of “government responsibility”, “government management and organisation”, “cooperation between government and social (market) capital”, “for-profit older adult institutions”, “foreign investment” and “non-profit organisation and institutions” forming the light green cluster. As the orange cluster shows, although the government-led initiative has gradually evolved into community, market, government and other multi-subject participatory arrangements, governments are still responsible for supervision as before. Another noticeable feature in the network is the use of various supportive policy instruments to fuel CCRCs growth by providing the industry with funds, land, tax relief, insurances, etc., as reflected in the blue cluster. The 2013 policy of Several Opinions on Accelerating the Development of the Older People Service Industry highlighted the importance of providing capital, location and personnel convenience, bolstering market-funded housing and facilities for older adults. Since then, this programmatic policy has guided the growth of CCRCs business, and 2013 is recognised as its inaugural year. In addition, “service” arises throughout time and is also a commonly stated keyword in the policies, such as in “public service”, “life service industry”, “reform of services for older adults”, “service system for older people” and “nursing and care facilities and services”. The dark green cluster is chiefly composed of such terms as “culture”, “life service industry” and “talents education and training”, which are normally mentioned in policies aimed at improving the quality of life for CCRCs residents by fostering a favourable cultural environment and enhancing professional services. Furthermore, “Construction of a socialized care service system for older people” is the centre of this network. Due to locally traditional care for older adults having been gradually disrupted by diminishing family structures and other societal shifts, the central government legislated an overall development plan for the care service system during the CCRCs policy exploratory stage, stipulating that market-invested care services should become an important force. Since 2000, the government released a series of policies to encourage market-oriented care services and the gradual installation of a diverse marketisation of the care service system for older adults. The notion of “market-oriented care for older adults” was initially introduced in the Opinions on Accelerating the Realisation of Social Welfare Socialisation in 2000. The link between care and the state’s welfare system would be increasingly dissolved by broadening the investment subjects and service objects. In the same year, the Decision on Strengthening the Aging Work explicitly stated for the first time “to construct a care mechanism based on family care for older people, backed by community services, and complemented by market care for older adults”, reflecting the view that the family is still considered the most common source of care, while the market is portrayed as a complement to care for older adults. Subsequently, the Opinions on Accelerating the Development of the Care Service Industry for Older People released in 2006 advocated “to construct a service system based on home care, supported by community services, and supplemented by institutional care for older people”. Of these, the term “service system” indicates that care services for older people are not only enhanced in their variety and complexity, but also in their coordination and general planning. In particular, the Plan for the Construction of Social Care Service System for Older People in 2011 and Opinions on Promoting the Construction of a Social Service System for Older People in 2012 were programmatic documents guiding the development of Chinese social care service. The policies established a new arrangement for care provision for older people, which was amended “to create a home-based, community-reliant, and institution-supported older people care service system”. Notably, the shift from “complemented by market care for older adults” to the institutionally supported care for older people” indicates that the position of institutions in the care system had altered, reflecting the government’s expectation that CCRCs should perform a pivotal role in a situation where the aging population is expanding and the conventional family care is fading. In 2013, with the deployment of the newly updated Law of the People’s Republic of China on the Protection of the Rights and Interests of the older people , the Ministry of Civil Affairs commenced the formulation of supportive rules to govern the operation and administration of CCRCs. A series of policies such as Consecutive Promulgation of the Measures for the Establishment of Care Institutions for Older People and Measures for the Administration of Care Institutions for Older People provide a legal framework for CCRCs to monitor. Simultaneously, such regulations as Guiding Opinions on the Government’s Purchase of Services from Social Forces , Several Opinions on Accelerating the Development of the Service Industry and indicate Several Opinions on Promoting the Development of the Health Service Industry all underlined the market’s preeminent role in resource allocation, which provides timely recommendations for boosting the CCRCs to become the primary provider in the growth of the older-care services sector. In general, the government offered policy support for the progression of CCRCs at this stage, and the tendency of marketisation became more apparent. Since then, a social older-care service system has been constructed that is home-based and supported by the community and institutions. Phase 2: Development stage (2014–2022) Figure 3 depicts clusters of keywords for CCRCs policies from 2014 to 2022. The principal policy content for this stage is nursing and care with comprehensive services for older adults, with its strategy to enrich and optimise the quality of care services, which represents a continuation of the systematisation and commercialisation of the CCRCs industry. The diversity of keywords in the network graph is positively correlated with the complexity of the policy content. The visualisation comprises five clusters of nodes of various sizes and hues, each representing a distinct theme. Tracking the associated policy content for each keyword helps gain a comprehensive understanding of the core meaning of each cluster. “Health” is the theme of the blue cluster, with the keywords of “integrated medical and nursing service”, “healthcare and nursing”, “medical institutions” and “safety and security”. Several policies like the Notice on Accelerating the Construction of Health and Service Projects for older adults and the Guiding Opinions on Promoting the Integration of Medical Care and Services for Older People emphasise the convergence of medical services and care in CCRCs in 2014. Following that, the Development of the National Aging Cause and the Construction of the Care System for Older People suggested establishing a “home-based, community-reliant, institution-supplemented, together with integrated care and nursing service system” as the cornerstone and development agenda during the 13th Five-Year Plan period. Since then, a series of consolidated care and nursing service policies have been launched, emphasising effectively adapting to population aging isas a major livelihood concern and long-term remedy for all sectors of society. The “technical innovation”-themed dark green clusters are composed of such keywords as “informatisation and smart care for older adults” and “comprehensive innovation in products for older adults”. To increase the quality of services provided in CCRCs, especially an integrated medical and nursing services, policies usually mandate the employment of emerging innovative techniques. Several Opinions on Fully Opening Up the Service Market for Older People to Improve Services for Older People in 2016 suggest “encouraging the progress of ‘Internet plus’ services” for the first time. Subsequently, several regulations in the “Internet plus” community care service model were published to provide CCRCs residents with guidelines for intelligent services. Moreover, such intelligent technology as electronic medical records play an essential role in nursing care services. Evidently, the employment of contemporary intelligent technologies such as big data and cloud computing in CCRCs services has become a prevalent trend. Furthermore, CCRCs have steadily spread to the outskirts of core cities and rural regions because of technological advancements and service specialisation; thus, “urban and rural housing construction” is also represented in this cluster. “Promoting the development of the nursing and care industry” is the central concept of the whole network and the light green cluster. The CCRCs market is a complicated endeavour; therefore, this cluster is comprised of several facets. On the one hand, CCRCs were evolving into a formalised and comprehensive industrial chain, as described in such keywords as “standardisation system of care services for older people”. On the other hand, the terms of “government coordination” and “policy implementation” posit that government should be accountable for monitoring the booming industry. The pink cluster is bigger but looser, with the primary theme of “nursing and care facilities and services for older adults”. The key phrases are “talent education and training”, “professional service” and “standardised institutional service”, suggesting that talents are seen as a significant factor in the growth of geriatric services. The pilot projects came into being as the industry expanded. “Pilot and reform”, as the orange cluster theme, relates to the reform strategy of “pilot first, progressively advancing, and comprehensively unfolding” proposed by the Third Plenary Session of the 18th CPC Central Committee. In addition, to fulfil the financing requirements for the renovation of the care system, the government postulates selecting a group of projects with guiding and demonstration effects for support and requiring banks to offer preferential credit policies that are overseen by government entities. As a result, a set of CCRCs projects with a significant demonstration impact and positive social reaction will be promoted in this manner to encourage the investment of market resources in the creation of CCRCs. Therefore, “financial assistance” and “supervision and assessment system” emerge as keywords with “pilot”. These three can be understood as an improvement in the substance of the CCRCs service. Policies such as “Several Policies and Measures for Promoting the Healthy Development of Private Investment”, “Several Opinions on Fully Opening Up the Service Market for Older People and Improving the Quality of Services for Older People” and “Notice on Accelerating the Reform of the Service Industry for Older People” persist in encouraging the domestic market and foreign investment to penetrate the CCRCs field, and concentrate on surmounting the challenges of CCRCs in financial assistance, talent training, tourism and education for older adults, etc. In 2018, following significant progress in the pilot programs, “complete liberalisation of the market for aged care services” was designated as one of the Ministry of Civil Affairs’ main priorities. Since then, the constant adoption of pertinent regulations shows that China’s CCRCs policy is progressively advancing and adapting to the times. During this period, the government has a more complete insight into how to formulate CCRCs policies, and both the volume and substance of policies have enlarged significantly. Comparing the keyword network graphs of stages 1 and 2, several prominent characteristics can be identified. Initially, the focus of the two stages is to encourage the market to invest in CCRCs. However, the former stresses marketisation, signifying that the care service in the preceding stage has recently transitioned from government-led to market-funded, while the latter emphasises industrialisation, suggesting that the care services in the succeeding stage are more advanced and diverse. Second, the construction of intelligent care services that boost the establishment of care personnel (such as professional property teams) enhances supplies for older adults, and research long-term development paradigms of urban and rural services for older adults are arising as the new trend in CCRCs policies. This finding implies that the policy emphasis involves abundant services for older adults and expanding outside of the central metropolis. Thirdly, the clustering of terms in the category of health service for older adults is more concentrated, denoting that increased health policies have been implemented, which has become a continuing driving force in the development of the health service system for older adults. Network of core CCRCs policy-making departments The connections between CCRC policy-making departments can be analysed through the number of policies issued separately or jointly. Thirty-nine government departments have been involved in issuing CCRCs policies since 2000. Phase 1: Exploratory stage (2000–2013) As shown in Table 2 , only eleven departments were involved in the formulation of CCRC policies between 2000 and 2013. The Ministry of Civil Affairs (MCA) issued the most documents (9), followed by the SC (7). It is important to note that the number of policies issued by all departments is small. This is because the issue of market-invested commercial institutions for older people had just entered the policy agenda and had not yet aroused widespread concern. Table 2 Ranking of Agencies Identified with High Frequency Among the CCRCs Policies During Phase-1 (2000–2013) Department Number of CCRCs Policies Issued Proportion MCA 9 31.03% SC 7 24.14% GOSC 3 10.33% CCCPC 2 6.90% SCNPC 2 6.90% STA 1 3.45% SDB 1 3.45% MOC 1 3.45% NDRC 1 3.45% MOF 1 3.45% NPC 1 3.45% Furthermore, these departments showed signs of departmental collaboration. Figure 4 visualises the department network of CCRCs policies across this period. The co-occurrence matrix containing the names of multiple departments were loaded into the Gephi software and the force atlas algorithm employed to generate a network diagram of decision-making departments. Individual departments are represented by nodes, and integrated departments are symbolised by connecting lines or edges. The thickness of the edges denotes the number of co-decision-maker ties between the departments (nodes), while the size of the nodes reflects the number of policies from a single agency. At this stage, 8 nodes, 5 edges, a diameter of 2 and an average route length of 1.375, define the CCRCs network. The network structure exhibits an overall decentralised, partial collaboration structure, with three clusters of settlements and three independent nodes. The Ministry of Civil Affairs (MCA), which ranks first in this network diagram, is the largest cluster centre, indicating that it is the principal ministry responsible for facilities and services for older adults and thereby develops the most policies. The National Development and Reform Commission (NDRC), Ministry of Commerce (MOC) and State Development Bank (SDB) encircle the centre, displaying their cooperation with the Ministry of Civil Affairs (MCA) on pilot projects, investment in institutions for older adults and financial measures, among other initiatives. Concurrently, the SC is the second-ranked department in terms of policy issuance and serves as the focal point of the cluster due to its status as China’s highest administrative institution, often releasing unilateral, macroscopical and guiding policies. On the opposite end of this network, the sole department with which it coordinates a publication policy is the Central Committee of the Communist Party of China (CCCPC). The State Taxation Administration (STA) and the Ministry of Finance (MOF) are the remaining collaborating institutions that jointly administer the financing and taxation of CCRCs. Phase 2: Development stage (2014–2022) The same approach is employed to illustrate the department network of CCRCs policies throughout this period. As illustrated in Fig. 5 , the government departments engaged have grown more diversified and have collaborated extensively since 2014. Joint publications played a significant role at this point, although some departments maintain autonomous publishing strategies. The network consists of 36 nodes and 191 edges, with a diameter of 2, and an average route length of 1.375, and clustering coefficient of 0.829. Three different clusters are in the network configuration, showing the presence of three groupings of departments with robust and trustworthy internal cooperative relationships. At the heart of the network is still the Civil Affairs Department (MCA), which serves as a link between the three clusters and helps tie them together. This node is the largest and possesses the most connection lines, signifying that it is not only involved in the greatest number of policies but also collaborates most frequently with other decision-making divisions. The blue cluster, centred on the Civil Affairs Department (MCA), has no obvious themes, probably because CCRCs policies became more pluralistic during this period. Some departments are closely linked to it. Other than the Ministry of Civil Affairs (MCA), the National Working Committee on Aging (NWCA) is responsible for establishing strategic initiatives and primary policies for care services in CCRCs, along with coordinating and facilitating the execution of policies by associated agencies. Financial subsidies from the government, investment and finance assistance all require the assistance and backing of the Ministry of Finance (MOF). The National Development and Reform Commission (NDRC) is involved in a variety of CCRCs reforms and pilot programs, including information initiatives for care services, wellness tourism, and integrated medical and nursing services. The National Health and Family Planning Commission (revoked) (NHFPC) is responsible for older residents’ health, assistance and medical treatment in CCRCs. The Ministry of Industry and Information Technology (MIIT) is responsible for a hotspot referred to as ‘smart care for older adults’ in the period. It also has other marginal components focused on some aspects of CCRCs services, such as providing resources such as land, tourism, housing, information technology and taxation. Some departments coloured orange were primarily concerned with geriatric medical treatment and health in CCRCs, jointly bolstering the advancement of the CCRCs sector and stimulating the integration of medical and care for older adults. The red cluster mainly focuses on policy governing CCRCs. The CCCPC and the SC collaborate with each other since they are the supreme authority and the executive authority of the highest authority, respectively. However, the SC is usually accountable for releasing autonomous, macroscopic, strategic outline-type policies. The SNA’s examination of centrality verifies this, with the SC obtaining a score of 1, suggesting that, although it cooperates with other departments, it does not collaborate tightly throughout the network. Discussion Underlying pattern Since 2000, China has seen a dramatic upsurge in the number of CCRCs policies. This development is commensurate with the progression of China’s aging society, as the placement and care for older adults has become a remarkable and pressing societal necessity [ 6 ]. It demonstrates the critical requirement for additional guidance for market-invested institutions for older adults and enhanced preparation for future demographic patterns [ 32 ]. Strengthening the supply of CCRCs services can be an effective response to problems rendered by socioeconomic factors such as “growing old before becoming wealthy”, an ineffective social security system, and a decline in family caregiving functions. The establishment of diverse market investment and management policy system for care institutions has emerged as a major task for several Chinese government departments. Many other nations encounter similar aging challenges, particularly those largely affected by Confucian culture, such as Thailand [ 33 ], Singapore [ 34 ] and Japan [ 35 ]. As a result, transferring some of the burden of aging services to the market has become an urgent priority for the government. These authorities have recognised the necessity for policies that encourage market investment in retirement and have formalised policies and strategies to address the aging population in the next decades. Specifically, the progression of CCRCs in China has undergone two phases, which is still in a process of exploration. The central emphasis of CCRCs policy has switched from rudimentary housing and care services for older adults from 2000 to 2013 to the delivery of high-quality and comprehensive care services in such institutionalised settings from 2014 to 2022. In both phases, China’s CCRCs policies aim to achieve the objectives of maintaining the basic living standards of older adults, fostering consumption diversification, enhancing service quality and mental and physical well-being, and fulfilling older adults’ rights. Similarly, the observable policy tendencies in China’s CCRCs converge with those of other countries whose backgrounds involve less developed economies and stronger traditional cultures, such as Japan at the end of the 20th Century [ 36 ]. It can be deduced, therefore, that China’s market-based care is likely to experience, or is currently witnessing, the same scenario as Japan’s. Therefore, many studies emphasise that Japan’s “fine care” is worth learning from China. Viewed critically, despite the privatisation of care services having been underway in the West for many years, Chinese policy tendencies will necessarily be different due to differing background forces [ 37 ]. In order to address the concerns of adults (born under the one-child policy) who are genuinely worried about the care of their older parents in China, and because the industry has missed many business opportunities, it is necessary to critically examine how to convert the needs of local care in China into actual industrial economic activities. Political, socioeconomic and pursue cultural environments, as well as the diversified demands of older adults, determine the characteristics of CCRCs policies at different phases - namely, from forced centralisation to market-oriented governance models, a swiftly improving socioeconomic environment, the establishment of a culture of reverence for older adults and the increasingly diverse demands of older adults. The policy theme of the first phase is to stimulate the market to deliver accommodation and care for elders. In the second phase, which is a continuation of the first, the CCRCs’ practice focuses on care service enhancement and quality optimisation, which serves as a continuance of the systematisation and commercialisation of CCRCs services. As a result of China’s reforms and “Five-Year Plans” throughout this period, each stage has undergone significant institutional and core policy institutional alterations. Chinese officials can consider the drawbacks of previous CCRCs policy frameworks and pursuing refinements. Room for improvement Although China CCRCs have undergone a trend of increasing marketisation of care for older adults during two recent decades, the quantitative analysis of the policy documents discloses a remarkable potential for future advancement. Keywords such as “integrated medical with nursing service” and “smart care for older people” (Wang and Xu, 2021) are highlighted in policies in the second phase, denoting the current hotspots in the CCRCs sector [ 38 ]. To a significant degree, this tendency reflects the government’s assessment of the seriousness of the issue of medical and aged care for older adults, which means the authorities have paid increasing attention in recent years to the application of information technology in conjunction with medical and care services, which assists in the information construction of an “integrated medical with nursing service”, “Smart care for older adults” and “combined medical care and nursing service” can increase the health level of older adults in CCRCs by enhancing the level of health management and treatment efficiency. Some countries have begun to ensure the implementation of relevant policies [ 39 ],[ 40 ],[ 41 ],[ 42 ]. Moreover, CCRCs policy likewise specifies psychological and mental health, education, physical fitness, commodities, financial management, tourism, legal services, etc., for older adults, but these have not become essential policy catchphrases currently, which might represent the potential direction of CCRCs to holistically enhance the wellbeing of their residents. In addition, several government departments on the periphery of the CCRCs’ network of decision-making departments are less interconnected, demonstrating the lack of coordination among the agencies involved; thus, interagency cooperation needs to be solidified. Furthermore, CCRCs providers are progressing toward diversification, but they remain government-led and market-centric. Diversified collaboration should be enlarged to include additional entities, such as non-profit, social service organisations, and even foreign governments and businesses; however, these are not prominent in the network diagram. Predictably, there is a major opportunity to prosper in the international market by drawing from the experience of more developed economies. Finally, to fulfil the increased requirements of older residents in CCRCs, stakeholders, including policymakers, researchers and service suppliers, need to seek out effective programs, resources and equipment in such a supportive policy environment. Limitation This study is limited in its policy focus merely depicting the policy-making network of government agencies when, in reality, interagency cooperation is more intricate, with authorities necessitating ongoing contact and discussion with each other. Further research is needed to present the whole process of policy release quantitatively. Notwithstanding, the findings of this study can inspire potential CCRCs developers to recognise the potential of China’s CCRCs sector, comprehend the policy orientation involved, and enhance the execution and administration of CCRCs. They also have the potential to serve as a guide for generating subsequent policy stages, such as in exerting more emphasis on formerly under-recognised areas, for government ministries. Conclusion The evolution of China’s CCRCs policy has traversed through an exploratory phase (2000–2013) and an industrialization phase (2014-present). The ongoing expansion of CCRCs policies indicates that the Chinese government places significant priority on care for older people. Moreover, throughout time, the policies for CCRCs have shifted their focus from basic accommodation and medical arrangements to high-quality and diversified services for older adults. Not only is this the Chinese government’s blueprint but, as livelihoods and progressive thinking advance, so do the demands of older adults. The Chinese government has modified the policy priorities, as evidenced by the occurrence of “smart care for older people”, and “integrated the care and nursing service for older people”, showing a quick reaction to new CCRCs requisites and transformations at the central policy level. Furthermore, the nucleus of two networks likewise demonstrates that the CCRCs development path is one of increasing marketisation. The market has increasingly shared the responsibility for providing services for older adults, which not only reduces government spending, but simultaneously augments the quality of care services by intensifying market competition. Additionally, Chinese CCRCs facilities and services have steadily extended beyond the sphere of the Ministry of Civil Affairs. Consequently, various government departments have enrolled in CCRCs policy formulation, so that the collaboration network has been continually reinforced, generating a policy synergy to stimulate industry development. To further guarantee policy collaboration and execution, all relevant government agencies need to establish corresponding policies and solidify a collaboration relationship. Abbreviations CCRCs Continuing Care Retirement Communities SNA Social Network Analysis PKULaw Peking University Law Database CCCPC Central Committee of the Communist Party of China SC State Council NPC National People’s Congress PBC People’s Bank of China MCA Ministry of Civil Affairs CBRC China Banking Regulatory Commission NDRC National Development and Reform Commission GOSC General Office of the State Council NHFPC National Health and Family Planning Commission MOE Ministry of Education NTA National Tourism Administration MOF Ministry of Finance NHC National Health Commission MIIT Ministry of Industry and Information Technology SDB State Development Bank NHC National Health Commission STA State Taxation Administration SCNPC Standing Committee of the National People’s Congress NWCA National Working Committee on Aging MHRSS Ministry of Human Resources and Social Security SAMR State Administration for Market Regulation CBIRC China Banking and Insurance Regulatory Commission NATCM National Administration of Traditional Chinese Medicine CDPF China Disabled Persons’ Federation LSDCMC Logistic Support Department of the Central Military Commission NMSA National Healthcare Security Administration MNR Ministry of Natural Resources MHUD Ministry of Housing and Urban-Rural Development MOC Ministry of Commerce NWF National Women’s Federation JPCMSC Joint Prevention and Control Mechanism of the State Council CPCPLAC CPC Political and Legislative Affairs Committee SPC Supreme People’s Court PRC Supreme People’s Procuratorate MPS Ministry of Public Security MOJ Ministry of Justice MOST Ministry of Science and Technology CIRC China Insurance Regulatory Commission MLR Ministry of Land and Resources GASC General Administration of Sport of China SAC Standardisation Administration of China NHFPC National Health and Family Planning Commission Declarations Ethics approval and consent to participate This study does not involve any human participants, human data, or human tissue. Therefore, ethics approval and consent to participate were not required. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Funding This work was supported by the China Scholarship Council (CSC) under Grant No.201908140086, and the Australian Research Council (ARC) Discovery project under Grant No. DP230101313. Author Contribution Conceptualization (XW, BX, MS), data curation (XW), formal analysis (XW), funding acquisition (XW, BX), investigation (XW, BX, MS, QC, JE), methodology (XW, BX), project administration (BX, MS), software (XW), supervision (BX, MS), validation (XW, BX, MS), visualization (XW), writing – original draft (XW), writing – review and editing (XW, BX, MS, QC, JE). All authors reviewed the manuscript. Acknowledgements We express our gratitude to the authors of the included studies. 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China has faster pace than Japan in population aging in next 25 years. Biosci Trends. 2019;13(4):287–91. 10.5582/bst.2019.01213 . Song P, Tang W. The community-based integrated care system in Japan: Health care and nursing care challenges posed by super-aged society. Biosci Trends. 2019;13(3):279–81. 10.5582/bst.2019.01173 . Wang B, Xu L. Construction of the Internet Plus Community Smart Elderly Care Service Platform. J Healthc Eng. 2021. 10.1155/2021/4310648 . Tokunaga S, Tamamizu K, Saiki S, Nakamura M, Yasuda K, VirtualCareGiver. Personalized smart elderly care. Int J Softw Innov. 2017;5(1):30–43. 10.4018/IJSI.2017010103 . Pekkarinen S, Melkas H, Hyypiä M. Elderly care and digital services: Toward a sustainable sociotechnical transition. Human-Centered Digitalization and Services. Singapore: Springer; 2019. 10.1007/978-981-13-7725-9_14 . Jung C, Awad J, Chohan A. The planning of smart elderly housing in Dubai with IoT technologies. Open House Int. 2021. 10.1108/OHI-08-2020-0121 . Cao S, Huang H, Xiao M, Yan L, Xu W, Tang X, et al. Research on safety in home care for older adults: A bibliometric analysis. Nurs Open. 2021;8(4):1720–30. 10.1002/nop2.812 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4664312","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":329866354,"identity":"ddd5f24d-83eb-4327-93d1-1841c0ec185f","order_by":0,"name":"Xuechun 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2","display":"","copyAsset":false,"role":"figure","size":210845,"visible":true,"origin":"","legend":"\u003cp\u003eKeyword network of CCRCs policies during the exploratory stage (2000-2013)\u003c/p\u003e","description":"","filename":"image2.png","url":"https://assets-eu.researchsquare.com/files/rs-4664312/v1/573d489db5ea722e8793a5bc.png"},{"id":60781881,"identity":"965889ca-1001-42f5-90e2-0290e13e873d","added_by":"auto","created_at":"2024-07-22 03:15:29","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":309709,"visible":true,"origin":"","legend":"\u003cp\u003eKeyword network of CCRCs policies during the development stage (2014-2022)\u003c/p\u003e","description":"","filename":"image3.png","url":"https://assets-eu.researchsquare.com/files/rs-4664312/v1/c24b5319a0c58ee62fe9fac0.png"},{"id":60781879,"identity":"e4924ce3-7ef8-4760-bfda-b12ca08bb2fe","added_by":"auto","created_at":"2024-07-22 03:15:29","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":24478,"visible":true,"origin":"","legend":"\u003cp\u003eNetwork of CCRCs policy-making departments during the exploratory stage (2000-2013)\u003c/p\u003e","description":"","filename":"image4.png","url":"https://assets-eu.researchsquare.com/files/rs-4664312/v1/3650c50ff05203849e20fe75.png"},{"id":60781877,"identity":"d6774f73-303b-47d0-a1d7-ad326d1e5283","added_by":"auto","created_at":"2024-07-22 03:15:29","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":122607,"visible":true,"origin":"","legend":"\u003cp\u003eNetwork of CCRCs policy-making departments during the development stage (2014-2022)\u003c/p\u003e","description":"","filename":"image5.png","url":"https://assets-eu.researchsquare.com/files/rs-4664312/v1/9addd7f23647568854460b41.png"},{"id":80810400,"identity":"fd0209a9-c1f8-4c7d-9193-2493c6c03a31","added_by":"auto","created_at":"2025-04-17 10:17:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1602835,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4664312/v1/412a2b14-f3ad-4c8c-8db2-eee7f55f63d9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A social network analysis model approach to understand continuing care retirement community policies in China","fulltext":[{"header":"Background","content":"\u003cp\u003eChina is aging at an unprecedented rate due to the sustained lower fertility caused by its one-child policy and increasing life expectancy [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. According to the National Bureau of Statistics of China [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], the number of people over 65 years old in the country was 1.9\u0026nbsp;billion in late 2020\u0026thinsp;\u0026minus;\u0026thinsp;13.5% of the total population. Meanwhile, the United Nations has forecasted that the proportion of older adults will rise to 25.0% by 2030 [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], and this is expected to grow to 26.1%, around 3.7\u0026nbsp;billion by 2050. The rapid growth of the older population poses great challenges for the Chinese government and society to provide and coordinate housing, and care for the increasing number of people involved [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHistorically, China has benefited from a robust and thorough system of family commitments, in which older adults are relied upon by their younger counterparts for considerable assistance in raising their family. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Meanwhile, those in need of intense health care, who constitute a small percentage of the older population, are housed in such institutions as nursing homes [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Downsized family structures and relevant societal developments, however, have relentlessly pressured care, shaking customary local patterns of home and institutional care [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eContinuing care retirement communities (CCRCs), emerging as a new residential arrangement that is primarily invested by the commercial sector in China, provide a series of alternative accommodation and facility options with sophisticated health services in relation to the aging process for more affluent older individuals [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Compared with other residential settings, the CCRCs provide at least some autonomy for older residents, at least upon their first entering as independent residents [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. When people age, become progressively incapacitated and lose their independence, they can move to more intensive levels of care in the same setting [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, CCRCs are still in their infancy in China, in contrast to those in western countries, which are firmly established, widely marketed and well-regulated housing options for older adults [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo support and regulate the development of Chinese CCRCs, a series of policies has been promulgated in recent years starting with 2013 - largely recognised by the industry as the \u0026ldquo;first year of CCRCs\u0026rdquo;, thanks to the unprecedented intensity of CCRCs policy introduction at that time. The SC\u0026rsquo;s \u003cem\u003eSeveral Opinions on Accelerating the Development of the Service Industry for older adults\u003c/em\u003e serves as the most essential programmatic policy to stimulate the development of the industry and emphasises that measures should be taken to encourage the market-invested care service for older adults to become the \u0026ldquo;protagonists\u0026rdquo; presently and in the foreseeable future. The 2013 policy motivated the growth of CCRCs, as evidenced by the increasing number of investors entering the market [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Subsequently, various government departments have formulated policies aimed at promoting investment in the finely tuned and diverse CCRCs services as its expansion, including policies in areas with integrated medical and nursing service communities, integrated tourism and nursing care communities, and smart nursing care communities [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Additionally, these departments have launched policies in many other aspects related to CCRCs, such as service standardisation, land supply, talent training and job placement mechanisms, tax incentives and pilot projects. The CCRCs industry is playing an increasingly significant role in accommodating and serving older adults in China [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, there is still a dearth of pertinent investigations into CCRCs policy changes. Therefore, this study aims to analyse the dynamic changes and trends through a comprehensive content analysis of China\u0026rsquo;s CCRC-related central-level policies from 2000 to 2022. The following specific questions are addressed: (1) How have CCRCs policies evolved since 2000? (2) What were the policy priorities at various stages of the industry? and (3) How did various government departments participate and collaborate in CCRCs policy formation? The findings of the study will help Chinese CCRCs stakeholders facilitate an understanding of the evolving process of the market-invested care management system for older people in China and explore future pathways of transformation. It not only yields important insights for industry practitioners, who may contemplate accessing the field and comprehending the orientation of policy support, but also serve as a reference for formulating strategies for the upcoming phase, to address current deficiencies and ensure the industry\u0026rsquo;s sustained healthiness.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eContent analysis, as a prevalent research approach to the analysis of social sciences paperwork, converts qualitative content into quantitative data, uncovers the significant content of diverse materials and thus assists in discovering the core of phenomena [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. According to Norton (2008), content analysis, in comparison to a qualitative method, is better suited to refining and deriving logical relationships and deep-seated laws symmetrically and fairly from the textual contents of policies [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAs such, the content analysis of government policies aids policy stakeholders in elucidating the core of these policies and gaining insights into policy topics or hotspots, ensuring that appropriate investment pathways are sought to correspond with these policies [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Content analysis is now extensively used to analyse the content of multiple policies [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], which encompass a variety of fields, including epidemics [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], food security [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], urban development[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], environmental protection [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], education [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], housing [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], transportation [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] and mental health [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Therefore, it is well suited to tracking the progress of CCRCs policies.\u003c/p\u003e \u003cp\u003eTo explore the dynamic changes and trends in China\u0026rsquo;s CCRCs policies, two important steps are involved: the collection and filtering of CCRCs policies and their subsequent analysis in both qualitative and quantitative modes. In the analysis phase, the temporal distribution and features of CCRCs policies over time are examined, followed by a co-word analysis and Social Network Analysis (SNA) to ascertain the CCRCs policy hotspots and cooperation among promulgating departments in each phase. These are both practical approaches for visualising this type of intricate linkages that have historically been used in policy research [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The Gephi program was adopted to produce a graphical map to explain policy hotspots and the relationships among government departments [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eA total of 186 policies enacted by the central government from 2000 to 2022 were collected. This involved a close examination of the policies before searching, to find the Chinese phrases commonly used in policy documents to represent CCRCs. This resulted in the identification of \u0026ldquo;Baoxian-Yanglao-Shequ (保险养老社区)\u0026rdquo;, \u0026ldquo;Baoxian-Yanglao-Shequ (保险养老社区)\u0026rdquo;, \u0026ldquo;Yanglao-Shequ (养老社区)\u0026rdquo;, \u0026ldquo;Yanglao-Dichan (养老地产)\u0026rdquo;, \u0026ldquo;Yanglao-Gongyu (养老公寓)\u0026rdquo;, \u0026ldquo;Laonian-Yiju-Shequ (老年宜居社区)\u0026rdquo;, \u0026ldquo;Laonian-Zhuzhai (老年住宅)\u0026rdquo;, \u0026rdquo;Laonian-Gongyu (老年公寓)\u0026rdquo;, \u0026ldquo;Yanglao-Jigou (养老机构)\u0026rdquo;, \u0026ldquo;Yanglao-Sheshi (养老设施)\u0026rdquo;, \u0026ldquo;Yanglao-Fuwu-Sheshi (养老服务设施)\u0026rdquo;, \u0026ldquo;Laonian-Yanghu-Jigou (老年养护机构)\u0026rdquo;, \u0026ldquo;Yanglao-Fuwu-Jigou (养老服务机构)\u0026rdquo;, \u0026ldquo;Yiyang-Jiehe-Jigou (医养结合机构)\u0026rdquo; and \u0026ldquo;Shequ-Yanglao-Fuwu-Jigou (社区养老服务机构)\u0026rdquo;.\u003c/p\u003e \u003cp\u003eSubsequently, policy documents that contained these specified keywords were searched using the Peking University Law Database (PKULaw), which is the most comprehensive database of Chinese legislation, regulations, rules, directives and guidance available [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Afterward, central government and ministry websites were adopted as a supplementary database for data validation to test whether the selected policy sample covered all Chinese CCRCs policies. Since the relevant policies originate from a closely-knit government decision-making network, the websites of all the Chinese central government departments were searched, including the State Council (SC), the Ministry of Civil Affairs (MCA) and the National Working Committee on Aging (NWCA) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePolicy-making government departments and their acronyms\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePolicy-Making Agency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcronyms\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCentral Committee of the Communist Party of China\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCCCPC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eState Council\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNational People\u0026rsquo;s Congress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNPC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeople\u0026rsquo;s Bank of China\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePBC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMinistry of Civil Affairs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMCA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChina Banking Regulatory Commission (revoked)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCBRC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNational Development and Reform Commission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNDRC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral Office of the State Council\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGOSC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNational Health and Family Planning Commission (revoked)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNHFPC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMinistry of Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMOE\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNational Tourism Administration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNTA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMinistry of Finance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMOF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNational Health Commission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNHC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMinistry of Industry and Information Technology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMIIT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eState Development Bank\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSDB\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNational Health Commission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNHC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eState Taxation Administration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSTA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStanding Committee of the National People\u0026rsquo;s Congress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSCNPC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNational Working Committee on Aging\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNWCA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMinistry of Human Resources and Social Security\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMHRSS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eState Administration for Market Regulation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSAMR\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChina Banking and Insurance Regulatory Commission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCBIRC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNational Administration of Traditional Chinese Medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNATCM\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChina Disabled Persons\u0026rsquo; Federation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCDPF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLogistic Support Department of the Central Military Commission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLSDCMC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNational Healthcare Security Administration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNMSA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMinistry of Natural Resources\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMNR\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMinistry of Housing and Urban-Rural Development\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMHUD\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMinistry of Commerce\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMOC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNational Women\u0026rsquo;s Federation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNWF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJoint Prevention and Control Mechanism of the State Council\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJPCMSC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCPC Political and Legislative Affairs Committee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCPCPLAC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSupreme People\u0026rsquo;s Court\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSPC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSupreme People\u0026rsquo;s Procuratorate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePRC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMinistry of Public Security\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMPS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMinistry of Justice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMOJ\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMinistry of Science and Technology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMOST\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChina Insurance Regulatory Commission (revoked)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCIRC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMinistry of Land and Resources (revoked)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMLR\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral Administration of Sport of China\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGASC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStandardisation Administration of China\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSAC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNational Health and Family Planning Commission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNHFPC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e Policy-making government departments and their acronyms\u003c/p\u003e \u003cp\u003e(Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, placed at the end of the manuscript).\u003c/p\u003e \u003cp\u003eIn addition, to ensure the accuracy and validity of the policies chosen, all pertinent policies were thoroughly scrutinised to identify those directly tied to, or applicable to, CCRCs. This resulted in a small number of keyword-based retrieved policies being discarded as not being relevant to CCRCs. It was also determined that the policy-making governments must be at the national level (such as the SC and its subordinate agencies) rather than the provincial or municipal level as - first, CCRCs vary significantly across provinces and regulations imposed by local authorities are heterogeneous, uneven and lack authority; second, the majority of local governments execute only the policies from the SC and their subordinate agencies. Finally, 186 national-level CCRCs policies were eventually selected based on these principles.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eBy conducting a thorough content analysis of 186 central-level policies from 2000 to 2022, this paper utilizes Co-word analysis and Social Network Analysis (SNA) methodologies, accompanied by Gephi-supported visualization of collaboration network, to investigate the dynamics behind policy trends, hotspots and the progression of coordination between departments.\u003c/p\u003e \u003cp\u003eSNA is the study of the patterns of relationships that compose social structures, viewed as networks of connections between the individuals and groups that comprise them [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Such intricate systems are denoted by node and edge patterns (lines). The nodes represent constructional components (such as, terms in a policy document), whereas the edges reflect the connections between them (such as, the co-occurrence relationship of two keywords in the same policy document) [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlgorithm and Graph visualisation advancements in SNA-enabled computer-based applications have aided academics in a variety of sectors in comprehending the intricacies and interactions between nodes in any such network. Additionally, visualisation and presentation tools such as Ucinet, NodeXl, NetDraw, E-Net, KeyPlayer, Automap, Pajek and Gephi have been established to view and display data networks [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. The most frequently recognised keywords and associated network diagrams are displayed via the Gephi program. The following benefits justify the use of Gephi in the present study: (1) it provides a statistical and metric framework for analysing such social network properties as degree centrality and other metrics, (2) it has exceptional and robust visualisation capabilities for navigating complicated networks, and (3) it has been used in many other studies [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSelected policies are examined here using the SNA approach for two purposes. One is to examine policy hotspots, and the other is to explore collaboration across policy departments using SNA. The technical procedure employed for both is the same, divided into three steps: (1) using Python to extract keywords from policy documents; (2) generating a co-word matrix using Python, a more versatile programming language than BibExcel, which requires prior data cleaning and extraction; and (3) raising a graphical atlas analysis through Gephi combined with SNA.\u003c/p\u003e \u003cp\u003eTherefore, correspondingly, in the process of achieving the first goal, the keywords (high-frequency terms in policies) were first found by employing the Python algorithm text segmentation toolkit to cut phrases into fragments for examination. Then, clusters are identified to investigate the link between the keywords by first cleaning data, such as by merging keywords with the same semantic meanings (for example, \u0026ldquo;pilot project\u0026rdquo; and \u0026ldquo;demonstration project\u0026rdquo;). A keyword co-occurrence matrix involving 40 terms is then visualised by modifying the weights and filtering away low-frequency words. The primary hotspots of CCRCs policies are reflected in the visual network graphs.\u003c/p\u003e \u003cp\u003eFor the goal of exploring the interconnections between policy-making departments, the name of the department that formulated the policy is the object to capture by Python. Then, the data is further cleaned (for example, the same departments with alternative names are tallied consistently and abolished departments are integrated with the replacement department). Following that, a matrix of keyword co-occurrences is generated to highlight the primary government agencies engaged in the design of CCRCs policy, as well as the departments\u0026rsquo; collaborative connections.\u003c/p\u003e \u003c/div\u003e"},{"header":"Findings","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eTemporal distributions\u003c/h2\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the distribution of the 186 CCRC-related central-level policies spanning from 2000 to 2022, showing the non-linear growth in the number of documents and the significant turning point. The development trajectory of CCRCs can be split into two subperiods based on the phrasing of the Chinese government documents or largely acknowledged industry viewpoints, and this segmentation is validated by the dynamic trend of the number of policies. Phase I is from 2000 to 2013 and Phase II is from 2014 to 2022.\u003c/p\u003e \u003cp\u003eIn 2000, China became an aging society. Policies of \u003cem\u003eOpinions on Accelerating the Socialization of Social Welfare (2000)\u003c/em\u003e and the \u003cem\u003eDecision on Strengthening the Work on Aging (2000)\u003c/em\u003e advocated that market-invested housing and facilities for older adults should be supported along industrialisation lines. Since the central government mandated that departments at all levels must establish preferential policies for older adults to inspire the market to invest in CCRCs, some CCRCs policies were launched in this phase.\u003c/p\u003e \u003cp\u003eBetween 2014 and 2022, the volume of CCRC policies increased significantly, with the cumulative number increasing from 47 to 186. In particular, there were more than double the number of policies released in 2014 than the previous year, which is a result of the SC promulgating its \u003cem\u003eSeveral Opinions on Accelerating the Development of the Older People Service Industry\u003c/em\u003e in 2013. The policy, which is a programmatic statement for the evolution of the CCRCs industry, specifies the fundamental orientation of the advancement, the main force on which to rely on it, primary path and its ultimate aim. The following policy analysis is based on these two historical phases.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eHotspots and changes in policy content\u003c/h2\u003e \u003cp\u003eCCRCs policy hotspots evolved throughout these two periods. This section examines the evolution of these by the Gephi visualised co-occurrence matrix. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e illustrate the co-word networks for each of the two subperiods, respectively. In the network, the size of the nodes represents the frequency of occurrence of a term, while the thickness of the lines denotes the intensity of co-occurrences. All keywords belonging to the identical cluster are represented by nodes of the same colour.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePhase 1: Exploratory stage (2000\u0026ndash;2013)\u003c/h2\u003e \u003cp\u003eFrom 2000 to 2013, China\u0026rsquo;s CCRCs policies had five broad theme areas, as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, which are the market-invested care services system for older adults (pink), supportive measures (blue), supervision and assessment (orange), cooperation between the government and market (light green) and introduction of talents (dark green). Although the largest node in each cluster reflects the topic of a cluster to some extent, it is not always accurate. Therefore, the source of each keyword was found and the policy document reviewed to clarify and interpret the meaning of the clusters.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eKeywords such as \u0026ldquo;private capital investment\u0026rdquo;, \u0026ldquo;nursing and care market\u0026rdquo; and \u0026ldquo;comprehensive innovation in products for older adults\u0026rdquo; in the pink cluster indicates the marketisation tendency of the care service for older adults. \u0026ldquo;Government department coordination\u0026rdquo; and \u0026ldquo;government management and organisation\u0026rdquo; that are likewise highlighted, implying that government departments must play a key role and collaborate with each other to manage CCRCs. Moreover, the diversification trend of the care providers is conveyed in the keywords of \u0026ldquo;government responsibility\u0026rdquo;, \u0026ldquo;government management and organisation\u0026rdquo;, \u0026ldquo;cooperation between government and social (market) capital\u0026rdquo;, \u0026ldquo;for-profit older adult institutions\u0026rdquo;, \u0026ldquo;foreign investment\u0026rdquo; and \u0026ldquo;non-profit organisation and institutions\u0026rdquo; forming the light green cluster. As the orange cluster shows, although the government-led initiative has gradually evolved into community, market, government and other multi-subject participatory arrangements, governments are still responsible for supervision as before.\u003c/p\u003e \u003cp\u003eAnother noticeable feature in the network is the use of various supportive policy instruments to fuel CCRCs growth by providing the industry with funds, land, tax relief, insurances, etc., as reflected in the blue cluster. The 2013 policy of \u003cem\u003eSeveral Opinions on Accelerating the Development of the Older People Service Industry\u003c/em\u003e highlighted the importance of providing capital, location and personnel convenience, bolstering market-funded housing and facilities for older adults. Since then, this programmatic policy has guided the growth of CCRCs business, and 2013 is recognised as its inaugural year. In addition, \u0026ldquo;service\u0026rdquo; arises throughout time and is also a commonly stated keyword in the policies, such as in \u0026ldquo;public service\u0026rdquo;, \u0026ldquo;life service industry\u0026rdquo;, \u0026ldquo;reform of services for older adults\u0026rdquo;, \u0026ldquo;service system for older people\u0026rdquo; and \u0026ldquo;nursing and care facilities and services\u0026rdquo;. The dark green cluster is chiefly composed of such terms as \u0026ldquo;culture\u0026rdquo;, \u0026ldquo;life service industry\u0026rdquo; and \u0026ldquo;talents education and training\u0026rdquo;, which are normally mentioned in policies aimed at improving the quality of life for CCRCs residents by fostering a favourable cultural environment and enhancing professional services.\u003c/p\u003e \u003cp\u003eFurthermore, \u0026ldquo;Construction of a socialized care service system for older people\u0026rdquo; is the centre of this network. Due to locally traditional care for older adults having been gradually disrupted by diminishing family structures and other societal shifts, the central government legislated an overall development plan for the care service system during the CCRCs policy exploratory stage, stipulating that market-invested care services should become an important force.\u003c/p\u003e \u003cp\u003eSince 2000, the government released a series of policies to encourage market-oriented care services and the gradual installation of a diverse marketisation of the care service system for older adults. The notion of \u0026ldquo;market-oriented care for older adults\u0026rdquo; was initially introduced in the \u003cem\u003eOpinions on Accelerating the Realisation of Social Welfare Socialisation\u003c/em\u003e in 2000. The link between care and the state\u0026rsquo;s welfare system would be increasingly dissolved by broadening the investment subjects and service objects. In the same year, the \u003cem\u003eDecision on Strengthening the Aging Work\u003c/em\u003e explicitly stated for the first time \u0026ldquo;to construct a care mechanism based on family care for older people, backed by community services, and complemented by market care for older adults\u0026rdquo;, reflecting the view that the family is still considered the most common source of care, while the market is portrayed as a complement to care for older adults.\u003c/p\u003e \u003cp\u003eSubsequently, the \u003cem\u003eOpinions on Accelerating the Development of the Care Service Industry for Older People\u003c/em\u003e released in 2006 advocated \u0026ldquo;to construct a service system based on home care, supported by community services, and supplemented by institutional care for older people\u0026rdquo;. Of these, the term \u0026ldquo;service system\u0026rdquo; indicates that care services for older people are not only enhanced in their variety and complexity, but also in their coordination and general planning. In particular, the \u003cem\u003ePlan for the Construction of Social Care Service System for Older People\u003c/em\u003e in 2011 and \u003cem\u003eOpinions on Promoting the Construction of a Social Service System for Older People\u003c/em\u003e in 2012 were programmatic documents guiding the development of Chinese social care service. The policies established a new arrangement for care provision for older people, which was amended \u0026ldquo;to create a home-based, community-reliant, and institution-supported older people care service system\u0026rdquo;. Notably, the shift from \u0026ldquo;complemented by market care for older adults\u0026rdquo; to the institutionally supported care for older people\u0026rdquo; indicates that the position of institutions in the care system had altered, reflecting the government\u0026rsquo;s expectation that CCRCs should perform a pivotal role in a situation where the aging population is expanding and the conventional family care is fading.\u003c/p\u003e \u003cp\u003eIn 2013, with the deployment of the newly updated \u003cem\u003eLaw of the People\u0026rsquo;s Republic of China on the Protection of the Rights and Interests of the older people\u003c/em\u003e, the Ministry of Civil Affairs commenced the formulation of supportive rules to govern the operation and administration of CCRCs. A series of policies such as \u003cem\u003eConsecutive Promulgation of the Measures for the Establishment of Care Institutions for Older People\u003c/em\u003e and \u003cem\u003eMeasures for the Administration of Care Institutions for Older People\u003c/em\u003e provide a legal framework for CCRCs to monitor. Simultaneously, such regulations as \u003cem\u003eGuiding Opinions on the Government\u0026rsquo;s Purchase of Services from Social Forces\u003c/em\u003e, \u003cem\u003eSeveral Opinions on Accelerating the Development of the Service Industry\u003c/em\u003e and indicate \u003cem\u003eSeveral Opinions on Promoting the Development of the Health Service Industry\u003c/em\u003e all underlined the market\u0026rsquo;s preeminent role in resource allocation, which provides timely recommendations for boosting the CCRCs to become the primary provider in the growth of the older-care services sector. In general, the government offered policy support for the progression of CCRCs at this stage, and the tendency of marketisation became more apparent. Since then, a social older-care service system has been constructed that is home-based and supported by the community and institutions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003ePhase 2: Development stage (2014\u0026ndash;2022)\u003c/h2\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e depicts clusters of keywords for CCRCs policies from 2014 to 2022. The principal policy content for this stage is nursing and care with comprehensive services for older adults, with its strategy to enrich and optimise the quality of care services, which represents a continuation of the systematisation and commercialisation of the CCRCs industry. The diversity of keywords in the network graph is positively correlated with the complexity of the policy content. The visualisation comprises five clusters of nodes of various sizes and hues, each representing a distinct theme. Tracking the associated policy content for each keyword helps gain a comprehensive understanding of the core meaning of each cluster.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e\u0026ldquo;Health\u0026rdquo; is the theme of the blue cluster, with the keywords of \u0026ldquo;integrated medical and nursing service\u0026rdquo;, \u0026ldquo;healthcare and nursing\u0026rdquo;, \u0026ldquo;medical institutions\u0026rdquo; and \u0026ldquo;safety and security\u0026rdquo;. Several policies like the \u003cem\u003eNotice on Accelerating the Construction of Health and Service Projects for older adults\u003c/em\u003e and the \u003cem\u003eGuiding Opinions on Promoting the Integration of Medical Care and Services for Older People\u003c/em\u003e emphasise the convergence of medical services and care in CCRCs in 2014. Following that, the \u003cem\u003eDevelopment of the National Aging Cause and the Construction of the Care System for Older People\u003c/em\u003e suggested establishing a \u0026ldquo;home-based, community-reliant, institution-supplemented, together with integrated care and nursing service system\u0026rdquo; as the cornerstone and development agenda during the 13th Five-Year Plan period. Since then, a series of consolidated care and nursing service policies have been launched, emphasising effectively adapting to population aging isas a major livelihood concern and long-term remedy for all sectors of society.\u003c/p\u003e \u003cp\u003eThe \u0026ldquo;technical innovation\u0026rdquo;-themed dark green clusters are composed of such keywords as \u0026ldquo;informatisation and smart care for older adults\u0026rdquo; and \u0026ldquo;comprehensive innovation in products for older adults\u0026rdquo;. To increase the quality of services provided in CCRCs, especially an integrated medical and nursing services, policies usually mandate the employment of emerging innovative techniques. \u003cem\u003eSeveral Opinions on Fully Opening Up the Service Market for Older People to Improve Services for Older People\u003c/em\u003e in 2016 suggest \u0026ldquo;encouraging the progress of \u0026lsquo;Internet plus\u0026rsquo; services\u0026rdquo; for the first time. Subsequently, several regulations in the \u0026ldquo;Internet plus\u0026rdquo; community care service model were published to provide CCRCs residents with guidelines for intelligent services. Moreover, such intelligent technology as electronic medical records play an essential role in nursing care services. Evidently, the employment of contemporary intelligent technologies such as big data and cloud computing in CCRCs services has become a prevalent trend. Furthermore, CCRCs have steadily spread to the outskirts of core cities and rural regions because of technological advancements and service specialisation; thus, \u0026ldquo;urban and rural housing construction\u0026rdquo; is also represented in this cluster.\u003c/p\u003e \u003cp\u003e\u0026ldquo;Promoting the development of the nursing and care industry\u0026rdquo; is the central concept of the whole network and the light green cluster. The CCRCs market is a complicated endeavour; therefore, this cluster is comprised of several facets. On the one hand, CCRCs were evolving into a formalised and comprehensive industrial chain, as described in such keywords as \u0026ldquo;standardisation system of care services for older people\u0026rdquo;. On the other hand, the terms of \u0026ldquo;government coordination\u0026rdquo; and \u0026ldquo;policy implementation\u0026rdquo; posit that government should be accountable for monitoring the booming industry. The pink cluster is bigger but looser, with the primary theme of \u0026ldquo;nursing and care facilities and services for older adults\u0026rdquo;. The key phrases are \u0026ldquo;talent education and training\u0026rdquo;, \u0026ldquo;professional service\u0026rdquo; and \u0026ldquo;standardised institutional service\u0026rdquo;, suggesting that talents are seen as a significant factor in the growth of geriatric services. The pilot projects came into being as the industry expanded.\u003c/p\u003e \u003cp\u003e\u0026ldquo;Pilot and reform\u0026rdquo;, as the orange cluster theme, relates to the reform strategy of \u0026ldquo;pilot first, progressively advancing, and comprehensively unfolding\u0026rdquo; proposed by the Third Plenary Session of the 18th CPC Central Committee. In addition, to fulfil the financing requirements for the renovation of the care system, the government postulates selecting a group of projects with guiding and demonstration effects for support and requiring banks to offer preferential credit policies that are overseen by government entities. As a result, a set of CCRCs projects with a significant demonstration impact and positive social reaction will be promoted in this manner to encourage the investment of market resources in the creation of CCRCs. Therefore, \u0026ldquo;financial assistance\u0026rdquo; and \u0026ldquo;supervision and assessment system\u0026rdquo; emerge as keywords with \u0026ldquo;pilot\u0026rdquo;. These three can be understood as an improvement in the substance of the CCRCs service.\u003c/p\u003e \u003cp\u003ePolicies such as \u0026ldquo;Several Policies and Measures for Promoting the Healthy Development of Private Investment\u0026rdquo;, \u0026ldquo;Several Opinions on Fully Opening Up the Service Market for Older People and Improving the Quality of Services for Older People\u0026rdquo; and \u0026ldquo;Notice on Accelerating the Reform of the Service Industry for Older People\u0026rdquo; persist in encouraging the domestic market and foreign investment to penetrate the CCRCs field, and concentrate on surmounting the challenges of CCRCs in financial assistance, talent training, tourism and education for older adults, etc. In 2018, following significant progress in the pilot programs, \u0026ldquo;complete liberalisation of the market for aged care services\u0026rdquo; was designated as one of the Ministry of Civil Affairs\u0026rsquo; main priorities. Since then, the constant adoption of pertinent regulations shows that China\u0026rsquo;s CCRCs policy is progressively advancing and adapting to the times. During this period, the government has a more complete insight into how to formulate CCRCs policies, and both the volume and substance of policies have enlarged significantly.\u003c/p\u003e \u003cp\u003eComparing the keyword network graphs of stages 1 and 2, several prominent characteristics can be identified. Initially, the focus of the two stages is to encourage the market to invest in CCRCs. However, the former stresses marketisation, signifying that the care service in the preceding stage has recently transitioned from government-led to market-funded, while the latter emphasises industrialisation, suggesting that the care services in the succeeding stage are more advanced and diverse. Second, the construction of intelligent care services that boost the establishment of care personnel (such as professional property teams) enhances supplies for older adults, and research long-term development paradigms of urban and rural services for older adults are arising as the new trend in CCRCs policies.\u003c/p\u003e \u003cp\u003eThis finding implies that the policy emphasis involves abundant services for older adults and expanding outside of the central metropolis. Thirdly, the clustering of terms in the category of health service for older adults is more concentrated, denoting that increased health policies have been implemented, which has become a continuing driving force in the development of the health service system for older adults.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eNetwork of core CCRCs policy-making departments\u003c/h3\u003e\n\u003cp\u003eThe connections between CCRC policy-making departments can be analysed through the number of policies issued separately or jointly. Thirty-nine government departments have been involved in issuing CCRCs policies since 2000.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePhase 1: Exploratory stage (2000\u0026ndash;2013)\u003c/h2\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, only eleven departments were involved in the formulation of CCRC policies between 2000 and 2013. The Ministry of Civil Affairs (MCA) issued the most documents (9), followed by the SC (7). It is important to note that the number of policies issued by all departments is small. This is because the issue of market-invested commercial institutions for older people had just entered the policy agenda and had not yet aroused widespread concern.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRanking of Agencies Identified with High Frequency Among the CCRCs Policies During Phase-1 (2000\u0026ndash;2013)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepartment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of CCRCs Policies Issued\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eProportion\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMCA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31.03%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.14%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGOSC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.33%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCCCPC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.90%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSCNPC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.90%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSTA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.45%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSDB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.45%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMOC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.45%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNDRC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.45%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMOF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.45%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNPC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.45%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFurthermore, these departments showed signs of departmental collaboration. Figure\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e visualises the department network of CCRCs policies across this period. The co-occurrence matrix containing the names of multiple departments were loaded into the Gephi software and the force atlas algorithm employed to generate a network diagram of decision-making departments. Individual departments are represented by nodes, and integrated departments are symbolised by connecting lines or edges. The thickness of the edges denotes the number of co-decision-maker ties between the departments (nodes), while the size of the nodes reflects the number of policies from a single agency. At this stage, 8 nodes, 5 edges, a diameter of 2 and an average route length of 1.375, define the CCRCs network.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe network structure exhibits an overall decentralised, partial collaboration structure, with three clusters of settlements and three independent nodes. The Ministry of Civil Affairs (MCA), which ranks first in this network diagram, is the largest cluster centre, indicating that it is the principal ministry responsible for facilities and services for older adults and thereby develops the most policies. The National Development and Reform Commission (NDRC), Ministry of Commerce (MOC) and State Development Bank (SDB) encircle the centre, displaying their cooperation with the Ministry of Civil Affairs (MCA) on pilot projects, investment in institutions for older adults and financial measures, among other initiatives. Concurrently, the SC is the second-ranked department in terms of policy issuance and serves as the focal point of the cluster due to its status as China\u0026rsquo;s highest administrative institution, often releasing unilateral, macroscopical and guiding policies. On the opposite end of this network, the sole department with which it coordinates a publication policy is the Central Committee of the Communist Party of China (CCCPC). The State Taxation Administration (STA) and the Ministry of Finance (MOF) are the remaining collaborating institutions that jointly administer the financing and taxation of CCRCs.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003ePhase 2: Development stage (2014\u0026ndash;2022)\u003c/h2\u003e \u003cp\u003eThe same approach is employed to illustrate the department network of CCRCs policies throughout this period. As illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, the government departments engaged have grown more diversified and have collaborated extensively since 2014. Joint publications played a significant role at this point, although some departments maintain autonomous publishing strategies. The network consists of 36 nodes and 191 edges, with a diameter of 2, and an average route length of 1.375, and clustering coefficient of 0.829.\u003c/p\u003e \u003cp\u003eThree different clusters are in the network configuration, showing the presence of three groupings of departments with robust and trustworthy internal cooperative relationships. At the heart of the network is still the Civil Affairs Department (MCA), which serves as a link between the three clusters and helps tie them together. This node is the largest and possesses the most connection lines, signifying that it is not only involved in the greatest number of policies but also collaborates most frequently with other decision-making divisions.\u003c/p\u003e \u003cp\u003eThe blue cluster, centred on the Civil Affairs Department (MCA), has no obvious themes, probably because CCRCs policies became more pluralistic during this period. Some departments are closely linked to it. Other than the Ministry of Civil Affairs (MCA), the National Working Committee on Aging (NWCA) is responsible for establishing strategic initiatives and primary policies for care services in CCRCs, along with coordinating and facilitating the execution of policies by associated agencies. Financial subsidies from the government, investment and finance assistance all require the assistance and backing of the Ministry of Finance (MOF). The National Development and Reform Commission (NDRC) is involved in a variety of CCRCs reforms and pilot programs, including information initiatives for care services, wellness tourism, and integrated medical and nursing services. The National Health and Family Planning Commission (revoked) (NHFPC) is responsible for older residents\u0026rsquo; health, assistance and medical treatment in CCRCs. The Ministry of Industry and Information Technology (MIIT) is responsible for a hotspot referred to as \u0026lsquo;smart care for older adults\u0026rsquo; in the period. It also has other marginal components focused on some aspects of CCRCs services, such as providing resources such as land, tourism, housing, information technology and taxation.\u003c/p\u003e \u003cp\u003eSome departments coloured orange were primarily concerned with geriatric medical treatment and health in CCRCs, jointly bolstering the advancement of the CCRCs sector and stimulating the integration of medical and care for older adults. The red cluster mainly focuses on policy governing CCRCs. The CCCPC and the SC collaborate with each other since they are the supreme authority and the executive authority of the highest authority, respectively. However, the SC is usually accountable for releasing autonomous, macroscopic, strategic outline-type policies. The SNA\u0026rsquo;s examination of centrality verifies this, with the SC obtaining a score of 1, suggesting that, although it cooperates with other departments, it does not collaborate tightly throughout the network.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eUnderlying pattern\u003c/h2\u003e \u003cp\u003eSince 2000, China has seen a dramatic upsurge in the number of CCRCs policies. This development is commensurate with the progression of China\u0026rsquo;s aging society, as the placement and care for older adults has become a remarkable and pressing societal necessity [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. It demonstrates the critical requirement for additional guidance for market-invested institutions for older adults and enhanced preparation for future demographic patterns [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Strengthening the supply of CCRCs services can be an effective response to problems rendered by socioeconomic factors such as \u0026ldquo;growing old before becoming wealthy\u0026rdquo;, an ineffective social security system, and a decline in family caregiving functions. The establishment of diverse market investment and management policy system for care institutions has emerged as a major task for several Chinese government departments. Many other nations encounter similar aging challenges, particularly those largely affected by Confucian culture, such as Thailand [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], Singapore [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] and Japan [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. As a result, transferring some of the burden of aging services to the market has become an urgent priority for the government. These authorities have recognised the necessity for policies that encourage market investment in retirement and have formalised policies and strategies to address the aging population in the next decades.\u003c/p\u003e \u003cp\u003eSpecifically, the progression of CCRCs in China has undergone two phases, which is still in a process of exploration. The central emphasis of CCRCs policy has switched from rudimentary housing and care services for older adults from 2000 to 2013 to the delivery of high-quality and comprehensive care services in such institutionalised settings from 2014 to 2022. In both phases, China\u0026rsquo;s CCRCs policies aim to achieve the objectives of maintaining the basic living standards of older adults, fostering consumption diversification, enhancing service quality and mental and physical well-being, and fulfilling older adults\u0026rsquo; rights. Similarly, the observable policy tendencies in China\u0026rsquo;s CCRCs converge with those of other countries whose backgrounds involve less developed economies and stronger traditional cultures, such as Japan at the end of the 20th Century [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. It can be deduced, therefore, that China\u0026rsquo;s market-based care is likely to experience, or is currently witnessing, the same scenario as Japan\u0026rsquo;s. Therefore, many studies emphasise that Japan\u0026rsquo;s \u0026ldquo;fine care\u0026rdquo; is worth learning from China. Viewed critically, despite the privatisation of care services having been underway in the West for many years, Chinese policy tendencies will necessarily be different due to differing background forces [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. In order to address the concerns of adults (born under the one-child policy) who are genuinely worried about the care of their older parents in China, and because the industry has missed many business opportunities, it is necessary to critically examine how to convert the needs of local care in China into actual industrial economic activities.\u003c/p\u003e \u003cp\u003ePolitical, socioeconomic and pursue cultural environments, as well as the diversified demands of older adults, determine the characteristics of CCRCs policies at different phases - namely, from forced centralisation to market-oriented governance models, a swiftly improving socioeconomic environment, the establishment of a culture of reverence for older adults and the increasingly diverse demands of older adults. The policy theme of the first phase is to stimulate the market to deliver accommodation and care for elders. In the second phase, which is a continuation of the first, the CCRCs\u0026rsquo; practice focuses on care service enhancement and quality optimisation, which serves as a continuance of the systematisation and commercialisation of CCRCs services. As a result of China\u0026rsquo;s reforms and \u0026ldquo;Five-Year Plans\u0026rdquo; throughout this period, each stage has undergone significant institutional and core policy institutional alterations. Chinese officials can consider the drawbacks of previous CCRCs policy frameworks and pursuing refinements.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eRoom for improvement\u003c/h2\u003e \u003cp\u003eAlthough China CCRCs have undergone a trend of increasing marketisation of care for older adults during two recent decades, the quantitative analysis of the policy documents discloses a remarkable potential for future advancement. Keywords such as \u0026ldquo;integrated medical with nursing service\u0026rdquo; and \u0026ldquo;smart care for older people\u0026rdquo; (Wang and Xu, 2021) are highlighted in policies in the second phase, denoting the current hotspots in the CCRCs sector [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. To a significant degree, this tendency reflects the government\u0026rsquo;s assessment of the seriousness of the issue of medical and aged care for older adults, which means the authorities have paid increasing attention in recent years to the application of information technology in conjunction with medical and care services, which assists in the information construction of an \u0026ldquo;integrated medical with nursing service\u0026rdquo;, \u0026ldquo;Smart care for older adults\u0026rdquo; and \u0026ldquo;combined medical care and nursing service\u0026rdquo; can increase the health level of older adults in CCRCs by enhancing the level of health management and treatment efficiency. Some countries have begun to ensure the implementation of relevant policies [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e],[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e],[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e],[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Moreover, CCRCs policy likewise specifies psychological and mental health, education, physical fitness, commodities, financial management, tourism, legal services, etc., for older adults, but these have not become essential policy catchphrases currently, which might represent the potential direction of CCRCs to holistically enhance the wellbeing of their residents.\u003c/p\u003e \u003cp\u003eIn addition, several government departments on the periphery of the CCRCs\u0026rsquo; network of decision-making departments are less interconnected, demonstrating the lack of coordination among the agencies involved; thus, interagency cooperation needs to be solidified. Furthermore, CCRCs providers are progressing toward diversification, but they remain government-led and market-centric. Diversified collaboration should be enlarged to include additional entities, such as non-profit, social service organisations, and even foreign governments and businesses; however, these are not prominent in the network diagram. Predictably, there is a major opportunity to prosper in the international market by drawing from the experience of more developed economies. Finally, to fulfil the increased requirements of older residents in CCRCs, stakeholders, including policymakers, researchers and service suppliers, need to seek out effective programs, resources and equipment in such a supportive policy environment.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eLimitation\u003c/h2\u003e \u003cp\u003eThis study is limited in its policy focus merely depicting the policy-making network of government agencies when, in reality, interagency cooperation is more intricate, with authorities necessitating ongoing contact and discussion with each other. Further research is needed to present the whole process of policy release quantitatively. Notwithstanding, the findings of this study can inspire potential CCRCs developers to recognise the potential of China\u0026rsquo;s CCRCs sector, comprehend the policy orientation involved, and enhance the execution and administration of CCRCs. They also have the potential to serve as a guide for generating subsequent policy stages, such as in exerting more emphasis on formerly under-recognised areas, for government ministries.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe evolution of China\u0026rsquo;s CCRCs policy has traversed through an exploratory phase (2000\u0026ndash;2013) and an industrialization phase (2014-present). The ongoing expansion of CCRCs policies indicates that the Chinese government places significant priority on care for older people. Moreover, throughout time, the policies for CCRCs have shifted their focus from basic accommodation and medical arrangements to high-quality and diversified services for older adults. Not only is this the Chinese government\u0026rsquo;s blueprint but, as livelihoods and progressive thinking advance, so do the demands of older adults. The Chinese government has modified the policy priorities, as evidenced by the occurrence of \u0026ldquo;smart care for older people\u0026rdquo;, and \u0026ldquo;integrated the care and nursing service for older people\u0026rdquo;, showing a quick reaction to new CCRCs requisites and transformations at the central policy level. Furthermore, the nucleus of two networks likewise demonstrates that the CCRCs development path is one of increasing marketisation. The market has increasingly shared the responsibility for providing services for older adults, which not only reduces government spending, but simultaneously augments the quality of care services by intensifying market competition. Additionally, Chinese CCRCs facilities and services have steadily extended beyond the sphere of the Ministry of Civil Affairs. Consequently, various government departments have enrolled in CCRCs policy formulation, so that the collaboration network has been continually reinforced, generating a policy synergy to stimulate industry development. To further guarantee policy collaboration and execution, all relevant government agencies need to establish corresponding policies and solidify a collaboration relationship.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCCRCs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eContinuing Care Retirement Communities\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSNA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSocial Network Analysis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePKULaw\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePeking University Law Database\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCCCPC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCentral Committee of the Communist Party of China\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eState Council\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNPC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational People\u0026rsquo;s Congress\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePBC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePeople\u0026rsquo;s Bank of China\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMCA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMinistry of Civil Affairs\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCBRC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eChina Banking Regulatory Commission\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNDRC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational Development and Reform Commission\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGOSC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGeneral Office of the State Council\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNHFPC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational Health and Family Planning Commission\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMOE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMinistry of Education\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNTA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational Tourism Administration\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMOF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMinistry of Finance\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNHC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational Health Commission\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMIIT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMinistry of Industry and Information Technology\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSDB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eState Development Bank\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNHC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational Health Commission\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSTA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eState Taxation Administration\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSCNPC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStanding Committee of the National People\u0026rsquo;s Congress\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNWCA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational Working Committee on Aging\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMHRSS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMinistry of Human Resources and Social Security\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSAMR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eState Administration for Market Regulation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCBIRC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eChina Banking and Insurance Regulatory Commission\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNATCM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational Administration of Traditional Chinese Medicine\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCDPF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eChina Disabled Persons\u0026rsquo; Federation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLSDCMC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLogistic Support Department of the Central Military Commission\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNMSA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational Healthcare Security Administration\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMNR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMinistry of Natural Resources\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMHUD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMinistry of Housing and Urban-Rural Development\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMOC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMinistry of Commerce\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNWF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational Women\u0026rsquo;s Federation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eJPCMSC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eJoint Prevention and Control Mechanism of the State Council\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCPCPLAC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCPC Political and Legislative Affairs Committee\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSPC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSupreme People\u0026rsquo;s Court\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePRC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSupreme People\u0026rsquo;s Procuratorate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMPS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMinistry of Public Security\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMOJ\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMinistry of Justice\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMOST\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMinistry of Science and Technology\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCIRC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eChina Insurance Regulatory Commission\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMLR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMinistry of Land and Resources\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGASC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGeneral Administration of Sport of China\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSAC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandardisation Administration of China\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNHFPC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational Health and Family Planning Commission\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003eThis study does not involve any human participants, human data, or human tissue. Therefore, ethics approval and consent to participate were not required.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis work was supported by the China Scholarship Council (CSC) under Grant No.201908140086, and the Australian Research Council (ARC) Discovery project under Grant No. DP230101313.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConceptualization (XW, BX, MS), data curation (XW), formal analysis (XW), funding acquisition (XW, BX), investigation (XW, BX, MS, QC, JE), methodology (XW, BX), project administration (BX, MS), software (XW), supervision (BX, MS), validation (XW, BX, MS), visualization (XW), writing \u0026ndash; original draft (XW), writing \u0026ndash; review and editing (XW, BX, MS, QC, JE). All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eWe express our gratitude to the authors of the included studies.\u003c/p\u003e\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e \u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWan D, Liu H, Guo J, Guo L, Qi D, Zhang S, et al. Spatial Distribution and Accessibility Measurements for Elderly Day Care Centers in China\u0026rsquo;s Urban Built-up Area: The Case of Tianjin Nankai District. 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Nurs Open. 2021;8(4):1720\u0026ndash;30. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/nop2.812\u003c/span\u003e\u003cspan address=\"10.1002/nop2.812\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Ageing, Cooperation between government departments, Continuing Care Retirement Communities, Content analysis, Quantitative policy analysis","lastPublishedDoi":"10.21203/rs.3.rs-4664312/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4664312/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground\u003c/p\u003e\n\u003cp\u003eChina experiences rapid population aging. Continuing Care Retirement Communities (CCRCs) are an emerging institutional living arrangement in China for providing older residents with care services. Although the authorities have issued a multitude of supportive policies, it lacks a comprehensive overview nor in-depth analysis of these policies. This study aims to investigate the dynamical trends of policy hotspots and the progression of coordination between departments.\u003c/p\u003e\n\u003cp\u003eMethods\u003c/p\u003e\n\u003cp\u003eWe conducted a thorough content analysis of 186 central-level policies from 2000 to 2022. The temporal distribution and features of CCRCs policies over time were examined, followed by co-word analysis and Social Network Analysis (SNA) to identify policy hotspots and cooperation among promulgating departments in each phase. Gephi-supported visualization was used to create graphical maps, highlighting policy focuses and the relationships among government departments.\u003c/p\u003e\n\u003cp\u003eResults\u003c/p\u003e\n\u003cp\u003eChina’s CCRCs policy has transitioned from an exploratory phase (2000-2013) to an industrialization phase (2014-present). SNA analysis reveals that during the initial phase, policy themes focused on market-based elder care, support measures, supervision, government-market cooperation, and talent introduction. In contrast, the industrialization phase emphasized health, technical innovation, senior care industry growth, and pilot projects and reform. Of the eleven departments initially involved, the Ministry of Civil Affairs (MCA) was the most active, with participation eventually growing to 36 departments, resulting in 191 interdepartmental collaborations and forming three departmental cooperation clusters.\u003c/p\u003e\n\u003cp\u003eConclusions\u003c/p\u003e\n\u003cp\u003eCCRCs are moving towards increased commercialization, with the market increasingly sharing the responsibility for providing services for older adults. Moreover, the participatory governments proceed to increase, but there is still a lack of coordination amongst them.\u003c/p\u003e","manuscriptTitle":"A social network analysis model approach to understand continuing care retirement community policies in China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-22 03:15:25","doi":"10.21203/rs.3.rs-4664312/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"80de8597-70aa-4136-85a6-9d46f07df3c9","owner":[],"postedDate":"July 22nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-04-17T10:08:47+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-22 03:15:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4664312","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4664312","identity":"rs-4664312","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}