In light of the Anil Potti story  Dr. Deol points light fun at my own take on the Superbug fiasco because I admonish Indian politicians for their carelessness by way of contrast with the rigorous professional standards of the Lancet (and because Anil Potti worked at my alma mater, though I’ll point out it’s not his alma mater).

The facts being as they are, I certainly can’t complain about Deol’s playful riff since it is meant much more so to criticize the Lancet for its failure to uphold standards than as a dig at inconsequential young me.  The Lancet, indeed, cooked it’s carrots without peeling them, and because of that shortcut it’s rightfully dealing with criticism.

But, I still think my reasoning regarding India’s politician’s to be solid because despite the Lancet’s failing in this one instance it would be foolish to dismiss its many decades of credible science reporting.  The Indian politicians attempts to make the Lancet report out to be the bumbling of laymen journalist idiots, is dangerous.

My answer to Dr. Deol’s questions then is the same as his (later in the article he shares his own experience with the unregulated pharma market in India) a resounding “EVERYBODY”.  Everybody involved in related activities of health monitoring, research and reporting needs to wake up, and in this brave new world of global migration, global research networks, digital data bases, and global pressures, it’d be good if they could wake up quickly because the problems of rushed research and complicated, dangerous pathogens are only going to get more stark as our numbers grow and our world continues to speed up.

Read Dr. Deol’s article here.

Thank you Boeke for making your photos available on the Flickr creative commons.

GPO stands for “Group Purchasing Organization”.  The typical GPO’s role, grossly simplified, is to negotiate bulk order rates for medical and related supplies on behalf of multiple hospitals.  The largest GPO’s handle orders for hundreds of hospitals and clinics.  Since their inception in the 1960′s, because they are self-regulating, highly profitable, and almost immune from laws that guard against kickbacks, GPO’s have been accused of everything from endemic corruption to stifling the innovation of small beans inventors like Thomas Shaw, to actually increasing hospital costs – in short, the opposite of what GPO’s are supposed to be doing.

The part of the story that relates to China and Asia is towards the bottom. One day, Thomas Shaw finally gave up on trying to break into the American hospital market;

So he [Thomas Shaw] partnered with Chinese companies, which put up money to build
assembly lines in China in  return for permission to produce his syringes for the Chinese
market. When his patents do run out, the Chinese manufacturers will be the ones poised
to bring his technology to the world market, meaning all the jobs and economic benefits
that could have gone to the local residents will instead go to the people of Gansu Province.

This got me thinking (and I bracket the thought within the confines of primary care because Thomas Shaw and small inventors make devices that cater to everyday patient needs, and not high tech devices like the CT Scanner).  Are Chinese standards of hospital care going to leap frog those of America, because the American medical market is unfriendly to it’s own innovators? Broader Southeast Asian healthcare standards, same thing?  Could the intellectual blockade by GPO’s in the US lead to a medical gains in markets more receptive to homegrown American entrepreneurship?

I’ll keep my eyes open, and I hope you do, too. Now go read THE STORY.

UPDATE: On September 2, 2010, ChinaGeeks posted a follow up with new details about Tian Xi’s arrest.

A few months ago Samuel Green wrote a piece for us that assessed the current levels of knowledge about HIV/AIDS amongst Chinese, as well as their attitudes towards HIV/AIDS sufferers.

In some ways, things are on the mend.  The first HIV discrimination case in Chinese history was filed today.  But, in others, things are still not looking so good.

Yesterday Charles Custer put up a translation of a Chinese language blog post about HIV/AIDS activist, Tian Xi, himself afflicted with the virus after a botched blood transfusion in the 1990s, who was detained in Henan province for “damage to commercial property”.  The hook of this otherwise all too common story is that Tian Xi is being denied treatment while detained.

It’s almost like the police officers in question don’t understand the seriousness of the disease?  Or perhaps they just view Tian Xi to be a miscreant.  Either way, it doesn’t speak well of the captors.

I don’t want to generalize too broadly from this example, so I’ll let you read both stories (Samuel’s and the Charles Custer translation) and draw your own conclusions.

Just for the purpose of perspective…America still has officially segregated schools.

Corrections note:  A previous version of the article stated that Tian Xin was arrested after petitioning the government.  This happened during a previous arrest, but  this time Tian Xin was arrested for “damage to commercial property”.

Just like Western expats without Chinese language skills living in China, Chinese expats without English speaking skills living in America have a hard time understanding where to get help for their needs.  This is especially important for Chinese expat seniors who’s healthcare needs are great and ability to improve language skills are limited.  It’s interesting that American insurance companies are partnering with the community leaders to get Chinese community members into hospitals.

The video is embedded below, though you will need a VPN to see it if you’re reading from China.

With love of archaeological digs now established here’s a link to a type of find in Xinjiang, China which has rarely come along.  A jade merchant walking at high altitudes near Xinjiang China found a buffalo-size stone covered with paintings.  Some depict animals, other shapes are not so clear.  Hat tip to Josh, Xinjiang correspondent and writer at FarWestChina ( twitter is –> @farwestchina) for sending out this link.  The paintings are believed to be 6000-7000 years old.  Like Josh said, “take that 5000 years of Han Chinese history.”

Well, all I can say is, boy it’s good to be in the US of A, where I can safely say, “Go F[ine and self regulate] yourself [better] TianTian Puhua Hospital in Beijing for taking suffering people’s money and feeding them false hope.”  I really hate to get half-way to vulgar like I just did, but medical predators make me so angry.

Fang Xuanchang is a respected Chinese science and technology journalist who was recently beaten by two men he suspects were thugs hired by an angry doctor he exposed in a story. The incident suggests a new enemy to journalists in a nation filled with government press crackdowns: vindictive story subjects who hire mobsters to seek revenge. Photograph by: John M. Glionna, Los Angeles Times/MCT

Then, today, I picked up on this touching article from the Vancouver Sun about Fang Xuanchang, a Chinese investigative reporter who specializes in reporting on quack doctors and false hope operations.  Mr. Fang got his head beaten in by lead piping by thugs as he was walking home one evening, all because he was uncovering doctors committing crimes against unwitting patients.

Could have been me, I guess.

The lessons for readers are 1) to always, always, always get more than one recommendation for a doctor when you’re in China, 2) if you’re going to have surgery in China, and you have the time to plan it out but don’t have time to hop on a plane and go back home, have a Western doctor at one of the International SOS clinics or a private, English-speaking staff hospital recommend a doctor for you to see, and 3) figure out what hospital you would want to be taken to in case of an emergency, and have it written down on something that will be on your person at all times.

As a matter of fact, follow the above advice (slightly modified for context) wherever you’re living.  Bad doctors are everywhere.

And, of course, if you don’t have to, then don’t go around busting quack doctors in countries where that kind of work is quickly silenced.

It’s 1974, and you’re a fac­tory worker in the For­mer Yugoslavia.  You’re a highly skilled mechan­i­cal engi­neer, no less: a mem­ber of the the intel­lec­tual and trained elite.  The clock on the fac­tory floor strikes 11 am and you go down to the cafe­te­ria to grab some musaka, a swig of yogurt and smoke a few cig­a­rettes.  The foreman’s called a lunch meet­ing, which means you can just sit there, smoke and listen.

Min­utes later you’re in your seat at a round, blue metal table.  Your chair is made of alu­minum and uphol­stered with some sort of brown poly­ester mate­r­ial.  Every­one has food in front of them, and every three peo­ple share an ashtray.

“Our coun­try,” the com­pany fore­man starts, “is not like any other coun­try in the world.  Every­one else is evolv­ing, but here we prac­tice neg­a­tive selec­tion.”

Every­one around you, all men and women with advanced degrees in engi­neer­ing and the hard sci­ences, turns in the direc­tion of a pri­vate room on the far side of the mess hall.   You turn, as well.  It’s the big bosses door, a room apart from every­one else.  Inside it sits a round, snot nosed, and communist-magnolia red adult man who has no idea what this com­pany even does.  He has a pot­ted fern in there.  You saw it through the crack of the door once, and there’s whis­pers about him har­bor­ing a huge col­lec­tion of French porn in his desk. Nobody knows for sure.  Usu­ally, you only see him a few times a year when he parades other, higher-up com­mu­nist offi­cials around your fac­tory.  Oth­er­wise, the only way you know that red-faced pig is even at work is if you walk by his car on the way home.  His car is parked inside the fac­tory gates.  You and the rest of the fac­tory employ­ees have to walk much far­ther to the offi­cial fac­tory park­ing lot.

That fat fuck­ing pig. What a waste of life, you think.  He hasn’t even fin­ished  high school but because his father was a high falutin party mem­ber,  that ass­hole got to become the com­pany man­ager.  Your cousin’s wife in Amer­ica talks about their being a glass ceil­ing for immi­grants and women.

“At least, Krushka” you’ll tell her next time, ” in Amer­ica you can see and touch the ceil­ing.  Here the fac­to­ries have no ceil­ing to touch, and it’s hard to sim­ply find room enough to walk for­ward a few steps with­out pok­ing into a sharp­ened sickle or slam­ming into a locked door that smells of stolen money and pig shit.”

What a waste. You turn back around.

“The rea­son our car indus­try can’t get past the Yugo,” con­tin­ues the fore­man “is because our dumb­est peo­ple are the ones we put into lead­er­ship posi­tions.  Here we make elec­tric motors for indus­trial machines, and that cunt-lick over in that room doesn’t know his Tes­las from his Jules.  But he’s the one who decides how many peo­ple we get for a job, and how much time we get to do it.”

You feel the urge to inter­rupt.  You’ve been lis­ten­ing to this crap for years now, off and on, about var­i­ous bosses that have sat in that one-fern, French pussy cov­ered room.  When you were younger, you were sur­prised to have a boss who was incom­pe­tent and who no one respected.  But with each suc­ces­sive ass­hole you’d accepted that things just worked that way.  Cor­rup­tion, nepo­tism, thiev­ery.  Who knows.  But today, it’s dif­fer­ent.  You’ve been here for fif­teen years now, and it’s struck you that you really want to know.

“But let me ask you some­thing,” you say.

Read more at china/divide.

Earlier in Shanghai today, at the Swedish pavilion of Expo 2010, a company called SCA, that describes itself as “the world’s third largest global paper and hygiene products company,” presented  the results of a global hygiene attitudes study.

The stated goal of the study was to find out how the flu pandemic of 2009 may have changed global attitudes towards hygiene, and its findings suggest that a high portion of Chinese pay more attention to good hygiene habits today than before the flu pandemic.

They asked us to share the study with our readers and we are happy to oblige.  The press release is below, and you can find a full copy here —> SCA Hygiene Matters 2010 – Focus China (English).

I am of the opinion that the more information we can get about the healthcare picture in China the better, and I commend SCA for undertaking this effort.  I especially like that this study was repeated in a total of nine countries, and I believe that the analysis of data between countries is it’s most valuable feature.

That being said, I wish to point out a few important  limitations to any rigorous academic applicability of this study*:

The biggest drawback is that the study is based on web-based surveys.  This presents a range of issues in terms of how we should interpret the results, the biggest of witch is that the sample of people who took the surveys is a mystery because it is impossible to know with certainty who the respondents were, where they’re from, how much money they make, gender, etc.

Moreover, all data was collect in September of 2009, at the tail end of the most intense period of coverage for the flu.  China was also the most severely effected by the SARS outbreak at the beginning of the decade, and it’s difficult to know whether this was taken into account by the surveyors since the study methods have not been published.  A methodology section would really help here, as would have data showing the standard deviation and error estimates for the data (again, impossible without better sampling).

And, because of this being a web-based study, there is likely a very heavy sampling bias towards more urbanized, better connected regions.  One look at a rural China community away from the city, or at a migrant community within the city – a state of existence that represents a billion people if not more – will confirm that hygiene is still a far away thought for many.  This sample bias is probably best revealed by the fact that 99% of Chinese respondents to the survey listed that they would like to have stricter hygiene in densely populated areas.

Therefore, it is not advisable, in my opinion, to use the numbers quoted in this study as a true reference point for any sort of academic endeavor.

But, because problems of internet anonymity and bias exist in all of the countries that were surveyed,  the SCA report’s analysis of data across countries is something that probably gives us a good enough picture of varying attitudes towards hygiene across the world.  Some of the data comparisons I’ve not seen before, and that also made this interesting reading.

Most interesting to me is that the Chinese respondents were more likely, by a wide margin, than respondents from any other country to say that public hygiene is a problem that the government should be heavily involved in.

A place that the report really shines is in examining how the widespread use of the internet has impacted Chinese attitudes about what good health practices are – both for better and, the report seems to indicate, for worse.

Again, the pdf of the report can be found here –> SCA Hygiene Matters 2010 – Focus China (English)

and the press release is below.

Shanghai, August 20, 2010

SCA STUDY FINDS:
CHINESE FOCUS MORE ON PERSONAL HYGIENE

Increased awareness of hygiene in the wake of the global flu pandemic of 2009 has lead to an increase in hand washing and home-cleaning in China, according to a study presented today by SCA, the world’s third largest hygiene and personal care company.

Nine out of ten people in China now wash their hands more frequently and seven out of ten Chinese people clean their homes more often, the study found.

The 2010 Hygiene Matters study included over 5000 respondents spanning 9 countries (Australia, China, France, Germany, Mexico, Russia, Sweden, the United Kingdom and the United States). The Chinese findings were presented August 20^th, 2010 at the Swedish Pavilion at the Expo 2010 in Shanghai.

In the study China stood out markedly among countries surveyed, especially regarding attitude changes. For instance, nine out of ten Chinese think about hygiene more often and at more occasions today than before the flu pandemic.

China is also the country where most citizens would like hygiene to move up on the political agenda. 85% of China respondents believe hygiene should be given higher priority by politicians and the media compared to only 38% in Sweden and 59% in the US.

“Hygiene is vital to public health. The results from SCA’s 2010 Hygiene Matters report show that attitudes in China to hygiene and behaviors such as hand washing changed dramatically as a result of a global health threat,” said Rolf Andersson, SCA’s Senior Advisor on Hygiene, about the findings of the report.

The SCA study also found that both in China and globally, women and the higher educated are more likely to have reacted with changed attitudes and behavior to the flu pandemic. Younger respondents also appear to be more concerned about hygiene in general, both personal hygiene and the hygiene of others. Older people are less concerned about hygiene issues, and are less likely to change their behavior.

At the August 20 press meeting, Kersti Strandqvist, newly appointed Senior Vice President Sustainability, also spoke about SCA’s sustainability efforts; reducing consumption of raw materials, minimizing waste and involving employees worldwide in creating small-scale resource-saving projects.

“For some of our customers the green credentials is an important factor when selecting a supplier. By including sustainability targets in our company strategy, we assure they become part of our daily operations and that we can meet the ethical demands of customers and consumers”, she said.

Ashoka: Innovators For The Public is a highly respected organization in the development and academic community.  Founded by 1984 MacArthur Foundation Fellow William Drayton, Ashoka has used a venture model to help the world’s most promising social entrepreneurs achieve a greater impact in local communities.  The organization’s mission has grown with it over the years , so that today in addition to financially supporting it’s fellows for a period of three years Ashoka also provides a lot of back end support work to help the fellows build lasting project infrastructure through partnerships with other similarly focused individuals, as well as private and public sector organizations.

A relatively new venture for Ashoka is something called Ashoka Changemakers which describes itself like this;

Changemakers® is a community of action where we all collaborate on solutions. We know we have the power to solve the world’s most pressing social problems. We’re already doing it, one project, one idea at a time.

How do we do it? We talk about the issues, share stories and mentor, advise, and encourage each other in group forums, even engage in friendly competition. We form surprising connections and unexpected partnerships across the globe that turn the old ways of problem solving upside down. We try things that have never been tried before.

Our mantra is “Everyone a Changemaker.”™ Whatever your passions, however you want to make a difference, you’ll find a way to make it happen it here. Changemakers® connects you to action because we’re on the ground, making changes every day.

The solutions are all around us. Join us.  And be at the center of change.

(After checking their website you might notice that it’s not directly linked to Ashoka.org, or vice versa.  So, if you’re wondering, I did vet Changemakers by calling the Ashoka.org offices. The Ashoka rep assures me that Changemakers intimately linked with the Ashoka foundation and not just using the Ashoka name as a marketing boost.)

As far as I can tell, Changemakers is a potent mix of things – multilingual web portal for entrepreneurs to connect with project opportunities across the world, good old fashioned social network, showcase of innovative development projects – but at the heart of the site lies money and competition.  Money changes everything, and doubly so in the world of social entrepreneurship which is characteristically short on funds.

Each competition has a very specific theme and is often cosponsored: the NFL’s Atlanta Falcons, National Geographic and Exxon Mobile have all been sponsors.   The large prize pools – some in the tens of thousands of dollars – are impressive, and the winning projects I’ve seen are fascinating.  My favorite entry is Dr. Laura Stachel’s solar suitcase power system that provides LED luminance for underpowered hospitals, the winner from the “Healthy Mothers, Strong World: The Next Generation of Ideas for Maternal Health”.

Now, James and I have been asked to provide feedback to entrants of the Patients| Choices| Empowerment competition sponsored by AMGEN that dares entrants

“to answer the question of how we can elevate patients’ voices to improve health outcomes globally.”

I know there are Asia Healthcare Blog readers out there ready to answer the call.  As far as I know there are no age or nationality restrictions, but make sure to check all of the eligibility guidelines and criteria.  The instructions for submitting your great idea/organization are self explanatory, and how much it’s up to you to decide how much explanation your entry deserves.

There will be three winners, and the prize for each will be HUGE: $10,000.  It’s worth a shot.  I strongly encourage you to enter.  All entries are due by September 29, 2010 at 5pm EST.  If you enter before August 25th, 2010 you are eligible for the $1000 best early entry prize.

Blogging at AHCB for almost two years  has afforded me many opportunities to meet fine people, and has been a formative experience in my personal life, as well.     Reader and blogger community feedback has imbued me with a full range of emotions, from the gratification of occasionally being recognized as a good writer on down to the indignant fury only a comments section full of wingnuts can provoke.

I know it has helped co-blogger James Flanagan figure out some career choices, as well.  Our partnership (I speak of it only briefly here, since this is not a forever goodbye) has truly been a productive one: I never would have been able to write as much as I had if James wasn’t constantly fixing the inner workings of our site.   We’ve made some great discoveries together and even broken some stories.  In all, we’ve put up over 250 articles, and tallied 200,000+ words.

This year, instead of regularly writing AHCB articles, I will be focusing on my first year of law school, and have decided it best to set aside as many other commitments as possible during that time.  I am assured by those wiser than me that my interests will still be there after 1L is over.

Of course, I can’t give up writing all together.  I plan to write for AHCB occasionally as well as  contribute to china/divide since it is a group blog and doesn’t depend on my efforts alone to maintain readership.  I also plan to continue writing narrative fiction and will likely post a reworked and more complete version of my first very successful piece, The Guy: A Conman Living in Beijing.  It’s hard to believe that this will mean less writing, but it does.   Again, however, I will not be writing regularly on this blog.

The reason I am bothering to write a goodbye post at all is three fold.  First, I’d like to bring some level of closure to this project, and give a heads up to regular readers.  It has been two years, after all.  Second, I spent considerable time researching and then composing many of the articles on this site and I think that many of them are worthy of a second look so I wanted to do a ‘best of’ post.  Third, I don’t want this site to die this year, and so by leaving this up for nine months or so as a ‘sticky’ post I hope to still have the option to pick it up at a later point when I have more bandwidth to work with.

So, goodbye to readers and blogger/writer friends for now, and please refer to the below list for what I consider  AHCB’s “best of”, though I believe that many additional articles on this site are of a very high quality.  Not all of these pieces are my own: the list includes contributions from Samuel Green, Bradley Hoath, Ninie Wang and Paul Steele.

p.s. – This may or may not be my version of a Jay-Z retirement album.

How China is Shaping North Carolina’s Future: A Shotgun Romance,

AND

How China is Shaping North Carolina’s Future, Part II: Learning From Our Neighbors

I consider these two North Carolina pieces my best efforts at real reporting.

Part I:

“Far from a match made in Wall Street heaven, Chinese and North Carolinian business norms and strategies often run counter to one another. For one thing, the rationality governing the respective approach of either party when it comes to business deals is diametrically opposed. The Chinese are steeped in two thousand years of Confucian business practice where winner takes all, and the highest positioned is the winner; North Carolinians are more apt to serve sweet tea and talk golf while sitting at a round table. For another, the market focus of Chinese multinationals is bound to be centered on a China-first, developing markets second, strategy. Employees of North Carolina based Chinese companies will be in for a world of hurt if they are not prepared to be treated as second fiddle players.”

Part II:

“Within North Carolina’s industry centers and robust academic institutions, the state’s Chinese immigrants are poised for an epochal period of ascent to positions of strategic importance. The collapse of traditional NC industries like textiles and furniture manufacturing due to NAFTA and the advent of cheap Chinese goods necessitated, somewhat ironically, the strengthening of bonds between North Carolina’s business interests and China. Working with Chinese businesses that have China-based profit models, however, is new territory for most Carolinians, and in order to come out ahead, they need help.”

America’s Abortion Debate is Infecting China’s

My second best piece of researched reporting.  I put a lot into this one emotionally.

“Radical politicization, hysteria fueled violence, and stalemate defines America’s abortion debate. In turn, and owing in part to historical considerations, China’s ruling elites view the debate as composed of inherently destabilizing forces that must be precluded from interrupting the harmony of Chinese society. Where technology has made it easier to bring the basic tenets of our debate directly to the Chinese people, the Pro-Lifer’s and Pro-Choicer’s insistence on waging ideological Realpolitik has negated any such gains by overshadowing and stigmatizing some of our most important humanitarian insights into pre-natal life.”

Coughing Butterfly Effect: Path to Safer Food and Drug Control, in China

“The problem is that by the time the news cycle is finished covering one of China’s food and safety scandals, the average consumer of news is ill informed the story layer which has to do with her own well being. More often than not, international news stories about China’s food and drug safety issues are reported in a way that scores points for economies doing trade with China , and, in the worst cases, China’s food and safety problems are unceremoniously grouped in with to a long list of China’s human rights issues. It is the classic case of elites writing for other elites. The politically and economically expedient information is seized upon while the truly important aspect of it is let go by the wayside.”

The rural life and times of China’s aging population , Part I , Part II: Caregivers and Institutional Outcomes, Part III: Institution Problems, Part IV: Limiting Catastrophe

Truly excellent series by Samuel Green on the State of China’s Aging Population.  One of the best series on the Chinese blogosphere of 2010, period.

We predicted that H1N1 cases would seemingly “explode” in China, and we were right.

A real moment of triumph for us at Asia Healthcare Blog.  A previous post – Due to corruption, Asia is in for a big swine flu year – analyzing  H1N1 underreporting in Southeast Asia proved to be correct.  Coincidentally, I believe all of my friends in Beijing have had the swine flu at least once already.

Hotel Beijing, by Paul Steele

The quintessential Asia Healthcare Blog story.  One of my friends, a talented story teller, relates his experience in a Beijing H1N1 quarantine hotel.

“When I was taken into quarantine it was impossible to estimate the extent of the government’s commitment to the exercise.  Doctors and their questionnaires appeared official, but random implementation and chaotic execution of the process suggested opportunity for the reassuring degree of negotiation typical of grass roots enforced, Chinese bureaucracy.”

China’s Essential Drug List prompts Rise of Retail Drug Stores

I’m including it here because  James and I ‘broke’ this story, and it was heavily cited.

“On August 18, the Chinese MoH released a list of 307 essential medicines that will become available at heavily subsidized prices starting on September 25th.   An IHS Global report summarizes things well; All the drugs in the list will be included in the country’s basic health insurance catalogue with a higher reimbursement percentage, which is [...]“

Private Healthcare With Chinese Characteristics

One of my early pieces.  I still like it.

“…where are the ‘middle of the parallel, health industry innovators? China has the high end hospital chains – (Parkway Health and United Health Systems); it has the private clinics offering proven international standard outpatient care (International SOS); and, it has the private clinics that offer services specialized to the needs of the local high income populations, like vamped up physician and OBGYN services.

But,  why is there nowhere I can go for a basic consultation that offers me local health care rates (20-100 RMB per consultation) yet provides me with a clean environment and an english speaking medical staff ?   If scaling up 50RMB (about $7) check ups to a profit is possible anywhere in the world, it should be possible in China.”

Blood Money, Why Blood Transfusions Are So Dirty in China, by Bradley Hoath

Well researched, written and thought out.

“During the 1980s, in the United States, Canada, Japan and France thousands of people who underwent blood transfusions were infected with the HIV/AIDS virus. Subsequent national investigations into these scandals revealed that blood collection agencies were under-regulated and ripe with corruption. After approximately five years, increases in government oversight of these agencies and improved blood collection [...]“

Elderly in China, in Need of an Innovators Prescription, by Ninie Wang

Ms. Wang translated two of her Chinese pieces for us.  Excellent stuff.

“Ms. Yang stated that recreational care centers primarily accept healthy and independent seniors. She added that the community’s activity centers are a place specifically for the elderly. Having a foldable bed or a couple of stable beds is just in case the need arises. But the truth is that most fully functional senior citizens do not need beds, said Yang. “After lunch they usually go home, and basically no one sleeps here.”